Title: Delay in seeking treatment and associated factors among women with pelvic organ
prolapse in Wolaita Zone, Southern Ethiopia: Hospital based mixed method study
Version: 3 Date: 11 Feb 2023
Reviewer:  Tadesse Belayneh
Reviewer's report:
The author tried to respond to the concern that are raised in version 1. It is now much better, but
still needs improvement.  The following points need revision/response.
Overall/introduction
• The response of authors does not indicate the page number or line to which they made a
modification.
• Spelling, grammar and other editorial corrections are still needed.
• Be consistent in reporting decimals in CI, proportions and percentages.
• Modify the word “….sex, and……pee”.
• Does “48.3 months” is found in reference # 12 or 14? Please again use local evidences (e.g.
43.8 months).
• The author/s still didn’t add strong justification. Scarcity…might be one but not a strong
justification. The author response seems the advantage/relevance of the study. Why?
Method
• Which type of qualitative study design was used for qualitative part? Elaborate this.
• Good to explain in setting about service cost (I think it is free, or is out-of-pocket?), specific
beds for the POP (if any), number of POP surgery done per day, etc.…
• Is there any difference between study population vs study population? Is there a possibility
that admitted women to be discharged without getting treatment? Look again.
• Why larger sample size (221 Vs 384) was planned? This is totally unacceptable: in terms of
time, human and cost. It is not about having large sample size to detect the outcome. Is there
any setting, individual or other factor difference b/w available study (82.6% delay in seeking
help in Gondar) and your setting (50% assumption)? Why author didn’t calculate for ‘associated
factors’?
• Pretesting: where and on how much was made needs to be elaborated again. Of course, you
respond on that, however, there is no “quality management section”. Even the one you mentioned
in “Data collection methods, Instrument and measurement” only stated about the administration
of pretested interviewer-administered questionnaire. For next, authors please mention the page
and line number to which your response refer for.
• Variables: The following IDV needs to be elaborated (operationalized, and measurement tool/
questionnaire used) further as most of them are “constructs”, difficult to measure using single
yes/no question: social stigma, women’s decision-making power, lack of awareness, culture
influence, and psychosocial care and support.
• Author report “….social and cultural thoughts, perceptions and beliefs” but not listed in IDV.
Why?
Results
• What does it mean ‘women participated regardless of the stage of POP, because magnitude of
delay was one of the study objectives’ Do you mean stage I/II women are admitted for treatment?
How do you see definition of study population? I think it is contradicting.
• Author need to look again on “…while the remaining 30% sought treatment for stage II POP”.
• Author report ‘…but I wrote the full form as “Crude odds ratio (95%CI) and Adjusted odds
ratio (95%CI). This should come first either in Method or other section (AOR/COR).
Discussion
• To which “This…” referred for? Delayed seeking for POP treatment or mean length of delay
for POP treatments? It is also good to include mean length of delay in 1st paragraph in Discussion
section.
• The author tires to compare their results with other findings and justify for its similarity/
difference. But still didn’t gave the “so what, what does that imply for?
• Comparison with USA result: Why is that? As much as possible compare with local evidence
or other setting with comparable population.
• Is ‘prevalence’ the objective of your study? Is ‘delay’ equivalent to ‘prevalence’?
• Change ‘Enhanced’ to ‘associated’