Title: Knowledge of obstetric fistula and its associated factors among women of reproductive
age in Northwestern Ethiopia: a community-based cross-sectional study
Version: 3 Date: 02 May 2022
Reviewer's report:
First, thanks for allowing me to review the manuscript entailed “Knowledge of obstetric fistula
and its associated factors among women of reproductive age in Northwestern Ethiopia: a
community-based cross-sectional study”. I honestly consider it a good piece of research, may
benefit from some adjustment, and can be published.
Title & Abstract
# Title of study was relevant and acceptable for publication
# There is duplicate information in the abstract section of the manuscript, such as the Banja
District, Northwestern Ethiopia, primary education, secondary education, and higher education.
# I propose rewriting the method section of the abstract to include all the relevant information.
# For example, data entry methods and statistical methods used to select candidate variables
for multivariate logistic regression, the adjusted odds ratio (AOR), confidence interval (CI), p-
value, and so on.
# When did the author collect the information? The beginning and end dates of data collection
should be clearly stated.
# Results: Mentioned the total number of participants with response rate, as well as the frequency
of study participants with good knowledge of obstetric fistula.
# Based on the P-value and CI, the author should choose only one variable from the educational
status of the participants.
# Conclusions: I propose adding the word "Only" to the conclusion section to make it more
palatable, especially for recommendations part.
#  To improve their understanding of obstetric fistula, the author should mention the responsible
body for their proposed recommendation.
Background
# Background information is presented clearly.
Methods
# Give detailed information about sampling procedures, techniques and data collection
procedure.
# The author stated in the abstract that study participants were drawn from six rural and one
urban kebele. However, kebeles are not mentioned in the sampling procedure section.
# How many kebles are available in each of the six sub-districts and the town?
#  As a result of this, how many kebles are included in the study? What does it mean, Keble?
because readers are not only from Ethiopia.
# How do you choose the first participants?
# Where did you administer the pre-test?
# The author indicates that changes and corrections were made following the pre-test. Please
inform the reader about what this entailed.
# A structured questionnaire was used as a data collection tool; The author should provide the
reader with a brief summary of the questionnaire's content.
# More information is needed for data collection. How were women selected to participate in
the study?
# How long did the interviews take?
# Where did you gather the data? In which location?
# Are there any other people available during the data collection process besides the women
and the interviewer?
# What is the occupation or profession of the data collectors?
# Is the author adapted or developed the tool?
# It seems that the authors created the tool after reviewing the d/t literature. because the author
has been cited in more than 7 research articles.is the author used a standard tool to collect the
data in this study or not?
# Is the author validated tool or not?
# Are the author check normality distribution of the data before using mean to categorized as
‘good and poor knowledge? if yes by what method are the author check normality distribution
of the data should be incorporate it.
Result
# The results are relevant. The data is plausible. The findings are represented in a tabular form
and a detailed description of table done. However,
# The author mentioned the following sentence “In this study, a total of 784 women of
reproductive age were participated, yielding an overall response rate of 98.6% (773)”.
# The preceding paragraph are confused the reader. if 784 women of reproductive age
participated in the study, it gives 100% of response rate.
# I propose change the sentence to :- In this study, a total of 773 women of reproductive age
were participated, yielding an overall response rate of 98.6%.
DISCUSSION
# There is a duplicated information on the first paragraph of the discussion with the study's
conclusion.
# The author mentioned sociodemographic characteristics as a possible explanation for the
difference in findings when compared to other studies. What sociodemographic characteristics
of the study's participants cause variation in the findings? why?
# The author should place the possible scientific justification of the study findings lower than
previous studies done in different locations.
# The primary issue to be addressed in this section of the manuscript is comparison and
contrast with existing literature. However, this section is currently lacking and reads more like
a comparison of the study's findings with other publications backed up by scientific evidence.
# What can health-care providers do to prevent obstetric fistula and its complications in remote
areas such as Africa, including Ethiopia? Please address it in the manuscript.
# What are the clinical implications of the current study's findings? Please include this in the
discussion.#
# One of the most important aspects to discuss when analyzing the topics, in my opinion,
is the clinical implications. Please consider focusing on that rather than making broad
recommendations.
Conclusions and recommendation
# This section should be simplified, and should be more highly tied to the data.#
# Based on the findings of the study, the author should make recommendations to the responsible
body and the scientific community.
Ethical considerations
# What ethical considerations were undertaken to protect the respondents’ privacy, anonymity
and autonomy?
Minor comments
# There should be a space between the last word and the brackets containing the references cited.
# It is preferable to use the same font style and size throughout. Use 1.5 line space and same
font style throughout the manuscript as per as the Journal protocol.
Finally, some of the references are outdated.