Title: The Role of Adverse Childhood Experiences in Predicting Child Abuse Perpetration
among Married Mothers in Alexandria, Egypt: A Cross-sectional Study
Version: 2 Date: 04 Oct 2023
Reviewer:  Nouh Harsha
Reviewer's report:
Dear Sir;
Thank you for presenting this important paper. In order to make it of publishable quality, I have
given some comments which I hope will help in improving presentation, flow and validity of
this work.
Technical notes
Use a uniform style of writing the main sections of the paper, please [see background is written
at the beginning of the line, while methods is written as a separate title, ….].
Use same writing style throughout the paper. For instance, see page 5, line 7-10. Why is it in
bold?
Avoid putting publication year in brackets, particularly beside the references. It distracts the
readers.
Use same punctuation style for references. For example, page 5 line 21, The full stop is placed
around the reference from both sides. Be consistent.
Avoid unnecessary capitalization (e.g page 6 line 8 “Stressful”)
Capitalize the word Table in page 11, line 3. Check others also, please.
Use same referencing style. See page 15, line 7. Why superscript?
Double check your entire paper for the above mentioned comments, since I have only given
some examples.
The title
Use of abbreviations in the title is discouraged. Consider removing, please.
Instead, display year of the study within the title, if possible.
Abstract
Line no. 5. Do you mean ACEs of the mothers on their children later? Clarify the statement,
please.
Line no. 10. Avoid using statistical terminology wherever possible. Use bivariate and
multivariate analysis for easier comprehension by the public.
Specify the statistical tool/s used in the data analysis, please.
Make sure you revise and adjust your abstract after completing the overall modifications
required.
Background
Page 5
Line 3-6. Define ACEs clearly, please.
Line 7. “2,000 adults aged 18-69 years”. Were the adults females? Or males and females were
included? Explain the point.
Line 12-13. Add a reference, please.
Line 13-17. It is too long sentence. Consider dividing into 2 or 3 sentences, please.
Page 6
Line 2. What is IPV? Spell upon first use and make sure you include in the abbreviations list.
Line 12. What do you mean by inadequate?
What is the hypothesis of your study? State it clearly, preferably, at the end of your introduction
and prior to the aim of the study.
I suggest dividing the last paragraph in page 5/6 and integrating it with other paragraphs, given
that it is too much relevant to its previous and next paragraphs.
Methods
Page 7
Line 5- 7. Selection of the 3 FHCs with the highest attendance rate is a good idea. However, it
may result in selection bias or compromise the ability to generalize the results nationally. This
needs to be mentioned and emphasized under study limitations section.
Line 11. What was the total population of the study upon which the sample size was determined?
Which software tool was used to calculate the sample size? Indicate with proper referencing,
please.
Why did you select 80% for study power? Was it the practice in other similar situations?
Line 15. What was the nonresponse rate in your study? What were the given reasons for not
participating?
Line 21. What do you mean by “after Fahmy and El-Sherbini”? Further explanation is needed
here.
Page 8
Line 1. It would be very useful if you display the set of the given questions (in English) in the
appendix, please.
Line 3. What is the sixth item? You enlisted 5 only.
Line 6. I can see seven here! Correct this point in line with the previous comment.
Line 13. Display the set of the question in the appendix please.
Page 9
Line 5. Did you try to improve the internal consistency via excluding some of the variables
from neglect or very severe physical assault scales? The low Chronbac’s alfa indicates a low
reliability of the measuring tool for this particular setting. Using a single variable or a scale with
two or more variables with high internal consistency is preferred in such situations.
Line 6. Add the set of the questions to the appendix section, please.
Line 8. Why did you select this cutoff point? Are there similar situations in other studies?
As a part of the methods section, it is good to have independent subtitles for both independent
variables and dependent variables, along with the required explanation related to each.
Recall bias is likely while filling the questionnaire by the mothers. This should be admitted in
the limitations section.
Line 20. Was that a verbal or a written consent? Specify please.
Results
The first part of the result represents the sociodemographic characteristics of the study sample.
Why do not you place the given data in a Table?
Page 10
Line 9. Explain what is “moderate socioeconomic score”, preferably at the introduction of the
variables under independent variables in methods section, please.
Line 10. “Table 1, 2 in 3 mothers”. This arrangement of the numbers is misleading. Consider
rephrasing or at least spelling.
Line 10-16. Double check the given numbers with the corresponding values in the Table.
Line 13-14. Invert the sentence to make the comparison from lowest to highest range.
Line 10 and line 16. Table 1 is mentioned in 2 locations. One is enough. Remove either, please.
Page 13-14.
Put the 95% CIs for the regression results in addition to the Odds ratios.
Page 14
Line 1. Domestic violence? Or spousal violence?
Line 7. “It is evident that ACE of witnessing domestic violence , moderate”.
Is it the domestic violence or spousal violence? Again? Double check all the given values and
make sure that it is accurate throughout the paper.
Table 3
“logistic regression results”.  This is a statistical term. Use multivariate analyses instead, please.
I suggest removing B and SE values from the Table. You may (optional) display the unadjusted
OR along with their 95% CIs at the left side of the adjusted ORs column. That would be more
informative. Also, use only 2 decimals for both ORs and the 95% CIs.
Discussion
Page 15
Line 7. Be consistent in referencing style throughout the paper, please.
Line 8. Was that study conducted or published in 2018?
Page 16
Line 1-2. These points are among study limitations. Make sure you emphasize under study
limitations section.
Page 17
Line 6-8. The sentence is somewhat ambiguous! Double check the statement to make sure it
flows properly.
Page 18
Line 13. Add a reference or a source for the given information.
Mother’s age was a significant predictor of all forms of child abuse and neglect. However, it is
a double edge sword.  As mothers age increases, they are more likely to commit child abuse.
On the contrary, other parts of the literature reported a decrease in child abuse among older
ladies, due to the fact that women become more tolerant to their children and more experienced
in rearing them compared to younger ones.
Add to your discussion an explanation of mother’s age impact on child abuse in line with your
results, and give possible reasons behind this trend.
Conclusions
Suggest some ways to address violence at the national level.
Study limitations
Last sentence must be placed under conclusions and recommendations section.
References
Use same style of referencing throughout the paper, please.
Refresh your references list with more modern references to make sure you included results of
the modern researches in the field. Very few references are 2018 or above, and none is in 2020
or above.
Thank you