Title: Pattern and determinants of contraceptive use among the Muslim women in Wajir and
Lamu counties in Kenya: A cross-sectional study
Version: 7 Date: 16 Nov 2023
Reviewer's report:
I congratulate the authors on this interesting and informative piece of research. Understanding
the factors that impact women’s use of modern FP is extremely important, and the comparison
between these two counties in Kenya provides a nice opportunity to look at differential effects of
these factors in what seem to be otherwise quite similar contexts. There are, however, a number
of areas that I encourage the authors to consider in order to strengthen this paper:
Spelling, grammar, punctuation
There are some errors in the newly added revisions, and spelling and grammatical errors
throughout the manuscript. There are also some inconsistencies in, for example, % vs per cent
vs percent vs percentage throughout.  There are also inconsistencies in the number of decimal
places reported throughout.
Substantive comments and suggestions for the paper
In the paragraph starting: ”The number of women using contraceptives has tremendously
increased over time.” The language could be slightly moderated – here the increase in mCPR
from 32% to 58% is described as tremendous, whereas the fall in unmet need from 28% to 18%
is described as limited – perhaps more nuanced language would be suitable as the fall in unmet
need, while smaller than the increase in CPR, is not insignificant.
Study design and setting - the authors might consider explaining what the criteria were for the
purposeful selection of the sub-counties included in this study.
“All eligible household members aged 15-49 within the selected households were eligible for
the study. However, only one woman of reproductive age was interviewed per household.” - can
the authors explain a little more clearly what the eligibility criteria were for the study – this is
not clear from the above text.
If I understand correctly, FP awareness is operationalised in the study through naming a list of
modern methods. Can the authors explain how this is calculated – is it based on the number of
different methods someone can name, or is it a binary variable? It would be useful to comment
also on the validity of this metric as a measure of FP awareness, which might otherwise be
considered to extend to understanding other aspects of mCPR than just the name of products?
Figure 1: can the authors confirm what these results are showing – is this ever use or current
use? The %s appear to total more than 100% for each county
Is there any data on the degree of religiosity in these two counties – this seems like it could be
an important determinant that is not reported in the paper as far as I can see, and would help the
reader to better understand these contexts.
I also would encourage the authors to consider other factors that were not captured in the analysis
but likely to play a role in the uptake and use of modern methods, and consider discussing these
in the limitation section, or discussion, as appropriate. Such factors might include, for example,
differential levels of access to FP products in the two counties, and differential provider attitudes
or bias?
“The results revealed that in Lamu, culture was a key determinant of FP utilization while in
Wajir permissibility by Islam was a key determinant of FP uptake.” It would be useful if the
authors could expand on this statement – what is the definition of culture being employed here,
how does it sit apart from religion?
Table 2:
It is a little unclear what the p values relate to – are these comparing FP prevalence rates between
the two counties, or within them? If within, why is there only one p value per group?
Table 3:
These results are quite difficult to read due to the formatting of the table. I would encourage
the authors to consider how they can make these results clearer. It appears that in the adjusted
results, the control variables are not having the ORs reported. Can these results be included, or
alternatively perhaps the authors can comment on their exclusion.