Title: Utilization of Full Antenatal Care Among Scheduled Caste Mothers in India, 2015-2021
Version: 1 Date: 22 Dec 2023
Reviewer:  Md. Hafizul Islam
Reviewer's report:
Review report
The authors have tried to explore antenatal care utilization and its determinants among
comparatively unprivileged Scheduled caste mothers. It is an interesting piece of work that
might contribute to exploring these unprivileged mothers, especially in terms of pregnancy care.
However, I am concerned that a few points can be considered to improve the manuscript.
1. In the material and method section of the abstract, please report the number of mothers
included in the study.
2. Revise lines #23-24 as “The outcome variable full ANC was determined from three
components of ANC, the attendance of at least four ANC visits, the administration of a minimum
of two tetanus toxoid (TT) injections, and the consumption of iron-folic acid (IFA) tablets.”
3. In the result section (Line #28-29), the coverage of TT is also expected to be included.
4. In lines #31-33, please replace OR, CI with AOR and 95% CI.
5. In lines #30-33, OR has been reported but no direction of the relation between the outcome
variable and predictor variables is mentioned. Please specify the direction of whether the relation
is positive or negative. Like, exposure to mass media had a positive effect on the utilization of
full ANC (AOR, 95% CI).
6. In lines #40-41, be specific with your findings rather than a general conclusion.
7. Use the abbreviation of a term whenever it appears after the first time. Please use ANC for
antenatal care, and SC for scheduled caste throughout the manuscript whenever it appears after
the first time.
8. In lines #83-85, give a reference highlighting the previous/existing situation of ANC coverage
among the mothers of the SC community.
9. Reference #16 in line #92 is more than 15 years old. It is recommended to use up-to-date
information with references to highlight different castes.
10. In lines #127-128, match the value with the value in the Figure 1.
11. Lines #130-131, the sentence is not completed.
12. Please recheck the flow diagram in Figure 1 to make it clear to the readers and be consistent
in describing the figure in the text. Please explain in a few words why you excluded the
women not currently married. Moreover, the exclusion of 7 and 4366 observations at the end
is very confusing as not aligned with the previous portion. For clarification, you can make a
flow diagram following the https://www.ssph-journal.org/articles/10.3389/ijph.2023.1605944/
full article.
13. Line #142, in defining the full ANC only three components were considered. The initiation
of the first ANC visit within three months of conception can also be included in defining the
full ANC.
14. In line #151, reference #23 is from almost 20 years ago. Please replace this reference with
the latest one. Like https://www.ssph-journal.org/articles/10.3389/ijph.2023.1605944/full and
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2473-6
15. In line #154, replace “mother education” with “mother’s education”.
16. In lines #153-158, several studies in LMICs highlighted maternal pregnancy
intention/unintended pregnancy, women’s decision-making capacity, intimate partner’s
violence, partner’s education, etc. as significant predictors of ANC utilization. These
variables are expected to be included or at least discussed in the discussion
section with references. https://www.ssph-journal.org/articles/10.3389/ijph.2023.1605944/
full, https://reproductive-health-journal.biomedcentral.com/articles/10.1186/1742-4755-10-50,
https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-14-94
17. In line #157, keep it low- and middle-income countries.
18. In Appendix Table A, the first row and second column should have a heading with
“Operational definition”. Please mention how mass media exposure was classified into not
exposure, low exposure, medium exposure, and high exposure. Also, revise the first sentence
in the operational definition of Antenatal care (ANC) visits; replace the word timing with
frequency.
19. In lines #175-178, please give references for VIF and multicollinearity.
20. In lines #182-283, Table 1 has been reported but the data in the table is not described in the
text. Please explain Table 1 in the text under the section “Sociodemographic characteristics of
the study participants”. Report frequency in the first column and then percentage in the third
column.
21. Check the values in Table 1 (mass media exposure).
22. In lines #186-187, check the grammar.
23. In lines #196-217, Table 2 doesn’t include any significant level/p-value for statistical
analysis. However, the description in the text includes several terms like association, significant
difference, considerable difference, three times higher, etc. Please mention the statistical test
and p-value if any statistical test is conducted. If not, please try to avoid above mentioned terms
in the text. Also, report the frequency along with the percentage.
24. The variable “residence” in Table 1 is reported as “place of residence” in Table 2,3,4. Be
consistent with all the tables and text.
25. In lines #221-227, the sentences described how predictor variables were included in the
multivariate regression model. These should be described in the method section. Moreover,
Table 3 can be merged with Table 2 or with Table 4.
26. In Table 3, and Table 4, report the p-value as <0.0001/<0.001 rather than <0.000.
27. Check the values in Table 4. OR and its 95% CI are not aligned in the variable “Meeting
with ASHA / ANM / Anganwadi in the last 3 months of pregnancy”.
28. In Table 4, the Odds Ratio should be replaced with the Adjusted Odds Ratio (AOR).
29. In lines #236-247, replace OR with AOR and CI with 95% CI.
30. Line #242, check the values of OR and 95% CI. There is an obvious anomaly in OR and CI.
31. In table 3 and 4, and also in the text, the values of OR and its 95% CI can be kept in two
decimal points.
32. Give a summary of the findings in the first paragraph of the discussion section.
33. In lines #338-341, the meaning of the sentence is ambiguous. Please simplify the sentence
to make it lucid to the readers.
34. In lines #350-352, the positive/negative effect of the sociodemographic variables is not clear.
Please specify which variables have positive and which variables have negative effects on the
utilization of comprehensive ANC.
35. Reference #34, 37, 46, 47, and 48 are of 15 years ago. Please replace them with the latest
references.