Reviewer's report
Title:Knowledge of Obstetric Danger Signs and Associated Factors among
Pregnant Women in Erer District, Somali region, Ethiopia
Version:2Date:11 October 2015
Reviewer: Lisa Thompson
Reviewer's report:
• Major Compulsory Revisions
--There are many grammatical errors, too numerous to list here; the authors
should get an editor because this is important information, but needs to be
conveyed more clearly. Use active voice instead of passive voice. Avoid
redundancies.
--Unsure why chose the definition of “at least two danger signs during each
interval” as dependent variable. Lines 146-8: This is the definition of the
dependent variable and should be justified by other sources or by investigator.
--Line 99-104: I believe the sample size formula is incorrect (needs citation too),
and is missing design effect in numerator. I am getting 744 using:
-- Show the p values for the independent variables included in the multivariate
analysis. Was visited by HEW or received maternal health education significant?
I would think that those would be in adjusted models. IV’s tested were in Table 1
and 2. Authors could show differences in socio-demo in in these tables to help
readers see differences in chosen variables. Women could be divided into two
groups: danger signs/no danger signs. For this, since only 98 women met the
definition for complete understanding of ODS, they might have to show by
“Mentioned at least two danger signs” vs “Couldn’t mention at least two danger
signs”.
-- Repeats results of tables in text which is redundant. Text should be used to
add additional information not shown in tables, not repeat exactly what is in
tables.
• Minor Essential Revisions
The author can be trusted to make these. For example, missing labels on figures,
the wrong use of a term, spelling mistakes.
--Abstract:
1. Remove stats packages in lines 10-11
2. Describe what obstetric danger signs you are referring to and how you
operationalized dependent variable in lines 15-17
3. Define pastoral—nomadic animal herders (?) or rural (?)
--Introduction:
1. Change lines 51-57 to read: “Obstetric danger signs are complications that the
woman and her family can easily recognize, and they are different depending on
the obstetric period in which they occur. The most common signs are
…list...during pregnancy; …list... during labor and childbirth and …list...during the
postpartum period.”
2. Lines 58-65 essentially repeat the same concept. Also you don’t describe the
first phase of delay, don’t put it into contexts of the other delays, or cite the
authors who developed the three delays framework.
3. Lines 70-71: if the Ethiopian government is targeting increase in knowledge
around danger signs, how are they doing it? Did they do it in the area you
surveyed? Important background, but no elaboration.
4. Lines 71-74: Add “Increasing knowledge of…and preparing for birth are two
strategies…
5. Line 75: Different instead of deferent…
6. Line 76-79: Where any of these studies intervention studies, or where they all
cross-sectional like present study? Any effort to actually change knowledge
through education? Important to state in background and discussion.
7. Line 80: Add increasing women’s knowledge
--Methods
1. Line 92: pastoral, not postural.
2. Line 97: What illnesses were excluded
3. Line 129: add recruitment of data collectors and supervisors was done…
4. Line 133: remove by going through the questionnaires question by question
5. Line 135-7: Change to: “Educational stats of female participants and their
partners were assessed independently. Additionally, respondents were asked if
other household members had formal education.”
6. Line 149: Remove first sentence in paragraph. This whole data analysis
paragraph has to be rewritten. Not clear or standard language.
--Results
1. Line 173: attended or currently attending? Assume these are respondents
children.
2. Lines 197-206: Unclear what is adjusted for in each of these analyses.
Discussion
1. Line 208: Add obstetric complications during three periods
2. Lines 211-213 are not clear, where these cross-sectional? Intervention
studies?
3. Line 215 remove: There is evidence that shows
--Conclusion
1. Line 237 remove: In conclusion the study showed that
2. Line 239-40: This is not correct, we do not know that your results (lack of
knowledge) will lead to delay in seeking care. Your study design can’t answer
that.
3. Line 240-41add: The implication is that lack of recognition may lead to delay
4. Line 243: again, mention first phase of delay without context or definition.
Table 2
1. What is model household?
2. Spell out HEW/ANC
Table 3: Categorize into three periods: Add pregnancy, labor/delivery,
postpartum row headers
Table 4:
1. C is unadjusted OR? What is the C?
2. COR column has an issue: occupation Ref/OR is not in the correct row
3. State what the AORs are adjusted for in the footnotes of the table
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
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