Reviewer ’s report  
 
Title: Discontinuation rate of implanon and its associated factors among women who ever used 
implanon in Dale District, Southern Ethiopia  
 
Version: 3 Date: 15 Sep 2018  
 
Reviewer: Mary Losch  
 
Reviewer's report:  
 
As noted in previous reviews, this study addresses an important topic in contraceptive access and 
utilization. Overall, the approach seems appropriate to the research question. Despite some 
important revisions, several issues remain.  
Additional detail  about the health books/frame is important but it is still not clear how 
researchers were provided with names of patients without their permission. Although participants 
provided consent for the interviews and the data were confidentially maintained, the p rovision of 
the medical information to individuals outside of the clinic (even researchers) would be 
considered a breach of privacy in many jurisdictions. No additional information about whether 
such transfer of information is common and acceptable for thi s area was provided. Although the 
IRB approved the study, this dimension is still a concern.  
The development of the questionnaire and wording has been adequately addressed.  
Data collection protocol has more detail.  
The additional information and question wording has clarified the findings regarding reasons for 
discontinuation include both "fearing of side effects" and "health concerns."  
The discussion still notes that the discontinuation rate found in this study was  "a bit higher" than 
other studies. However, the earlier background info indicates that other studies of implant 
discontinuation were in the 5% - 16% range for the 12 -month study period. The 23% rate here is 
substantially higher. The authors suggest a few possible reasons but given the large difference, it 
should not be characterized as "a bit higher" in my view.  
It is not clear what happened to this variable in the current version:  The discussion of 
satisfaction with service is not clear. The statements  that satisfaction during the insertion were 
related to lack of satisfaction with choice, privacy and "explanation of service provider" are not 
connected to the findings in the study. The factor of satisfaction with service during insertion is a 
significan t predictor of discontinuation but how the authors took a leap to the factors underlying 
that lack of satisfaction is unclear. Were other data and analysis conducted but not reported? If 
not, then these connections are speculation and should be presented a s such.  
Last issue is the need for extensive revision of the language - corrections in syntax, grammar and 
usage are needed throughout for clarity.  
Are the methods appropriate and well described?  
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.  
 
Yes 
 
Are the conclusions drawn adequately supported  by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended , please specify what aspects require further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edi ted 
 
Declaration of competing interests  
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5. Do you have any other financial competing interests?  
 
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