Reviewer ’s report  
 
Title: Discontinuation rate of implanon and its associated factors among women who ever used 
implanon in Dale District, Southern Ethiopia  
 
Version: 1 Date: 20 Mar 2018  
 
Reviewer: Mengistu Asnake  
 
Reviewer's report:  
 
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Yes 
 
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No 
 
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No 
 
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I recommend additional stati stical review  
 
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Needs some language corrections before being published  
 
  
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Controls: It should have been good to identify the place of insertion (Hospital, Health Center, or 
Health Post) and the event of insertion (routing service or training of providers) to clearly link to 
the level of counseling and quality before concluding o n the quality of services. In addition some 
inclusion of qualitative component that include key informant interview for providers and FGD 
among women who chose removal should have made the study a complete one.  
 
Conclusion: The issue of quality counseling as a conclusion can not be only drawn from a client 
interview and the addition of observation and more qualitative assessment should have been 
included in order to triangulate the results from the qualitative analysis. In addition the definition 
of early r emoval as less than a year will confuse a lot and if data is available it is good to dis 
aggregate the less than one year category into months to really see the early removals. Some of 
the reasons given for removals were switching method and want to have a  child should not be 
lumped together since the family planning services are given based on choices of clients not a 
prescription from the provider. Initially clients may chose implant and when they want to switch 
or have a child it is their choice rather t han related to poor quality of counseling. Therefore the 
authors should revise their analysis to see these issues.  
 
Foe me there is an interesting result in terms of the age of users where most users are at a 
younger age compared to other studies or the DH S data and it is good to include that in the 
discussion as a positive finding.  
 
Did the authors include what happened after removal in terms of being protected with a 
contraceptive method? Stopping contraceptive use versus switching to other method has a 
different impact in the reproductive life of the woman. If data is available it will be good to 
include that.  
 
References: Reference number 6 is incomplete and if someone needs a citation how can you 
access it? If it is unpublished data then it should be i ncluded in the reference section.  
 
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