Reviewer ’s report  
 
Title: Contraceptive use and determinants of unmet need for family planning; a cross sectional 
survey in the North West region, Cameroon  
 
Version: 1 Date: 26 Jul 2018  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
REVISION ASSESSMENT FROM THE ACADEMIC PEER REVIEWER:  
Has the author addressed your concerns sufficiently for you to now recom mend the work as a 
technically sound contribution? No  
 
Reviewer comments: The revised version of the paper is significantly better than the original  
version.  That said, it is not yet ready for publication.  There are still  numerous problems with 
languag e and syntax throughout.  More substantively,  additional detail about the methodology is 
needed and some of the  findings are unclear.   
 
Additional remarks  
Background section:  
In the last sentence of the first paragraph of the background you likely mean Cameroon's 
sustainable development agenda.  
For ""sampled women with socio -economic and cultural beliefs which are different..."" Does the 
author  mean socioeconomic status? It currently reads as ""socio -economic...belief""  
If only 21% were using FP how  could the unmet need be only 18%?  
For ""The potential demand for contraception in the Northwest Region was at 55.8% with only 
68.3% of this demand satisfied."" What does  this figure represent?  Percentage of women who...  
 
Method section:  
The second para graph of the methods is problematic. There seem to be words missing from the 
first sentence. It is not clear what the authors are trying to say. They used the absolute precision 
required on either side of the proportion, a cluster effect of 2 and a 95% con fidence interval to 
determine the sample size needed?  
The end of the last sentence of the methods says ""among others"" - the authors likely mean ""as 
well as other information""  
 
Data analysis:  
The second paragraph is still very difficult to follow.  Consider replacing this paragraph with the 
paragraph that defines the various terms  that are used.  
What do the 1s and 2s represent?  
The third paragraph indicates ""excluding women with an unmet ne ed who are pregnant or..."" 
But weren't these women included in the calculation above? How could women who were 
ammenhoreic have an unmet need for contraception?  
The end of the third paragraph - This makes it sound  like  these women  were satisfied with the 
method they were using, which may not  be  the case.  Maybe talk instead about met demand.  
 
Operational terms  
unmet need - This is quite redundant with the description of the method ---although I found it 
much easier to follow.   I would  consider expla ining the method this way.  
 
Results  
""able to state the correct use"" What does this mean?  Were respondents asked to explain 
correct use to the interviewer? Were they asked to explain specific  methods?  
By ""most cited"" Do the authors mean these are the  methods respondents were most likely to be 
aware of (as opposed to the methods they were most likely to use)?  
""modern contraceptive prevalence of 13.0"" How was this calculated?  
""1.5% of the population surveyed"" It is a sample.  
""The rate of unplan ned pregnancy among women with unmet need (50.5%) was more than 
doubled the rate of unplanned pregnancy among women with no unmet need for family planning 
(20.4%)."" Need a table showing these results. Do the authors mean that 50% of those with 
unmet need were currently pregnant or had had an unplanned pregnancy in  the past?  
 
Discussion  
First paragraph - No need to repeat the information in this paragraph here.  It was already 
presented  
Please avoid the pejorative phrase ""the masses""  
""dissuasion"" Seems like the wrong word.  Don't FP caregivers want to encourage people to use 
contraception?  
""unmet need for planning was more than doubled"" As noted above, it is unclear how to  
interpret this finding.  Are the authors saying that wome n with an unmet need for family 
planning  were twice as likely to have had an unplanned pregnancy as women without an unmet 
need?  That seems  like an important finding that merits its own discussion rather than being 
buried in the middle of this paragraph .  
What do the authors mean by ""the right information?""  Is it just access to information?  Isn't 
also  access to contraception?  What are sensitization and dissuasion techniques in this context?  
Isn't the idea to persuade women  to use contraception ---not dissuade them?  
""This strong influence..."" should be a new paragraph  
""Programs of fight against"" So the authors  mean  programs to prevent reproductive coercion?  
Why is it important to survey men and couples?  Perhaps this belongs in the discuss ion of 
strengths and limitations.  
The final paragraph of discussion is out of place, coming as it does  at the  end of the  discussion 
section.  It really detracts from  the overall message.  I would suggest dropping it.  
Perhaps the authors could include  a sentence or two elsewhere in the discussion about why 
education was no longer significant in the multivariate model.  
 
Limits and strengths  
I am not sure what the authors  are trying to say but ""emission of hypothesis"" makes  no sense.  
Maybe they shou ld just drop that phrase and  leave  the rest of the sentence as  is.  
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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional st atistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality 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 received reimburseme nts, fees, funding, or salary from an  
organisation that may in any way gain or lose financially 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 gain 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 salary from an or ganization 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 answer 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.  
 
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recommendation.  
 
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