Reviewer ’s report  
 
Title: Continuum of Sexual and Gender -Based Violence Risk s among Syrian RefugeeWomen 
and Girls in Lebanon  
 
Version: 2 Date: 30 Dec 2019  
 
Reviewer: Nancy Glass  
 
Reviewer's report:  
 
Summary: The article expl ores the effect of different forms of armed conflict on the nutritional 
status of children aged six to 59 months of age as measured by the height -for-age z -scores. This 
measure is frequently used to assess for childhood stunting. Within the research's resu lts and 
discussion sections that girls more than boys and those living in the northern region of the 
country are more impacted by violence -related stunting. Additionally, violence from improvised 
explosive devices more greatly impacts height -for-age z -scores than other forms of violence 
included in the analysis. This research is an important contribution to our understanding of how 
different forms of armed conflict differentially impact child nutrition outcomes by using novel 
micro -level analysis methods.  
 
Major issues: No major issues were appreciated in the authors' methods. Independent and 
dependent outcome measures are well established and were appropriate for the study's aims.  
Minor issues: In the introduction and discussion sections the authors state that no empirical study 
examining how exposure to violence has affected children's physical health living in 
Afghanistan, Iraq, or the Syrian Arab Republic. Please specify that this is the first article to use 
this type of methodology to measure violence's  effect on child nutritional status. Work by Ghazi 
and colleagues (2014; 2013) has explored the relationship between safety and nutritional status 
of children living in Baghdad City, Iraq. Please cite the statistical analysis package used for 
analyses.  
 
On page 5 of the manuscript in the methods section the authors write that the analytical sample 
period covers the time between parliamentary elections in February 2006 and the withdrawal of 
U.S. troops from cities into their bases as part of an armed forces agreement. Please elaborate as 
to why this historical concept is important in understanding the pattern of violence of consider 
removing this detail.  
 
In the discussion section the authors elaborate on the disproportionate impact of violence on 
girls' nutr itional status and surmise that this might be a result of girls receiving less or lower 
quality foods or delays in receiving medical treatment. I think it is important to provide relevant 
context to social and gender norms and gender inequality nationally and specific focus on 
differences by geography.  While the results of this research do point to the burden of violence -
induced stunting falling on girls, this is divergence to research from other contexts that indicates 
that boys are at greater risk for ex periencing stunting (Akombi et al., 2017; Keino, Plasqui, 
Ettyang, &amp;  van den Borne, 2014).  It is also important to consider the reality of household 
level factors on health and well -being on children.  Little mention is provided related to the 
impact of prolonged conflict and trauma on parenting and mothers/fathers' mental health,  gender 
inequality and violence in the home and how that impacts boys and girls differently - health and 
well-being.   Further, the databases focused on data from 2002 -2009, 2011 - what has been 
happening related to conflict, trauma and nutritional programs for young children that might 
have influenced the findings in this study.  How are the findings going to be used to inform 
policies, programs and future research - more foc us on implications of findings will be useful.  
 
Akombi, B. J., Agho, K. E., Hall, J. J., Wali, N., Renzaho, A. M. N., &amp;  Merom, D. (2017). 
Stunting, wasting and underweight in sub -saharan africa: A systematic review. International 
Journal of Environmen tal Research and Public Health, 14(8), 863. doi:10.3390/ijerph14080863  
 
Ghazi, H. F., Isa, Z. M., Shah, S. A., Abdal Qader, M. A., Hasan, T. N., &amp;  Al-Abed, A. A. 
(2014). The Relationship between the Neighborhood Safety and Nutritional Status of Childre n in 
Baghdad City, Iraq. Journal of nutrition and metabolism, 2014, 686934. 
doi:10.1155/2014/686934 Ghazi, H.  
 
Ghazi, H.F., Mustafa, J., Aljunid, S., Isa, Z., &amp;  Abdalqader, M. A. (2013). Malnutrition 
among 3 to 5 years old children in Baghdad city, Ir aq: a cross -sectional study. Journal of health, 
population, and nutrition, 31(3), 350 -355. doi:10.3329/jhpn.v31i3.16827  
 
Keino, S., Plasqui, G., Ettyang, G., &amp;  van den Borne, B. (2014). Determinants of stunting 
and overweight among young children and a dolescents in sub -saharan africa. Food and Nutrition 
Bulletin, 35(2), 167 -178. doi:10.1177/156482651403500203  
 
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 supporte d by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please spe cify 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:  
 
Acceptable  
 
Declaration of competing interests  
Please comp lete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of t his 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat 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 apply ing 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 y es to any, please give details below.  
 
I declare that I have no competing interests  
 
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on my report to the authors and, if the manuscript is accepted for publicat ion, my named report 
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to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal