Title: Use of reusable menstrual management materials and associated factors among women
of reproductive age in Ghana: analysis of the 2017/18 Multiple Indicator Cluster Survey
Version: 1 Date: 15 Jan 2022
Reviewer:  Williams Agyemang-duah
Reviewer's report:
Thanks for the opportunity to review the manuscript titled:  “Use of reusable menstrual
management materials and associated factors among women of reproductive age in Ghana:
analysis of the 2017/18 Multiple Indicator Cluster Survey".  This manuscript is of interest, well
written and falls within the scope of the journal. However, the manuscript will benefit from
some revisions.
Abstract:
1. The research gap driving the study is not clearly indicated in the abstract.
2. The rationale of the study should be included in the abstract
3. The authors’ used the word ‘older’ in the abstract, I think they need to be a bit specific. Older
in terms of what age. So the age should be added to this to make it read better. Also, they used the
word, “disabled”, for me, the use of the word ‘disabled” is not appropriate. Instead of disabled,
I will use word or phrase like “women with disabilities” or “those with disabilities”
4. I would be careful about using the expression, “interventions”. For many researchers, this
implies doing something like developing a vaccine and vaccinating an at-risk group. What you
are really suggesting is a change in policy or programme or creating a new policy or programme.
Other areas may benefit from this revision.
Background
5. You need to comment on the findings of previous studies and how your study builds on those
studies. It is not enough to just state that studies have been done on the attitude etc. You need
to go ahead to state what those studies found, their gaps and how you contribute to addressing
the gap(s).
Methods
6. Provide information on the study location and justify why  the location was selected for the
study
7. Page 3, ‘Data were analyzed using Stata/SE, version 16”.  We do not analyze data using Stata.
Stata is a software which houses all the analytical frameworks like regression, chi-square etc.
Thus, you need to modify the above referenced statement. You can say, we employed binary
logistic regression and chi-square embedded in Stata/SE version 16 as analytical frameworks.
Results
8. The results did not capture evidence on model fitting information. The authors thus need to
include information on model fitting to help readers determine the robustness of the model.
Discussion
9. In the discussion of the prevalence of reusable menstrual management material, the authors
should follow these 3 approaches.
a. Report studies that have found a higher prevalence than your study and justify why
b. Report studies that have found a lower prevalence than your study and justify why.
c. Report studies that have reported prevalence which is the same as the one reported in your
study.
Following the above approach will let you do a good discussion about the prevalence of reusable
menstrual management material.
10. The authors should strengthen the policy implications of the study in the discussion. Issues
like the implications for policy, practice and research should be extensively discussed in light
of the findings.
Limitations and strengths of the study
11. The strength of the study is not strongly discussed. The strength of the study should be
discussed in light of contribution to empirical knowledge and the methodology employed.
12. Considering the measurement of the prevalence of reusable menstrual management material,
the issue of under-reporting or over-reporting of the dependent variable is possible which
should be acknowledged as a limitation. Another possible limitation of this study is its cross-
sectional survey nature. With the use of cross-sectional survey, no causal relationship or
association between the dependent and independent variables could be determined. This should
be acknowledged as a limitation of the study.
OTHER GENERAL RECOMMENDATION(S)
13. Looking at the nature of this study, I think the authors can use Andersen’s Behavioural Model
to serve as a theoretical framework for the study. I am of the view that, this could strengthen the
current version of the study. However, this suggestion is not mandatory; authors can choose to
include it in the manuscript or otherwise.