Reviewer's report
Title:Prenatal care and childbirth assistance in Amazonian women before and
after the Pacific Highway Construction (2003 - 2011).
Version:2Date:2 October 2015
Reviewer: Emma Williams
Reviewer's report:
Major Compulsory Revisions
1. The authors indicate that “The aim of this study is to assess changes in
prenatal care and childbirth assistance in the municipality of Assis Brasil, Acre,
before and after the Pacific road was constructed.” However, they have actually
looked at factors associated with use of prenatal and facility childbirth separately
during two time periods. They are saying that geographical access to health care
improved between the two data collection periods but not presenting any data to
support that. This can be made more clear from the start.
2. The abstract needs to be revised to reflect the main study findings.
3. This is sentence is unclear: “In 2011, the main association was found between
ethnicity and attending prenatal care. While only one non-indigenous woman did
not attend prenatal care, the lack of prenatal care among indigenous woman was
high (24%). Because of that, an analysis including only indigenous women was
performed. This analysis (Table 5) is based on a sample of only 59, too small for
regression analysis. I don’t understand the purpose of this analysis, and it was
not presented in the methods section. If the ethnic distribution had remained the
same during the two time periods, would coverage of prenatal and institution care
have improved? It would be useful if the bivariate analysis were shared to help
the reader understand this.
4. The authors state, “By using health care worker registries of all children under
five-years old living in the urban areas in January 2003 and January 2011, we
identified pregnancies and deliveries (and their 147 respective mothers) that
occurred from 1997–2003 and 2006–2011.” How are these records collected? Is
the completeness and accuracy of the data known?
5. The authors indicate, “We were not able to interview mothers that moved from
the urban area of Assis Brasil to rural or riverine areas or to other municipalities
between 1999 and 2011.” This seems like a potential source of bias, but it’s
unclear how many participants were lost this way.
6. A major limitation that should be discussed is that they have no variables
related to access to health care and other factors that could be used to explain
why there apparently was no increase in prenatal or delivery care use during this
time. Similarly, why is prenatal coverage so high relative to institutional delivery?
Surely other researchers have investigated this question, and this could be
added to the discussion.
Minor Essential Revisions
7. Alcohol and smoking are not usually considered predictors of prenatal care
use; the decision to include them needs further explanation.
8. Tables 4 and 6 – Titles need to be more specific so that the difference
between these two tables is clear
9. “It was not possible to adjust the multiple regression models for 2003 since
there was a small number of participants; for this year, we presented the results
of the univariate analyses in” –Note typo in this sentence
10. Explain why only vaginal deliveries were included in the outcomes.
11. Typo lines 259-260
12. Religion categories – adept vs. not adept – Explain what this means and why
it would be determinant of health care usage.
13. In the tables, write “p value” instead of “p valor” and use a “.” For decimal
point instead of “,”.
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests.