Title: Examining Birth Preparedness and Complication Readiness: A Systematic Review and
Meta-Analysis of Pregnant and recently delivered Women in India.
Version: 3 Date: 26 Dec 2023
Reviewer's report:
The article displays shortcomings in conceptualization and authors’ standpoint, requiring
significant revisions. Detailed comments are offered below to provide clarity and guidance.;
1. The title appears somewhat confounding. I recommend a revised formulation that commences
with: "Examining Birth Preparedness and Complication Readiness: A Systematic Review and
Meta-Analysis of Pregnant Women in India." This proposed title aims to enhance clarity and
concisely convey the focus of the research effort.
2. The article fails to illustrate the innovative insights it seeks to provide, leaving unaddressed
the question of how it contributes to the existing body of knowledge. Furthermore, the rationale
for undertaking a systematic review and meta-analysis on birth preparedness and complication
readiness at the present juncture lacks explicit clarification.
3. In accordance with the Cochran systematic review framework employed in this study, it
is imperative to explain the precise research question guiding this study. Additionally, an
exploration into the meticulous approach adopted in the systematic review to address and fulfill
the parameters of the aforementioned research question is reasonable.
4. The introductory section of the manuscript is notably deficient in articulating the implications
of the study and explaining its unique contributions. The unclear importance of the study makes
it hard to understand.
5. A significant concern lies in the time-based scope of the literature considered, spanning from
2009 to January 2023. The rationale behind incorporating articles from 2009 remains unclear
and necessitates clarification.
6. Given the initiation of the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in 2016,
a program encompassing elements pertinent to birth preparedness and complication readiness.
To enhance the scholarly merit of the review, I recommend that the authors examine the goals
and objectives of this program, thereby fostering opportunities for the generation of insightful
perspectives and fruitful discourse among researchers and scholars.
7. Upon examination of the Community Health Workers (ASHA) program in the nation,
inaugurated with the inception of the National Health Mission in 2005, it is distinguished that
the ASHA initiative stands as an outstanding and robust community health endeavor within
the country. Notably, Module 6 of the program is dedicated to the acquisition of skills deemed
essential in preserving lives. It would have been advantageous had the authors incorporated a
discussion elucidating the integration of this program with the knowledge and preparedness of
pregnant women.
8. The clarity of the search terms appears to be lacking; subsequent to conducting an exhaustive
set of searches, their precision was found to be less than optimal. Discrepancies between the
stated outcome results and those derived independently were identified. Notably, considering the
article's explicit focus on pregnant women in India, an oversight observed in the incorporation
of this specific demographic criterion in the formulation of search terms prompts inquiry into
the rationale behind this omission.
9. The authors have indicated the utilization of four distinct search engines, namely Google
Scholar, PubMed, ProQuest, and the Cochrane database. However, the supplemental sheet
provided by the authors does not include the findings derived from the Google Scholar search.
10. The discussion section requires further refinement, as the authors predominantly rely on
quoting studies to outline differences, similarities, or improvements. To enhance the depth of
analysis, it is advisable for the authors to strategically choose few indicators they consider
pivotal for Birth Preparedness and danger identification. Subsequently, they should articulate
their perspectives on these chosen indicators and support their argument with existing evidence/
studies. The discussion presently incorporates certain indicators that may be more appropriately
situated within the results section, prompting the need for a reassessment of their placement.
11. In conclusion section, the authors propose the implementation of cost-effective awareness
campaigns targeted at women. It is imperative to explicate the characteristics and modalities of
these cost-effective campaigns, including the methods by which they should be disseminated to
women. My suggestion is consideration should be given to fortifying existing resources, such as
frontline workers and primary healthcare, as a strategic approach to augmenting the effectiveness
of awareness initiatives.
12. The variation in awareness and knowledge is contingent upon contextual factors, particularly
in urban and rural settings. It is expected that the authors have duly accounted for these
contextual nuances. Given the diverse socio-cultural landscape of India, characterized by distinct
cultural, caste, and class differences, there exists a notable influence on women's knowledge
and comprehension. It is imperative that the systematic review incorporates a comprehensive
consideration of these contextual intricacies throughout its analysis.