Reviewer's report
Title:Reproductive health of women with and without disabilities in South India,
the SIDE Study (South India Disability Evidence) Study: A Case Control Study
Version:2Date:8 August 2014
Reviewer: Nadine Seward
Reviewer's report:
The manuscript entitled “Reproductive health of women with and without
disabilities in South India, the SIDE Study (South India Disability Evidence)
Study: A Case Control Study” was an interesting piece of work and read well.
However I still feel that overall, the manuscript will require considerable major
compulsory works before it is fit for publication. Importantly, the author does not
state the main objective of the paper and how this will be assessed for, only that
the reproductive health of women will be described.
I feel this is a decent first attempt, but a paper that looks at a specific outcome
that is of public health interest would be more beneficial to the reader, in addition
to the univariable analysis. As an example, a paper that looked at predictors of
having a live birth in the past 2 years in women with a disability compared to
women without a disability.I’m not an expert in disability by any means, so I’m not
sure about topics of public health importance.
I also feel the authors would benefit from hiring an epidemiologist or statistician
to help with some of the more technical aspects of the paper.
The report I detail below is based as my experience as an
epidemiologist/statistician and not as a clinician. Although many corrections are
required, I have only presented a few general comments below that will hopefully
be of some value to the authors:
1. Is the question posed by the authors well defined?
• The abstract does not specifically state what the objective of the study was,
only that they would look at reproductive health experiences of women with
disability in South India. How will the authors attempt to do this? What is the
purpose of having the case control study? Are the authors comparing women
with disability to women without disability? If so, this should be clearly stated in
the objective.
• Although a vague objective is proposed, authors still need to state the main
question of the study. The following excerpt illustrates how vague the authors
have been: “There is a complete lack of published literature in peer reviewed
journals on the reproductive health status of women with disabilities in India. The
present study was therefore conducted to bridge this evidence gap to enable
need-based appropriate reproductive health services for women with disability in
India.”
• Authors compare reproductive health of women with disability to women without
disability. Is this how authors which to look at reproductive health experiences? If
so, this should be stated in a clear objective.
2. Are the methods appropriate and well described?
• The statistical methods were not described in sufficient detail. The authors state
a chi-squared test was used for associations and authors do not state
associations for what. It was also state logistic regression was used to determine
odds for associated variables, but does not state associated variables of what.
Furthermore, logistic regression presents odds ratios, not odds.
• Although the univariable analysis provides an initial understanding of the
situation, further work is required to understand if there is truly no difference/or a
difference between these two populations. There was no attempt to account for
clustering, nor were there an attempt to create a multivariable model whilst
adjusting for appropriate confounders with an appropriate outcome measure.
• The results are not presented in a way that is considered appropriate. For
example, for a chi square test, it is only necessary to present the p value and not
the chi square. Also, the mean age of women in the two separate groups is
presented, but authors do not state if there is a difference or not.
• Authors should provide a reference for the large study (i.e. South India
Disability Evidence Study) that the present study is a part of.
• Tables mention that some statistics are age adjusted, but the methods on how
this was done were not reported.
3. Are the data sound?
• Impossible for me to tell from the information provided.
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
• Results have not been appropriately stated. If authors state something is
“significantly higher”, then a p value should be reported.
• Presenting results as “x” times higher is not appropriate. Authors should state if
this is an odds ratio, rate ratio, etc.
• Results tables need some work. As an example, there is no need to report the
number and percent in two separate columns. One column will do!
• If authors are comparing two groups, a statistic to describe the associations
should
also be stated.
• These are only a few of the many corrections that are required with the
information in the results section.
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
• Discussion and conclusion requires considerable work
• Authors state reproductive health indicators are comparable between these two
populations. What are the reproductive health indicators? These should be
clearly stated in the discussion when the authors state there are no differences
between the two groups.
• Limitations are not discussed.
• Discussion and conclusions are not adequately separated out.
• Authors state there are no significant differences on most parameters of
reproductive health. The results section to not support this statement.
• Future research is not discussed
6. Are limitations of the work clearly stated?
• Limitations of the study are not discussed
• Recall bias? Women report on reproductive health and outcomes of any
pregnancy over the past 2 years
• Have controls been appropriately selected? They are age and sex matched, but
authors do not state why they think this was important.
• Other potential bias?
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
• This has been adequately completed.
8. Do the title and abstract accurately convey what has been found?
• The study findings are adequately described in the title and abstract
9. Is the writing acceptable?
• Writing is acceptable English
Level of interest: An article of limited interest
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare I have no competing interests