Title: SEVERE MENOPAUSAL SYMPTOMS AND ASSOCIATED FACTORS AMONG
POST- MENOPAUSAL WOMEN IN AMBO TOWN, WEST SHEWA, ETHIOPIA: A
CROSS- SECTIONAL STUDY
Version: 3 Date: 19 Dec 2024
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This manuscript about severe menopausal symptoms has been
reviewed earlier and the authors have provided their responses fairly well. However, i read
the manuscript as new reviewer and providing my own feedback about concerns that were not
made by the reviewers on the initial version of the manuscript, based on my feedback i provide
a recommendation to the editor. Please consider my comments for improved version of the
manuscript for possible publication.
REQUESTED REVISIONS:
Overall the manuscript writing is of poor due to both technical language and use of English
language as well the structure of the manuscript (length and missing items as per STROBE
checklist).    1) background is lengthy and be shortened by reducing well known factors but keep
focus and severity of menopause symptoms in LMICs context and how such survey research
could inform clinical practice to improve quality of life among women in mid life and beyond.
2) methods is the weakest section of the manuscript--the replies on sample size are far from
convincing and they are not correctly written in the revised version. Why did the authors
not write sample size estimation in the initial  version--perhaps it was not priori determined.
Sampling is not multistage method--and therefore design effect is not needed. The MRS is a
tool for self-administer. The interviewer administered questionnaire was in which language?
Local language is not mentioned. Was the local language version validated. Please note that
MRS has been translated into many international languages. How the attitude and knowledge
measured, constructs and scale of measurement? Can the authors share the questionnaire? How
were variables on knowledge and attitude operationalised  into the analyses should be explained
in the methods section as per STROBE guidelines.  Finally what were the procedures followed to
identify those with diabetes and hypertension by the interviewers? How was BMI measured. The
entire methods section raises a lot of questions.  The study lacks methodological rigor therefore
the study lacks internal validity (raised by another reviewer)."