Title: Residential status and household wealth disparities in modern contraceptives use among
women in Ghana: A cross-sectional analysis
Version: 3 Date: 21 Jul 2023
Reviewer's report:
Introduction
General comment: The introduction reads well but it does not much focus on wealth quintile and
residential status. It is not clear why it is important to focus on wealth quintile and residential
status. For example, it is important to measure and understand wealth differentials so as to
identify and target the poor in health delivery. If the study establishes any link for example,
between the poor and modern contraceptive use, then interventions can be tailored to address
this. There is currently no clear justification for the study.
Lines 110- 112: The justification for the study was based on the literature review. Please provide
details on how the literature review was done. How thorough was the literature search? It would
have been better if a scoping review or a systematic review was conducted if this was going to
be used as the basis for the study. Alternatively, reference to systematic reviews conducted on
the subject can make the justification better. Please provide references to the literature review
statement.
There have been studies looking at the relationship between wealth quintile and other
independent variables on modern contraceptive use in Ghana. Please state this and reword the
novelty. Your study is adding to the studies done on wealth index. I don't think there is any
novelty here. The main difference here is that this study is focusing primarily on residential
status and wealth index, unlike other studies which have either looked at many other independent
variables or in other cases, only one independent variable like wealth index. Most of the other
studies have also used the GDHS and not the MICS databases.
There is not enough justification for the study as things stand now. It is also not clear what
problem the study seeks to address and hence the need for the study. I also recommend that the
authors focus a bit more attention in the introduction on the importance of residential status and
wealth quintile on modern contraceptive use.
Methods
The methods section is well outlined. However there are some clarifications to be made. This
will make the methods section clearer.
Line 145-146: The authors state that they took into consideration clustering, stratification, and
sample weight effects due to the complex sampling design of MICS. However, how this was
done is not stated in the analysis.
It is unclear whether the data was 'survey set ' (svyset) for example to address some of these
issues. Please provide details on how the clustering, stratification, and sample weight effects
were dealt with.
Line 148-149: Please reference this since this formed the basis for the selection of variables.
Line 152. Please state if this was a normal data set. Please indicate if any initial analysis was
done on the data set to ascertain whether or not it was normally distributed. Was the data ‘svyset’
before analysis considering the fact that the team was dealing with large complicated survey
data? How did the team deal with clustering etc?
It would also have been better to start the paragraph (Line 152) by stating that the data was
described using frequencies and percentages. It would also be helpful if the variables used here
were described. Were all the variables categorical or there were some numeric variables? Was
the cross tab done alone or done with chi-square for example since the team was looking at
significant factors? Please clarify
Results
The results are well presented.
Line 168. The title is misleading as it delves into other factors associated with the use of modern
contraceptives and not just prevalence.
Discussion
I recommend that the first two paragraphs of the discussion be rephrased.
Lines 265-276:  A lot of the information there is not needed in the first paragraph. Please go
straight to the point. The first paragraph should be used to state your key findings based on your
objectives.
Eg. Our study showed that the use of contraceptives was low. Wealth quintile and residential
status were associated with the use of modern contraceptives. Other factors associated with
use....
Line 277. This can start the second paragraph. I recommend however that you have two strands.
The first strand should start with the geographical location and wealth quintile since that is the
main focus of your work. The second strand should look at other factors including obstetric
characteristics.
I am not sure why you are expatiating on the obstetric characteristics as a subheading since that
was not an objective of the study. Additionally, you didn’t make any special reference to this
in the introduction. I recommend that you discuss it under the other factors. It can be the last
paragraph under the other factors.