Title: A comparative study of menstrual poverty among urban and rural female learners in
government schools of Zambia
Version: 3 Date: 26 Sep 2024
Reviewer:  Antonio Bandala-Jacques
Reviewer's report:
Dear authors -
Thank you for submitting your reviewed manuscript.
Overall, I think that the manuscript has significantly improved after the latest reviews, and I
offer the following comments and suggestions:
INTRODUCTION
A) Overall, while the introduction is much clearer, I believe it can still be significantly edited
down. I would focus only on the most essential aspects to provide justification for your study
question. Paragraphs one, two, and three deal with very similar aspects (the causes and impact
of menstrual poverty), and could be edited down
B) There are still some editorial issues on the introduction, such as  "Based on the forgoing, lack
of menstrual pads by learners, leads to them missing miss school until their menses are done"
C) I recommend that the last sentence in your introduction is a well-defined aim or study
question. Your current last sentence, "Ultimately, the findings will inform targeted interventions
to address menstrual poverty, improve menstrual hygiene management, and promote gender
equality in education. " looks like it would better fit a conclusion.
METHODOLOGY
D) In the sentence ". This particular study design and approach where useful in obtaining
information that systematically described the problem. ", did you mean "were". But irregardless,
this,  and the next sentence "the qualitative data complemented in filling gaps in the quantitative
data and providing context on menstrual hygiene knowledge, attitudes and practices among
learners in both rural and urban schools in Kabwe district of Zambia's central province.", feel
like justification in the methods sections, and you have already discussed in the introduction
while you feel like you need to use these methods
E) The sample size calculation is now adequate - thank you for the corrections
F) In "Given the nature of the study, a multi-stage stratified random sampling technique
was utilized to determine the requisite number of participants.", I would re-word. the word
'determine' makes it sounds like a sample calculaiton. how about simply stating: "a multi-stage
stratified random sampling technique was utilized"
G) I understand the purpose of sampling with replacement, but I still believe that this, by
definition, could have led to selecting the same participant twice - which given your mixed
methods design, could have been problematic. Fortunately, this did not occur.
H) You mention "Only learners who had not participated in the one-on-one interviews were
eligible to participate in the focus groups.". However, in the prior paragraph you mention that
you interviewed "two head teachers (one rural and one urban), four female class teachers (two
rural and two urban), and four female parents from the Parent-Teacher Association (two rural
and two urban) ". There are no learners in this individual interviews
I) There is an out-of-place capitalization in "The questionnaire included demographic, socio-
economic questions, and menstrual poverty Knowledge, attitudes, and practice questions"
J) There is an extra "on" in "Descriptive analysis entailed generating statistics on (means,
medians, percentages, and frequency distributions)". Or remove the parenthesis. There is a
missing space in "whereas bivariate analysis involved generating cross-tabulations (based on
Pearson chi-square values at 95%significance level) "
RESULTS:
K) When you present statistics, such as "The average age of participants was 16.0±1.58",  is the
1.58 the standard deviation? If so, I would specify on its first use
L) In "Geographically, urban learners experienced their first menstruation slightly earlier at
113.1±1.34 compared to rural learners at 13.3±1.34.", there is an extra "1". Also, I would be
weary of making assertions when the differences are so small. I would argue that these were
not different.
M) Overall, I would avoid delving too much into descriptions of variables involved in the
sampling process. for example, since you selected participants from 'basic and secondary
schools', , and since sampling was stratified, it is expected for ages to be similar, and for
proportion in urban vs. rural schools to be similar (by design). I think this can be left to the table,
making the results more concise and focused on your outcome of interest
N) In "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." I would maybe revise to "formally employed"
O) In ""I engage in selling second-hand clothes, and I manage to make around K8,000.
However, after reinvesting in the business and covering various expenses, I usually end up with
K600." (Parent: School 1).", is is possible to specify within the parenthesis if this is an urban or
rural school? This is your primary outcome, so it would help give context
P) In "Even parents who held formal employment, which included tasks like cleaning toilets and
working on farms, earned no more than K1,000.", this implies that no parent whatsoever make
over K1,000. Is this correct?
Q) the interview extract ""I work as a toilet cleaner and earn K1, 000 per month." (Parent: School
B)." is identical to the introductory sentence right before. I would add a bigger excerpt
R) In "All the 447 learners interviewed, all of them reported knowing what menstruation is
(100%). ", please change the first work to "From" or "Out of"
S) In "(74% verses 50%)", did you mean 'versus'?
T) "Menstruation" is misspelled in Table 2
U) Please add column totals to the tables. For example, in Table 2, at the top
Urban (N= XXX) and Rural (N=XXX)
V) Is it spelled Chintenge or Chitenge?
W) "Term" is misspelled in Table 3
X) "Menstruation: is misspelled in the title of table 4
DISCUSSION
Y) Please consult the journal styling for citing, but it is customary to include the name of who
you are citing, such as Contrarily, a study by Bachloo et al., [30] instead of "A study by [30]".
Alternatively, remove the work "by"
Z) Your conclusion, albeit important, contains information not belonging to a conclusion. For
example "In conclusion, menstrual health of learners is an issue of great importance to the
government and organizations like UNFPA and Civil Society Organizations, as it is a significant
indicator of the development of reproductive health in adolescents and young girls.". I don't
believe you can conclude this from your study. I would shorten the conclusion and focus on
what you truly want your readers to take away from your important work.