Title: Delay in seeking treatment and associated factors among women with pelvic organ
prolapse in Wolaita Zone, Southern Ethiopia: Hospital based mixed method study
Version: 1 Date: 14 Dec 2022
Reviewer:  Tadesse Belayneh
Reviewer's report:
Reviewers comment
This is a very important topic on a public health challenge in the LMICs that evaluate predictors
for delay in seeking treatment among women with POP. The study findings will be invaluable to
both the academic community and policy makers/implementer. However, the manuscript needs
the following corrections:
General comments
• Professional English editing is recommended. There are many writing and grammatical
mistakes.
• Adhering with Journal recommendations/guidelines (Font, font size, Heading and sub-heading,
line number, page number, word limit, abbreviations when it comes first ….).
• Make sure in using words/phrase throughout consistently (participants/women, factors/
predictors….)
• Combining of sub-section in Method section is recommended.
• “Method” section need through revision.
Specific/major and minor comments
Title
• Is “factors” or “predictors?” appropriate?
Abstract
• Adhere to the word limit.
• Keyword: change the words, already in title.
Introduction/background
• Authors ignore the inclusion of available evidence, especially when they stated on Factors.
Moreover, locally available evidence from Ethiopia are not considered. Authors should consider
the inclusion of variables affecting “delay” in Introduction and/or Discussion section.
• Authors poorly justify why they start to conduct this study: known and unknown are not
explained well.
Methods
• Methods didn’t follow standard format. The authors should check this journal guidelines and
correct accordingly.
• Study area/setting
- I did see the importance of stating all things in ‘setting’ section. Focus on statement which is
relevant to the topic (border, area, latitude, and distance from center…?). Give more emphasis
on included study area/hospital (beds, number of operation, any functional partner….).
- Is quantitative and/or qualitative data collection methods? Please elaborate on this.
• Source and study population
- Elaborate which women were included in your study: women visiting at OPD level or those
admitted for treatment? If in the OPD, Who confirm the POP, which staging criteria/tool were
used, and what was their definition?
• Sample size and sampling
- There is evidence showing 82.6% delay in seeking help in Gondar. Why 50% assumption to
calculate SS?
- Are women were homogeneous in seeking help to private and government hospital?
- Which type of purposive sampling technique was used by author?
• Data collection methods, Instrument and measurement
- Was the questionnaire pretested and validated locally? Any correction after pretesting/
validation? Was the technique of data collection interview- guided? How the Delay was
assessed, any model used for factors women face to achieve timely care?  Which version of the
questionnaire was used to collect the data?
- Authors explained that 12 months and above and 03 years to get treatment is considered as
delayed to get treatment'' How was determined this cut of? Why authors defined “delay” as 12
months and three years?  Why that discrepancy?
- Author would better include “Data quality issue” in this section than writing in separate sub-
section.
• Operational definitions
- Are these women having stage II included in the definition of “Delay in seeking care/treatment
of POP”?
- Remove already defined terms (POP…)
- There are variables (IDV) that still need operational definition. I recommend the authors to
consider.
• Ethical consideration
- Author miss this important section.
- Were the study participants provided informed consent for the study?
- Did the IRB approve the study?
- Did women with Advanced POP get treated after interview, if they were interviewed at OPD?
• Data processing and analysis
- Which software was used for Qualitative analysis?
- There are some statement which seems result. Revise it.
Results
Socio demographic characteristics
• Be economical in using words. Avoid repeated words and those which doesn’t add value to
the sentence. Reduce the text, because the information is also in the Table.
• Don’t start sentence with number. Use either percentage or number. If possible and appropriate,
explain using the word/phrase “more than half”, “majority…”
• Avoid double explanation: “More than half 222 (54%)…”…. of them completed
(2x)”…”Majority of them 250 (61%) presented with stage III prolapse “
•  Make Table in one page. Consider removal of Ethnicity and Religion. Educational status can
be grouped into two.
Magnitude of delay in seeking treatments
• Replace the “magnitude..” with “Proportion of delay in seeking treatment”
• “A total of 412 women with clinically diagnosed pelvic organ prolapse were assessed for their
time of initiation for treatment”. What does it mean by “clinically diagnosed POP”? Did you get
those women with three months, too much? Please clarify this in Method section.
• How many of the “clinically diagnosed POP” have stage III/IV?
Reasons for delay in seeking treatment for POP
• Please look agreement between text and figures (Text vs Table).
• Table 2: Rx – what it stands for?
Factors associated with delayed treatments
• Revision is a must, in general
• Mention Table 3 for both analysis bi and multi, as a reference.
• Table 3 must specify the meaning of COR and AOR.
• Good to mention the value of the Hosmer and Lemeshow goodness of fit test either in Table
or text.
• “The Women who lacked support were five times [AOR=4.88; 95% CI (1.8-13.23)]” It is not
five times, but almost five times. Revise other statement also.
• It is surprising that none of the sociodemographic variable are associated (except income), any
reason?
Discussion
• The statement in the first and second paragraph need rewriting.
• Lacks justification for the disagreement or agreement of findings. Moreover, it is good to
indicate the “so what?” or implication of that finding (magnitude and factors).
• Strength: …??
Recommendation
• The recommendation should be drawn from the results. They seem text book recommendation.
References: need revision