Title: Decision-making pathways for contraceptive use among refugee and host populations in
Adjumani district, Uganda; An exploratory study
Version: 2 Date: 14 Dec 2023
Reviewer's report:
Ref: Submission ID e879f1e4-f4fd-4bb0-8e73-c6775e44a65b
Manuscript title: Decision-making pathways for contraceptive use among refugee and host
populations in Adjumani district, Uganda.
Dear Editor,
Again, thank you for the opportunity to review this manuscript.
Comments
1. Background section: Paragraph one, lines 10 and 11, rather, show the proportions that qualify
your statement (for majorly sub-Saharan Africa), and also provide citations to this note. In
addition, in case it shares the citation with line 9 and partly line 10, please indicate.
Line 15: It is misleading to assume that contraceptive use could be a new phenomenon.
Also, the authors should substantiate this statement with more relevant literature (concerning
contraceptive use rather than COVID-19 as referenced).
Line 16, and partly Line 17: Please substantiate this statement with relevant literature, especially
on refugees.
Line 17 and 18: I would like the authors to specify the kind of emergency they are referring to
here, and why they think uptake of contraceptives would be crucial in the referred emergency.
Line 20: It seems to be a continuation of “a certain” statement, please link if there is any.
When the authors highlight that “…80% of these refugees…” they lose the reader, so could they
indicate the refugees they are referring to. Also, please cite relevant source(s) to support this
kind of argument.
Line 24: I seek that the authors cite their source(s)
Line 35 – 37: I encourage the authors to include specific refugee statistics in the same context.
However, since the authors focused on contraceptive use, I think the statistics should have that
composition rather than on only modern contraceptive use.
Line 40: Please also indicate the rates for refugees in the district.
Line 43: In such a case that contraceptive use is unknown amongst refugees, it’s therefore pivotal
for the authors to demonstrate what triggered them to undertake this study. This is because it is
possible that they may not even be using any contraceptive method.
Line 44: I suggest that the authors quantify this numeric narrative. Also, are these women being
referred to as refugees? Include relevant citations.
Line 48: Please clarify the unmet need being referred to here.
Line 48 and 49: Considering that the authors earlier noted that contraceptive use among refugees
is unknown, I seek their clarity on the linkage between this statement and contraceptive usage
among refugees.
Line 58-59: Why did the authors focus on ONLY the three refugee settlements? What is unique
about them?
2. Method section: Line 70: I seek for clarity from the authors on why they did not prefer to
indicate the age category of male participants. Also, this information on males is missing in the
abstract section under methodology.
Line 75-79: I seek the authors to clarify whether this is their study finding. Line 80: The
authors should indicate the implication of having a higher refugee population than the host
population regarding decision-making pathways to contraceptive use. Also, I would like to know
the indigenous population. This is because I could be a host member but that does not qualify
me to be an indigenous.
Line 85-88: I suggest that the authors clarify the maximum and minimum period concerning the
study exclusion criteria, and provide the rationale for the control period. It is more logical to
control the time of stay for both refugee and host participants- including the subject of commuters
under the host community.
In addition, in response to the reaction from the authors regarding sexually active women, I
think the authors should clarify how they controlled non-sexually active participants, such as
catholic nuns, etc.
Line 89: In Lines 69-70, the authors specify that women (participants) were aged 15-49. Could
they clarify this?
Past experiences: In response to past experiences, I think the authors should explain clearly how
they distinguished from obtaining responses from past experiences (unconsciously).
3. Field editing:
Line 115:  I suggest that the authors clarify the interpretation of the (+) sign below the table.
Also, since the authors have indicated a percentage column, I think they should not again attach
a percentage to the figures- I think they can use the percentage sign (%) instead of the word
percentage. Further, in Table 1, the last column on the right (“Total, [%], N=220”) – I suggest
that the authors create a separation for each of them- “N” can be above.