Title: Household food insecurity, family size and their interactions on depression prevalence
among teenage pregnant girls in Ghana, a population based cluster survey.
Version: 1 Date: 11 Jul 2023
Reviewer:  Farrukh Ishaque Saah
Reviewer's report:
The authors reported on the effect of the interactions between food security and family size
on depression among pregnant teenage girls selected through a WHO STEP multistage cluster
sampling technique. The findings have implications for the prevention of depression among
pregnant teenage girls.  However, it has not been written without issues. The manuscript
will benefit more from thorough proofreading, and ensuring that the STROBE guidelines are
followed. The following issues should be addressed.
Title & Abstract:
1. Title does not need to include the sampling technique. Rather, it should be changed to the
study design. Please revise.
2. Background: Sentence 1 and 2 are missing some articles (a/the), check. Also, be consistent in
choice of words like “household food insecurity” or “household-food-insecurity” or “household-
food insecurity”. I think in most of the context, it should be “household food insecurity.” Ensure
consistency throughout the work. Similarly, “family-size”, “healthy-living”, and “social-unit”
are not hyphenated terms.
I suggest instead of “This study explored…”, revise to “This study investigated/examined…”
Also, check the use of the preposition for and on in the title and the objective. Is it “interactions
for” or “interactions on”? These may seem same but actually mean different things. Please clarify
the study’s position and revise throughout the work.
3. Methods: What is the study design? what is the study population? and what analyses were
done? These should be summarized in this section.
4. Results: Revise this section to provide summary of the key variables and the associations and/
or interactions. What was the level of food insecurity and family size reported? What was the
prevalence of depression reported? All the statistical figures should be in parenthesis and not
hanging in the sentences, they make it difficult for the reading to flow.
5. Conclusion: This is not supported by the results presented in the abstract. No depression
prevalence is reported here. The recommendation is not consistent with the findings and not
specific enough. What do you mean by “population-based public health interventions”?
Introduction:
6. The section is unduly long and lacks coherency and relevance. I believe that there is too much
of write up dedicated to food security and family size than the main variable of interest in the
study, depression. I appreciate the need to provide some basic definitions for readers but the
current write-up deviates largely away from the purpose of the section on food security and
family size. Rewrite the introduction to adequately and concisely link the three variables in not
more than 2.5 pages.
7. The problem is not clearly written. Authors should revise to show clearly the research problem
and justification/significance of the study. Why among pregnant teenage girls? How is food
insecurity, family size, and depression a public health problem in Ghana or the study site is not
demonstrated. What is the prevalence of household insecurity/depression in the municipality or
its region and even Ghana compared to other places? Why is the Twifo-Atti-Morkwa district
peculiar?
8. Only surnames of authors of cited studies are required in the intext citation. However, the
manuscript has been written with intext citations of the first name and abbreviated other names
of the authors. Revise these.
Methods:
9. Authors should include a subsection “Study design” to describe what study design was
adopted and justification for the choice of design.
10. There many details for sample size determination rather included in the study population.
Yet, authors failed to provide justification for the study population and the describe the
inclusion and exclusion criteria they employed. Authors should revise the subsection “Sampling
procedure” to “Sampling” which should include how the sample size was determined, what
sampling techniques were used and how these were done. Provide citation to support use of
30% contingency sample. Also, there is no consistency in the final sample size. In the “Study
population”, authors stated final sample size as 225 while they state 200 in the sampling
technique. Reconcile this.
11. Provide a detailed description of the instrument: what was the structure/format and how?
“The questionnaire used in this study was pretested among 20 individuals…”, this is unclear.
What population is this individuals? Where were they located, is it same study site or different
one? What was the purpose of the pre-testing. If it was for checking validity and reliability of
the instrument, then provide the reliability score and/or outcome of the pretesting (what did the
pretesting say about the instrument? And how was the lessons from pretesting employed in the
final instrument?)
12. Again, the data collection procedure does not explain how the data were collected aside
stating that questionnaire was used. Provide more details on how the data were collected and
the approach used.
13. Authors do not state how the data was captured and if it was cleaned before analysis. It is
a known knowledge the basic assumptions under which multinomial logistic regression is to be
applied. Delete sentence 6 of “Statistical analysis” section.
14. Revise the last sentence to clearly state the direction of significance from p-value of 0.05:
less than, equal to, or greater than?
15. Add a subsection “Ethical issue” to describe how the study was conducted taking into
consideration ethical concerns. How was informed consent obtained from the participants? Also,
how was participants’ anonymity, privacy, and confidentiality maintained? Provide details.
Results:
16. Structure the section into three subsections: 1. Demographic characteristics including family
size and household food security 2. Prevalence of depression, and 3. Predictors of depression
(that is the results of the logistic regression analysis).
17. Demarcate clearly where the various tables should be inserted in each subsection of the
results section. Separate the different tables in their own paragraphs. Tables should be formatted
with all four borders for each cell.
18. The statistical results of the logistic regression should be in parenthesis and should be written
as: (AOR= 0.27, 95%CI=0.11-0.71). Authors should also type a legend below each table to
clarify the boldened p-values. I suggest use of *, **, and *** should be used to indicate the level
of significance and this be clearly stated at the end of the tables. For example, *** p-values
<0.001 etc.
Discussion:
19. First the research questions or objectives should be restated and the summary of their
key findings reported in same order before taking each finding in paragraphs to discuss in a
paragraph. Then take each key finding and discuss in separate paragraphs.
20. Revise sentence 1. What do the authors mean by “In Twifo Attimorkwa district, prevalence
of depression is present among the populace?”
21. “Strengths and limitations” should be written in a single paragraph under a single subsection.
Conclusion, References & Declaration:
22. Again, your first statement is rhetorical and should be restated. The conclusion should be
rewritten to not just rehash the results but draw conclusions based on the results (What do the
results mean for policy, practice, and research) and make recommendations that are targeted at
specific institutions/organization.