Reviewer ’s report  
 
Title: Magnitude, trends and causes of maternal mortality a mong reproductive aged women in 
Kersa Health and Demographic Surveillance System, Eastern Ethiopia  
 
Version: 1 Date: 08 Nov 2017  
 
Reviewer: Marie Hélène Bouvier -Colle  
 
Reviewer's report:  
 
I propose to simplify the objectives of your paper and to reinforce its main message: probable 
decrease of maternal mortality oberved in the Kersa districts from 2008 to 2014: le ssons learnt.   
 
 
P3, l 2 -15, Introduction can be shorten, particularly the very general first paragraph could be 
avoided.  
 
 
P5,l 45 46, How were identified the non pregnant women for exclusion of the studied population 
? 
 
 
P6, l7, Why you don't use a temporal t rend test ?  
 
 
P6, l24 -24, Precize calculation and justify the utilisation of the life time risk  
 
 
P6-7, A major difficulty stands on the rather small number of total maternal deaths observed 
during the period, 43 in 7 years, meaning than one can expect around  6 deaths by year.  
 
 
So the authors should calculate CI around the annual MMRatios ; they have to present a table 
with numbers of maternal deaths by year and MM ratios with their IC.  
 
 
P7, l45 -55, This paragraph should take place as element of discussion not in results.  
 
 
P8, l8 -9, Do the leading cause of maternal death significantly vary from one year to another ? If 
not, be careful for interpretation.  
 
 
P8, l15 -25, These results are of no use here.  
P8, l51 -60, Again, I don't see the utility of the comparison between maternal and all other 
women deaths, differently characterized obviously.  
 
 
P10, l10 -11, Repetition of P9, l57 -8. 
 
 
P10, l44 -59, Could be shorten as this is not the core of the subject.  
 
 
P12, l1-27, Interesting part of the discussion, particularly the place, role and training of TBA 
which are always controversial. Please add litterature references to reinforce your arguments.  
 
 
P12, l50, « Limitations of the study » would be better placed at the beginning of the discussion. 
Could you insure no modifications arrived in the KHDSS data collection during the studied 
period.  
 
 
I did not see any discussion of the increased MMratio of 2011. You should give potential 
interpretation particularly of hypertens ive disorders.  
 
 
 
Are the methods appropriate and w ell described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Unable to assess  
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is rec ommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
 
 
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