Reviewer's report
Title:Women are considerably more exposed to intimate partner violence than
men in Rwanda -due to denial of incidents or gender power imbalance? A
population based study
Version:1Date:17 May 2014
Reviewer: Andreia Schineanu
Reviewer's report:
1. Is the question posed original, important and well defined?
This is an important study in it’s filed, particularly as it investigates IPV in males
as well as females. The research question posed by the authors is easily
identifiable and understood. Overall, the paper is well written, easily understood
and provides new information in the field of IPV in sub-Saharan Africa,
particularly about IPV among males.
A major limitation of the study which the authors should address is the age of
their sample population. Most studies on IPV, survey participants between the
ages of 15-49 (i.e. in the reproductive age group). However this study collected
data only from those between the ages of 20-35 years. This needs to be
adequately addressed in the discussion as it is a major limitation particularly as
age is a major risk factor for IPV.
2. Are the data sound and well controlled?
From the information provided, I believe that the data in this study is sound and
well controlled. The methodology used by the researchers is well described and
appropriate for this kind of study. I have requested a clarification around the
determination of the sample size as well as the reasoning behind the grouping of
age into unequal categories.
3. Is the interpretation (discussion and conclusion) well balanced and supported
by the data?
Data was interpreted adequately, my only concern being the comparison of IPV
rates between this study and other similar studies without due acknowledgement
and discussion of the limitations imposed by the narrow age of the current study
sample.
Otherwise, the authors discuss important and valid points with respect to the
reasons why IPV rates among Rwandan males are so low compared to Rwandan
women. Conclusions were made based on the study results and other relevant
work was referenced as necessary.
4. Are the methods appropriate and well described, and are sufficient details
provided to allow others to evaluate and/or replicate the work?
Methods are described clearly and in detail and would allow for the study to be
reproduced by peers in the field. I am confident in my ability to assess the
statistical analyses carried out. I believe that the analysis was appropriate and
produced valid results.
5. What are the strengths and weaknesses of the methods?
Strengths of the methods include the use of a validated survey instrument, the
use of a multi-stage random sampling strategy, the use of experienced and
trained staff to collect the data, the study followed WHO guidelines on ethical
issues related to violence research, and the research protocol and study tools
were approved.
Weaknesses of the methodology include the fact that the study was cross
sectional and the sample population had a narrow age gap (20-35 years).
6. Can the writing, organization, tables and figures be improved?
The presentation including sentence construction, syntax, prepositions, verb
tenses and English are all good. The results were organised and presented in
appropriate formats. I do have some formatting comments about Figure 1, which
are provided below.
Major Compulsory Revisions
1. Methods, Study design, study population and sample size, Paragraph 1
How did the researchers determine the size of the sample population, in this
case 919 people? Was it power analysis or some other way? Even though the
sample size may have been calculated to address the aims of the Rwandan
Violence, Mental Health and Barriers to Care project (RwVMHBC-project) this
information needs to be provide to the reader. In particular how did the authors
ensure that the sample size was sufficiently large to ensure statistical
significance between the variables of interest?
2. Discussion, Paragraph 2
The authors compare their prevalence rates of IPV with those of other studies
however a major concern is the fact that the ages of the participants in the other
studies were between 15 to 49 years (as stated by the authors) while in this
study only 20 to 35 year olds were interviewed. Many other studies that
investigate IPV have found that a woman’s age and her age at marriage are
strongly associated with their risk of violence, with younger women and women
married at a younger age more likely to experience IPV. The WHO Multi country
study for example, covering 11 developed and developing countries found that
younger age of women was strongly associated with recent risk of IPV with
women in the 15-19 age group being 5 times more likely to experience violence
compared to women over 35 years. I think these age discrepancy issues needs
to be acknowledged by the authors of this study, and they need to discuss the
potential impact on IPV rates of the fact that the participants in their sample were
aged only between 20-35 years. Is it possible to extract age grouped data from
the Rwanda DHS and the other studies cited to match the age groups in this
study and thus to enable a more accurate comparison with current study??
Minor Essential Revisions
3. Methods, Measures, Independent Variables, Paragraph 1
The authors state that “Age was grouped into 2 categories (20-29 years and
30-35 years)”. Can the authors explain why they decided to group them into
these specific, unequal categories?
4. Figure 1
“FIGURE1. Overlaps between different types of intimate partner 647 violence for
Women.” Possibly a space is needed between the words Figure and 1. I do not
see why Women is capitalised. In the figure itself, the legend box needs to be
shifted lower as it covers up the titles of the figures. In “Earlier in life prevalence
(right hand side of figure) there is an arrow head in the green circle which does
not seem to belong anywhere.
Discretionary Revisions
5. Introduction, Paragraph 4
One or two sentences that describe the place of women in Rwandan society with
respect to culture, patriarchy and gender inequality would be beneficial in this
paragraph to provide the reader with a more realistic picture of women’s place.
Furthermore, providing only factual information such as the adoption of certain
legislation may be misleading to a reader not familiar with the country or the
culture. There are many examples of countries adopting various legislations to
protect women but in reality the law does not make much difference due to
corruption, bureaucracy, lack of implementation etc (see India). Thus a brief
comment on if and how the Prevention and Punishment of Gender-Based
Violence law is being implemented as well as its efficacy may provide the reader
with more accurate insight into the situation in Rwanda.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'