Title: Maternal Satisfaction with Delivery Service and Associated Factors among Women Who
Gave Birth at Public Hospitals in Guji Zone, Southern Ethiopia
Version: 2 Date: 12 Dec 2023
Reviewer's report:
The authors are commended for submitting their manuscript that focused on women’s
satisfaction with intrapartum care following institutional birth in one public hospital in Southern
Ethiopia using a structured 20-point validated questionnaire.
Overall, the article provides rich information that is useful for service delivery improvement
towards Ethiopia’s ambitious plan to ensure more than 85% of women are satisfied with their
birth experiences, the aims are well articulated, and the methodology is well described.
Find below detailed comments on the manuscript and some areas for strengthening.
Abstract
1. The aim is clearly articulated.
2. Improve the sentence line 30- this can be shortened.
3. Items in the result section need clarification – for example, shorter duration of labor, better
fetal outcomes, and waiting times less than 30 minutes were associated with maternal satisfaction
with intrapartum care
4. Line 45- perhaps the word target (85% and above) may be a suitable word compared to plan.
5. In the conclusion- line 47/48, mentions focused antenatal care- while referencing
complications during delivery. I would recommend strengthening care during childbirth
intrapartum care, or emergency obstetric care, as this would result in timely delivery and better
birth outcomes (which is different from antenatal care).
6. Lin 49- consider adding the word  ‘’leadership’’ to read ''health facility leadership is expected
to supervise'.
Keywords
Consider revising, may not need to include words that are in the title.
Background
1. Consider updating reference 1.
2. The author makes an excellent point concerning lines 62-76, that access to institutional birth is
not enough, and women need and have the right to quality care across the pregnancy continuum
that includes adequate and competent staff and well-resourced health facilities, however, even
this is not enough. Women need and have the right to a positive birth experience. These sentences
need some reorganization to strengthen the flow.
3. Reduce repetition.
Methods and materials
1. Well described.
2. Minor issue – clarify the date in line 125.
3. Line 127- reorganize population data from zone to hospital.
4. Please add some details on the particular facility that was selected from among 4 hospitals and
42 health centers – the sentences in lines 124 to 127 are in the plural. All the table titles refer to the
plural. Confirm if the study was done in one hospital or more than one and describe the selected
hospital selected.  How many births per year?  this has implications for the generalizability of
the findings.
5. Line 181 is a repetition of line 174
6. Reference 52 does not elaborate on similar methods compared to this study yet is cited as
a reference.
7. While the procedure to compute satisfied versus dissatisfied is indicated, it was unclear in the
first reading. I suggest the addition of an introductory sentence - satisfaction is classified into two
categories which are satisfied and unsatisfied or dissatisfied. These were computed as follows:
We used the demarcation threshold formula: {(total highest score total lowest score)/2} + Total
lowest scores. Any participant that scored above the cutoff was categorized as satisfied etc.
Results
- Clarify what the 99.1% response rate means.
- Line 260 (2/5th, 98 (39.4%) - perhaps the percentage with the number may be enough)
- Line 273- normal outcomes - what does normal mean, no complications/ alive and well, baby
Apgar score above 7 ??. It needs to be clarified.
- Line 279 – 287 is a repetition from the methods section. The additional details may be better
placed in the methods section and omitted from the result section.
- Consider starting the results with line 287 ‘’The overall maternal satisfaction with delivery
services was found to be 138(55.4%)95%CI(49.1- 61.7)(Fig 1).’’, however, this sentence needs
to be rephrased for clarity.
- It appears most of the variables except privacy scored above 70%.
- Consider re-ordering the tables ( to start with socio-demographic  characteristics)
strengthen the presentation of the data in the tables.
Discussion
The comparison of study findings with other areas in Ethiopia and other countries can be
summarised.
The reasons for the differences need to be strengthened- are the methods, study populations,
and tools used the same?
The language and presentation of the discussion could be summarized and strengthened with
inspiration from reading the discussions in the rich reference list.
Limitations need to be strengthened and expanded, for example,
Postnatal interviews often uncover less mistreatment compared to direct observation or follow-
up interviews at home (Freedman et al and Sando et al)
While the instrument explored satisfaction – items related to mistreatment- physical and verbal
abuse, etc. were not explored, or mentioned if that is not a concern in Ethiopia, it certainly is an
issue in some other low-resource urban settings in Tanzania (see Sando et al.,)
Some inspiration will be gleaned from reading the rich reference list.
Conclusions
As mentioned in the comment in the abstract section – antenatal care is different from
intrapartum care and emergency obstetric care. Strengthening the provision of intrapartum care
is recommended to ensure better maternal and fetal outcomes that were highly correlated with
maternal satisfaction.
References
Review the formatting of the references carefully as in some there are unnecessary semi-colons
and the year appears twice. Recommend inclusion of references that were used and removal of
unnecessary references for example  reference 52