Reviewer's report
Title:Predictors of women's autonomy regarding their own and children's health
care utilization in Bale Zone: A community based study
Version:2Date:2 February 2014
Reviewer: Abebaw Gebeyehu
Reviewer's report:
While possibly an interesting paper, there are some methodological issues that
require clarification before acceptance.
Major Compulsory Revisions
1. The method part did not show the targets (study subjects) clearly. Did the
study considered all women who have under-five children? Did all mothers and
their children seek care? (Did the children experience any illness?). If they did
not seek care, they cannot be asked about their decision-making (autonomy).
2. After how many months (years) of seeking care they were asked? To judge
the effect of recall bias, it is essential to know the period of interview. Should be
stated in the method part.
3. From my experience, getting appropriate information about income is so
difficult in such kinds of community-based studies (most are farmers (76.5% not
paid). How the farmers’ income is estimated in the form of cash? What is your
ground to classify income in to three categories? It needs appropriate
description, otherwise better to remove and do reanalysis.
4. Similarly, the measurement of variables including “Mother’s knowledge on
MCH” and “Mother attitude towards MCH” are not clearly described.
5. In some of the variable, like ethnicity, religion, payment type and husband
educational status, small categories should merged and do reanalysis of your
regression.
6. I recommend merging Table 2 and 3 by considering AOR for all variables but
removing the p-values.
Minor Essential Revisions
1. “The objective of this study is to assess the level of women’s autonomy and
predictors of women autonomy regarding their own and their under-five children’s
health care utilization in Goba District, Southeast Ethiopia.” Their own and their
under-five children’s health care is not specific. Women autonomy (decision)
varies according to the type of care. Decision-making power (autonomy) should
be addressed by specific maternal and child services like ANC use, delivery care,
PNC, Immunization, child illness …. Good to consider at least as limitation.
2. This study involves both descriptive and analytic components. However, the
sample size calculation is only for the descriptive part. Because of it, the
regression analysis suffers from problems associated with very small sample
sizes in the categories of many variables when try to identify predictors. Please
consider in the limitation part.
3. “The data were collected by community health agents (CHA)”. However, the
education level of most of CHAs is not more than elementary, and they are highly
involved in the culture (patriarchic thinking). What measures you have taken to
reduce bias associated with this problem?
Discretionary Revisions
1. If the overall score of autonomy is calculated, it will be preferable to use linear
regression by treating the score as a continuous variable. Why you ignore this
option?
2. The study involves both qualitative and quantitative methods but the qualitative
part is not sufficiently addressed. It may be good to remove the qualitative
statements.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests