Reviewer ’s report  
 
Title: Barriers to essential surgical care experienced by women in the two northernmost regions 
of Ghana: A cross -sectional survey  
 
 
Version: 1 Date: 04 Feb 2016  
 
 
Reviewer: Laura  Harris  
 
 
Reviewer's report:  
 
I appreciate the authors' thorough and thoughtful responses to the reviews. I think that they h ave 
made excellent edits to the manuscript. I would like to acknowledge the significant amount of 
work that these edits entailed, and to congratulate the authors on the manuscript. In my opinion 
the manuscript is ready for publication if the authors addres s the few minor suggestions below.  
 
Line 99: The authors write: "While women had a slightly lower barriers to surgical care index 
than men, the actual significance of this difference is not yet known." I appreciate that the 
authors edited this statement p er my and reviewer 2's comments. However, given that some 
readers will be skimming the abstract and will be unfamiliar with the index, I suggest relating the 
statement back to what the lower index score may indicate while still acknowledging the 
uncertaint y, in order to facilitate conceptual understanding. One possibility: "Women had a 
slightly lower barriers to surgical care index than men, which may indicate greater barriers to 
surgical care. However, actual significance of this difference is not yet know n." 
 
Line 116: The authors write: "Given this gap between the burden of surgical conditions and the 
availability of surgical care services, the prevalence of unmet surgical need - a situation where a 
person has a condition treatable by essential surgical c are or is in need of a surgical consultation 
and is not able to access required care - even for common conditions (i.e. skin and soft tissue 
masses, breast and gynecologic problems) is high in LMICs.[4 -6]" 
 
I found new formulation of this sentence a bit con fusing and I suggest breaking it into multiple 
sentences. For example: "Given this gap between the burden of surgical conditions and the 
availability of surgical care services, LMICs have high prevalence of unmet surgical need - a 
situation where a person has a condition treatable by essential surgical care or is in need of a 
surgical consultation and is not able to access required care. This is true even for common 
conditions (i.e. skin and soft tissue masses, breast and gynecologic problems).[4 -6]"  
 
 
 
Some references may need to be shifted if the sentences are broken up in this way.  
 
Line 191: I think that the most appropriate term is purposive, as you had originally. I.e.: "sites 
were purposively sampled". I suggest changing purposely back to purposively, b ut it is fine if 
you prefer to keep it as purposely.  
 
Line 434: The first sentence of the conclusion now seems out of sync with the abstract and rest 
of the paper. To bring it more in accordance, I suggest adding "may" to this sentence - i.e. 
"Women in the  two northernmost regions of Ghana may have more barriers to essential surgical 
care than their male counterparts."  
 
Are the methods appropriate and well described?  
If not, please specif y what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects requ ire further  
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interest s, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from 
an organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the fut ure? 
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the cont ent of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you hav e any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand t hat any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal