Title: Prevalence and determinants of maternal near miss in Ethiopia:  A systematic review and
meta-analysis, 2015-2023
Version: 3 Date: 05 Jun 2023
Reviewer's report:
Dear Authors,
We sincerely apologize for the misleading and delayed reviewer report that should have been
sent to you in a timely manner. As reviewers, it is our responsibility to provide constructive
feedback and help improve the quality of your work. However, due to unforeseen circumstances
and an oversight on our part, we regrettably failed to fulfill this duty. We understand the
importance of receiving timely and accurate feedback, and we deeply regret any inconvenience
or frustration this may have caused you. We are committed to rectifying this situation and
ensuring that you receive a comprehensive and helpful reviewer report as soon as possible.
Please accept our sincere apologies for any inconvenience caused. We value your contribution
to the field and appreciate your understanding in this matter. If you have any further concerns
or questions, please do not hesitate to reach out to us.
Once again, we apologize for any inconvenience caused and thank you for your patience.
Sincerely, Dr.Bahaa Aldeen AbdulRahman Hadi
1."Prevalence and Determinants of Maternal Near Miss: A Systematic Review and Meta-
analysis in Ethiopia, 2000-2023"
This revised title includes key elements such as the focus on maternal near misses, the systematic
review and meta-analysis methodology, the geographical context (Ethiopia), and the timeframe
of the included studies (2000
2. Feedback for abstract background and methodes sections:
• Abstract: a. The abstract lacks a clear objective statement, which should clearly state the
purpose of the study.
• b. It does not provide a summary of the key findings, making it difficult for readers to quickly
understand the main results.
• c. The abstract does not mention the implications or recommendations based on the findings.
• Background:
• a. The background section provides general information about maternal mortality and near
misses without clearly stating the research gap or the need for the study.
• b. It does not provide a concise and focused review of the existing literature on the topic. c.
Some of the statements lack specific references to support the claims made.
• Methods:
• a. The eligibility criteria for study selection are mentioned but do not clearly specify the criteria
for defining a maternal near-miss or the determinants.
• b. The search strategy is not adequately described, and specific search terms used are not
provided.
• c. The quality assessment process is briefly mentioned, but the specific criteria or tools used
for assessing the quality of included studies are not stated.
• d. The statistical analysis section lacks details on how the data synthesis and meta-analysis
were conducted.
• e. The assessment of heterogeneity and publication bias is mentioned, but the specific methods
used for these assessments are not described.
•  f. There is no mention of the potential limitations of the study, such as bias or confounding
factors.
Overall, the abstract, background, and methods sections could benefit from more clarity,
specificity, and thoroughness in order to improve the transparency and reproducibility of the
study.
2.Main notes recorded for results,discussion and conclusions sections:
Results:
• In the study identification section, it would be helpful to provide more details about the
inclusion and exclusion criteria used to select the studies.
• The flow diagram in Figure 1 should provide more clarity on how the studies were screened and
selected. The numbers and percentages of studies excluded at each stage should be clearly stated.
• In the study characteristics section, it would be beneficial to provide more information about
the quality assessment of the included studies, such as the risk of bias assessment.
• The description of the sample sizes of the included studies in Table 1 is incomplete. It should
include the sample sizes for each individual study, not just the range.
Discussion:
• The discussion section could benefit from a more detailed comparison of the findings with
previous studies. While some comparisons are mentioned, more studies could be included for
a comprehensive analysis.
• The reasons for the observed heterogeneity in the pooled prevalence should be explored and
discussed in more detail. Possible sources of heterogeneity, such as differences in study design
or population characteristics, should be addressed.
• The discussion of the factors associated with maternal near misses could be expanded.
Additional discussion on the potential mechanisms or pathways through which these factors
contribute to maternal near misses would provide a more comprehensive understanding.
Conclusion:
• The conclusion should summarize the main findings of the study more clearly and concisely.
• It would be helpful to include specific recommendations or implications for policy and practice
based on the study findings.
• The limitations of the study could be addressed more explicitly in the conclusion section,
acknowledging potential sources of bias or limitations in the data or methodology used.
Addressing heterogeneity, and expanding the discussion and implications of the findings would
improve the quality and impact of the results, discussion, and conclusion sections.
3.Feedback on references:
• Lack of consistency in citation style: The references follow different citation styles, which can
make it difficult for readers to locate and verify the sources.
• Incomplete publication information: Some of the references lack complete publication
information, such as page numbers or volume numbers, which can hinder readers' ability to
access the full articles.
• Missing DOI or URL: Several references do not include DOIs or URLs, which are important for
accessing online articles. Providing these details would enhance the usability of the references.
• Insufficient information on study design: Some references do not clearly specify the study
design employed, making it challenging for readers to assess the quality and validity of the
research.
• Lack of critical appraisal: The references do not provide any critical appraisal or evaluation
of the included studies. This information is essential for readers to understand the strengths and
limitations of the research.
• Inclusion of outdated references: While most references are recent, there are a few older
references that may not reflect the most current evidence on the topic. Updating the reference
list with the latest studies would enhance the relevance and accuracy of the review.
• Limited diversity of sources: The majority of the references are from the World Health
Organization (WHO) or focused on Ethiopia. Including a broader range of sources and studies
from different geographic regions would provide a more comprehensive overview of the topic.
• Inconsistent formatting: Some references have inconsistent formatting, such as variations
in capitalization or punctuation, which can affect the overall professional appearance of the
reference list.
It is important to note that these weaknesses are specific to the formatting and presentation of
the references, rather than the content or quality of the studies themselves.