Reviewer’s report
Title: 
Findings from a mixed-methods evaluation of a multi-level adolescent and
youth reproductive and maternal health intervention in Karnali Province, Nepal
Version: 
1 
Date: 
09 Mar 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: Overall, the paper describes an important
intervention to improve maternal and infant health in an area of Nepal. The
authors have designed the pre- and post- test well and have described those
findings thoroughly. I do however feel that more of the FGD findings could have
been published, as well as more of the methods implemented to analyse the FGD
data. 
In terms of meeting best practice, there are some concerns about how the
intervention was developed and the theoretical underpinnings used which i will
describe below.
REQUESTED REVISIONS: 
Further elaboration on how the intervention was designed would be valuable. At
the moment there is very little detail other than they were developed from
previous experience. This will greatly help in the interpretation of the findings
and the understanding of how the intervention could be rolled out further in a
sustainable way.
The socio-ecological framework is also suggested as a basis of the program
however very little explanation of how it was used appears in the paper.
There are also concerns with the results for breastfeeding knowledge that need to
be addressed in the discussion further.
And as mentioned before, there is very little information about the qualitative
methods used and details of the findings.
Declaration of competing interests
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paper?
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interests' below. If your reply is yes to any, please give details below.
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recommendation.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
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No