Reviewer ’s report  
 
Title: Gynecological Hysterecto my in Northern Tanzania:  A Cross -Sectional study on the 
Outcomes and Correlation between Clinical and Histological Diagnoses  
 
Version: 0 Date: 06 Apr 2020  
 
Reviewer: Sheyn David  
 
Reviewer's report:  
 
Michael et al present an overview of hysterectomy outcomes over a 1 year period. The paper is 
important because outcomes will vary with population of interest, surgical practices, and regional 
variation of various risk factors, to my knowledge there has no t been an overview of 
hysterectomy outcome in Tanzania published in the past. That being said I have several concern.  
 
1) I think this study is overly ambitious in trying to describe complication rates and risk factors 
and histopathological outcomes, and bo th types of outcomes are left somewhat short. I think this 
paper could be converted in to 2 separate manuscripts each with a different focus. I for one am 
more interested in the histopathology described in this study as it will likely vary from what has 
been described in the European and North American countries.  Along that note, I would like to 
know whether out of 478 cases performed in the study period, almost 60% were considered truly 
emergent and the reasons cited from including these. I would argue fo r including every non -
obstetric hysterectomy into this data set. If the remainder 60% excluded from the study were due 
to obstetric complications than I recommend stating that explicitly.  
 
2) in the methods I recommend stating explicitly what data was coll ected and what variables 
were used in the regression model.  
 
3) in the section labeled "study setting" I think there is too much detail about the hospital and 
would limit the description to location, population around hospital, referral population, and 
number of hysterectomies performed annually.  
 
4) Please clarify use of post -operative fever as an outcome: fever can be a very common finding 
after abdominal hysterectomy due to cytokine mediated response after surgery, I recommend 
only using fever as an outc ome if there was an identifiable infection source  
 
5) anemia as well should be clarified. Many patients were anemic prior to surgery, does this 
outcome include them, or only people who had normal hemoglobin levels  
 
Are the methods appropriate and well described?  
If not, please specify what is requi red in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please e xplain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financially from the 
public ation of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscrip t, either now or in the 
future?  
 
3.  Do you hold or are you curre ntly applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please g ive details below.  
 
'I declare that I have no competing interests'  
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