Reviewer ’s report  
 
Title: Women’s contraceptive discontinuation and switching behavior in urban Senegal, 2010 -
2015  
 
Version: 1 Date: 20 Nov 2017  
 
Reviewer: Tracy Irwin  
 
Reviewer's report:  
 
I commend the authors for trying to identify why women discontinue or switch methods in 
Senegal.  These women are have already accessed FP services and it is critical to find out how to 
keep them engaged.  Overall the paper is well written, however additional analysis and more 
focus would help this manuscript have more impac t. 
I would consider spending less time describing the entire cohort (which includes approximately 
45.6% of women with reported reduced need) and more time looking at women who are in need, 
switching methods, and having method side effects and/or failures.   
Additional analysis should include some reference to the passage of time and multiple 
observations per women. You looked at women over five years, however lumped all their FP use 
or non -use into one variable.  Multinomial logistic regression should not b e used when multiple 
observations are used over a time span of if women are allowed to change within the time frame. 
Consider changing your method to generalized estimating equations or mixed effect.  I find your 
decision to use the "in need" group as your  reference in Table 5.  Perhaps consider two separate 
questions 1) In Need vs. No Need and 2) among women who are in need - who switches and who 
doesn't.  Furthermore, in Table 4 addressing the amount of time to next event and whether that 
event is pregnan cy or next method is an important question to answer.    
 
Specific Comments:  
Background  
Overall this section is too long.  Line 86 -92 consider deleting. Line 94 -97 already stated in line 
81 consolidate or delete. Line 98 -11 move this to discussion section and compare to your results. 
Line 113 -118 deleting not important for your paper or what you are trying to discuss.  
 
Methods  
Line 170 -171 as noted above time and how it fits into your analysis need to be clarified  
Line 171 -175 Move to discussion section. OK  to simply state no censor period was used.  
Line 189 (up to one month? 30 days?) be specific  
Line 190 - See above for concerns about your analysis  
 
Results  
Table 4 - Clarify pregnancy intention/need as you discuss pregnancy rates. You found pregnancy 
is higher after stopping certain methods, but you don't discuss this in terms of need/intention. 
Perhaps women choose pills or traditional methods as they are perceived as easier to discontinue 
to become pregnant.   
Line 278 -279 - elaborate here - this is the g roup that needs further discussion.  
Table 5 - see comments above.  The column on left need to be predictors. Can you say with 
certainty that "method discontinued" and "source of method" are predictors and not outcomes?  
You need to list P -values for overa ll categories not just subsets.   
 
Discussion  
Line 314 - clarify as your results don't support this statement - there isn't discussion of time.  
Line 326 - Does your data allow you to discuss this further - why so high?  
Line 336 - inherent bias or recall b ias? 
 
Conclusion  
Line 353 -358 - I agree with the authors conclusions here, and hope they can look at their data 
more closely to provide programs and MOH more specific information on how to provide 
durable FP services.  
Are the methods appropriate and well 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 y our comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional stat istical review?  
If an additional statistical review is recommended, 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  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
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financi ally from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organiz ation that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
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below.  If your reply is yes to any, please give details below.  
 
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