Title: Self-referrals and associated factors among laboring mothers at Dilla University Referral
Hospital, Dilla, Gedeo Zone, Ethiopia: a cross-sectional study
Version: 1 Date: 26 May 2022
Reviewer:  Mohammed Hassen Salih
Reviewer's report:
Title:- Self-referrals and associated factors among laboring mothers at Dilla University Referral
Hospital, Dilla, Gedeo Zone, Ethiopia: a cross-sectional study.
Comments need to consider
Introduction part
Better to make it short on one page or try to minimize some sentences like the last sentence in
the introduction section” A self-referral trend by too many laboring mothers have been observed
at Dilla University Referral Hospital” may not be important as a researcher. It may create
researcher bias.
Methods part
I think we already know what is the meaning of SNNPR, DURH & PHC, but when we think
this paper will be used for international audiences it is better to mention their full-term first.
Why do you choose 50% for your sampling? I think we do have a lot of research you can use as a
proportion like the western Ethiopia study. And how you choose every other mother (systematic
random sampling technique) without knowing the number of mothers who will be attending the
delivery.
Self-referral operational definition good one but what about those mothers who already have a
follow-up in the nearest health facility but do not present with a referral paper? Please describe
clearly.
Again, on operational definition related to the perception of mothers, it is good to have the
reference. But how do you classify those mothers who scored exactly the median and why did
you choose median? You already write the answer in the result section. Therefore please edit it.
On the data collection part, which language do you use Amharic or Gedeofa, and how do you
make valid the translated version?
Result part
Please edit the language and each number in the scientific merit.
Please attach evidence of how you grouped age, family size & monthly income?
I don’t think this figure may not be a true representative about 225(60%) of the respondents say
they don’t have the information about the referral system.
For illiterate mothers how do explain hours or minutes from the health facility. Be honest, please.
Before you are going to collect the data do you operationalize what is clean water? Otherwise,
we may face difficulty.
Please revise table 2 in the standard format.
On the result section of the mother’s perception, we didn’t understand how you grouped the
mother perception Likert scale assessment.
I don’t understand why you put the mean on table 2 .. ?? please make it correct.
Factors associated with self-referral part
Please edit your result section based on one variable per paragraph and use scientific and
evidenced active verbs.
Dear Author your associated factor result says “From the perspective of the facility-
characteristic, mothers whose judgment was confident to the nearest health facilities have
adequate equipment and supplies were 42% less likely to self-refer than those who responded
they not confident [95 % CI: AOR; 0.58(0.354- 0.951) P-value = 0.031]” but on your table it
was different. It seems you may copy from other result or not properly edit it. The same as the
next one. It needs major revision.
To see the remaining data, especially in the discussion section we need to see a clear result and
then we can see each part
Thank you for your paper