Title: Perceptions of Pregnant Women on Antenatal Care visit during their First Trimester at
Area 25 Health Center in Lilongwe, Malawi – A Qualitative Study
Version: 0 Date: 08 Aug 2023
Reviewer:  Alinane Linda Nyondo-Mipando
Reviewer's report:
This is a much-needed discussion considering the implementation of the new WHO ANC
guidelines. The following areas need to be strengthened to make this paper better:
Abstract
Add the dates when it was done.
Introduction
Indicate for which year when there were only 15% women who initiated ANC at Area 25 health
Centre.
Methods
Add references for the design and justify the selection of the design,
Add more details about the setting, type of facility, clientele it serves, the health care workers
available, services provided and also the support the facility has, the volume of work.
Add reference for maximum variation.
Discuss how trustworthiness/rigor was observed.
Describe the composition of the FGD, were they divided according to age, or these were mixed?
Add the rationale for categorization or non-categorization.
At which number interview/FGD was saturation reached? What did you do when you noted that?
Describe the development of the codebook, what was involved, who was involved, how were
areas of disagreements resolved? What approach was used?
Specify the researchers that listened? Access the COREQ guidelines and apply them in the write-
up.
State who translated and why you opted for Chichewa transcriptions.
Describe how themes were realised? What was involved in the assessment?
Who validated the data and give examples of the data and how that was done?
What happened to the data that were not fitting to the theme?
Why did you opt for verbal consent? Were all participants literate? If there were some that could
not read nor write, explain consenting procedures.
Results
Report the absolute numbers alone and separate IDI respondents from FGD respondents, the
percentages exaggerate the findings.
Table 2 and 3 are not needed and can be summarised in narratives only.
The narratives should be worded carefully so that they communicate what the participants and
refrain from the researchers' interpretation eg It was found that most women knew could be
changed to, most participants stated that the timing for ANC is xxx (Please do this for all
narratives)
Some narratives are not informative and need to be revised and be updated with more
information.
In some cases, eg . This showed that the women had inadequate knowledge on the recommended
eight antenatal visits according to WHO 2016 guidelines which is very crucial in timing for
antenatal initiation. --- the authors prematurely discuss the findings.
Review all the results to ensure that you are only presenting what you found.
I think there should be more depth to the identifiers so that it should also show the variation as
well as the data collection method.
This information - Through In-depth interviews with these women (since we wanted to protect
their privacy and keep their information confidential, we only asked about their health problems
during IDIs), -- it needs to be in the limitations section.
The barriers should be better classified, e.g Physical barriers, Functional Barriers, economical
barriers or use the following classification: Health System, Individual and community /social
barriers - in that way there will be another lens of viewing them than the way they are presented
at the moment.
Discussion
This section needs to be written in a concise manner. At the moment it discusses the results
the way they have been presented and hence fails to highlight the response to the objective of
this study- The discussion should share the perception and its influence and compare it to other
literature.
This section requires more synthesis to the findings and grouping similar results irrespective of
where they are at in the results so that the objective of the study is well addressed.