Reviewer ’s report  
 
Title: "The sun keeps rising but darkness surrounds us": a quali tative exploration of the lived 
experiences of women with obstetric fistula in Ethiopia  
 
Version: 4 Date: 03 Jan 2018  
 
Reviewer: Solina Richter  
 
Reviewer's report:  
 
Dear Authors  
 
 
Thanks you for attending to the revisions.  It greatly improved the quality of the manuscript.  
 
 
There is however, more revisions required to make  this a paper publishable.   
 
 
I have uploaded the manuscript with the comments for correction, but will try to also summarize 
the suggestions.   
 
 
Please attend to the following:  
 
1. Page 3 Line 17 - 18: change '97% had mental health problems' to '97% develope d mental 
health problems'.  
 
 
2. Page 3 Line 31 - 32: Change '… visits for their pregnancy' to 'visits during their 
pregnancy'.  
 
 
3. Page 3 Line 35 - 36: You talk about skilled assistant.  I suggest that you are more precise.  
Are you talking about 'skilled bi rth attendants'?  
 
 
4. Page 3 line 46 - 47.   I am not sure if I agree with this statement.  Most of t research on 
obstetrical fistula (OF) particularly focus on experiences if living with this condition.  
Maybe in Ethiopia there is not much known.  I still ne ed a stronger motivation what this 
research will contribute to new knowledge related to OF.  
 
 
5. Page 3 Line 52: would like a better description between the association between home 
delivery and early marriage and the delivery of obstetrical fistula.  
6. Page 4 Line 8: What is the research questions?   
 
 
7. Page 4 line 21: remove 'on'.  
 
 
8. Page 4 Line 24 - 25. The sentence,  'The researchers approached bracketing through.' Is 
not a complete sentence.  
 
 
9. Page 4 Line 25 - 26.  The sentence, ' The current research reported the experience of 
fistula "what"  and how they become a fistula victim "How it experienced'.  The sentence 
construction need some editing.   
 
 
10. Page 4 Line 48.  I suggest that you remove the three words, ' and provides surgery'.  
 
 
11. Page 5 Line 1 9 - 20. Were ten participants selected or recruited? Were 10 
selected/recruited or was this sample sufficient to give you an in -depth understanding of 
the phenomena?  
 
 
12. Page 5 Line 20 - 33. Add 'a between in and convenient. The place cannot keep 
confiden tiality.  The place ensure privacy and can contribute to confidentiality.  Please 
change the sentence.  
 
 
13. Page 5 Line 47 - 48. Delete the words 'through the interview'.  
 
 
14. Page 6 Line 10. Was the transcript translated to English and how was the translat ion 
quality addressed? I suggest that you add information on the backward and forward 
translation and who was involved in this process?  
 
 
15. Page 6 Line 19. You stated that, "Discrepancies on the application of code guide were 
reviewed and resolved. This e xercise ensured that the coders had a common 
understanding of the code guide and its applications'. How was this resolved? Sentence 
structure needs revision.  
 
 
16. Page 6 Line 43 - 44. You stated that, ' before transitioning to the next theme or statement 
on the study guide, the interviewer read back the summary………' .  It was not a study 
guide but rather and interview guide and wonder how this was possible as the interviews 
was not yet transcribed at this stage.  
17. Page 6 Line 58. Change to : An independen t researcher who was not part of the 
study…….'  
 
 
18. Page 7 Line 23 - 24: Change 'had had' to ' who had developed (or experienced)'.  
 
 
19. Page 8 Line 51 - 58. This statement need a reference otherwise it reads like an 
assumption.  
 
 
20. Page 18 Line 46. Change ' Fistula' to 'obstetrical Fistula'.  
 
 
21. Page 18 Line 51 - 53.  You stated that 'the finding has positive implications for health 
care service utilization and for discouraging early marriage practice'.  This is a very 
vague statement and I suggest that you e xpand on this statement.  I agree but need to 
know more about the 'how'.  
 
 
22. Page 20 Lines 15 - 25. What about educating the family and community about the causes 
of OF and the treatment options. Can you suggests any further research generated by your 
findings?  
 
 
23. There are is still many grammatical and editorial changes need ed.   
 
 
This is important findings to share and I suggested again revisions and resubmission.  
 
 
 
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 your comments to t he authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the qualit y of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years receive d reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way ga in or lose 
financially 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 sala ry from an organization 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?  
 
If you can answ er no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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