Reviewer's report
Title:Pregnancy-related anxiety and wealth quartile in interaction with partner
relationship associated with antenatal depression in pregnant women in Northern
Tanzania: a cross-sectional study
Version:2Date:1 June 2015
Reviewer: Meredith Tavener
Reviewer's report:
MAJOR COMPULSORY REVISIONS
1) Throughout the manuscript the authors have to be consistent with their use of
“depressive symptoms” (which they can and are exploring) versus “depression”
(which they cannot and are not measuring). Do a double check of the entire
paper to make sure a diagnosis of depression is not being given.
2) I would caution the authors about writing that they “ensure a representative
sample” in Methods, first paragraph. They have a selection of women from
different health service sites, and do not offer a comparison against
characteristics of all other women NOT in their study to say they represent
everyone else with their sample. Look for this throughout the manuscript.
3) Methods, first paragraph – the authors name the hospital, health centre and
dispensary to be sites in their study. But no explanation is given as to why
THOSE locations, over the other choices. For example, out of 12 dispensaries,
why was Buhongwa selected? Such information is extremely valuable in terms of
your results and interpretation of those results.
4) Similarly the next sentence provides details of the numbers of women seeking
antenatal care at the health service sites. But is this low or high compared to
those sites not selected for the study. A brief comparison should be given to help
put your study into context.
5) Also, the “study period” mentioned by the authors in Methods – was there
anything about that period worth noting? A special time of year, any particular
ceremonies or celebrations occurring, perhaps climate change means those
months are particularly hard. For readers who are not familiar with Africa and the
location of study, perhaps a very brief mention of whether or not those months
held any particular meaning. If not, simply state that.
6) The authors should mention if the women were interviewed in private? That
is… in a separate room, and also without members of family or husband present.
This is important information for the results.
7) Methods, paragraph nine – if the authors maintained items in their statistical
models which were based on social/cultural significance, as opposed to statistical
significance, perhaps a reference could be included which supports this.
8) Results, first paragraph – the reader does not know how many women were
approached and did not participate. We are told that 397 pregnant women took
part – out of how many? Did every woman consent/agree? Then state this.
9) Discussion, paragraph one – again, authors perhaps should not use
“representative sample” – instead refer to the diversity?
10) Discussion, final paragraph – before the study limitation and strengths, I
would recommend a reflective paragraph which appraises the methodology. It is
important for studies such as this one to receive publication consideration, as it
does detail experiences of women who do not hold high SES status, or perhaps
have a multitude of health services available to them – and I would like to see the
authors reflect upon their own work, and the suitability of their methods (or
improvements for next time), how this could have impacted on their results and
what this means. Culturally situated research such as this would benefit from a
moment of reflection on what was done, and implications for future work. I
believe a couple of paragraphs along such lines would really add to the overall
manuscript.
11) A thorough proofing for expression and correct grammar.
MINOR ESSENTIAL REVISIONS
1) Title of manuscript – seems a little lengthy for the reader. Perhaps the authors
would consider a more succinct title?
2) Background, second paragraph – text reads “…that is the 10/90 gap…”
perhaps the authors might qualify this very briefly in brackets afterwards … for
example…. (whereby less than 10% of the worldwide expenditure on health
research…etc )
3) Background, final sentence on the page currently – use of “countries” two
times in the same sentence… “…between countries in low- and middle-income
countries”…. Remove “countries in”.
4) Background, second page, last sentence before Methods heading – the
authors say they will determine the proportion of depressive symptoms among
pregnant women in Mwanza city… etc. Naturally the authors are looking at
proportions and risk factors in a “selection” of women… not all women.
5) Question – were staff at the health service sites trained by researchers to
approach women to participate in the study? In Methods, paragraph three – the
text reads that “the research team was provided two days of orientation”….
Shouldn’t the research team already know what they are doing? Do you mean
the onsite health staff were provided with training in study protocols by the
research team? It’s not coming out clearly enough at present in the text.
6) Question – what happened when a woman attended the different health
service sites – could she have been recruited at any of them? What happened
when a woman was recruited once and then visited another site and might have
been recruited a second time? No mention is made of this possibility.
7) Methods, paragraph six – the text reads “women were asked to respond to
three questions closed-ended questions”…. Remove the first “questions” where it
appears.
8) Methods, paragraph seven – final sentence says data were checked to ensure
there were no errors. So, what happened if there were errors? What types of
errors are the authors referring to? Could a woman be re-interviewed? How did
researchers reconcile errors if they did occur?
9) Results, first paragraph, Start of 5th sentence – spell out long hand “195”. Do
not begin a sentence with a number.
10) Discussion, paragraph four – the authors refer to a qualitative study. This
does need a reference. They are presenting some of the results in the
Discussion, so a reference is required.
11) Discussion, paragraph five – the authors did not ask the women if they
worked during their interview? So, although interesting, it’s not elaborating on
results from the research.
DISCRETIONARY REVISIONS
1) Background, first paragraph – text reads “…and its association with
underutilization of antenatal care services, negative experiences of childbirth…”
perhaps the authors would consider re-ordering the five things in that sentence in
an order more indicative of pregnancy and birth? Underutilization of antenatal
care services, then complications during pregnancy, then negative experience of
childbirth, then adverse pregnancy outcomes and then infant mortality.
2) Question – Background, second paragraph – text reads “… a systematic
review of 21 studies on antenatal depression….” As the next sentence refers to
studies in low and middle income countries, the authors might consider stating if
the 21 studies were all high income.
3) The use of “peri-urban” could benefit from a very brief description for readers
who are used to different expressions.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests.