Reviewer ’s report  
Title: A cluster randomised controlled trial to assess the impact on  intimate partner violence of a 
10-session participatory gender training programme delivered to wo men taking part in a 
groupbas ed microfinance loan scheme in Tanzania (MAISHA CRT 01): study protocol  
 
Version: 1 Date: 19 Sep 2017  
 
Reviewer: Suzannah Creech  
 
Reviewer's report:  
1) The authors of this submission are to be commended on undertaking such important and 
impactful work to improve the lives of women in Tanzania. I hope my comment s are helpful 
as they continue to refine this work.  
2) Abstract: lines 31 -36, the authors should specify that this work is being undertaken in 
Tanzania  
3) Abstract: lines 50 -58 and continuing onto the next page - the primary and secondary 
outcomes sound the  same to me - physical and sexual IPV in the past 12 months  
4) Page 6, lines 16 -21, please add detail on the 2030 Agenda for Sustainable Development. 
E.g. is this a WHO initiative, a UK initiative etc., and please add a citation if possible  
5) Page 6, the authors have a focus on physical and sexual IPV, and rightly so. However, I 
wondered why they do not increase their focus on psychological IPV? At least in US 
samples, psychological IPV is known to predict and precede physical and sexual IPV , and 
several studies have shown that psychological IPV is associated with greater mental health 
difficulties compared to other types of IPV. Something to consider.  
6) Page 7, lines 1 -7. Can the authors please add greater detail on what a microfinance 
intervention is, and what a gender and HIV training program is? Please include citations 
where possible.  
7) Page 7, 43 -46, I wondered throughout this manuscript if there was opportunity to refine the 
research question so that it is more precise - the research  question should include the 
outcome (IPV).  
8) Page 7, lines 44 -58, CRT1 and CRT2 sound the same to me. I do not understand a rationale 
for why one wouldn't examine the influence of both treatments if they are being 
conceptualized as treatments in one stu dy. The most rigorous method would examine IPV 
outcomes across all 4 groups (microfinance + gender training, microfinance + no gender 
training, no microfinance + gender training, no microfinance + no gender training).  I do not 
think the 4th no treatment c omparison group is present however? Perhaps it is the way this 
presented that is confusing. Something to consider is that the sample for the study is 
Tanzanian women participating in group microfinance. An alternative way to frame this 
study may be the fol lowing: Among Tanzanian women participating in group microfinance, 
this study seeks to examine whether a gender curriculum is associated with reductions in 
IPV in comparison to a no -intervention control group. I do not believe the microfinance 
piece is bei ng studied, so I think clarity could be enhanced if that aspect is described as part 
of the study sample.  
9) Page 8, aim and objectives - the primary and secondary IPV objectives sound the same. 
There are also added secondary objectives not mentioned befo re.  
10) Page 9, please explain what BRAC is (not sure it was spelled -out previously).  
11) Page 10 - Please add detail on the MAISHA curriculum. Who are the facilitators, what are 
sessions like? What is the content? Are there practice assignments etc… the table is helpful 
but not sufficient. What is the theoretical framework of the intervention? Why should it 
improve IPV?  
12) Page 10 - as noted prior - I am not sure it makes sense to conceptualize the microfinance 
component as part of the intervention. Rela ted to this, I am not sure the authors made a case 
in the introduction for why this population was selected (women in microfinance groups). 
This raises concerns regarding how representative the sample is of Tanzanian women.  
13) Page 11 - outcomes: again, p rimary and secondary are the same.  
14) Page 13 , lines 17 -34. Greater specificity is needed with regard to the measurement of IPV. 
Sample items and scoring are needed to understand how IPV will be measured (frequency of 
IPV? Incidents of IPV, yes/no etc).  Are all women in the study in relationships? This will 
need to be factored in as well.  
15)  Pages 14 -15. The inclusion of interviews, focus groups and photo voice raise great concern 
for me - these are  all added intervention (see literature on the Hawth orne effect) and in a 
RCT - may contaminate outcomes. The investigators will need to co -vary this out and/or 
remove these participants from analyses of primary outcomes given that their participation 
is so different. Participant burden is a concern here as  well.  
16) Page 15 - participatory observation - again, this is added intervention. If the authors wish to 
do this as well as the interview etc.  mentioned above - the study is best described as a 
treatment development study and not an RCT. If the authors  truly do not know the 
information that is to be gained from interviews, photo voice and observation, one might 
argue there is not enough evidence to support randomizing women to MAISHA, vs. no 
MAISHA.  
17) Page 17, line 1, one would expect a detailed stat istical analysis plan to be prepared now. 
Greater specificity would be useful throughout this section.  
18) Page 22, lines 13 -31 - now CR2 is described differently than it was on page 7.  Can the 
authors please attend to this and revise?  
 
A few remaining c oncerns to consider:  
1) What if all women in a microfinance loan group do not want to participate?  
2) How might length of participation in microfinance influence findings?  
3) Throughout the study the authors seems to implicitly subscribe to the view that w omen are 
victims of IPV and men are perpetrators. Therefore, this intervention and the way it is 
presented suggests that the responsibility for stopping IPV rests with the victims. The authors 
probably do not really believe this - however, this will have t o be dealt with more thoroughly 
in the manuscript.   
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
No 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
No 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
No 
Are you able to assess any statistics in th e manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
Not relevant to this manuscript  
Quality of wri tten English  
Please indicate the quality of language in the manuscript:  
Acceptable  
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