Reviewer's report
Title:Women, poverty, and adverse maternal outcomes in Nairobi, Kenya
Version: 4Date:4 October 2010
Reviewer: Cyril Engmann
Reviewer's report:
Dear Editor,
Thank you for inviting me to review this manuscript. It is my privilege to do so.
This manuscript serves to explore the link between poor urban Kenyan womens'
views and lived experiences of pregnancy, and adverse events during and after
pregnancy.
I will now make point - by - point responses.
1. Is the question posed by the authors well defined?
Yes. The authors build the case convincingly that despite the well-studied link
between poverty and adverse maternal outcomes, little is known about how poor
women themselves view economic disadvantages and adverse maternal
outcomes. Therefore, this manuscript sets out to answer this question.
2. Are the methods appropriate and well described?
No. I feel this manuscript will benefit from a consideration of formalized
guidelines for reporting qualitative research such as the COREQ, or some similar
set of guidelines. The authors should address the following.
1. Who conducted the focus group discussions (FGD) and in-depth interviews
(IDI)?
2. What were the researchers’ credentials?
3. What were the researchers’ occupations at the time of the study?
4. Were the researchers male or female?
5. What training and experience did the field workers have?
6. Was a relationship established prior to study commencement?
7. What did the participants know about the researchers?
8. What characteristics were reported about the interviewers/facilitators?
9. How many women were interviewed for the IDI?
10. How many women participated in FGD?
11. How was sampling done ie how participants were selected?
12. Method of approach? Was this solely through a community survey? Did this
include women who were illiterate?
13. How many people refused to participate or dropped out? How were such data
handled if they dropped out half-way through?
14. Where was the data collected?
15. Were there other non-participants’ present during the interviews?
16. Were questions, guides or prompts provided by the
authors/researchers/facilitators’?
17. Was there pilot testing?
18. Did the research use audio-visual recording?
19. Were field notes made during the interviews or focus groups?
20. What was the duration of the interviews or focus groups?
21. Was data saturation discussed?
22. Were transcripts shown to participants for comment or correction?
23. How many data coders coded the data?
24. Was there a formal coding tree utilized?
25. Were themes identified in advance or derived from the data?
26. What software was used to manage the data?
27. Did participants provide feedback at this point?
28. Were there minor themes that emerged?
MAJOR COMPULSORY REVISIONS REQUIRED.
3. Are the data sound?
It is difficult to determine this because of the lack of detail given in the methods.
MAJOR COMPULSORY REVISION
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
No. See comments to question 2.
MAJOR COMPULSORY REVISION
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
No. The results and discussion will benefit from clarification and more detail on
the fact that women work even harder during and after pregnancy. Similarly, the
respondents raise some intriguing points regarding TBA's which I believe merits
a discussion. Aspects of the results section appear more like a discussion.
MINOR ESSENTIAL REVISION
6. Are limitations of the work clearly stated?
Yes, although I suggest the authors consider moving a discussion of limitations
from the methods to the discussion section. MINOR ESSENTIAL REVISION
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
Yes.
8. Do the title and abstract accurately convey what has been found?
Yes
9. Is the writing acceptable?
Yes, although it would benefit from some minor editorial improvements.
Introduction: Line 7: "Other accounts focus on poorer womens elevated
odds....line 16". This section needs to be written clearer, with more references
provided for each of the issues mentioned e.g. higher probability of experiencing
closely-spaced births leading to substantial loss of vital stores of micronutrients.
The second to last paragraph of the introduction has the word "by" after the
sentence and period.
The last paragraph of the introduction appears more like a conclusion.
There is a discussion of limitations in the methods section which will be better
placed in the discussion section.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I have no competing interests.