Title: Home birth and its associated factors among mothers aged 15–49 years in Somalia: A
nationwide population-based cross-sectional study
Version: 0 Date: 29 Jul 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: The study estimated the prevalence of homebirth and assessed the
contributing factors among mothers of reproductive age 15–49 years in Somalia. The findings
provided additional evidence for policymakers to address home delivery challenges as well as
lower maternal mortalities in Somalia.
The theoretical construct for the study as well as the conceptual framework is appropriate.
REQUESTED REVISIONS:
What are the similarities between home delivery and homebirths? Define and stick to one
L17 contradicts L5/6…..If 75% give birth at home, more than 25% cannot have skilled birth
assistance
L18: what do you mean by “External environment”? Contextual?
L19-24: These are inappropriate patterns of reporting odds ratio. For instance, no formal
education, (AOR = 2.38, 95% CI: 1.84–3.06) versus primary or tertiary etc.
Also, what does AOR=2.38 mean?
L25/26: How can urban and rural residences, be associated with decreased odds of home
deliveries.?
L134: nomadic, rural, and urban sectors? Or areas?
L211: Multilevel model is more appropriate to explore the hierarchical structure of the data, why
didn’t you use multilevel logistic regression?
L213/219: what informed the sequence of entering the models into each of the four models?
Typically, you start from the individual level models -the predisposing factors…, followed by
enabling a etc and lastly add the contextual/societal factors
L260: Usually there are several places of delivery including mission delivery. So you can't limit
delivery places to homes and health institutions alone. Table 1 shows you have “others”…but
where are the others in Figure 1.
Table 2: how do you interpret 13.4% for institutions00 in the North-West? Your percentages
are wrong. Get a Biostatistician to help you
L290: what is “Poor household wealth”? This is called “women from households in the poorest
wealth quintile”.
Figure 3 is misplaced, you can’t present results within the discussions
Table 4: It is surprising that you didn’t include maternal age and age at first birth in any of the
four models, whereas they were both significant uncontrolled predictors
What are the policy implications of your finding
Can you elaborate on the study limitations and how you ensured that these did not impact on
the reliability of your findings