Title: Residential status and household wealth disparities in modern contraceptives use among
women in Ghana: A cross-sectional analysis
Version: 3 Date: 01 Jul 2023
Reviewer's report:
This paper sought to examine residential and household wealth disparities in modern
contraceptive use among women in Ghana using pooled data obtained from MICS. The authors
found that the odds of modern contraceptive use are higher among rural residents, second,
middle, and fourth household wealth quintiles compared to their respective counterparts. While
this paper is interesting and potentially impactful, there are several concerns that should be
addressed before it can be deemed publishable. Here are my comments by section:
Title
I think the "A population-based trend analysis" in the title is not necessary as the primary focus
of the paper is not a trend analysis. Authors should consider using a “cross-sectional analysis’’.
Abstract
Lines 40-44. The results section is not clear. The authors should revise this section to clearly
show that the figures reported are odds ratios and not mere percentages.
Line 47. Conclusion. This is too long and is a repetition of the results. It should be brief and
include potential policy implications or significance.
Background
The background needs some improvements. Line 60, “increase’ should be “improve”. The
authors have made multiple important statements without relevant citations. The following are
key examples: Lines 65-7, 70-73, and 74-76 (likely National Population Council policy paper).
Lines 78, 81, and 85. Reference number 5 is not the appropriate citation for that text. Some of
these can be found in the National Population Council policy paper.
Lines 86, 87: Not clear. Recast.
Materials and methods
Line 123. Which sampling procedure was used in the survey? Briefly describe.
Lines 144-146. Briefly state how the covariates were measured.
Lines 146, 147. Provide examples of the literature as citations.
Line 151. Write cross-tabbed in full - cross-tabulated.
Line 156. How many dependent variables? Authors should revise this text accordingly.
Line 162. Was the analysis weighted? Authors mentioned in Lines 143,144 that they took into
consideration clustering, stratification, and sample weight effects due to the complex sampling
design of MICS. Please briefly describe how this was done.
Results
Line 168. Authors should be consistent with the use of place of residence throughout the
manuscript instead of using it interchangeably with “area”.
Line 184. It is a “percentage’’ instead of “proportions”.
Line 201. Presentation of results for Models I and II should be done together for each of the two
main independent variables instead of presenting them separately as the authors did; unadjusted
immediately followed by adjusted for each variable for easier understanding. For confounding
variables, only model II should be presented afterward as they're not the main results.
Line 204. Potential confounding variables you mean?
Lines 211-213. The presentation of these odds ratios is wrong. Rather, the middle and fourth
wealth quintiles had 40% and 41% higher odds of modern contraceptive use, respectively. The
same applies to line 222, it’s rather 19% and 17% higher odds instead of the 81% and 83%
reported by the authors.
Line 225. It’s 39% and 38 % higher odds rather than the 61% and 62% reported.
Line 230. It should be a “confounding” variable, not a “mediating” variable.
Discussion
The discussion section also needs considerable restructuring to present and discuss the issues in
order of importance based on the main purpose of the study. The current subsections and their
order do not reflect the primary purpose of the study.
Lines 262, 263. Authors need to use their first paragraph to introduce the main objective and
summarize the key findings before any discussion in the context of related literature.
Lines 264-268. Authors should focus on discussing their key findings first, which are based on
place of residence and household wealth. Findings on types of modern contraceptives and the
covariates are secondary findings and should be briefly discussed in the latter part of the section.
Line 329. This section should ultimately be the primary discussion of key findings on
residence and wealth status, possible reasons underlying the findings, and their implications or
significance.
Lines 331,332. The authors did not provide citations for their statistics.
Lines 333-335. The authors have mentioned four statistics from Nigeria, Togo, Malawi, and
Ethiopia but have provided only two citations from Ghanaian and Nigerian studies. Where are
the other citations? Each citation should be attached to each country and their statistics for easy
reference but not all packed in one bracket.
Lines 336-338. Do the authors have any evidence that the Central, Eastern, and Brong Ahafo
regions are more developed regions than Volta and the Northern regions?
Conclusion
Lines 422-426. The recommendations should ultimately be based on key findings on residence
and wealth status. Secondary findings on confounding factors can only be briefly stated
afterward.