Title: Hotspots and determinants of women’s discriminatory attitude towards people living with
HIV; Evidence from Ethiopian Demographic and Health Survey data
Version: 1 Date: 12 Jul 2022
Reviewer's report:
Thank you for the opportunity to review the manuscript entitled “Hotspots and determinants of
women’s discriminatory attitude towards people living with HIV; Evidence from EDHS 2016
data”.
The authors describe a secondary analysis of national survey data to determine discriminatory
attitudes from women of people living with HIV in Ethiopia. They describe which regions are
hotspots for these types of attitudes.
I hereby provide my review of the above title manuscript of which should be a revise and
resubmit.
General: Manuscript could benefit from a thorough and comprehensive review for language
inconsistencies and grammatical issues. Title should also spell out EDHS or state this study is
centered in Ethiopia.
Further, the manuscript would benefit greatly from a thorough revise and rewrite to ensure that
there is a clear and defined approach to the variables used within the study and how those were
analyzed. At present the data analysis is not clear and does not enable the reader to be able to
replicate said study or understand which variables were used within the modeling exercises.
Abstract:
Need to call out the acronym, people living with HIV (PLWH) in the background section of the
abstract as it is used later in the methods.
The survey data used was not described or named in the abstract methodology nor was there
any variables from the survey that were used in the analysis described, suggest that the author
review this section and rewrite to detail those items.
Line 35: muli-variable regression is spelled incorrectly
Results section of abstract, acronym for persons living with HIV is spelled out and provided,
suggest authors do this earlier in the abstract (see above) when it is first used. Also, the author
should be consistent with their language and use women’s discriminatory attitude rather than
just stating discriminatory attitude throughout the manuscript.
At this point hard to determine how exactly the author was determined or defined discriminatory
attitude – how was that calculated from the variables they listed in the results section?
Background:
Review for language and grammatical errors, use of acronyms needs to follow general language
rules and edit the background as needed.
I would recommend that the author provide definitions and references for what they deem to be
discriminatory attitudes and which variables may be an indication of such. They do not define
this at all.
Methods:
Further description and any references linking to the EDHS are needed in the methods section.
What is this survey for and how is it administered?
Sample size description needs to be written more clearly, define a cluster, assuming it is an
enumeration area, define that.
Explain the GPS data, do the authors mean that there was associated coordinates or other
geographical data attached to each response?
For the missing data that was excluded, the authors states that this was due to missing outcome
data, outcome data is not well defined or explained, suggest the author includes that in the
methods section.
There are many inconsistencies on the variables that are included in the analysis, for example,
compared with the results and the variables listed in the methodology section these do not align
and it is hard for the reader to understand exactly what was included in the analysis. Suggest
that the author review and provide a comprehensive list or table of the variables used within the
survey and their definitions ensuring consistency and comprehension throughout the manuscript.
Discriminatory attitude seems to have two questions used based on the provided variable
definition. Did the author combine these variables into one in the analysis? This is not described
and needs to be clarified.
The author states “We conducted the spatial scan statistics using the Poisson model by
considering the 25% of the population at risk”. How was this derived and decided? Provide
further clarification and a reference if required.
The model descriptions are incomplete and should include variables used and how they were
created. There is no definition or link to variables to determine which are deemed individual or
community level as stated.
Results:
Review language and grammatical and formatting issues within this section.
Table 1 should include total column.
The author should define what they mean by “most likely cluster” – this is not clear.
Table 3 – suggest the author reviews this table and clarifies what the ID is referring to and how
number of cases/expected cases were derived. Define also primary and secondary clusters and
how they were calculated/determined.
What is a high-risk cluster?
Discussion:
Caution the author against on the use of conjecture throughout the discussion and they should
ensure that statements made have clear citations to back up their discussion points.
Limitations/Strengths:
This section seems to be incomplete; the author should describe further the limitations of the
use of these data/missing data and methodologies used.
Conclusions:
Suggest the author include which variables indicate the most discriminatory attitudes as they
only state it is high and this is the point of their study.