Title: Effectiveness of health education intervention on intention not to perform female genital
mutilation/cutting in the future among key decision-makers: A Systematic Review and Meta-
Analysis
Version: 2 Date: 18 Aug 2024
Reviewer's report:
General Comments:
The study addresses a critical issue in global health and contributes valuable insights into the
effectiveness of interventions aimed at reducing FGM/C.
The systematic review and meta-analysis were conducted rigorously, following established
guidelines, which enhanced the reliability of the findings.
Areas for Improvement:
The manuscript could benefit from a thorough language edit to improve clarity and readability.
Some sections are overly complex and could be simplified.
Specific comments:
1. Abstract
Areas for Improvement:
The abstract could benefit from specifying the statistical significance of the findings in the results
section. For example, rather than just stating "The overall pooled relative risk...," it could include
the p-values or confidence intervals to give a clearer idea of the statistical robustness.
The abstract should also mention the main limitations of the study, which are crucial for readers
to understand the context of the findings.
2. Introduction
Areas for Improvement:
The introduction could be more concise. While the background on FGM/C is important, some
sections are overly detailed and could be streamlined to maintain reader engagement.
The rationale for focusing specifically on key decision-makers could be more clearly articulated.
Why was this group chosen, and how might the results differ if the intervention targeted other
groups?
3. Methods
Areas for Improvement:
The methods section would benefit from a clearer explanation of how the quality assessment
tool (EPHPP) was applied. Were there any discrepancies between reviewers, and if so, how were
they resolved?
The inclusion and exclusion criteria could be more detailed, particularly regarding the rationale
for excluding certain studies.
The meta-regression and sensitivity analyses are mentioned but not thoroughly explained. It
would be helpful to include more detail on how these analyses were conducted and interpreted.
4. Results
Areas for Improvement:
The heterogeneity among studies is acknowledged but not deeply explored. It would be
beneficial to discuss potential sources of heterogeneity in more detail and how they might affect
the findings.
Some results are presented without sufficient interpretation or context. For example, while the
pooled relative risks are reported, there is limited discussion on what these numbers mean in
practical terms for public health interventions.
5. Discussion
Areas for Improvement:
The discussion could be more balanced by providing a more critical evaluation of the study’s
limitations. For instance, potential biases in the included studies or the generalizability of the
findings to different cultural contexts should be addressed more thoroughly.
The study could benefit from suggesting specific areas for future research, particularly in terms
of the types of interventions that might be most effective in different settings.
6. Conclusion
Areas for Improvement:
The conclusion might overstate the effectiveness of health education interventions, given
the limitations mentioned earlier. A more cautious tone, acknowledging the need for further
research, would be more appropriate.
The conclusion could also briefly revisit the limitations of the study to reinforce the need for a
cautious interpretation of the results.