Reviewer's report
Title:Trends and determinants of mortality in women of reproductive age in rural
Guinea-Bissau, West Africa.
Version: 1Date:8 July 2013
Reviewer: Latifat Ibisomi
Reviewer's report:
The classification of comments into the three recommended categories of (1)
Major compulsory revisions, (2) Minor essential revisions and (3) Discretionary
revisions does not arise in the review as the manuscript does not enough content
to warrant its publication. I have therefore opted to provide comments according
to the issues the review is to address as follows:
Is the question well defined?
• The importance of studying WRA needs to be convincingly enumerated
Methods appropriate?
• Seems manuscript was hurriedly put together without attention to necessary
details. For instance, the readers may not have as much intimate detail of the
data and the study site/country as the authors. These are assumed in the
manuscript.
• The section on data management and analyses is not detailed enough. For
instance, how the outcome variable was operationalised to warrant the use of
hazard modeling. Why age group 30=39 when the others are in 5-year age
groups?
Sound data?
• No! entering only region, age and ethnicity into the model of determinants of
mortality of women is grossly inadequate. They do not even start the lineup of
factors that have been identified in frameworks or theories of mortality
Manuscript adhered to relevant standards for reporting and data deposition?
• The writing style puts readers under some stress trying to appropriately
locate/put meaning to intertwined information and at other times, piecing together
information that are scattered in the various tables, figures, introduction and
methods section. At times, a sentence in the discussion section might require
going through three different sections of the manuscript to make sense. A more
comprehensive layout of the results might reduce this.
Balanced discussion and conclusion and adequately support data?
Results section, Paragraph 6:
• The geographic grouping of the regions should be reflected on the Table if the
results have to be presented geographic wise. That will make it easier for readers
to see, the regions in each geographic zone. How the geographic distribution
may have impacted on the result should also be discussed.
Discussion section, Paragraph 1:
• Which age group, area, etc were mostly affected by the meningitis?
• Despite the presence of many IDPs in Biombo, the area still had lower rates.
So, can the higher rates at Bafata and Gabu (areas that were less affected) be
tied to the war?
• To actually tease out the effect of the war, the analysis has to be done
piecemeal by the defined periods.
Discussion section, Paragraph 2:
• Give an idea of HIV treatment options and fatality around the period.
• Last sentence - Link to happenings at study site not the country only.
Discussion section, Paragraph 3.
• First sentence. This is not reflected anywhere. Period is not controlled for in
analysis
• Any issues with the data (such as incompleteness) especially in 2007?
Discussion section, Paragraph 4:
• Expand on methodology used by other existing studies. What were their
findings and conclusions?
Discussion section, Paragraph 5:
• Do Gabu and Bafata have any advantage over the others in terms of availability
of healthcare services, job opportunities, etc.
Discussion section, Paragraph 7:
• What interventions take place at the HDSS? List and let readers decide whether
they may have impact or not.
• Is there any finding that is amenable to intervention? What is the policy or
programme implications of the findings?
• I expected a comparison of WRA findings to MMR to give an indication of the
contribution of MMR to WRA mortality.
Limitations stated?
• Some of the limitations are flagged in the methods section. However, it is not
sufficient for the few variables used. Further, the last sentence of Paragraph 5 of
the methods section reads: In the present dataset, the exact date was known for
18% of the deaths and … Meaning exact date of 82% unknown. That says a lot
about the data quality.
Table 2:
• Attention was not paid to the necessary details that should appear on the table.
For instance, (1) significance of the hazard ratio were not denoted. Readers are
left to look through the confidence interval to decide. (2) The unadjusted hazard
ratio for Cacheu not written. (3) The – mark not inserted for 95% CI and p-value
for reference categories in the unadjusted columns .
Figures:
• The figures’ number and titles should be attached to them.
• When printed as black and white, there is no distinction between Bafata and
Biombo and also between Cacheu and Oio. The labels may be attached to the
lines for this purpose or more distinct patterns used for each.
Level of interest:
The article is ordinarily of great interest but in this manuscript, in content does not
live up to the title nor add to what is already known
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
'I declare that I have no competing interests'