Reviewer ’s report  
 
Title: Use of contraceptives, high risk births and under -5 mortality in Sub Saharan Africa: 
Evidence from Kenyan (2014) and Zimbabwean (2011) Demographic Health Surveys  
 
Version: 4 Date: 05 Jul 2018  
 
Reviewer: Marshall Makate  
 
Reviewer's report:  
 
Many thanks for responding to my earlier comments, this is a much improved version of the 
manuscript. However, after careful read -through of the paper, there are few minor issues that still 
need some attention which I note below:  
 On page 6, Line 45 and 46, the statement "community -level variables were represented by 
the PSU of the data" seems odd to me.  What exactly do you intend to say? This will be less -
clear to the reader. If you meant that community -level variables were calculated using the 
PSU as the grouping variable, its better to be direct and say that instead.  
 
 On page 7, Line 47, change "effec t" to association. Effect appears much stronger and given 
that your analysis did not examine causality, it makes sense to tone down the language.  
 
 Page 7, line 56, "…was evaluated using…"  
 
 Page 8, Lines 9 -11. The model to be stated here should be "the mu ltilevel logistic regression 
model", not logistic regression model.  
 
 Please can you make the section on page 8, lines 4 -20 a bit more concise? For example, first 
sentence could easily be combined to include information on the levels considered. e.g. you 
could continue previous sentence by adding…."fitting of multilevel models in which 
individual women (level 1 units) were nested in communities (level 2 units) etc. etc..  
 
 On page 10, lines 43 -45, while I understand what you intend to say, but for consisten cy (just 
as you do in succeeding lines), it's much better to interpret the result "increasing birth order 
was positively associated with high risk birth (not vice versa).  
 
 Again, page 11, line 14 -15, see earlier point on consistency in interpretation of results.  
 
 On page 12, line10, start with "prevalence of contraceptive use,…."  
 
 Page 12, line 48, correct tense required…."women who had" not have. Again, consistency is 
needed in the use of past/present tense, see your statements on "lines 55 -59". If you  can stick 
to this style, will be good, not jumping around and switching back and forth as you do. Please 
check the whole manuscript for this as well.  
 
 On page 13, lines 29 -33, can you please give a brief rationale for this finding? Otherwise, if 
no expla nation is given, its not necessary to simply repeat this here since it has already been 
interpreted in the results section.  
 
 On page 14, lines 15 -20, I think the statement on the contradictory -nature of your findings to 
Chama -Chiliba and colleagues is ra ther misleading. From my understanding, Chama and 
colleagues focused on the role of community -level factors on the uptake of antenatal care 
services and your analysis focuses on the role of community -level factors on contraceptive 
usage. Clearly, you seem to be comparing apples to oranges here. The follow -up explanation 
for the reason for the contradictory in results is less convincing. How can you simply state 
that the reason for the difference "could be due to the fact that community level factors , are 
group variables and mostly aggregates of individual independent variables"? This, we 
already know by mere definition of community -level variables. You need to give reasons 
why community variables could on one hand influence antenatal care use and on the oth er 
not influence contraceptive usage.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the aut hors.  
 
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, plea se 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 require 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:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, 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 publi cation of this  
manuscript, either now or in the future?  
 
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 curr ently applying for any patents relating to the content 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 have 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 declare that I have no competing interests  
 
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