Reviewer ’s report  
 
Title: The acceptability of using IUDs among Egyptian nulliparous women . A cross –sectional  
study  
 
Version: 1 Date: 27 Jan 2020  
 
Reviewer: Research Square Reviewer 1  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other article types: is there a clear objective)?  
No - there are minor issues  
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
No - there are major issues  
 
EXECUTION - Are the experiments and analyses performed with technical rigor to allow 
confidence in the results?  
No - there are major issues  
 
STATISTICS - Is the use of statisti cs in the manuscript appropriate?  
No - there are issues with the statistics in the study  
 
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not 
overstated?  
Yes - the author's interpretation is reasonable  
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
Maybe - with major revisions  
 
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS:  
The objective of the study wa s to assess the acceptability of IUD use by both nulliparous women 
and health care providers in Egypt. More clarification, specifically on how questions for the 
outcomes were asked, needs to be presented in the methods section of the paper.  Further 
analys is needs to be conducted. The study may help design future interventions.  
 
 
 
REQUESTED REVISIONS:  
* The objective of the study needs to be stated at the end of the introduction section and 
before the methods section.  
* In the methods section, the authors st ate that 10 public family planning clinics were 
randomly selected. Out of how many?  
* In the methods section, the authors state that the 530 nulliparous women seeking 
contraception were selected. What year were participants selected and over how long of pe riod?  
* Not clear what:  "able to understand questions" and "able to reply question during 
interview" mean in the inclusion criteria. Also point 6 in the inclusion criteria is not clear.  
* Inclusion criteria  needs correct numbering for physicians  
* The m ethods section should clearly state how the question about acceptability for the 
women and the providers were asked and what were the categories of the answers.  
* The authors state that "validity of the questionnaire was tested by sending it to an 
experts  to look at and examine how well designed to measure the concept of the study". This is 
not clear.  
* It is important to state in the methods section details about how the questions about 
reasons for non -acceptability of IUDs were asked and what were the an swers (were the answers 
yes and no or likert scale where the authors had the re -group the answers to yes/ no).  
* Table 2 shows that 510 women and 165 providers reported that IUD was not accepted. 
Table 3 refers to reasons for non -acceptability among women and physicians. It is expected that 
the analysis for Table 3 be restricted to those who said it is not acceptable (510 and 165 mothers 
and providers) and not the total sample.  
* Not clear how p values for table 1 were obtained? So the p value 0.9 for the a ge group 
16-20 compared those  who were 16 -20  years of age to all ages combined? Usually one p value 
is reported for the whole variable age.  
* The paper would benefit from assessing relationships between the characteristics of 
women presented in table 1 a (including the variable minia and suez canal ) and the acceptability 
of IUDs. This could be done by performing chi square statistics at the bi -variate level and 
logistic regression and at the multivariate level. Also, physicians years of experience and its  
association with acceptability of IUDs among healthcare providers (physicians) wold be 
interesting to present in the paper.  
* A paragraph on the limitations and strengths of the study needs to be added to the 
discussion section.  
* Paper needs to be revie wed for editing  
 
 
 
 
 
 
 
 
 
 
 
 
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.  
 
No 
 
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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with  
declared or apparent competing interests are not utilized for these reviews. This reviewer has  
agreed to publication of their comments online under a Creative Commons Attribution License  
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer  
recommendation.  
 
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