Reviewer ’s report  
 
Title: The acceptability of using IUDs among Egyptian nulliparous women . A cross –sectional  
study  
 
Version: 0 Date: 14 Aug 2019  
 
Reviewer: Radwa Rasheedy  
 
Reviewer's report:  
 
Abstract:  
 
Methodology: study type should be mentioned.  
 
Background:  
Line 52 to 55 in page 4 == very old reference for IUD users in Egypt  
Line 10 page 5 == is run on sentence,  the whole paragraph is not well read.  
The whole background need language editing, as some sentences are difficult to follow and most 
of the paragraphs don't have clear idea to deliver.  
The rationale and the prespecified hypothesis are not clear.  
 
Methods:  
"The study was approved by ethical committee board"==== specify which ethical committee 
approved it /the approval date and number.  
"The ministry sent authorization letters in advance of data collection to clinics participating in 
the study"==== what is act ually meant by this?? is the ethical approval obtained from the 
Ministry Of Health.  
 
"These family planning clinics were chosen randomly"=== how was this random selection done  
Did you mean Cu IUD only in your questionnaire or also LNG IUS as bleeding and a menorrhea 
rates are different between both types, also the difference in availability and costs.  
 I think follow up should be at least 1 year to be easily to compare with most studies reporting 
cumulative discontinuation rate per year  
 
Inclusion and exclusi on ccc were not specified:  
The population of interest should be clearly defined: age, previous contraception used, other non 
contraceptive benefits that may favors specific contraception use, contraindications for IUD use, 
is there was specific years of ex perience required for those physicians, their academic degree, 
their previous training level, working position, number of patients seen per month and number of 
contraceptive methods available in their facilities.  
 
"Only Ministry of Health clinics were inc luded because it is serving more than 50%" ==== this 
mean that your results can not be generalized on all the Egyptian women who seek contraception 
advice in private settings. With these women have different socioeconomic status and different 
educational l evel 
Was the systematic approach used to develop the questionnaire used?  
Item generation ==== a better formatting of your background to explain the idea behind your 
work and how you generate the items involved in the questionnaire  
 Item reduction=== for redundant items, was there any items excluded  
Formatting and Pretesting ==were individual questions within the questionnaire pretested  
Was the questionnaire tested?  With pilot testing to exclude any ambiguity in the questions  
Have y ou conducted validity testing?  
How were the questionnaires administered?  
 "The response rate was 100% for completing the questionnaires"==== was this for all women 
and physicians and for all questions  
 
 
Statistical analysis  
Sample size justification should  be mentioned  
 
Results:  
Have you performed a reliability test?   
I think that using p value, CI to illustrate if there was any significant difference between these 
proportions.  
Table 2, 3  
82.5% of providers refuse IUD insertion and most of them due to fea r of PID mean that your 
physician know nothing about the WHO or UK medical eligibility criteria.so these results cannot 
be generalized to all health care provider in Egypt and the authors must include their ages, years 
of experience, their academic degree,  years of practicing in contraception providing and number 
of patients attending these facilities.  
Increased cost, increased expulsion rate, decreased efficacy=== instead of cost, expulsion, 
efficacy.  
 
Table 4:  
In women agreed to insert IUD what about inse rtion pain scores, provider rating of difficulty of 
insertion, failed insertions???  
 
Discussion: this section is incoherent, long and redundant. I recommend revising the flow with 
language editing.   
 
Conclusion:  
The general population and physicians in Suez  city and Minia Egypt ===== your results cannot 
be generalized as mentioned before  
However further evaluation and assessment are required=== what exactly is meant by this 
sentence  
 
 
 
 
 
 
Abbreviations:  
Many abbreviations are not listed  
Ethics approval and consent to participate:  
This study was approved by the ethical committee of the Department of Obstetrics and 
Gynecology, Minia and Suez canal University Hospital on  15/04/2015 (Registration number: 
MUH15330).all patients were consenting  for participation in this research work=== I think those 
are 2 different university  
What is the registration date and number for each?  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the autho rs. 
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comme nts 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 comm ents to the editors.  
 
I am able to assess the statistics  
 
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 declar ation 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  
manuscrip t, 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 a pplying 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?  
 
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 de tails below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal