Title: Modern contraception utilization and associated factors among all women aged 15-49 in
Ethiopia: Evidence from the 2019 Ethiopian Mini Demographic and Health Survey
Version: 0 Date: 20 Nov 2022
Reviewer's report:
Title: Modern contraception use and associated factors in Ethiopia: Evidence from the 2019
Ethiopian Mini Demographic and Health Survey.
Ref: Submission ID ce28838c-974c-47aa-ab49-9d00363c4dad.
General comments to authors
Title: I could not see the relevance of the word ‘.…. use….’ included in the title. Instead, its
noun (utilization) would be sound for your title. As well as incorporating the study participants
in the title is necessary. For instance, among whom you did the analysis?? All women?? Only
Married women? In what age range of women you did the analysis?
Abstract:
# The title has two objectives. However, only one objective is mentioned at the end of the
background section of your abstract. So, please add one more aim of the study at the end of your
background section of the abstract.
# At the method section of your abstract, you reported that you used logistic regression to
examine the association. However, you did not specify which types of logistic regression you
used. It is good to report the p-value and confidence interval in the method part of you abstract.
# In the result section of your abstract, you reported that “28.1% of women used modern
contraceptives. About 40% of the modern contraceptive users were between age of 25-29 and
30–34 years”. This report contradicts with the 2019 Ethiopia Mini Demographic and Health
Survey report. How it could be? Because in the 2019 Mini EDHS report around 41% of women
aged 15-49 years utilize modern methods. I frustrated about miss reporting? Is it ethically good
and expected from researcher? So, I suggest the authors to recheck the data. As well as it is good
to mention how many women use implant, pills, injectables…., others.
# In the result section of your abstract, it is good to mention the p-value, odds ratio, and
confidence interval of the associated variables to make it clear to the readers.
# In the conclusion section of your abstract, you stated that the use of modern contraceptives is
low in Ethiopia. What is the cut point to saying the utilization of modern contraception is low
or high? It is good to use other terms to make it sound.
# In the conclusion section of your abstract, you stated that increasing the awareness of
women to use modern contraceptive methods is vital. Yes, it must be. But, how do the
policy formulators and implementers, and any stakeholders increase women’s awareness? What
methods, interventions, and strategy they used to increase women’s awareness? As a researcher
show the way how the stakeholders to increase women’ awareness.
Background:
In the first paragraph of your background you stated that the world’s population by 2015 was
estimated at 7.3 billion, and projected to be……what is your reference to say the world’s
population was estimated at 7.3 billion? The reference is needed after 7.3 billion, and before and
projected…. The same is true reference must be provided in the first paragraph, line three after
“… 73 million”, and before “it is projected……...”.
In the second paragraph of your background, line three you stated that “… However, the recent
Ethiopian Mini Demographic and Health Survey have shown a low uptake of contraceptive
methods and high-unmet needs.” This needs citation and as well as the recent Mini EDHS report
stated that modern contraception is increasing from time to time. But, you look to contradict
the Mini EDHS report unless the report states it and the cut point to say low or high is well
known. So, I recommend the authors to use sound words like inadequate, insufficient…. etc. In
the 2nd paragraph, line two, I did not get what” 29% contraceptive prevalence rate…...” mean?
Is it utilization?  I suggest you to rewrite the whole sentence in clear way.
In the last sentence of the background of the manuscript, just before the aim of your study
you mention some factors in the previous study done in Ethiopia, Nigeria, Malawi and Ghana,
and you cited at the end of the sentence as a whole. Please cite the reference separately which
factors affect the utilization of modern contraception in which country. Please make sure the
completeness of this sentence? And you did not make clear what is affected by mentioned
factors? Modern contraceptive utilization.
Generally, the background section of your manuscript is very short, not well articulated, the
author did not review the modern contraceptive utilization from global to local study area.
Methods:
# In your methods part, you sated “study setting”. But, you wrote about your data source and
then you proceed directly to sampling techniques and procedure. Study setting is not yet touched
# You did not write what study design you used
# You did not write about the data source and how you obtained it. For instance, how you get
permission from the Measure Demographic Health Survey (DHS) website?
# You must provide sub-heading for the sampling procedures as sampling procedures.
# You did not write about the study population!! Researcher should write the study and source
population.
#  You did not write the exclusion and inclusion criteria! As researcher’s inclusion and exclusion
of the study population should be written.
# In the study variables of the methods section, you stated the dependent variable. However,
I am frustrated about your operationalization. As you wrote” ……categorized as ‘Yes’ for
those who uses PILL, IUD, injectable, implants, male condom, emergency contraception,
standard days method (SDM), lactational amenorrhoea (LAM) and other users, while “No”
for those who uses rhythm, withdrawal, other, and none users of family planning methods.”
What does other users mean? Users mean for me someone who use something, and it is not
type of modern contraceptive method! You missed other least known modern mothed such as
female sterilization is not mentioned in your operationalization. Why?? As well as you did
not cite your source. The operationalization should be rewritten well. For instance, how one
modern contraceptive user use all methods at once?? Your operationalization says like this. Is it
recommendable to use more than one method at once?? It is good for health? I think these who
use either of one is considered as a user of modern contraceptive method. I did not get when you
say “No for these who use rhythm, withdrawal……”?
# In the study variables of your methods section, just the last sentence….” Individual-level
variables include respondent age, residence, region, education and wealth quintile.” If you say
individual level variable, you should also other level variables for instance community level
variable. If so, region and place of residency could not be individual level variables. Your
independent variable is only demographic characteristics of the study participant. important
predictors like media exposure would be good if you included as a predictors of modern
contraceptive method utilization, and others.
# I am not clear about your data analysis process at all. It should be rewritten clearly. For
what purpose you used the survey weighing variable? How you weight the data? Did you use
traditional logistic regression for analysis? If so, do you think that traditional logistic regression
model is good for survey data? I recommended you to change your analysis method and use
advanced logistic regression model that handle the violation of data/ observation independence.
As you know, DHS data were ordered hierarchically that means mothers are nested within
households and households were nested within clusters. Hence, mothers from the same clusters
are more similar than those mothers who were from different clusters in terms of the outcome of
interest. This nature of the DHS violates the independence of observations and equal variance
assumption of traditional logistic regression.  This is why I suggest you to use advanced model
that can overcome the mentioned problems. Additionally, in traditional logistic regression
model, 5% of p-value is not considered for bivariate analysis. It is good to use p-value up to 2%
for bivariate analysis, and 5% for multivariate analysis.
Results:
# In the result part of the manuscript, you stated that “Most of women in the survey were
completed primary level of education (41.7%).”  However, 41.7% is too much higher than 2019
MINI EDHS report. Please recheck the data.
# As you stated “Modern contraceptive method were used by 28.1% of women, of which 18.7%
were injectable” the figures (28.1% and 18.7%) very lower than the 2019 mini EDHS report.
So, please recheck your analysis.
# You cited the table for the results, but not correct cited, please avoid dot (.) before table citation.
# “About 40% of the modern contraceptive users were between ages of 25-29 and 30–34 years
followed by women in age group 20-24 (34.7%).”  Please make sure this result.
# In result of regression analysis table (Table 3), please differentiated the significance and non-
significance variable’s category in in the Table 3.
Discussion:
In the discussion section of the manuscript, you stated that “About a quarter of women in
reproductive age who were included in the study used modern contraceptive.” I did not get
“about quarter” for your figure (28.1%).
In the discussion section of your manuscript, you stated that “Since Mini-DHS is a cross-
sectional type of survey, temporal relationship between contraceptive use and associated factors
cannot be assured and the evidence should be used in caution.” I am not clear about this? Do
you mean that there is no temporal relationship between dependent and independent variables?
If so, in cross-sectional study design, one of the limitations of cross-sectional study design is
existence of temporal relationship.
In the discussion section of the manuscript, you stated that “Findings in 2019 Ethiopian Mini
Demographic and Health survey shows that uptake of weighted modern contraceptive method at
national level has improved to 28.1% from previous years Ethiopian Demographic and Health
Survey, that is 9.7% in 2005, 18.7% in 2011 and 24.9% in 2016”. But, this looks contradict the
2019 Mini EDHS report. Please make sure and recheck your data.
In the discussion section of manuscript, you stated that place of residence is not statistically
significant factor for modern contraceptive utilization, and you proceed that it contradicts other
studies.  However, you are not expected to discusses insignificant predictors. So, remove it from
discussion and others if there is any more.
Totally, you lack in discussion of your findings including dependent and significant predictors.
In the discussion section of the manuscript, you are expected to write your finding and then
discuses with other similar studies with reasonable justification. For instance, if the figure of the
dependent variable is less or greater than other studies’ report. Then should reason out why it is
lower and higher than other studies’ report. The same is true for the significant variables.
Conclusion:
In the conclusion section of the manuscript, please write the implications of your findings.
General comment
I think that the problem you currently deal (Modern contraception use and associated factors in
Ethiopia: Evidence from the 2019 Ethiopian Mini Demographic and Health Survey) was studied
with advanced logistic regression model. If so, what values your study adds for readers and
stakeholders? What makes your study different?
Generally, the manuscript is methodologically poor, background of the manuscript not well
articulated, results are not well discussed, what makes the manuscript to be different from a
similar study, and what values the study adds for readers and stakeholders.