Title: Determinants of quality contraceptive counselling information among young women in
Sierra Leone: Insights from the 2019 Sierra Leone Demographic Health Survey
Version: 2 Date: 20 Feb 2023
Reviewer's report:
The manuscript reports the determinants of quality contraceptive counseling information among
young women in Sierra Leone using the latest DHS in Sierra Leon. Overall, the authors
investigate an important factor in modern contraceptive use among women. Contraceptive
counseling is a crucial factor in family planning services. However, the study lacks some
fundamental theoretical framework that justifies this analysis.
Introduction
1-  the manuscript has an interesting topic and has valid point to be published.
2- the authors did not clearly indicate the gap in the literature. what is missing?
Methods:
3-  why did the authors choose the 15-24 age group? why not all 15-49 age group?
4- why did you choose an individual level outcome variable to measure the quality of counseling?
how accurate is that compared to facility-level observation and client exit interviews?
5- why do you have covariates that are not correlated to the outcome in theory? how does
exposure of women to mass media could affect quality of counseling? or women's access to
internet? age? religion?
6-the multivariate analysis is not valid because of the choice of the independent variables. not all
correlations mean causation. there should be a theory or at least a plausible hypothesis behind
the corelations.
For example, it is not clear how exposure to mass media or access to the internet could affect
the quality of contraceptive counseling. While it is possible that these factors could play a role,
there is no clear theoretical or empirical basis for such a relationship. Similarly, the authors did
not provide a clear rationale for including age and religion as covariates, as these factors may
not be directly related to the quality of counseling information.
Furthermore, the multivariate analysis is not valid because the choice of independent variables
is not based on a theoretical framework or a plausible hypothesis. Not all correlations imply
causation, and it is important to have a clear understanding of the underlying mechanisms that
explain the relationships between the independent and dependent variables. Without a theoretical
framework, the multivariate analysis can produce biased or spurious results, leading to incorrect
conclusions.
7- the authors did not include a discussion of potential limitations of the study such as selection
bias, social desirability bias, and the possibility of unmeasured confounding variables.
Results:
8- the authors did a good job presenting the results in tables and figures.
9- the presentation of the results lacks a clear interpretation of what the results mean in relation
to the research question.
Discussion:
10- the authors need to provide a more detailed discussion of the implications of the findings.
11- the authors did not discuss the policy implications of the results, especially in the context
of Sierra Leone.
12- the conclusion is not clear and does not summarize the main findings of the study.
Overall, the manuscript has potential, but it needs to be revised to address the issues mentioned
above. The authors need to clarify the research question, the rationale for the chosen variables,
and the limitations of the study. The authors also need to provide a more in-depth interpretation
of the results and discuss the implications for policy and future research.
In addition, the authors need to improve the validity of their multivariate analysis by using a
theoretical framework or at least a plausible hypothesis for the choice of independent variables.
Overall, the manuscript could benefit from a more structured and focused approach, with a
clear emphasis on the practical implications of the findings for improving quality contraceptive
counseling among young women in Sierra Leone.