Reviewer’ s report
Title: Effect of health education on knowledge and attitude of menopause among middle age
teachers
Version: 0Date: 09 Dec 2019
Reviewer: Tatjana M. Gazibara
Reviewer's report:
This study describes an educational intervention aimed at increasing knowledge about menopause
among teachiner s from Asmara, Eritrea. The study is interesting, but there are a number issuesthat need to be improved. Also, use of English language need to be improved.
Abstract
I suggest to modify the background part of the Abstract so as to describe why is this study relevantin this particular population. Or whether there is a lack of this type of studies.
Introduction
Please check punctuation throughout the manuscript. There is a full stop right at the beginning ofthe first sentence in the Background section and use of commas is also problematic throughout.I suggest removing "and so on" from the sentence."Women in midlife are also involved in various life events in which one of them is menopause" -this sentence sounds odd. I suggest rephrasing.I suggest using a different reference (not the one referring to quality of life of women fromKazakhstan) when referring to the average age at menopause, such as a review article. I also
strongly suggest the authors to check the median age at menopause, as the majority of literature
suggest it is 50-51 years of age. There is variability for sure, but I suggest that the authors presentwhat is most common either worldwide, or in their own country.I suggest that the authors use a different reference no.4 for their claim about menopause (not anbehavioral intervention in India, but a review article on menopause itself). In fact, menopause is atransitional period, so it cannot be said that women spend one third of their life in menopause, butrather that postmenopausal period accounts for one third of woman's life.The second paragraph is not clear. There are too many numbers, but not enough clear messages. Isuggest removing this paragraph altogether.I suggest omitting the word "unfortunately".Please specify what country you are referring to in the last paragraph in Introduction.Overall, there needs to be a stronger rationale for the study in this particular population group.Why are teachers relevant? What are the authors trying to achieve by conducting a study in thispopulation. I suggest adding a paragraph on this topic.The last sentence in Introduction should be moved to the paragraph where the authors will explainthe rationale for this study in this particular population.
Methods
Please explain how the teachers were invited to participate ? Also, many schools out of total
number of schools in the city are represented in your sample ? Were they all from urban orsuburban areas. How many teachers were invited to participate? What was the response rate?Please add this data to the manuscript.Did teachers sign inform consent for participation? What Ethics Committee approved this study?Please add that data in the Methods.It is unclear from the description what was the sequence of events. Please add the followinginformation: Were all 99 teachers together at the same event or not? Were they first given lectureand then handed out the brochures or was it the other way round?
The description of the intervention is confusing. The authors write that "The intervention was a
health educational program based on manual, hand out and brochure which 110 were prepared bythe research team". From this description there was only written material as the "intervention".What happened with the training? Was it before or after receiving the brochures? I suggest that theauthors first describe everything that intervention entailed: what participants received before,during and after lectures (training). Start from the beginning.When did the training take place? Please add this in the text.What references did the authors use to assemble the brochure? Please add that in the text.I suggest clarifying "Mixed-between-within effect model" in the text. Did the authors refer tomixed effect model?
Results
I suggest moving the first sentence on response rate to Methods.Please provide the corresponding value of US dollars or Euros instead of the local currency.It is not clear what "they increased to more than nine tenth" means. Please clarify.
Concclusion
I suggest omitting the first sentence from Conclusion because it is unnecessary repetition.
I suggest omitting "This evidence shows that women can take care of themselves when they are
empowered through health educational intervention". Instead, the authors might consider addingthat interventions such as this should be continued in order to raise awareness on menopause.The last two sentences in Conclusion were not observed in your study. I suggest removing them.
Tables
There are overall too many tables in this manuscript. I suggest that Tables 5 and 9 are moved tosupplemental material. Table 8 should be described in the text.
Use of English is problematic and difficult to read at times. I suggest proofreading by a native
English speaker for style.
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Unable to assessAre 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 furtherassessment in your comments to the editors.
I am able to assess the statisticsQuality of written English
Please indicate the quality of language in the manuscript:
Not suitable for publication unless extensively editedDeclaration 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 salary from an
organisation that may in any way gain or lose financially from the publication of thismanuscript, either now or in the future?
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3. Do you hold or are you currently applying for any patents relating to the content of the
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4. Have you received reimbursements, fees, funding, or salary from an organization that holds
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5. Do you have any other financial competing interests?6. Do you have any non-financial competing interests in relation to this paper?
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