JerMa88/BMC_Womens_Health_Peer_Reviews huggingface dataset:
Title: Determinants of fertility in Malawi: Does Women Autonomy Dimension Matter?
Version: 1 Date: 20 Oct 2021
Reviewer:  Wingston Ng'ambi
Reviewer's report:
1. The title is broad. When the authors talk about fertility what specific measure are the
investigating?
2. The paper needs to have numbers. This makes a review easier.
3. The abstract should be structured in IMRaD structure.
4. “Though women’s autonomy does not have independent effect on fertility, it may be
interacting with other socio-cultural norms prevailing in the society.”- Did you test for the
interaction effect?
5. P-values (0.000) should be changed to <0.001
6. I would take this out and focus on autonomy and fertility situations in Malawi:
“Located in Southern Africa, Malawi is landlocked and shares its borders with Mozambique,
Zambia#and#Tanzania. The country has an estimated population of 17.6 million according to
Census report 2018. Malawi remains one of the poorest countries in the world and the economy
is heavily dependent on agriculture, employing nearly 80% of the population, and it is vulnerable
to external shocks, particularly climatic shocks [38]. However, poverty and inequality remain
stubbornly high. The latest poverty figures show the national poverty rate increased slightly
from 50.7% in 2010 to 51.5% in 2016. Poverty is driven by#low productivity in the agriculture
sector, limited opportunities in non-farm activities, volatile economic growth, rapid population
growth, and limited coverage of safety net programs and targeting challenges [38]. Malawi has
made progress in improving the health of the people over the years. Life expectancy at birth is
63.7 years from 46.1 years in 1990 [39]. “
7. I would take this subtitle out: Exclusion criteria.
8. Shorten the “Independent variables” subsection.
9. The analysis section is very weak. MDHS used weighting and the authors don’t tell us whether
the weights were used or not. Further, the model building strategy to move from bivariate to
multivariate is not clear. It is also not clear what software was used.
10. If the authors are using Stata software, they may consider using tfr2 stata ado file to have
unbiased results as this module incorporates the weighting.
11. With this weak analysis the findings are highly likely to be fallible. The authors need to redo
the analysis where they should explicitly mention the weighting used as well as the statistical
modelling technique used.
Title: Determinants of fertility in Malawi: Does Women Autonomy Dimension Matter?
Version: 4 Date: 12 Mar 2022
Reviewer:  Wingston Ng'ambi
Reviewer's report:
1. The paper is looking at children ever born so the title should be revised in that aspect as I
still find the title too broad.  The authors should not take a defensive approach to addressing the
issues but rather to incorporate reviewer comments.
2. Line 56-7 speculates interaction but in the analysis this has not been tested. Therefore, the
analysis should reflect this?
3. The authors should consider utilizing tfr2 or similar modelling for their analysis as I still find
the analysis not convincing enough
4. Try to read these papers for model building strategies
using DHS data for Malawi: https://journals.plos.org/plosone/article?id=10.1371/
journal.pone.0263650; https://www.iomcworld.org/articles/factors-associated-with-uptake-of-
hiv-testing-in-malawi-a-trend-analysis-of-the-malawi-demographic-and-health-survey-dat.pdf
Title: Determinants of fertility in Malawi: Does Women Autonomy Dimension Matter?
Version: 6 Date: 21 Apr 2022
Reviewer:  Kennedy Machira
Reviewer's report:
The paper is ok and the topic queit relevant to Malawi. However, i have the comments which
I require the authors to  work on.
i) consistent use of fertility for children ever born its measure need to  be considered.
ii) Abstract require extensive review as suggested in the manuscript in track changes.
iii) Policy statement in  the abstract, MUST have a direct policy direction.
iv) there is need to adjust some issues in the introduction to make the argument very clear. There
is a bit of mixed up of the points which require extensive review.
v) in the methodology, definition of the variables are not well elaborate. need revision
vi) the weight determination that was used to balance the data require explanation more
especially on the variable used to determine the weight. This is very important as the authors
have indicated that they used different weights which to the reader is complicated.
v) the use negative binomial is not well elaborate. The authors need to understand the definition
of over inflated zeros and goodness of fit and its interpretation to have a rationale of the the use
of the negative binomial. Also, the need not to confuse use of Incident Risk Ratio (IRR) to odds
ratios, there is need for the authors to have a clear understanding of the terms and use them  as
used in standard terms. This includes also on the interpretation part.
vi) on the model results, I am not convinced the way the authors are presenting the results,
Find a section in the methodology where they can present the flowchart of the core variable per
each model and present it. This is to create a better understanding on the variables and model
translation. More especially the autonomy aspect which is the principal base of the paper.
Vii) In my view, the way the paper is designed, the nest would have been nested  Poisson
regression methods wo that autonomy factors  can be checked to estimate fertility in one model.
Then, the same autonomy factors be used to estimate fertility after controlling for the covariates
or control variable which are the socio-economics attributes of women. I suggest that this be
tested and checked. That is going to create a better balance to the paper. As the hypothesis is
hinting much on the autonomy of women  vis a vie the fertility in Malawi.
viii) make sure that that all the variable that are highly significant are concluded in the conclusion
section. I suggest that the authors adjust this as its weakly presented.
vix)  In the recommendation, make sure that your recommendation is drawn from what  is
concluded.  I suggest this is revised.
Title: Possible significance of degeneration and decreased expression of progesterone receptor
in postmenopausal uterine leiomyoma
Version: 1 Date: 13 Jul 2022
Reviewer's report:
The paper compared the PGRAB, PGRB and ESR1 expression in the leiomyoma patients at  pre
and post menopause with different  surgery requirement.  It will provide very useful information
for the study of leiomyoma growth and drug treatment for the post-menopause patients. There
are several parts needs to be clarified.
1. Line 134-135, "We confirmed that the expression of hormone receptors significantly increased
in the endometrium even after menopause (Figure 1)" From Fig. 1, it seems PGRAB was actually
reduced after menopause. Please clarify which receptor.
2.  The authors compared three groups A, B and C. It would be better if the author present one
representative image of each group for each receptor expressions.
3. Similarly,  instead of showing the score, it would be better to show a representative image of
PGRA B and PGRB in the leiomyoma and myometrium.
Title: Possible significance of degeneration and decreased expression of progesterone receptor
in postmenopausal uterine leiomyoma
Version: 2 Date: 01 Aug 2022
Reviewer's report:
To authors,
The authors have faithfully reacted to this reviewer’s comments, of which incorporation into
the manuscript markedly improved the paper quality. The authors showed/characterized the
features/characteristics of progesterone receptor and degeneration in postmenopausal myoma
requiring surgery. They stated the possible relationship of these data/findings with the myoma
increase (or not decreasing in size). Precisely speaking, all these are based on speculation.
However, to me, all these statements/speculations are scientifically sound and thus permissible.
The authors straightforwardly described the limitations; yes, these are limitations, but not to the
extent that these hinder the study-significance.
Title: How gender norms and ‘good girl’ notions prevent adolescent girls and young women
from engaging with PrEP: Qualitative insights from Zimbabwe
Version: 1 Date: 30 Mar 2022
Reviewer's report:
This is an excellent paper with important contributions to the literature that help explain why
PrEP has not been the gamechanger for AGYW in HIV prevention that many had hoped it would
be. The paper is nearly ready for final publication and I submit only minimal edits for clarity.
Introduction
On page three, the note that “Uptake and successfully engagement with PrEP amongst
AGYW in sub-Saharan African is, however, not undermined by lack of interest.” While the
demonstration projects later cited are excellent, they are not necessarily representative of all
AGYW populations in SSA and the statement should be moderated
Also on page three, where it notes “Qualitative studies have found HIV-related stigma,
scepticism towards the use of HIV drugs for prevention, fear of negative reactions and lack of
support from relatives, friends, and partners to contribute to low uptake of PrEP” it would be
also helpful to signal that this skepticism can be translated into policy barriers (this is referenced
in the paper later but signaling it here would be additionally useful). “Blood blockages and
scolding nurses: barriers to adolescent contraceptive use in South Africa” is a great paper on
this – as is “"They have this not care - don't care attitude:" A Mixed Methods Study Evaluating
Community Readiness for Oral PrEP in Adolescent Girls and Young Women in a Rural Area
of South Africa”
Methods
On page 6, the first sentence of data collection and analysis should list the number of participants
total in Saksom (n=15) and Watku (n=11) – it is possible to add the provided numbers but making
this a little easier would not be amiss!
Similarly, on page 6, you note, “Data were generated between March and June 2019 by
experienced qualitative researchers who spoke the local Shona language.” Providing a clause
noting why we can call them “experience qualitative researchers” (years working in the field,
perhaps?) would be helpful!
Results
On page 8, you note, “Prep is revealing of sexuality.” I’m a little unclear on what this means!
As a more general point within the results, you can get a little repetitive between results and
analysis! One way to fix this is to move some of the analysis you’re currently doing in the
results to the analysis section – I’m mostly thinking of anytime you cite outside literature! It’s
not hugely confusing and some repetition is always helpful to the reader but you could work to
tighten this a little to streamline the paper.
Overall, I learned a lot here and the paper is wonderful with a coherent story and great data to
back it up. And the stakes for policy are very clear. Well done!
Title: How gender norms and ‘good girl’ notions prevent adolescent girls and young women
from engaging with PrEP: Qualitative insights from Zimbabwe
Version: 1 Date: 12 Apr 2022
Reviewer's report:
Introduction
The background is appropriate, clear and sets the scene.
Methods
“if they met one of the following eligibility criteria: between the ages 18-24, HIV-negative,
sexually active, and considered “at risk” – Is this right? They were eligible with one criterion,
not all?
Out of curiosity, why/how did the team decide on giving bars soaps as a reimbursement?
The last paragraph under location and participants: present this information (participant
demographics) in a table format as table 1 for clarity and easy reading.
Transcripts were coded on Nvivo— Coding was done by who? If multiple coders were involved,
how did you ensure intercoder reliability?
Results
Are participants’ names pseudonyms? If so, mention it in the methods section. If real names,
replace them with pseudonyms.
There are inconsistencies in the study site name. Is it Saksom or Sakson? Check for
inconsistencies throughout the document.
Make sure you include the study site and whether it's an IDI for all quotations-- Check for
inconsistencies.
Participant identifiers are mentioned twice, e.g., Mary said… then quote, again Mary, Saksom,
IDI. To avoid repetition of names, I suggest you choose whether you mention it in the text as
Mary, an IDI participant from Saksom…, or as a quote reference done at the end of the quote
as you mostly did.
“Also male partners were said to project their expectations of AGYW” What expectations? This
is confusing as the following sentence speaks to stigma by partners rather than expectations.
Discussion
In study limitations, you report, “First, the study relies on self-reported data” So what?
How else could you capture this information besides self-reporting? Your limitation and
your recommendation about an in-depth longitudinal approach aren't aligned. How would this
longitudinal approach address the limitation of self-report?
Perhaps your recommendation about the longitudinal approach could be more meaningful to
address this study's cross-sectional/ snapshot nature.
Concerning your third limitation, qualitative work aims not to generalize, anyway.
I agree with your final limitation. Also, it may be necessary to study AGYW taking PrEP, as the
current findings seem to be hypothetical experiences.
I  recommend professional editing of the manuscript to address grammatical errors, and
inconsistencies.
Overall, this paper addresses an important area of concern for impact of gender norms on HIV
prevention, and makes a n important contribution to literature.
Title: How gender norms and ‘good girl’ notions prevent adolescent girls and young women
from engaging with PrEP: Qualitative insights from Zimbabwe
Version: 3 Date: 26 May 2022
Reviewer:  Lynda Oluoch
Reviewer's report:
The perspective on gender role impact on PrEP uptake is quite interesting. Thank you for writing
this paper, it was quite informative and interesting to read. It was very well written. I look
forward to reading the published paper and sharing it with my peers!I have a few questions.
Page 5“The group turned out to be very diverse. Both married and unmarried AGYW were
represented, some had one or more children while others had none. Most had gone to secondary
school and finished form 3 or 4. Some were, at the time of the interview, studying at college,
whilst others were worked by buying and selling goods. Many of those who were married stayed
at home, taking care of the family. Whilst some had established their own family, others stayed
with relatives such as parents, grandparents, or siblings. None of the participants disclosed PrEP
use, but a few had friends who had just taken up PrEP”
Was this data presented in a table that was not included in the manuscript? Curious to know. It
would be good to have a summary of the sociodemographic characteristics laid out if possible
Page 5 “They were randomly selected due to their urban/rural location. Both Saksom and Watku
- as much of Manicaland - are characterized by poverty and high HIV prevalence rates”
Do we have the exact prevalence rates of HIV in these areas?
Page 5 “With AGYW being a core target group of the intervention study, we recruited 26 AGYW
from the two communities to participate in in-depth individual interviews (IDIs) and focus group
discussions (FGDs).”
How was the recruitment done/how were they approached? Were the girls recruited from health
facilities? CHVs?
I am curious to know how many of the interviewed participants had heard about/known of  PrEP
prior to the interview?
A few questions asked in the topic guide alluded to some knowledge of PrEP.
• “What do you think about PrEP as a HIV prevention method?
• How might PrEP be viewed in your community? What are your views on PrEP services being
delivered in your community?
• What do young women think about PrEP as a prevention method? What do you think about it?
• What are the advantages of PrEP? Why do some young women want PrEP?
• What are the limitations of PrEP? Why do some young women refuse to get PrEP?
• What would convince these young women / you to access PrEP?
• What community factors prevent young women from accessing PrEP? [probe: community
norms, parents]
Page 7 result section “Even though some participants distanced themselves from notions of being
suppressed by what we in this paper refer to as emphasized femininity (cf Connell, 2013), for
instance by expressing views of sexual confidence and independence”
I was glad to read some girls felt confident in their life choices!
Title: How gender norms and ‘good girl’ notions prevent adolescent girls and young women
from engaging with PrEP: Qualitative insights from Zimbabwe
Version: 3 Date: 22 Jul 2022
Reviewer's report:
This was an excellent paper on an important topic that may be relevant to many populations of
AGYW across the world. I appreciate the overarching concept of emphasized femininity, which
nicely ties together all the points that the authors make.
Some things that are really well done:
1. The introduction provides plenty of detail and lays out how the authorship team approached
the data and the research question.
2. The qualitative research methodology is excellently explained, which is a good resource for
future researchers who are just beginning their work with qualitative data.
3. The discussion does a great job of summarizing and interpreting the data, and the conclusions
recommend concrete and actionable solutions.
This paper is very close to being ready for publishing. I only have a few suggestions.
1. At the end of the third introduction paragraph, the authors discuss how other studies have
looked at AGYW’s social position, but not their gender. I argue this is a false statement, as
gender and social position are intrinsically linked. I would reword this sentence to emphasize
how other studies have not looked at gender norms and PrEP use through the lens of social
control mechanisms and “good girl” expectations.
2. Consider looking at all uses of “AGYW” and being consistent with plurals and possessives.
It seems sometimes “AGYW” is used regardless of plurals or possessives, whereas other times
“AGYWs” or “AGYW’s” are used.
3. In the results section titled “Stigmatisation as a gender-control mechanism affecting AGYW
PrEP use,” the following quote feels ineffective. The introduction of the quote seems to say that
few women resist their lack of control and sexual decision-making, but the quote does not seem
to support that statement very well. It feels lacking.
“Women are the ones who are shy [but] Personally I do not face any problems [..]”. Mary,
Saksom, IDI
4. Throughout the manuscript, there are many discussions of stigma. I think it would be impactful
to tie in established language around stigma, such as enacted and anticipated stigma. There are
many resources in the literature that discuss the different types of stigma, especially as they
relate to HIV. Additionally, much of this discussion may involve intersectional stigma, as the
stigmas of sexuality and HIV prevention are intertwined. See the following: Turan, J.M., Elafros,
M.A., Logie, C.H. et al. Challenges and opportunities in examining and addressing intersectional
stigma and health. BMC Med 17, 7 (2019). https://doi.org/10.1186/s12916-018-1246-9
5. There are quite a few sentences with odd syntax and spelling/grammar mistakes. Check your
use of commas throughout.
6. Almost all of the quotes don’t end with any punctuation. I would also suggest citing where
the quote in the interpretive paragraphs came from. For instance, you could write “loose
woman” (Claire, Mary, Charlotte) – thereby referencing all of the IDIs or FGDs that said these
quotations.
Title: Menopause Rating Scale (MRS) in the Malay language- Translation and Validation in a
Multiethnic Population of Selangor, Malaysia
Version: 2 Date: 27 May 2022
Reviewer's report:
GENERAL COMMENTS
This paper aimed to translate and validate the Menopause Rating Scale (MRS) into the Bahasa
Melayu version. Although this article addresses an interesting topic, many issues should be
addressed before publication. A major issue was observed whereby the questionnaire was also
being used and translated before.
Example:
Ismail NN: A study on menopause in Malaysia. Maturitas 1994,19(3):205–209.
10.1016/0378-5122(94)90073-6
Rahman, S. A. S. A., Zainudin, S. R., & Mun, V. L. K. (2010). Assessment of menopausal
symptoms using modified Menopause Rating Scale (MRS) among middle-age women in
Kuching, Sarawak, Malaysia. Asia Pacific family medicine, 9(1), 1-6.
SPECIFIC COMMENTS
INTRODUCTION
The introduction needs major revision and clarification. First, the aim of the study is not clear.
The introduction should answer a specific research question, which is lacking in this study.
Also, the way the authors build up their introduction does not lead to the research question. The
introduction was too short and missed so many menopause studies in Malaysia. I suggest that
the authors should re-structure their introduction, explaining why their research is important.
More importantly, this should lead to a clear research question.
METHODS
The methods section needs major revision. The authors mentioned Malaysia in the title, but in
method, the data was only collected in Klang, Selangor. How can this data represent the entire
Malaysian population?
- Why women aged 40 to 60 were chosen only?
- Please explain the MRS scale more deeply. What is the validity and reliability of this
questionnaire?
- What translation method are the authors using?
- Why did only one person translate the questionnaire and review it by one researcher? How
many peoples are in the panel?
- Does this study receive ethical approval? If yes, please state the full code.
- When was the data collection conducted?
- Is the EFA and CFA using the same data?
- Why need to conduct Structural Equation Modelling? Please justify.
RESULTS
The results section needs major revision. Probably, including a research question would help
the authors to structure their results. I think the authors put too much unnecessary information
in the tables, making the entire manuscript hard to follow.
DISCUSSION
In the discussion section, the authors should further discuss their findings and the implication of
these findings. They should also discuss their findings in more depth. However, in this section,
the authors present much information. These results should be moved to the introduction section.
The authors also discuss many topics that are not related to the results. The limitation is also
not well thought out. Please revise.
Thank you.