Title: Unmet Menstrual Needs and Psychosocial Well-being among Schoolgirls in Northern
Tanzania: Baseline Results from the PASS MHW Study
Version: 2 Date: 12 Jul 2024
Reviewer:  Mriganka Dolui
Reviewer's report:
Title: Unmet Menstrual Needs and Psychosocial Well-being among Schoolgirls in Northern
Tanzania:  Baseline Results from the PASS MHW Study
The article is interesting. I find that this manuscript holds promise for offering a valuable
contribution to the scientific community. Following a comprehensive and critical evaluation, I
wish to bring attention to several findings that require addressing. By addressing the following
points or modifications, authors can enhance the clarity and impact of their research work.
However, I highly recommend publishing this article once the corrections are implemented.
Minor comments:
1. Abstract
-line 8 needs to be rephrased.
-lines 23-24 are incomplete.
-mention sample size in methods.
-line 24-25 unclear.
2. Introduction
-page 4 lines 17-19, reference missing
-citation is not evenly placed, follow the journal guideline
- consider including Tanzania -specific prevalence statistics on menstrual products uses
- page 5 lines 3 reflects poor literature review and overconfidence of the statement. Hence, more
rigorous literature review is required to establish the study objective. The following literature
is aligned with the title.
• Effect of menstruation on girls and their schooling, and facilitators of menstrual hygiene
management in schools: surveys in government schools in three states in India, 2015. J
Glob Health. 2019 Jun;9(1):010408. doi: 10.7189/jogh.09.010408. PMID: 30546869; PMCID:
PMC6286883.
• Understanding the social and physical menstrual health environment of secondary schools in
Uganda: A qualitative methods study. PLOS Glob Public Health. 2023 Nov 29;3(11):e0002665.
doi: 10.1371/journal.pgph.0002665. PMID: 38019777; PMCID: PMC10686490.
• Attention to menstrual hygiene management in schools: An analysis of education
policy documents in low- and middle-income countries. https://doi.org/10.1016/
j.ijedudev.2017.09.008.
-the introduction needs to be revised.
3. Methods
-page 5 lines 19-21, on which basis the statement stands? Reference missing
4.  Results
- Page 9, line 9, “…… majority (81%, 390/486) of the participants”, the sample (390/486) is not
necessary; percentage points are sufficient while interpreting any results in the entire manuscript.
- Page 9, line 10, “the remaining 19% were Muslims”, other religions also contributed 0.2%;
hence, change the word “remaining”.
- Page 9, line 19,  “…..Always® or other disposable pads (60%; 252/424), fabric (50%;
210/424)”, interpretation is not matching with table 2, rewrite the interpretation. What is meant
by “®” ?
- In table 2, under “Pain management practices variable”, Median pain score (IQR), 3 (1 – 7),
check and revise.
- Page 10 – interpretation of table 3 is unclear and confusing, explain it either in variable-specific
or school-level wise.
- Page 11- interpretation of table 5 is not clearly understandable, rewrite it.
What is the reference category in the logistic regression model in table 5? The significance level
is missing from Table 5, mention it.
5.  Discussion
- the discussion is too lengthy and unclear; revise the discussion section with the alignment of
results.
- the factors that are significantly associated with MPNS are not discussed rigorously; hence,
they should be addressed with more literature.
- what is the significant contribution of this study, and how will this add value to the literature?
- policy suggestions are very weak and need to be strengthened.
6. Conclusion
-  the conclusion section needs to sharpen and strengthen