Title:  Assessment of Mothers’ Satisfaction Towards Child Vaccination Service in South Omo
Zone, South Ethiopia Region: a survey on clients’ perspective
Version: 2 Date: 25 Dec 2023
Reviewer's report:
Review report
Title: Client’s Perspective Assessment of Mother’s Satisfaction towards Childhood Vaccination
Service in South Omo Zone, Southern Ethiopia
This paper comes with an important less explored topic related to immunization.
Major comments
Introduction
1. Paragraph 3 shows the quality of vaccination service is low. However, the paragraph only has
data related to coverage. Authors should also indicate the data related to quality of care.
2. Paragraph 4: the author claimed that 66.7% of health professionals do not receive training on
immunization. However, this statement is not true because health professionals already receive
immunization training as part of their formal health professional training.
3. Sufficient justification of the study is not well presented in the introduction part of the study.
Authors should indicate what has been known on the topic so far. Since the research problem
raised is mother satisfaction. Though client satisfaction is an indicator of quality, it is not a direct
measure. Quality is more than satisfaction.
Method
4. More information is needed in the study setting. The authors stated the study is conducted
in PHCU, please indicate how many PHCU are there and whether health post is also part of
the study.
5. Study population: For the study that assesses immunization coverage, it is advisable to
include children aged 12-23 months. However, for the satisfaction study children who currently
receive vaccination at the health facilities should be included. Did you explain why your study
population is a mother with less than 2 years? How is the recall bias managed for children who
already finished the vaccine and where are the mothers recruited, since there is no point of
contact unless the child is sick?  The authors should also show whether any exclusion criteria
are applied.
6. Sampling: Why primary health care unit only? And this has to be indicated in the study setting
sub-heading that the study is conducted in PHCU. Did the study also include health posts?
How did the authors manage the health post-level data collection? Authors only indicate the kth
interval, please explicitly show that Kth interval for each facility included in the study. Health
facilities could also have different intervals since they don’t have similar caseloads.
7. Measurement: please indicate which literature used to adopt the tool of data collection, and
whether those tools are validated in our setting.
8. The authors indicated the data collection tool is translated from English to Amharic, however,
there are non-Amharic speaker populations. How does the author manage those participants
unable to speak Amharic?
9. Data analysis: the findings from the principal component analysis should be indicated in the
result section not in the method section. The author claimed biologically plausible variables
are included in the analysis, what kind is variable has biological plausibility for satisfaction to
vaccination service?
Result
10. Table 1: what is the reason for classifying age as above 30 and below 30? Less than 30 years
does not indicate younger mothers, since younger mothers are those less than 18 years old.
11. Table 1: knowledge level is better indicated in a separate table with other parameters that
are used to contract the knowledge level.
12. Vaccination and health service: no need to compare with findings of other studies
13.  Table 2: vaccination visit is better to indicate the dose of vaccine the child is receiving rather
than the number of visits. There are only five mandatory doses including the measles vaccine.
14. Table 2: Is type adverse experience obtained through mothers’ reports or confirmed during
data collection? Please indicate.
15. Table 2: data related to maternal satisfaction should be presented in detail. It is the main
variable that has to be presented separately as it is the main variable of the study. Please have
a separate table for it.
16. Factors associated sub-title: the first paragraph needs more explanation on bivariate analysis.
Reporting the number of variables that are included is not sufficient.
17. Table 3: this table should show also data on not satisfied. The authors should indicate the two
by table of each variable. Further satisfaction should be reported as level rather than satisfied
or not satisfied.
Discussion
18. The discussion part manuscript should be revised for the following issues. The first
paragraphs should be changed to the summary of findings. The claims that are forwarded for
association should be cited properly. For example, the explanation given for the association
between satisfaction and maternal age is not cited or not correctly cited. It is similar to other
explanations in the whole discussion section.
19. Conclusion and recommendation: the recommendation given is not sufficient, the author
should with recommendation based on the finding of the study.