Title: Proportion of Stillbirth and Associated Factors among Women Who Deliver at Public
Hospitals in Bahir Dar city, North-West Ethiopia
Version: 0 Date: 30 Aug 2023
Reviewer's report:
Thank you editor for selecting me to review the research manuscript titled “Proportion of
Stillbirth and Associated Factors among Women Who Deliver at Public Specialized Hospital in
Bahir Dar city, North-West Ethiopia”
I would like to congratulate authors for their nice work.
Below are my review comments for authors.
1. Overall
- Edit your manuscript for English. Make shorter the long sentences and paragraphs to make
your manuscript more attractive and clear to readers.
- Don’t use indentation unless it is required according to the journal guideline
- Remove bulletins from your manuscript. Organize the contents in a paragraph.
2. Title
- Remove the word ‘specialized’ from the title; I don’t think it adds anything to your title.
- Change ‘Hospital’ to ‘Hospitals’. I think the study hospitals are two. See the suggested revision
to the title.
3. Author email address on the title page(see the details in the comments manuscript document)
- Only email of the corresponding author is required on the title page. Remove the PO Box and
phone. Remove email address of the remaining authors. See the journal guideline to authors
4. Abstract( see the details in the comments manuscript document)
Results:
-  You only show the point estimate of the still birth proportion. CI is also required.
- Result about factors presented here are not clear enough.  Re-write these results to make it
more clear. Include the compared categories clearly.
- Conclusions: I don’t see the difference between your results and conclusions. They are the
same.  Conclude your findings in a way that makes sense and make clear recommendations (who
should do what?) for them.
5. Introduction ( see the details in the manuscript file)
- Why did you use indentations for the first three paragraphs of your introduction and, of course,
in other parts of your manuscript? Is that according to the journal guidelines? If not, correct.
- References cited for contents under introduction are not appropriate. Check the detail in the
manuscript file.
- In your introduction, you reported that the stillbirth rate in Ahmara region, according to the
2016 EDHS, was 50 out of 1000 pregnancies. I think this is not right. I checked the 2016 EDHS.
The stillbirth rate in the Amhara region was 50 out of 2,105 total pregnancies. As a researcher,
you are required to be careful and genuine about such impactful national indicators. You don’t
need to mislead readers.
- Your introduction needs major modification. I suggest reworking the section, considering these
comments.
- Also include the listed information.
- Golobal, regional, and local magnitude and distribution of your outcome variable (stillbirths)
from the appropriate references.
- its consequence,
- factors associated clearly ,
- national strategies , achievements, and what is still a problem,
- Gap and justification of your conducted study.
• Gap and justification/rationale:  In your introduction, you stated that most previous studies
in our country were retrospective and lacked precise information regarding the occurrence of
stillbirth and related factors. But do you think that your study is stronger than EDHS and
other national level studies?  Check “Tesfay N, Legesse F, Kebede M and Woldeyohannes F
(2022) Determinants of stillbirth among reviewed perinatal deaths in Ethiopia. Front. Pediatr.
10:1030981. doi: 10.3389/fped.2022.1030981” which is based on the national perinatal death
surveillance data.
Also check other studies conducted in Ethiopia:
• Mekonnen Dagne H, Takele Melku A, Abdurkadir Abdi A. Determinants of Stillbirth Among
Deliveries Attended in Bale Zone Hospitals, Oromia Regional State, Southeast Ethiopia: A
Case–Control Study. Int J Womens Health. 2021;13:51-60
https://doi.org/10.2147/IJWH.S276638
• Lakew, D., Tesfaye, D. & Mekonnen, H. Determinants of stillbirth among women deliveries at
Amhara region, Ethiopia. BMC Pregnancy Childbirth 17, 375 (2017). https://doi.org/10.1186/
s12884-017-1573-4
• Mohammed-Ahmed A, Abdullahi A, Beshir F. Magnitude and associated factors of stillbirth
among women who gave birth at Hiwot Fana Specialized University Hospital, Harar, eastern
Ethiopia. European Journal of Midwifery. 2022;6(August):1-9. doi:10.18332/ejm/150354.
• Wolde J, Haile D, Paulos K, Alemayehu M, Adeko AC, Ayza A (2022) Prevalence of stillbirth
and associated factors among deliveries attended in health facilities in Southern Ethiopia. PLoS
ONE 17(12): e0276220. https://doi.org/10.1371/journal.pone.0276220
• Others
You need to base your argument on a convincing rationale and restate your rationale.
6. Methods and materials ( see the details in the comments manuscript document)
- Sample size estimation:  You used a confidence level of 97%, but the z score value you used
to estimate the optimum sample size is 1.96. I think z = 1.96 is for the 95% Cl. Why is that?
Your sample size would have been at least 448 with a 97% CL.
7. Results ( see the details in the manuscript file)
- The stillbirth rate is reported under the socio-demographic and socio-economic characteristics
heading. It should be reported under a separate heading, may be 'stillbirth rate’, including its
confidence interval.
- Table 1 and 2: Why do you need to have the column about ‘A respondent with stillbirth only
I don’t think it is important there? Suggest removing. Also see the tables for the revisions I
suggested to the column 4 and 5.
- Figure 1 & 2: Data are already included in tables 1 and 2. So, I don’t see the importance of
having these figures in your manuscript. Avoid repetitions.
- Table 3: remove proportion from the table. Frequencies are only required.
- Table3:  Why ‘NO’ is the first category in the obstetric complications variable? , why you
wanted to have it a reference category? I think there is some think wrong here. Suggest redoing
this analysis
- Table 3:  In partograph use, the last category is used as a reference category which is in this
case only. You cannot do this in the model. Something wrong. Redo the analysis.
- Associated factors: Muslim religion was one of the factors positively associated with stillbirths’
rate. How do explain this? Did you consider some confounding issues?
8. Discussion, conclusion and recommendation: should be re-worked.