Reviewer’s report
Title: 
Spatial distribution and determinants of intimate partner violence among
reproductive-age women in Ethiopia: Spatial and Multilevel analysis
Version: 
0 
Date: 
18 Aug 2020
Reviewer's report:
Comment to Authors - BMWH-D-20-00679
In this paper, the authors sought to explore the spatial patterns of women's
experience of intimate partner violence in Ethiopia. The authors employed two
methods for their spatial analysis: multilevel modelling that accounts for
individual and community level factors; and SatScan for identifying areas of
significant clusters. The manuscript is well-written but needs improvement in
some sections before publication. Please find my comments below:
Introduction
1. The authors need to problematize the spatial focus of this research. That is, the
introduction needs to include a discussion of socio-cultural and socioeconomic
differences among regions or areas in Ethiopia. Such a discussion gives credence
to the need to examine spatial distribution and determinants of IPV among
women in the country. For instance, on page 13 line 267 to 268, the authors
allude to differences in women's access to education and information in border
areas compared to the rest of the country. However, there is no background
discussion that helps readers understand why women in border areas are more
vulnerable in these indicators compared to the rest of the country
2. I recommend the authors also update some of the references cited in this
section. There are a lot of works on IPV in the sub-Saharan African region recent
and even the East Africa region in particular; including works using spatial
analytic methods. Using old sources such as "Hindin MJ, Adair LS. Who's at
risk? Factors associated with intimate partner violence in the 377 Philippines.
Social science & medicine. 2002;55(8):1385-99" portrays the authors not being
abreast with the current literature. 
3. The authors made the following assertion in the page 4 line 79 to 80 which
they need to read carefully and revise accordingly: "Intimate partner violence is
widely considered as an indicator of women empowerment in the community
(22)". This statement conveys the message that is different from what the authors
may have intended. Are the authors saying IPV shows women's empowerment or
the presence of IPV show the level of women's empowerment in their
communities? You need to be explicit in your statement and discussion. This is
an issue throughout the manuscript. 
Methods
1. How were these community-level variables measured? Are they derived
measures from questions in EDHS or they are direct questions captured by the
survey? The authors need to clarify how these community-level factors were
measured and/or constructed. Additionally, the words "community media
exposure, community women empowerment etc." are ambiguous. What does
community mean here? Is it the cluster level or region level or what? Again,
reading recent works from SSA and East African region on IPV, community-
level factors and multilevel models would give an insight on how to define these
factors or clarify what they mean.
2. I don't think this bit of the outcome variable write-up is relevant: "The
response variable for the ith mother is represented by a random variable Yi with
two possible values coded as 1 and 0. So, the response variable of the ith women
Yi was measured as a dichotomous variable with possible values Yi = 1, if ith
mother had experienced intimate partner violence and Yi = 0 if ith mother didn't
experience intimate partner violence." The preceding sentence explains how the
outcome was constructed in plain language. 
Discussion
1. The authors need to strengthening the discussion For instance, you make an
excellent point on education giving women greater autonomy in health-related
issues and welfare, however, you completely ignored the socioeconomic
empowerment aspect. Traveling and seeking healthcare advice, in my humble
opinion does not offer strong or a plausible explanation of how education
reduces IPV among women. This socioeconomic empowerment enables educated
women to exit potential abusive relationships. See (note some of the cited works
are or cited in the reviewer's works. You are not obliged to cite them but rather
to strengthen your argument on the link between women's education and IPV)
Women's education, marital violence, and divorce: A social exchange
perspective. Journal of Marriage and Family, 75, 565-581.
doi:10.1111/jomf.12018
Variations in Emotional, Sexual, and Physical Intimate Partner Violence Among
Women in Uganda: A Multilevel Analysis. Journal of Interpersonal Violence.
https://doi.org/10.1177/0886260519839429
Gender, power, and intimate partner violence: A study on couples from rural
Malawi Journal of Interpersonal Violence, 29 (5) (2014), pp. 866-888
Intimate partner violence: Causes and prevention. The Lancet, 359 (9315)
(2002), pp. 1423-1429
What geography can tell us? Effect of higher education on intimate partner
violence against women in Uganda. Applied Geography, 106, 71-81.
2. Again, your discussion on the community-level factors and their influence on
IPV (page 14 lines 290 - 298) needs to be strengthened. You need to be more
explicit in your explanation of how these factors reduce the risk of IPV. You
should offer a brief but detailed explanation on how community-level
empowerment or control of economic resources or sexual behaviour reduce
women's risk of IPV
3. Limitations
a. Please explaining your weighting approach. Did you account for the fact that
you used a sub-sample (ever-partnered women) of the EDHS? The weight in the
EDHS is for the entire sample hence when you use a sub-sample you need to
adjust for that.
b. Your limitations should also include a critique of your estimation methods
(kriging). Note that the DHS sampling approach means any estimation on a
geographic scale below the strata (regions and rural/urban) is not robust. You
should acknowledge that there is a high degree of uncertainty in your estimation
of IPV across Ethiopia.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
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