Title: Magnitude and associated factors of Early Implanon discontinuation among rural women
in public Health facilities of central Ethiopia: A community-based cross-sectional study
Version: 1 Date: 04 Nov 2021
Reviewer:  Wubet Alebachew Bayih
Reviewer's report:
General comments
Dear authors on your scholarly work; you have brought an important study problem with good
findings that have public health importance in the area of practice.  However, the manuscript has
multiple language usage flaws including punctuations, wordings, spelling and mainly grammar
errors. These problems are found throughout the manuscript. Moreover, there are several
methodological gaps. Therefore, please make repeated proof-reading and thorough copyediting
before considering the manuscript for publication. This would help increase the readability of
the manuscript.
Some of the language use errors which the authors made consistently include.
Eg. First sentence of the background in the abstract: Import …. To mean important
Bivariate ……… to mean bivariable and multivariate …….. to mean multivariable
Specific comments
Title
Considering your community based study in central Ethiopia, I recommend reframing your
title as “The magnitude and associated factors of Early Implanon discontinuation among rural
women who removed it in public Health facilities of central Ethiopia: A community-based cross-
sectional study. What is the difference between rate and magnitude in the context of your study?
Please be ‘word wise’ while writing title.
Abstract
1. Background of the abstract doesn’t clearly show the existing burden of the problem in the
country or other country even. Generally, burden of Early Implanon discontinuation should be
stated followed by the objectives showing the research gap the authors would like to address.
2. Methods of abstract should include measurement of early Implanon discontinuation, type of
data collection tool (adapted or adopted), software for data entry, and cut off P-value to declare
statistical significance of factors for bivariable analysis .
3. Results; kindly include response rate of the study at the beginning, followed by key findings.
Besides, I am afraid that what the authors have summarize here contradicts with the report from
table 3 (mainly on factors including No formal education (AOR = 0.53 [95% CI: 0.3-0.94],
inadequate pre-insertion counseling (AOR = 0.55 [95% CI: 0.31-0.98]), lack of appointment for
follow up(AOR = 0.16 [95% CI: 0.05-0.54]),and didn`t satisfy with service provided (AOR =
0.067[95% CI: 0.015-0.29]). Most importantly, how did you operationalize the words such as No
formal education, inadequate pre-insertion counseling, and lack of appointment for follow up?
4. Conclusion: The discontinuation rate of Implanon among those who removed Implanon after
using itin this study was high. When you say high, compared to what? Introduction
5. The introduction is 2 pages, which is too bulky. As there are redundant ideas, kindly synthesize
it?
Methods
6. Study design and sample size determination: As this study is community based study involving
likelihood of intra-cluster and inter-cluster correlation, why didn’t you consider design effect?
7. Inclusion and exclusion criteria of study population: Why did you exclude non-biological
mothers?
8. Variables and operational definitions: Kindly include list of the independent variables
considered for the study.
9. Please provide an operational definition for early discontinuation of implanon.
10. Data collection instruments, methods and procedures: It would be more self explanatory and
easily understandable if the authors showed pictorial presentation (flow chart) of the sampling
procedure including how many districts # Kebeles # househlds # sample size were considered to
reach a response rate of 96.5%. Please upload your data collection tool as additional file. Why
did you consider 0.25 for entry to multivariable analysis?
11. Data analysis: Which confounding factors did the authors adjust during multivariable
regression analysis? Which software did the authors use for analyzing the qualitative data?
12. Ethical clearance: What beneficent actions did the authors provide the mothers in return for
the interviews?
Results
17. Socio-demographic characteristic of mothers: Don’t give detailed narration of what is listed
in the table. This works for all other results presentations in the subsequent sections. What was
your base to classify maternal age? The word illiterate shall be replaced by ‘unable to read and
write category’
18. Factors associated with pre-lacteal feeding East Ethiopia: As it is a community based study,
how would it be possible to determine average monthly income by asking the mothers of their
salary i.e why didn’t you consider principal component analysis?
19. The study brought good findings. However, only little has been recommended on how to
tackle this problem of public health importance. Therefore, kindly suggest who should do what?
(at kebele, district, zonal, regional and national levels)
Good luck!
Wubet Alebachew Bayih