Reviewer’s report
Title: Knowledge, attitude and practice (KAP) of health providers towards safe abortion provision in
Addis Ababa health centers
Version: 0 Date: 30 Jun 2017
Reviewer: Laura Harris
Reviewer's report:
General impression:
This manuscript adds to body of literature on abortion in Ethiopia - an important and understudied
subject. The findings are useful for researchers, policymakers, and planners. However, the manuscript
is limited by unclear writing and use of English. With significant revisions, especially significant
editing of language, the manuscript might be suitable for publication. I encourage the author to revise
this manuscript with the help of an editor, and do hope that the results are eventually published as it
would be of great benefit to the reproductive health community.
Specific revisions:
For easier editing and communication in the future, the authors should arrange the text in one column
rather than two.
This manuscript needs major editorial revision for English language and copy-editing. At many points
the grammar makes it difficult to understand the points that the authors are trying to make. The
following are a few examples from the abstract: 
- Add the text in brackets: Emphasizing [the need to] increase knowledge…
- Add the text in brackets: A total of 405 MLPs [were] included…
- Need to define MLP as midlevel provider in abstract before using the abbreviation
- Knew abortion definition → change to knew the definition of abortion in the Ethiopian context
- The word "had" is repeated in error in the first sentence of the results section in the abstract
- In that same sentence, the verbs should all be in the past tense
In the results section in the abstract, instead of "Providers who had adequate knowledge related to
abortion (OR 2.019, 95 % CI 1.335-3.055) and male providers (OR 1.591, 95% CI 1.044-2.426) had
positive attitude towards safe abortion services." The sentence should read "…were more likely to have
a positive attitude towards…
Introduction, 2nd paragraph: "notwithstanding the new law…" Before this sentence, please specify
what the current law/penal code states about abortion and when it was put in place.
Materials and methods, study design and setting, paragraph 2: please clarify the sentence "The subjects
were chosen randomly, considering the homogeneity of health care providers. 
Materials and methods, study design and setting, paragraph 3: This is not a complete sentence and I
don't understand its meaning. Please edit for clarity. 
Materials  and  methods,  data  collection  and  analysis,  paragraph  1:  "Health  providers  working  in
selected health centers as full-time in Addis Ababa during the study period, and nurses (B.Sc. diploma
nurses and nurse assistants), Health Officers, Midwives (diploma ,degree graduates) were included in
the study."  This sentence should be in the prior section.
Materials and methods, variables, paragraph 1: "The first was Knowledge about
Magnitude…" Please clarify what the magnitude refers to. Magnitude of abortions? 
Results, Knowledge of respondents related to abortion, paragraph 2: if respondents said they were
familiar with abortion techniques, does this mean that they were aware of these techniques, or that they
themselves were trained in how to perform these techniques?
 Results, Knowledge of respondents related to abortion, paragraph 4: "If continuation of pregnancy
endangers the women's health 229 (69.4%) respondents mentioned that women should not be in ill
health to get the services even if the pregnancy endangers the women's health while 59 (17.9%) said
they will give the service if she is not necessary ill even the law…" I don't understand this point. Please
explain  the  meaning  of  this  item.  If  the  pregnancy  endangers  a  woman's  life,  shouldn't  she  be
considered ill by definition? 
Results,  Knowledge  of  respondents  related  to  abortion,  paragraph  5:  Know  components  of  post
abortion care → does this mean that the respondents know how to perform the components themselves,
or are aware of the components?
Figure 1 should be in % rather than N and should be re-formatted for clarity and ease of reading.
Results, Attitudes of mid-level health care providers related to abortion, last paragraph: This paragraph
is an exact repeat of the last paragraph in the next sub-section. It should be deleted here and kept in the
next subsection.
Results, Practice of Safe Abortion Care (SAC) among Mid-level health providers, paragraph 2: specify
that 95.6% and other percentages in this paragraph are out of n=68. Why is this number smaller than
the 83 that are trained in safe abortion? 
Results, Factors associated with knowledge, paragraph 1: why should knowledge above the mean be
considered adequate knowledge? Why not characterize this as, "above average knowledge"?  Also,
please explain how this score was calculated; were the number of correct knowledge questions simply
added together? 
The language used to describe ORs and other statistical measures in this section needs to be edited for
clarity. 
Table 5: The adjusted ORs can't all have been adjusted for adjusted for years of experiences, age and
profession since these are the main variables in the different regressions. Please specify which variables
were used to adjust which specific regression.
Results, Factors associated to mean attitude score: please define how the mean attitude score was
calculated and edit this section for clarity. 
Discussion paragraph 1: This paragraph should be moved to the introduction. In addition, in this
paragraph, please specify the conditions under which abortion can be performed, and whether women
need to provide evidence in the case of rape or incest.
The discussion in general could benefit from significant editing and reshaping to make its points and
overall flow clearer and stronger. At the moment I am unable to comment further as the discussion is
somewhat difficult to understand.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
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
statistical review?
If  an  additional  statistical  review  is  recommended,  please  specify  what  aspects  require  further
assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively edited
Declaration of competing interests
Please complete a declaration of competing interests, considering the following questions:
1. Have you in the past five years received reimbursements, 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 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?
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your reply is yes to any, please give details below.
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