Reviewer ’s report  
 
Title: DOUCHING PRACTICES AMONG WOMEN IN THE BOLGATANGA 
MUNICIPALITY OF THE UPPER EAST REGION OF GHANA  
 
Version: 1 Date: 07 Sep 2017  
 
Reviewer: Margaret P. Kasaro  
 
Reviewer's report:  
 
Thank you for conducting this research and effort to contribute to literature on women's health.  
I have some concerns on this draft as you move towards publication.  
My main comment is what is the aim and justification of the study and based on that what would 
be the appropriate conclusions to make. If the gap is that there is no data on this issue in the 
specific locale then it is justifiable to conclude with a definition of the problem and a 
recommendation on what should be next step to improve data or to remedy the problem. That 
said just to say that health care providers must use proven interventions may not be the 
appropriate thing to do here. The compelling reason why the research was done is not evident by 
simply making that conclusion. Phrasing the conclusion to include that the identi fied factors may 
be important information to guide formulation of interventions specific to this region may 
strengthen your cause.  
The next general concern is language and flow of information.The paper itself has information to 
discuss your topic of choice but will require further work to improve the language and flow of 
information. I will highlight a few illustrations - the definiti on of VD that has been provided may 
seem to be restricting VD to menstruation and post coital cleansing. In the paper there is 
information which actually indicates that you have the accurate information but have not just 
ensured everything needed is in the  definition. The next two sentences in the introduction also 
speak to the need to improve the presentation of your work. The first is  leaning towards a 
sweeping statement of this common practice globally and then in the next it is talking about 
incidence.  Please note that prevalence and incidence are different.  
 
Here are some specific comments on each section:  
Background - your literature summary seems to be emphasizing the bad of VD and not 
summarizing current evidence and then to highlight the gap that  your research wants to address. 
It may benefit from paragraphs addressing each point  
line 37 VD is not only practiced for post menstruation or after ciotus it may be a daily hygiene 
practice. Most literature highlight hygiene, health/therapeutic and sexua l enhancement. 
Contraception may be added to this list but may not be commonly cited.  
line 45 pay attention to tense vary here must be varies and this sentence and the next are not well 
linked  
line 54 highlights the deficiency in your definition of VD as h ere you have included more than 
fluids which is in your definition  
Line 57 seems to be a conclusion  
 
Methods - In the site and participants, please separate out the design description. The other 
comments are participants were from that area and not mainly from, this would imply you had 
participants from else where. Also, please do not mix information on participants and other 
procedures like the ethics. For data collection was the translation done as needed or the 
document was already translated? For the st atical methods, is cross tabulation sufficient for use 
in and describe your analysis?  
 
Results - The style of reporting results in your paper needs review to ensure clarity. Here  is an 
example, instead of - Table 1 presents the demographic data of the par ticipants. Majority (83%) 
of the participants were within the ages of 15 - 30 years, 13% aged 31 - 40 whiles less than 10% 
were above 40 years. Out of the total, 66% of the participants were single, 71.5% were Christians 
whiles over 90% had some level of f ormal education, - suggested format - Table 1 presents the 
baseline demographic data. In summary, majority (83%) were between 15 and 30 years, 66% 
were unmarried, 71.5% were christians and over 90% had formal education.  
Similar concerns and comments apply for the other results reported. In table 2 what is the 
difference between reasons for and factors influencing VD?  
For table 4 and 5 for associations you have selected presented p values, you have not include the 
statistic used for testing the associations which should indicate the directions of the association.  
What is the statistical method used, I recommend review to show the statistic used and how the 
conclusion can be made.  
 
Discussion section suggested flow - make a general statement on the findings of  your study for 
para 1, para 2 could be limitations and strengths, para 3 and so on (broken down per points) can 
discuss the findings in relation to current knowledge, is your data in agreement or not and maybe 
you can state some reasons for that.  
 
Conclu sion - although including health education at the end seems appropriate it may not be 
tying to what you have indicated as the aim of the study. It may be more appropriate to state that 
these identified factors may be useful in formulation of interventional  packages specific to this 
locale.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not,  please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manusc ript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of w ritten English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares  in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you recei ved reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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