Title: A comparative study of menstrual poverty among urban and rural female learners in
government schools of Zambia
Version: 2 Date: 15 Aug 2024
Reviewer:  Antonio Bandala-Jacques
Reviewer's report:
Dear authors. I have received your manuscript. After reviewing, may I offer the following
comments and suggestions
TITLE
A) I believe your title could me more informative. In "A comparative study of menstrual poverty
among urban and rural female learners in government schools of Zambia " Does this imply you
are comparing urban versus rural? That is why I get from the title. If not, you should rephrase
INTRODUCTION
B) There are some issues with spacing  and formatting in the manuscript, as well as some typos
(soci0-cultural, "by" instead of "buy" etc) Please revise
C) I suggest you rephrase "Menstrual poverty is a matter of deprivation that borders on the
welfare of menstruating learners which has been top of the discussions on international fora."
- it is difficult to understand
D) Your introduction is excessively long. I suggest you restructure it to keep only the parts
that are most relevant for your objectives, and remove additional information. For example,
paragraphs 2-4 mostly deal with the same themes and could be summarized. Additional
examples - paragraph five uses five lines to say there have been government and NGO efforts
to provide menstrual products and facilities
E) In Paragraph five , "$198 000 ". What currency is this?  Is this information truly relevant
for your objectives?
METHODOLOGY
F) You should better describe the source population before describing the study population
G) For your sample size calculation, this requires specifying what the outcome is. What is P
exactly? proportion of what? And how did you determine that P=0.5?
H) What were the inclusion and exclusion criteria of the study population?
I) Why did you sample with replacement? Did you interview the same girl twice at some point?
J)  For your data collection, you mention that you used semi-structured questionnaires for the
quantitative part? Would this not be for the qualitative interviews?
K) For the quantitative variables, you should clearly define and operationalize all of them. I
assume your main exposure was rurality of the location, and all of the rest are "outcomes". Please
define each of these variables
L) The quantitative questionnaire was asked by interviewers, correct? These are sensitive topics,
how did you ensure confidentiality for accuracy of responses?
M) What software did you use for que qualitative analysis? Did at least two independent
reviewers generate the codes? Howe did you handle discrepancies?
N) How did you collect the qualitative data? Did you only write down the answers or record
participants?
O) Did you have stopping criteria for the qualitative aspect? Was saturation reached?
P) you should cite any software you use, such as STATA
RESULTS
Q) Why is the average age 16 if you samples girls aged 13?
R) Additionally, you mention you sampled girls aged 13 because you assumed they had not yet
begun menstrual periods? But age of menarche varies considerably in Zambia
https://pubmed.ncbi.nlm.nih.gov/12320094/
This will be better clarified when you specify your inclusion and exclusion criteria
S) Figure 1 is mostly unnecessary. Pie charts are not very informative, and this information will
be easily presented in Table 1
T) I don't understand why you are comparing age across the strata if age is part of your study
design?
U) You mention "Findings indicate more urban learners (64%) than rural learners (53%) were
aged 16 years p = 0.016" What is the relevance of specifically comparing age 16?
V) Same for ". More learners in urban schools are in grade 10 or higher (62%), whereas majority
for learners in rural areas most of them are in grade 9 or lower (69%)." What grade they're in is
just a result of the sampling technique and associated to age, I don't see how this is relevamt
W) you mention "The data gathered from interviews revealed that parents who were not
employed were involved in activities such as peasant farming or selling items like groceries,
second-hand clothes, vegetables, or fruits. The income generated from these endeavours
typically ranged from K600 to K2,000. For instance, one of the parents mentioned:"  Pleas
specify what "K" is. Additionally, one could argue this is employment, just not "formal
employmeny"
X) For table 1, please add group totals to the columns
Y) In table 1 you present a P value of 0.000. P is a probability, and as such cannot be 0. It would
better to present it as <0.0001
Z) Nowhere in the manuscript do you mention the statistical test you used to calculate P values.
Please include in the methods, and as a footnote in tables
AA) You compare number of times learners receive menstruation pads with a T-test. Was this
normally distributed? It should be specified in the methods what process you used to choose
your statistical tests
AB) Please revise the results for spelling, language and formatting. there some grammatical
issues and duplications of words and phrases
AC)  Please add column totals to tables 2, 3, and 4
AD) Across the tables, for Yes/No variables, if they are the only two options, there is no need
to include both levels
AE) In Table 3, each row is a different subpopulation. Including totals for each variable can be
confusing. I suggest instead being more clear on what population each variable refers to
AF) Please improve the image quality of Figures 2, 3, and 4- they are pixelated
DISCUSSION
AG) I suggest you avoid phrases such as "In this study" as it is hard to determine if you are
referencing your own study or someone else's
AH) Overall, they discussion and conclusion adequately summarize and put the study in the
context of available literature