Title: Predictors of contraceptive method discontinuation among adolescent and young women
in three West African countries (Burkina Faso, Mali, and Niger)
Version: 1 Date: 15 Dec 2020
Reviewer's report:
Dear authors, congratulations on the manuscript. However, before any decision can be made,
there are some issues that need attention.
ABSTRACT:
Even though you call it “background”, there is no information on the rationale for the study you
have performed.
Minor issue: line 25, YOUNG
The conclusion you made, even though is correct, does not reflect your findings, please address
that.
BACKGROUND
You have a very concise text on your background, but the main point is not approached: why
assessing that in three different countries? What do they have in common (and what differences
do they present) as to justify studying them? And why is that theme important to be looked at
in those countries? Please add information on that.
METHODS
The study setting is only about the description of the countries of the study (which could be
placed in the background part). You could just start the methods section with the “study design”
subsection.
On the population: I believe that a flowchart would be helpful for us to understand: how many
women (from 15 to 24 years old) were eligible for the study? How many from each country?
How many (from the women aged 15-24) were excluded and the reasons?
And just a curiosity: what were the contraceptive methods included in the study? Did you include
all kinds of contraceptive methods or just hormonal? You could comment on that and, if possible
(if you have enough data), perform a regression on level of education and types of contraceptives,
for example. I believe that this new look into your data will bring significative contributions to
policy makers in those countries (and also help with a better understanding of how to approach
those adolescents and young women, by offering them alternatives with less side effects). If you
only included hormonal contraceptives, then you need to discuss on that, and call attention that
women may have some alternatives, and this should be in your discussion. Also, I do not know if
this is a common practice there, but there are women that combine more than one contraceptive
method, and that could also be included in the discussion.
On the community level, I think you could describe, even if you need to add supplementary
material, what each region of the countries assessed has as general characteristics (and why those
regions were chosen to be looked at). That will be helpful to guide your discussion.
Regarding data analysis: I did not understand the time interval you have chosen. You collected
data from population studies from each country (Burkina Faso in 2010; Mali in 2012-2013 and
Niger in 2012). Then, you mention that you have followed up women from the last 5 years
(2015-2020). How was that possible? If that is not what happened, then a thorough description on
how you have obtained you data needs to be inserted in this data analysis. As this is a secondary
analysis, it is not clear if you interviewed the women included in the study or just used data that
was collected on those populational studies. Please, add a section on how data was obtained.
I know it may be implicit, but you estimated the risk of interruption of the contraceptive method,
but how is that linked to the risk of discontinuation? Do they mean the same (and if so, that is
not really clear to me)?
RESULTS
How many adolescents were included from each country? Please, add that information in the
general description of the sample. Why did you have over 75% of your sample aged 20-24? Is
that an issue regarding minors? Are they a part of the populational studies developed in those
countries? Why is that?
DISCUSSION
You start your discussion by stating “over the past five years” (line 220) and again, I did not
understand the time interval you are using, if that is 2015-2020 or any other time interval. This
five-year observation period you mention (line 129) is not clear as the population study you have
based your data collection are from 2010, 2012 and 2013.
And you see, looking at your results, I think that adolescents (15-19 years old) and young women
(20-24 years old) could be assessed separately, and discussed separately, especially considering
the factors such as employment, wealth and marital status. If possible, modify your discussion
as to include one paragraph to compare those subsets of your sample.
There is one discussion point that I believe you could discuss a little better: educational level
x discontinuation (and that will be easier to discuss if you clear that you have only considered
hormonal contraceptive methods – I have understood that, but you need to clearly state that in
your methods): the more educated, the more they are aware of the side effects of this kind of
contraceptive methods, and they may opt to discontinue the use and choose one method that
offers less potential harm. On the other hand, if those educated women work, they may have a
work need of controlling dysmenorrhea (hormonal contraceptives are the most used treatment
resource for that) as to not interfere in their work ability. Please add that discussion on your text.