Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 9 Date: 19 Jun 2025
Reviewer's report:
This is a much-improved version of the manuscript, and I commend the authors for carefully
considering the previous feedback and implementing the required revisions. That said, there are
a few remaining issues that should be addressed before publication:
1. The conclusion in the abstract currently reads as biased and overly simplistic. While increasing
education levels may contribute to efforts aimed at ending FGM, it cannot be presented as a sole
solution. Rather, education serves as a structural intervention that may create safer spaces for
girls, leading to increased educational attainment and potentially reducing the likelihood of FGM
being perpetuated in the next generation. However, this is a long-term and indirect effect. As the
study findings demonstrate, several factors at different levels of the socio-ecological framework
are significantly associated with FGM. A more balanced conclusion would emphasize that
efforts to eliminate FGM require a multisectoral approach addressing determinants across
multiple levels.
2. The global and regional prevalence figures cited in the background section should be updated
to reflect the most recent data from the 2024 UNICEF report. According to this report, “Over
230 million girls and women worldwide have undergone FGM – a 15% increase (30 million
more) compared to data from eight years ago. The largest share is in African countries (over
144 million cases), followed by Asia (over 80 million), and the Middle East (over 6 million).
FGM is also practiced in smaller, isolated communities and among diasporas globally.” Please
update the manuscript accordingly and cite the source: https://data.unicef.org/resources/female-
genital-mutilation-a-global-concern-2024/
3. Results – In the section titled “Magnitude of association between socio-demographic factors
and FGM in Tanzania”, the inclusion of the variable “getting permission to access healthcare”
in the multivariate model needs clarification. This variable was not significantly associated with
FGM in the bivariate analysis and remained non-significant in the multivariate model (aOR CI
includes 1). What is the rationale for retaining it in the final model? Additionally, it is standard
practice to focus narrative results only on significant associations, rather than reiterating all
contents captured in the table.
4. The statement: “Women who at least once watched or listened to mass media had 0.98 times
(aOR: 0.98, 95% CI: 0.69–1.38) higher odds of reporting to undergo FGM compared to those
who did not...” is inaccurate. First, an aOR of 0.98 indicates lower, not higher odds. Second,
since the 95% confidence interval includes 1, the association is not statistically significant. Such
non-significant findings should be interpreted with caution and do not merit detailed coverage.
5. Discussion – There is a sentence repeated nearly verbatim in the discussion: “In addition,
at the community level, our analysis indicates that respondents who did not perceive distance
to a health facility as a big problem had lower odds of experiencing FGM.” “In addition, at
the community level, our analysis indicates that respondents who did not perceive distance to
a health facility as a major problem had lower odds of experiencing FGM.” Please revise to
eliminate redundancy.
6. Limitations – The following limitation is unclear and requires clarification: “Furthermore, a
limitation of difference in the timing of the dependent variable and the independent variables
is acknowledged.” Please explain what is meant here. Is the concern related to temporal
misalignment between when FGM occurred versus when covariates (e.g., education, access)
were measured? If so, this should be explicitly and clearly stated.
7. The manuscript would benefit from a thorough review for formatting consistency,
including line and paragraph spacing. There are noticeable variations throughout the document.
Additionally, a final language edit is needed to correct issues in punctuation, word spacing, and
sentence flow.