Reviewer's report
Title:Living with constant leaking of urine and odour: Thematic analysis of
socio-cultural experiences of women affected by obstetric fistula in rural
Tanzania
Version:5Date:30 July 2015
Reviewer: Melissa Watt
Reviewer's report:
This is a well written paper on the socio-cultural experiences of women with
obstetric fistula in Tanzania. The paper adds important insight into the lived
experiences of women with obstetric fistula in this setting. Below, I offer some
suggestions for how the manuscript could be improved for publication. Most
notably, I suggest that the authors include not just “failures” but also any
examples of resilience and positive support in their results section; and that they
reorganize the discussion section to map on to their theoretical framework (the
“Three Bodies” model).
OVERALL WRITING
1. While the writing was overall excellent and clear, there were several typos
throughout. I would recommend that the authors have another individual do a
close edit of the manuscript before resubmission. Just a few of these (as
examples) include lines: 45-“women experiences”, 53-“participants’ where”,
345-“how women experiences living”, 351- “women experiences of”
ABSTRACT
2. In background, define obstetric fistula for the reader
3. The first sentence of results is very unclear. I believe it needs to be edited and
separated into two sentence.
BACKGROUND
4. Obstetric fistula should be defined early in the first paragraph, before providing
statistics on its prevalence
5. In the paragraph starting with line 96, add this reference by Wilson et al on
psychological symptoms of fistula
(http://www.ncbi.nlm.nih.gov/pubmed/25670025) and potentially this reference by
Watt et al on religious coping among fistula patients
(http://www.ncbi.nlm.nih.gov/pubmed/24735435)
METHODS
6. Section on study design would benefit from a brief rationale of why both IDIs
and FGDs were conducted (i.e., did they explore different questions or seek
different perspectives?)
7. Section on setting should include more about CCBRT services (e.g., free
services, geographic reach for patient population)
8. Phrase “admitted at CCBRT hospital before or after fistula treatment” is
confusing. I think what you mean to say here is “admitted to CCBRT hospital for
surgical repair of an obstetric fistula.” You later state that interviews were
conducted either before or after surgical repair.
RESULTS
9. Similar to my comment on the abstract, the first sentence of the results section
would be more clear if it were broken into two sentences.
10. The results spoke to the loss of a child as it impacted a woman’s marriage –
but not specific to the loss/grief itself. Did the trauma of losing a child emerge as
one of the experiences women spoke about?
11. All the results focus on “failures”. While the negative impacts of a fistula are
well documented and certainly understandable, framing your findings as “failures”
may undermine women’s resilience and negotiation in the midst of these
challenges, and may fail to recognize the support that some women received
from others, even during their most difficult periods. I would encourage you to
look at your results for any examples of these more positive aspects, and if they
exist, then including them in the results. I would also consider finding an
alternative to the word “failures” in describing the themes.
12. Similar to the point above, in lines 293-294, there is a statement implying that
all of the 16 patients had been rejected/left by their husbands. Is that the case? If
there were any examples of women remaining in marriages and/or continuing to
receive support from their husbands, which would be important to include.
DISCUSSION
13. I would recommend that the first paragraph (reflection on method) be moved
directly before the conclusion section, and be renamed “limitations”
14. Given that the study was conducted with the theoretical approach of the
“Three Bodies” framework, I would suggest using this framework to organize your
discussion. I think this would make for a much more compelling discussion
section. The application of the framework on page 14 is very vague and does not
do a good job of contextualizing the results presented.
15. The sentence on lines 410-413 is about women with fistula turning to begging
and commercial sex. This did not emerge from your sample. I would recommend
either deleting that sentence of elaborating further on it.
16. I was intrigued by your statement about “the looking glass self” concept, but
this idea was not elaborated on – i.e., what it means and how it applies to your
data. If you organize your discussion section by the “Three Bodies” framework,
this would be a nice addition.
17. In the conclusion, I think it would be good to add the importance of linking
women to surgical repair, in order to improve the social conditions of their lives.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.