Reviewer's report
Title:Prevalence of IUCD discontinuation and its associated factors: Findings
from a retrospective study with clients of a social franchising network in Pakistan.
Version: 3Date:15 March 2012
Reviewer: Syed Iqbal Azam
Reviewer's report:
Reviewer’s Report
Title: Rates of IUCD discontinuation and its associated factors among the clients
of a social franchising network in Pakistan
Version: 3 Date: 03 March 2012
Reviewer: Syed Iqbal Azam
Reviewer's report:
Major Compulsory Revisions
Title
The title of this study can be modified as “IUCD discontinuation and its
associated factors among the clients of a social franchising network in Pakistan:
A cross sectional study”.
Abstract
1. Findings should start with IUCD discontinuation followed by its discontinuation
for different duration.
2. The percentages provided in the paragraph of findings “We found that 22.7%
of the IUCD acceptors experienced some health problem; while the overall
discontinuation rate was 18.9% with average time of usage of 8.27.4 (SD
±5.86.4) months before discontinuation. Half of them showed health concerns
(49.8%); of which a majority (70.2%) returned to Suraj provider for IUCD
removal” are unclear as these are for different denominators.
3.The sentence “field workers to prevent early discontinuation of IUCD among
the Suraj clients and by addressing the health concerns through proper
counseling, continued follow-up and immediate medical aid/referral in case of
complications” in the conclusion can only be used if health concerns are different
for clients of different duration. The conclusion should be revised in the light of
findings.
Main article
Methods
1. The sentence “In each district, a sample of Suraj providers was selected for
this survey” should be removed from study design and setting as this is more
appropriate for the section of sampling strategy, although the sentence is
incomplete (how many?).
2. The word “multi-stage sampling” should be replace with “multistage cluster
sampling with stratification”.
3. Two variables are described as stratum a) district and b) type of clients. Do
you think that these variables are different in terms of IUCD discontinuation? If
yes, report your findings.
4. Provide your rationale for the sample size of 3,000. What was the distribution
in each district and why?
5. Table provided in sampling section should be numbered and must have
description of the title.
6. Data collection tool should describe the list of variables in detail.
7. Statistical analysis should involve sampling strategy, sampling weights as the
analysis provided in the article is valid for simple or systematic sampling
techniques only. Use survey methods to calculate your factors and rates.
8. Prevalence ratio is correct according to modern developments, but odds ratio
can also be used particularly if going for complex data analysis.
9. The sentence in the statistical analysis section “The data for IUCD insertion
and discontinuation data were counted as single record” should be re-phrased for
your outcome of interest.
Findings
1. The result sequencing should be according to the objectives of the study i.e.
starting with study participants, rate of discontinuation, reasons for
discontinuation and factors related to discontinuation.
2. Describe your preliminarily findings by the variables on which stratified.
3. The sentence “Multivariate analysis in table 3 shows a high adjusted
prevalence ratio of discontinuation for women” should be replaced with
“Multivariable analysis”, because of one outcome variable only.
4. Sequencing in the factors described in tables should be critically examined.
Discussions
1. Re-phrase the sentence in third paragraph and 7th line “Discontinuation rates
among voucher and non-voucher clients were same, which indicates that the
vouchers were distributed to eligible women after proper need assessment”,
because it is a very strong statement in terms of scientific statement.
Conclusion
1. The first of first paragraph started with the word “such”, what is meant by this
word. It seems incomplete or describe in the context of your outcome of interest.
2. Your conclusion should be based on the finding of your study which seems
missing.
Level of interest:
An article whose findings are important to those with closely related research
interests
Quality of written English:
It is recommended that final version should be reviewed by native English
person.
Statistical review:
Yes, I have commented on statistics used in the manuscript.
Declaration of competing interests:
I declare that I have no competing interests.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'