Reviewer ’s report  
 
Title: Social networks and quality of life among female breast c ancer patients at Tikur Anbessa 
Specialzed Hospital, Addis Ababa, Ethiopia 2019  
 
Version: 0 Date: 28 Nov 2019  
 
Reviewer: Taqdir Bhandal  
 
Reviewer's report:  
 
Dear author s, 
Thank you so much for your contribution to research on breast cancer and female health.  Your 
study is so valuable and shows how important social networks are for people who are going 
through cancer recovery or palliative care.  Moreover, I am grateful  to see more representation 
from the Global South including Ethiopia which has such a unique history of politics, gender 
relations, colonial resistance, and more.  The wide variety of factors that you considered in relation 
to participants' quality of life  is a real strength to this project and paper. Please find below my 
critical feedback on where the paper can be improved. I am also happy to share any additional 
readings and clarification where required.  
 
 
ABSTRACT  
- Here you conflate sex and gender in E nglish. In the paper, since you collected research about 
female health (e.g. on the survey did you ask people about their sex? female, male, intersex? or 
gender? woman, man, trans, two -spirit, etc?), please continue to use female throughout rather than 
using 'female' and 'woman'.  Unfortunately it's a common misconception in health research. See 
the following link for info: https://www.cihr -irsc-igh-isfh.ca/course/index.php  
- Does this difference in sex and gender translate in Amharic and more Ethiopian lan guages?  
 
BACKGROUND  
- Good set up for why BC is important to consider for female health  
- Can you link this to the health of the Earth and land/water of Ethiopia? E.g. is there literature on 
why there has been a rise in breast cancer rates over the last f ew decades in Ethiopia? Higher 
pollution? pesticides? etc?  
- What are some ancestral healing concepts that can help us with the analysis? Rather than just 
Western biomedicine? I think the beauty of us doing research in our home countries in the Global 
South is that we can allow for multiple worldview to be showcased? What is particular about the 
Ethiopian understanding of the world, family structures, and health that will support you in your 
analysis?  
 
 
METHODS  
- STUDY AREA: Loss of appetite is a main finding.. what foods are people eating? E.g. has 
people's diet changed in the last several decades? Can you give an idea of the main foods that are 
nourishing people with breast cancer in the area?  
 
- DATA COLLECTIO N: I would like to read a line or two about the emotional, mental, and 
spiritual connections made during the month of data collection.  Rather than assuming the 
researcher is a neutral tool that did not speak with participants about their lives. E.g. can y ou write 
a few sentences about the emotional tone of the surveys?  
- Technical question to address: How did you do the surveys with people who are considered 
"illiterate" compared to those who were deemed "literate"?  
 
RESULTS  
- Social network characteristic s? Did you ask about sexual identity? e.g. straight, gay, bisexual, 
etc.? Or just assume that they were married to men?  
 
Suggested reading: Tadele, G., Amde, W.K. Health needs, health care seeking behaviour, and 
utilization of health services among lesbia ns, gays and bisexuals in Addis Ababa, Ethiopia. Int J 
Equity Health 18, 86 (2019) doi:10.1186/s12939 -019-0991 -5 
https://equityhealthj.biomedcentral.com/articles/10.1186/s12939 -019-0991 -5 
 
 
- It would be helpful to see a diagram or table as a visual displa y of the results.  
- Maybe you could provide a bit more of a nuanced description and qualifier of what a "good" 
social network could be. E.g. was there one participants story that you can share?  
- What a surprising finding! That participants with children are 5x more likely to have "good" 
social networks. I have more to say about this in my discussion notes and comments.  
 
DISCUSSION  
- P. 13, Line 30 - 33: Can you expand more on the topic of social supports through religious 
institutions? E.g. Do your findi ngs share insights about the connection between physical, 
emotional, mental, and spiritual health?  
- P. 54 Line 54 - 55: Can you expand on this idea of people being married, with children, and 
religious having greater social support networks? Is there a l ink between dominant cultural 
expectations of what females should do and how they engage with their community? E.g. Hetero -
normativity?  
 
SUGGESTED READING: Nortjé -Meyer, L. (2010). Deconstructing the Heteronormative Image 
of the Early Christian Household: Reconsidering Gender as a Key Organising Concept of Family 
Functioning. Acta Patristica et Byzantina, 21(2), 141 -151. doi:10.1080/10226486.2010.11879123  
 
- P. 14 LINE 19: High monthly income associated with good quality of life. Can you expand on 
this? Wha t is the average cost of anti -cancer pharmaceuticals, food, etc.?  
- P. 14 LINE 37: Can you provide a definition of what you mean by "unaffected emotional and 
cognitive functioning"? Do you mean that people were going through low vibrational emotions 
like s adness, depression, frustration, etc due to breast cancer diagnosis?  
- Using a connection to literature, can you add some statements about if there have been changes 
in how people relate to their social networks (e.g. through social media, more nuclear fam ilies, 
etc.)? How does this shed light on the findings?  
 
RECOMMENDATIONS:  
- Can you expand on how can we support public health initiatives that ensure diverse social 
networks based on people's needs and desires? Moreover, how can we support females to make 
choices about their own lives?  
 
 
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 y our 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 recommend additional statistical review  
 
Quality of written English  
Please indicate the qua lity of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salar y from an 
organisation that may in any way gain or lose financially from the publication of this  
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2. Do you hold or are you currently applying for any patents  relating to the content of the 
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3. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has  applied for patents relating to the content of the manuscript?  
 
4. Do you have any other financial competing interests?  
 
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below. If your reply is yes to any, please give details below.  
 
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