Title: The need for and acceptability of a curriculum to train nursing and medical students in
the sexual healthcare of clients with female genital mutilation/cutting in Tanzania
Version: 1 Date: 20 Nov 2023
Reviewer's report:
I would like to express my congratulations to the authors for dealing with these very necessary
issues and as they comment on the countries of origin.  And to the editor for inviting me to
review the manuscript.
Although the definition of the subject under study is complete in terms of prevalence, geographic
and economic data, I would like to know what other interventions are carried out in the
educational field and therefore why this new intervention is necessary.
The objective should conform to the use of the infinitive verb followed by the purpose of the
study.  This should be unchangeable throughout the manuscript, however it differs throughout
the manuscript, for example, “need and acceptability”  (in the abstract), “acceptability and
feasibility” (in the introduction), “to collect opinions to inform development of a training
curriculum in sexual healthcare of women/girls with FGM/C targeting pre-service HCPs” and
“for exploration and analysis of the perceived needs of the targeted professions was essential for
designing and informing implementation strategies to improve the training on how to manage
health and other complications related to FGM/C.” (in the conclusion).
METHODOLOGY
This section explains that the data referred to in the manuscript were collected during the
follow-up of a training intervention for health professionals in relation to sexual health, using
additional questions to explore need, acceptability and feasibility.  Perhaps this point needs
further explanation since, as I understand it, it asks about the need for training after the training
has already taken place (even if this intervention was generic to sexual care). Similarly, it asks
students about the acceptability of such interventions when they (the intervention group) have
already attended them.
In relation to this, given the number of participants in the study, I understand that the survey
has been completed by all the students, both in the control group and in the intervention group,
which leads me to reflect on the convenience of this point. I believe that the opinions of the
intervention group will be mediated by the considerations made during the training.  It would at
least have been necessary to disaggregate the results in relation to group membership.
On the other hand, the questions are asked on the following topics "level of knowledge in sexual
health challenges of patients with FGM/C, the interest of receiving training, and how much
training students have received regarding the provision of sexual healthcare to women who have
undergone FGM/C". When it comes to quantitative questions (Likert-type scale, what types and
number of answers they had as a choice...). And qualitative questions were about: "(“ to collect
their perspectives regarding the importance of the training in sexual healthcare of women with
FGM/C, the content and how they would like to receive the training".
Regarding the analysis of the quantitative data I do not understand the combination of data from
nursing and midwifery (as their competencies and knowledge will be different), this could mean
a generalisation of the data to these professionals in an incorrect way or an omission of their
perspective.  It would be necessary to comment on this limitation in the corresponding section
and to propose ways of research that would bring us closer to their perspective.
The use of descriptive statistics to describe is discussed: “frequency of interest of receiving
training, the quantity of training received before, acceptability as well as the scores of perceived
numbers of women who have undergone FGM/C. “ However, these results have not been shown,
nor was it the stated interest of this manuscript to know their perception of the number of women
who have been mutilated.
They have described the steps followed in the qualitative analysis, but even so, a section on the
rigor and reliability of this approach would have been appropriate, as well as an indication of
which authors they have relied on.  On the other hand, since qualitative research does not require
such large samples, it might be suggested to take their perspective into account in this section.
RESULTS
Given that the topic has a clear gender perspective and, as the authors comment, is taboo in
society, I think it would be interesting to disaggregate the data by gender in order to compare
their responses.  This would be possible thanks to the large sample the researchers have at their
disposal.
Results are shown for results that had not been questioned in the objective, such as interest in
the subject or previous training.
I am concerned about the rigorousness: “For example, a MEDICAL STUDENT stated, I have
seen some women who are victims of FGM, too bad I did not know how to go through, I hope
the training would give me the confidence to attend such clients (NURSING STUDENT)”.
DISCUSSION
The content of the discussion would be enriched by a more in-depth debate. It reiterates the
presentation of results, both known and new, such as the percentage of attendance (it is not
clear what this refers to) or awareness at the community level, and provides data specific to the
introduction section, such as prevalence or the consequences of the practice.
CONCLUSION
It states that "A design consisting of practical sessions with simulated patients was considered
the most useful and favorable by participants” however none of this has been stated before.
There are also differences with the abstract which talks about a culturally sensitive plan.