Reviewer’s report
Title: 
Factors Influencing Mothers’ Decisions Regarding Obstetrical Care in
Western Kenya: A Mixed-Methods Study
Version: 
0 
Date: 
12 Jan 2021
Reviewer: 
Joseph Abi Jaoude
Reviewer's report:
Thank you for the opportunity to review this manuscript, I have no COI to
disclose. 
This is an interesting study of women in Western Kenya, where the authors try to
analyze factors associated with pregnant women choosing to deliver at home or
at a relatively close hospital. The authors present multiple socio-economic and
health-related factors that play a role in such decision. The study presents both
quantitative and qualitative data, and would be interesting to the readers of BMC
Women's Health.
Few suggestions: 
The abstract section could be shortened briefly mainly in the Background 
and
Conclusion sections. 
Please reformat the abstract section so that your results are under "results" rather
than "conclusion" and remove the sentence "nformed by these interviews, we
developed a framework highlighting specific contextual, maternal, and systemic
factors that influence a woman's decision to deliver at home or at a healthcare
facility." As it offers nothing to the reader. 
"Quantitative and qualitative data were collected" Please elaborate briefly in text
on what data were collected on the participants. 
Was there any sample size
calculation? How did you arrive to your sample size of 380 women?
"Almost all participants" please give the actual number and percentage in
brackets. 
"Using an iterative inductive-deductive process based on the coding system,
frequency of codes, and a review of the quotes sorted by category, a framework
was developed to highlight the specific contextual and maternal factors that
influence perception and decision to deliver at home with a traditional birth
attendant or at the hospital." Please move this and any other similar methodology
section from your "results" to your "methods". Your "results" section should be
only focused on presenting your results rather than how you obtained those data.
"In Western Kenya, having many children contributes positively to a mother's
social status, although this reality was expressed indirectly." What do you mean
by "although this reality was expressed indirectly"? Please elaborate.
The discussion includes a "strengths and limitations" and "interpretation"
sections. Please remove the sub-headings as those are not necessary, and just
write them down. The interpretation can go in your discussion, and include your
limitations right before your conclusion. The strengths of the study could be
mentioned in the discussion or conclusion. 
In table 1: Please include both frequencies and percentages rather than only
percentages for all of your categorical variables. 
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Declaration of competing interests
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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?
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Yes
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Yes
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Yes
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from apparent manipulation?
Yes