Title: Review of Asherman Syndrome and Its Hysteroscopic Treatment Outcomes: Experience
in a Low-resource Setting
Version: 7 Date: 09 Jan 2024
Reviewer's report:
Dear Authors,
Important and interesting study about clinical features of Asherman syndrome in a low-resource
setting. However, there are some shortcomings, mainly in the method and result-section, of your
manuscript that need to be clarified.
Abstract
Background: I understand it as a previous reviewer asked you to write “mean age (mean±SD)
was 31±4.2 years” but I do not understand this.
Result: You write: “Most (47.5%) of them had severe Asherman syndrome” – but is 47,5%
really most of them?
Background :
Metod:
A cross-sectional study is a scientific investigation of a number of people carried out on a single
occasion. It thus provides a picture of a population at a certain point in time or during a short time
interval. Is this really what you have done? I am not sure that data collection between January 1,
2019, to December 31, 2022 (described in your abstract), can be seen as an short time interval.
In the method section, on page 3 you state that Data were collected from 1 to 31 January 2023.
To me this is a bit unclear.
I would like to have access to both the checklist and the telephone survey (the questions) that
were used in the study, to be able to evaluate the result.
Please, clarify the inclusion and exclusion criteria for the participants as this is unclear.
You state that 177 participants met the inclusion criteria, but in the result-section you write:
“only 177 study participants completed the telephone survey transcript, making the response
rate of 76%.” It is unclear for the reader how many participants were included in the study.
Under “Data collection tool and data quality assurance” the last sentence states: “The exclusion
criteria were considered” – meaning what?
Results:
That it is unclear how many participants that was included in the studies is recognized in Table
1, in table 1 patient characteristics is presented for 884 patients. This number is new for me as
a reader. More, the text above Table 1, describe marital status and state that 98.3% of the study
participants were married, but this is missing in Table 1. To make it clearer, print the number of
participants in the top row of Table 1 (this goes for all tables).
Table 2. 177 participants reported these factors described in the table?
Table 3 – this is more than the 177 participants that was included, and difficult to follow.
Then you write: “Almost all of the patients (97.7%) were prescribed prophylactic antibiotics
(Ampicillin, Ceftriaxone, or Doxycycline)…..” I wonder if it is 97,7% of 177 participants?
Please, clarify this.
Under the heading “Reproductive/obstetric outcomes” it is a good example of how you could
write to make shore the reader can follow. The first sentence states the number of patients and
then follows the %.
In Table 6 the total % is 100,1%, have you rounded the numbers correctly?
In Table 8 there are 174 participants, I didn’t follow what happened to the other three
participants. Did they drop of the study? Or how should I understand this number of participants?
Discussion:
You describe that you have “multiple data collection techniques, including telephone
interviews” but in the method section you describe a checklist and a telephone survey. To me
that is not the same.
Conclusion:
Formalities:
Make shore that all abbreviations under ABBREVIATIONS are written with bold text.
A reflection - is it the same institution that both gave the study ethical approval and paid for the
study? For me that is problematic.