Title: Practice of Non-Institutional Delivery and its Associated Factors among Women Who
Gave Birth in Southern Ethiopia, 2022
Version: 4 Date: 28 Jan 2023
Reviewer's report:
Title: I admire the authors' efforts in developing this research title. It may significantly contribute
to the improvement of maternal health. My concern is that different researchers have tried to
study institutional delivery in different parts of the country, so I am not sure what specific
findings the authors of this research come up with. Non-institutional delivery, in my opinion,
means the reverse of institutional delivery. What benefits does this research provide the scientific
community?
I recommend that authors include the phrase "study design" in the title.
It is difficult to comment one by one without page and line numbers.
Abstract
Well-written
The authors did not clearly indicate the gaps; they simply said, "Non-institutional delivery and its
associated factors vary from region to region, and in addition, no previous study was done in the
current study area." The mentioned reasons for the need for this study are not convincing because
there are a number of similar studies in a similar study area, and the similar quantitative studies
may not be suggestive. Also, the authors used old data to show the prevalence of institutional
delivery in Ethiopia. Why not consider the 2019 Mini EDHS data?
Avoid using the phrase "In this study, 252 (97%) pregnant women participated" in the abstract.
Is it relevant to your research?
Change "lobar" into "labor."
Conclusion: What do you mean by "responsible bodies"? Specify the responsible body, and your
conclusion should be in line with the main findings.
Introduction
Clear and concise
Avoid subheading “Background”
In paragraph four and last line change citations [4] [6] into [4,6]
In the last paragraph, modify the objective based on the title.
Methods
Add a community-based cross-sectional study and specify the duration of the data collection
period if it is not clear.
The authors stated that they have excluded women unable to hear and speak, and had any mental
problems. From ethical perspective, exclusion of these people (people with disabilities) may
not be acceptable unless the researchers have convincing reason to do so. What do you think
about the impact of excluding them on your findings? Why did you preferred to exclude them?
What could be the best solution if you are not supposed to exclude them? Also, they did not
state the source population and avoided the sentence, "Those mothers, who couldn’t fulfill the
inclusion criteria."
Sample size calculation: The sample size is not adequate for the community survey. Why do the
authors prefer the 2016 study with 19% non-institutional delivery over the recent findings? For
example, an article that was conducted in Glabella 2021 revealed a prevalence of 71%, which
was cited as reference 14. You have also missed the design effect.
Sampling technique: the authors described the technique they used to capture the eligible women
from the health post-family folder. I have a concern about how the researchers precisely locate
women’s residential households after getting their list from the family folder? What do you mean
by "interviewing every other respondent in each Kebeles"?
Data collection and analysis
Take out the duplicate sentence that you already defined in the operational definition... Women
who mention three or more of the knowledge questions about labor problems are deemed to
have high knowledge, whereas those who mention fewer than three are deemed to have low
knowledge.
Put the variable heading before the operational definition and clearly indicate variables (both
dependent and independent variables).
How are your data's quality standards upheld before, during, and after collection? Each stage
should be properly described by the authors. Is the tool used to collect the data pretested?
Clarification is required for the analysis portion. I don't get your analysis. Bivariate logistic
regression must be used in place of binary logistic regression because the latter can be either
bivariate or multiple/multivariable. Substitute multiple or multivariable logistic regression for
multivariate.
Results
You have used the adverb “respectively” after long orderly presented results, which may create
difficulties for readers to match things.
Why have you intended to present the mother's knowledge about obstetric complications by
figure? Is there any significance to your research findings? I recommend that you submit it as
text.
In general, the result needs the author’s attention for language.
Factors affecting the practice of non-institutional delivery
The author has not clearly described this part. They clearly indicate the variables selected in a
bivariate analysis, and these became significantly associated with the outcome variable.
Discussion
Strong evidence is required to support the findings. The findings are not well interpreted in
terms of depicting future research areas and implications for practice. Discussion is not merely
comparison. Also, sometimes like result. For example……”Women who gave their previous
birth outside a health institution were 8.7 times more likely to deliver their current child outside
a health facility compared to their counterparts.” write this in result part.
Authors not included the limitations of the study.
Conclusion
The authors need to conclude with recommendations on the modifiable factors they found in
this study. Moreover, they need to show the implications of the findings for future research and
practice. Focus on your research objectives.