Reviewer's report
Title:"I am alone and isolated": A qualitative study of experiences of women
living with genital fistula in Uganda
Version:1Date:4 May 2015
Reviewer: Guri Rortveit
Reviewer's report:
Thanks for the opportunity to read and review this manuscript, based on a
comprehensive qualitative study of 56 women with genital fistula in Uganda. The
need for studies on the subject is huge, and contributions from different areas
where obstetric fistula is relatively common is welcome. Below I will concentrate
on what I think are the main shortcomings.
Using qualitative methods is clearly the right way to go. However, there are some
issues with the design. As many as 8 groups were interviewed, and according to
table 1, informants were selected according to pre-defined criteria to fit into
different groups. Why is this not explained in the methods section, together with a
rationale? Instead, the authors state that the concept of saturation was used to
decide on the number of groups. This has to be clarified. Also, assuming that
there was a reason for selecting the groups according to table 1, this does not
show in the analyses. Were the young single women affected differently than the
divorced women with long-standing fistula?
Secondly, the results section is dominated by repetitions between citations and
the voice of the authors. Rather, we would like a meta-perspective from the
authors. It is difficult to see how the theoretical framework gave support to the
analyses throughout. In the discussion as well is a lot of text repeated from the
results section instead of giving the reader new input.
Thirdly, some aspects do not seem to be thoroughly analyzed. For example are
there lots of issues and citations under the subheading “Living psychologically
stigmatized and depressed” that could easily be categorized under “Living in
social deprivation and isolation”. It is the authors’ duty to explain why and how
these two main categories are different (and they are). Also, a finding that stands
out as a huge burden is that the women are not able to support themselves
economically. Putting this under the subheading of stigmatization and depression
under-communicates a structural pressure that these women struggle with.
Methodological considerations are placed after the conclusion, which is not
appropriate.
The abstract needs revision according to my points above.
A revision with special attention to the English language would be useful.
The reference list needs a thorough revision too, to align with the Vancouver
format.
I find it puzzling that the authors have not referenced one of very few studies
from Ethiopia on this subject:
Muleta M, Hamlin EC, Fantahun M, Kennedy RC, Tafesse B. Health and social
problems encountered by treated and untreated obstetric fistula patients in rural
Ethiopia. J Obstet Gynaecol Can 2008;30:44-50.
Also, I think this qualitative paper on urinary incontinence from Ethiopia should
be read and possibly referenced:
Gjerde JL, Rortveit G, Muleta M, Blystad A. Silently waiting to heal: experiences
among women living with urinary incontinence in northwest Ethiopia. Int
Urogynecol J. 2013;24:953-8.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
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