Reviewer's report
Title:"Every method seems to have its problems"- Perspectives on side effects of
hormonal contraceptives in Morogoro region, Tanzania
Version:2Date:6 August 2015
Reviewer: Vanphanom Sychareun
Reviewer's report:
- Major Compulsory Revisions
The author must respond to these before a decision on publication can be
reached. For example, additional necessary experiments or controls, statistical
mistakes, errors in interpretation.
Overall the quality of this paper would be greatly enhanced by providing and
using a conceptual framework to guide the analysis, findings and discussion to
tell a coherent story.
Outline what is known about FP experience of postpartum women and where
these studies have be undertaken
Pg 3 line 65 – what s meant by alternative sources of care? Are there any
settings in which other non-hormonal sources of managing fertility are not
available? It would seem that almost everywhere men and women can choose
other methods assuming they also have relevant information
End of page3 – what is significant about this research? How does it forward our
understanding of hormonal contraceptives? I think in the introduction you need to
make a stronger case of why this issue is important, provide a better overview of
what is already known and what your study adds
Under study setting provide a justification for the selection of Morogoro Region.
The section also needs editing and reorganizing as you jump from Tanzania to
the Morogoro Region and back to Tanzania. Start with the situation in Tanzania
more generally then move to the Morogoro Region
Also provide more information about the Morogoro Region – where is it?
Geography, demographics etc
Sampling – provide more details pf how the communities were stratified and
selected. How did this selection process allow you to explore nuances in
utilization?
How were respondents selected? How were Women who delivered in the 14
months preceding
the interview selected?
Explain how rapid ethnographic approaches informed the design and provide
references (this also seems to be in the wrong section (should be under study
design)
Who was included in the community-based interviews?
Given interviews took place in respondents homes or surrounding environs how
was confidentiality and anonymity assured? What safeguards were in place?
Who conducted the interviews? How many interviewees were there? What was
their gender? Occupation for the women, husbands, community? What
experience and training did the interviewers have? What language were the
interviews in? How was informed consent assured? Who was the filed
supervisor? Wat was their role?
Given you sought guidance from members of village health committees to
identify participants ow did you ensure diversity across socio-economic status etc
How many follow up interviews were needed? Did any potential respondents
decline to participate? If not, what explains the high response rate?
What was the role of the research assistants?
Some of the information under data analysis belongs under data collection
What type of information was collected – can you provide more detail
Who were the bilingual researchers?
Who were the regional and national stakeholders who helped refine the
framework for analysis?
Why was this done after and no the framework for analysis developed before and
then refined based on the data?
ATLAS is a data management tool, it does not analyse data
Provide more detail about the analysis process
The findings can be presented more concisely and under the themes, and
categories identified in the thematic analysis - Religious leaders, facility based
providers etc are not themes
Line 371 – have FP services in Tanzania been women-centered, excluding men?
Line 347-350 suggests that FP providers encourage men to come but men are
not interested which seems the opposite to your point in the discussion
In presenting quotes it would be useful to know if the views reflected are
representatives of most of the respondents or not
- Minor Essential Revisions
The author can be trusted to make these. For example, missing labels on figures,
the wrong use of a term, spelling mistakes.
Careful edit throughout there are some grammatical mistakes and some very
long sentences (e.g. first sentence of abstract) and do not start sentences with a
number
Line 75 - clarify which the poverty line
Line 355 “side effects continue to be an important reason for discontinuation of
FP methods, especially among women in the extended postpartum” You have
not demonstrated this is particular to women in the extended postpartum period
as there is no comparison.
Line 429 – you do not mention rapid qualitative data collection in the data
collection please explain the rapid nature of the qualitative data collection and
what was done to minimise the potentially negative effects of this
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
No competing interest.