Title: Respectful delivery care and associated factors among mothers delivered in public health
facilities of Dessie city, Northeast Ethiopia: A cross-sectional study
Version: 2 Date: 08 Mar 2022
Reviewer's report:
I enjoyed reading your manuscript and it provides information on the respectful delivery care
which is very important issue, especially in Ethiopian context. But I have some concerns
regarding the manuscript, which have been provided underneath.
General comment: The manuscript has many topographical and grammatical errors. Therefore,
I encourage the authors to review the manuscript carefully and correct.
Abstract: Background of abstract section states Ethiopia has been implementing CRC, but there
is limited evidence on respectful delivery care. Why did you focus on respectful care, leaving
compassionate care? Please put the balanced summary of the methods used in your study in the
method section of the abstract.
Background: Please show why your study was needed to be conducted precisely. What new
thing it added to the scientific literature. Describe specifically health system factors you stated
at the end of the background.
Methods
Please explain your rationale for adding 10% nonresponse rate.
The method section states (Line 92 – 95), …‘Sample size was also calculated based on second
objective for different independent variables. But, the sample size calculated using single
population proportion was greater than the one calculated for the factor so, the final sample size
was (n= 390).’ Please show these calculations in the manuscript.
You stated the women were selected by systematic sampling procedure. But there is stratification
in Figure 1. Please write clearly the way you followed/the procedures of sampling.
Under operational definition, you listed questions used for assessing the outcome variable.
Please remove them and upload all the tools you used for data collection as a supplementary file.
The manuscript states (Line 133 & 134), …‘Supervisors and data collectors were trained on
the objective of the study, how to approach participants and take informed consent.’ Do data
supervisors and data collectors need to take informed consent?
Why did you use 0.2 cut off point to select variables for multivariable logistic regression?
Result: The result part is presented and written in a good way.
Discussion:
The manuscript states (Line 199 – 203), …‘The higher educational status of mothers was
positively associated with respectful delivery care. In contrast to this finding, studies conducted
in Tanzania stated that educated women were more likely to experience disrespect (26). This
might be due to the reason that those educated mothers might understand their rights better than
non-educated (counterparts) to follow physicians' order.’ The justification you provided holds
true in the context of your finding (educated mothers more likely experiencing respectful care),
but not when it comes to the Tanzanian findings (educated mothers more likely experiencing
disrespect). Please provide possible reasons for such variations, rather than providing a statement
congruent to your finding and incongruent to the finding with which you compared yours.
The manuscript states (Line 206 – 208), …‘The possible reason for this association might be
that complicated labour requires frequent and careful follow-up and monitoring that makes the
provider tiresome and keeping all her rights may endanger her life, especially in emergencies.’
Do you mean health care provider do not need to all rights of women giving birth at the time
of complications?
The manuscript states (Line 211 – 213), …This might be due to that health providers during the
night time may be disturbed and they may not act normally because they awake from sleep. The
justification you, the authors, provided sounds right in the context of the finding, but my concern
is, do health care providers go night-duty for sleeping? Or do all the providers work on-call duty?
….. ‘The possible reason for this association may be due to the fact that high client flow in
hospitals may makes the providers became very busy and highly burdened’. Please provide
research-based evidence that highly burdening and busy working of healthcare providers results
in less respectful care.
Recall bias: what is recall bias? The mothers were interviewed right at the time discharge (24
hours after delivery). Within this time, is it difficult for the mothers to remember how the
providers care for them?
Ethical approval and consent to participate: Please provide reference number for Ethical review
committee