Reviewer ’s report  
 
Title: Reasons for Delay in Seeking Treatment among Women with  Obstetric Fistula in 
Tanzania: A qualitative study  
 
Version: 0 Date: 10 Mar 2019  
 
Reviewer: Amr Mahran  
 
Reviewer's report:  
 
The authors present a cross -sectional study to investigate the reasons for the delay in seeking 
obstetric fistula treatment in their country.  
 
1- Abstract:  
- Background: Long, can be shorter.  
- Results: Please add a phrase to describe the patien ts' demographics.  
 
2- Introduction:  
- Well written.  
 
3- Methods:  
Sampling:  
- The sample size is small. I wished the authors to include more patients. Including more 
patients might increase the chance of finding more themes of the desired prevalenc e.  
- Please, indicate how many patients were approached to participate? I would strongly 
recommend adding a flow chart for patients' selection process including the numbers of 
patients who refused  to participate, and numbers of partial and co mplete responses.  
 
4- Results:  
- Patients demographics: I would recommend adding a paragraph describing the 
demographics (mean ± SD for age, and number (%) of other demographics). Pleas e, include 
economic status and parity in the table. Multipa rity is an important risk factor.  
- How many patients did suffer from stigma against women, self -isolation, community 
isolation and so on...? A yes/no table would be appropriate including the themes and 
number of responses.  
- Most patients in the s tudy are unemployed with a low level of education. Did the authors try 
to investigate the factors associated with seeking early treatment in other patients? It would 
be great to draw such comparison. Education level, economic status, and employmen t are 
important factors that may contribute to the study findings.  
- Financial difficulty should be studied as a separate theme (not only under distance form 
hospitals) - fear of the cost associated with the procedure and/or complications.  
 
5- Discussion:  
- Please, discuss the possible contribution of unemployment, under -education, and 
multiparity.  
Are the methods appropriate and well descri bed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately sup ported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please  speci fy what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this  manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that holds 
or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
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on my report to the a uthors and, if the manuscript is accepted f or publication, my named report 
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I agree to the open peer  review policy of the journal