Title: The Association of Intimate Partner Violence and Decision Making Power on Nutritional
Status of Married Women in Ethiopia: A Multilevel Mixed-Effect Analysis
Version: 0 Date: 04 May 2023
Reviewer:  Lissandra Santos
Reviewer's report:
General comments
The topic discussed on the paper is extremely relevant and the results are very interesting to
the field.  However, there are so many important results that could be better explored on the
discussion section. My suggestion is to reduce a few words from the introduction and methods
section to improve the discussion. It is also important to make sure that all the acronyms used
are defined in the first citation.
I would like to highlight the strengths of this study:
1. The topic is innovative and valuable to the discussions about gender and health;
2. The national dataset has relevant information about Ethiopia;
3. The data analysis and methodology used is robust and can bring important insights on the
subject;
4. The community level analysis is a strong point of the study.
Abstract
This section reports properly the study, and I have minor suggestions to improve the reading.
In the first line of the section ‘Results’, remove an extra ‘in’ and on the sentence talking about
the violence that women experienced, I recommend switch the term ‘women had violence’ for
‘women reported all types of violence’.
Introduction
This section situates well the problem studied in the article, but in my opinion, it can be
summarized. Here are some suggestions in this regard: in the first paragraph, remove lines 4 to
6. I also suggest that some sentences be moved be moved to the discussion section: paragraph
2,  the last 6 lines; in the paragraph 3, lines 4 to 6; paragraph 4, lines 4 to 6.
Methods
- Add the reference from WHO (year) from the BMI cutoffs.
- About the outcome measure, it is important to cite that, besides BMI “does not require a
reference table from a well-nourished population”, it is also practical and is a population-level
measure of nutritional status.
- Since the analysis are done with population-level data, it is important  to clarify if the analysis
were done using complex design.
- Instead of describing all the questions about IPV, maybe it would be helpful to cite the
published report and just briefly describe the topics the questions are about (this could also help
to reduce the word count).
- Since it is a specific analysis, it would be interesting to write a brief paragraph about  the
applicability of the regression method chosen for your study.
Results
- On the tables, the authors describe the values using  2 decimals and all the descriptions over
the text use 1 decimal. Standardize. Also standardize the percentages cited throughout the text
(23.8% or 23.8 percent?)
- Tables should be self-explanatory. Review the tables and add footnotes with the meaning of
sign ‘*’ and letter ‘a’. Additionally, describe the statistical test done to get each result.
- What the ICC and AIC values mean on the results? The authors do not cite the interpretation
of these information.
Discussion
This section has good discussion about the topics, but it seems that it does not represent the
relevance of all the results found. My suggestions go in the direction of making the discussion
more organized, robust and richer from the data generated. About other cited studies, it is
important to talk about similar/different findings but also about the other author’s hypothesis
about their results.
Chant is a recognized author that talks about how women make better choices for the family and
household than men (Chant, 2015; Chant, 2008; Chant, 2007) and about the economic abuse
(Power, 2006).
Since there are limitations about the size of the paper, start this section with your main
findings seems better. To name a few: (i) “sexual IPV, any IPV and decision-making autonomy
had a statistically significant association with being underweight”; (ii) "all types of IPV
were significantly associated with overweight. Only sexual IPV, however, was found to be
significantly associated with being underweight"; (iii) "The percentage of women in the
community who had decision-making autonomy and who completed secondary or higher
education were significantly associated with being underweight".  What do these findings are
telling us? Other studies can be helpful on the discussion of these results (Issah et al, 2022;
Muluneh et al, 2021)
It would be important use the sociodemographic variables to explain these findings. For
example, how does the fact that most Ethiopian women live in rural areas impact these findings?
And about the wealth index, how does it relate to the findings?
I think is also important to question the normal value of BMI as a sign of good nutritional status as
well as to include the limitations of this measure to evaluate nutritional status. Some references
that can help with this discussion are described below (Mengesha et al, 2014; Molini et al, 2010).
Additionally, the IPV findings should be discussed in a global context (WHO,2021).
References
I recommend reviewing the formatting of references at the end of the article and standardize
them according to the recommended style (Vancouver).
* References than can help on the Methods section:
WHO Consultation on Obesity (1999: Geneva Switzerland), World Health Organization.
Obesity: preventing and managing the global epidemic: report of a WHO consultation. World
Health Organization. 2000. Available at: https://apps.who.int/iris/handle/10665/42330
* References than can enrich the Discussion section:
Central Statistical Agency/CSA/Ethiopia and ICF. 2016. Ethiopia Demographic and Health
Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF.
Chant S. Female Household Headship as an Asset? Interrogating the Intersections of
Urbanisation, Gender and Domestic Transformations. Gender, Asset Accumulation and Just
Cities: Pathways to Transformation. pp. 21-39, 2015.
Chant SH. Gender, generation and poverty: exploring the ‘feminisation of poverty’ in
Africa, Asia and Latin America. Cheltenham, UK: Edward Elgar, 2007.
Chant SH. The ‘‘feminisation of poverty” and the ‘‘feminisation” of anti-poverty
programmes: Room for revision? The Journal of Development Studies, v. 44, n. 2, 165–197,
2008. http://dx.doi.org/10.1080/00220380701789810.
Issah AN, Yeboah D, Kpordoxah MR, Boah M, Mahama AB. Association between exposure to
intimate partner violence and the nutritional status of women and children in Nigeria. PLoS One.
2022 May 12;17(5):e0268462. doi: 10.1371/journal.pone.0268462. PMID: 35550652; PMCID:
PMC9098093.
Mengesha B, Endris M, Takele Y, Mekonnen K, Tadesse T, Feleke A, etal.
Prevalence of malnutrition and associated risk factors among adult visceral leishmaniasis
patients in Northwest Ethiopia: a cross sectional study.BMCResNotes.2014;7:75.https://
doi.org/10.1186/1756-0500-7-75PMID:24490749
Molini V, Nube´M, vanden Boom B. Adult BMI as a Health and Nutritional Inequality
Measure: Applications at Macro and Micro Levels. World Dev. 2010;38:1012–1023.https://
doi.org/10.1016/j.worlddev. 2009.12.003
Muluneh MD, Alemu YW, Meazaw MW. Geographic variation and determinants of help
seeking behaviour among married women subjected to intimate partner violence: evidence
from national population survey. Int J Equity Health. 2021 Jan 6;20(1):13. doi: 10.1186/
s12939-020-01355-5. PMID: 33407515; PMCID: PMC7789001.
Power EM. Economic abuse and intra-household inequities in food security. Canadian
journal of public health = Revue canadienne de sante publique, 2006; 97(3), 258–260.
https://doi.org/10.1007/BF03405600.
World Health Organization on behalf of the United Nations Inter-Agency Working Group
on Violence Against Women Estimation and Data (UNICEF, UNFPA, UNODC, UNSD &
UNWomen). Violence against women prevalence estimates, 2018. Global, regional and national
prevalence estimates for intimate partner violence against women and global and regional
prevalence estimates for non-partner sexual violence against women. Geneva, Switzerland;
2021. Available: https://www.who.int/publications/i/item/9789240022256