Reviewer's report
Title:Factors Associated with Utilisation of Postnatal Care Services among the
Mothers of Nepal: Analysis of Nepal Demographic and Health Survey 2011
Version: 1Date:22 June 2013
Reviewer: David Doku
Reviewer's report:
Factor s Associated with Utilisation of Postnatal Care Services among the
Mothers of
Nepal: Analysis of Nepal Demographic and Health Survey 2011
The topic of this paper is definitely of public health importance in a developing
country like Nepal where maternal and infant mortality is relatively very high
compared to developed countries. The paper would therefore be very important
for those working to improve maternal and child health. However, in its present
form, major revisions are needed before the paper can be published.
Below are specific suggestions that if addressed will improve the manuscript.
Abstract
Introduction
First sentence. Replace the phrase ” to save the life of mother and newborn” with
“to save the life of the mother and newborn.
Third sentence. Start the sentence with “The”.
Methods
There was a weird character after the word “care”.
Results
“Of the 4148 mothers, less than a half (43.2%) had attended PNC visits; and
40.93% attended immediate PNC (within 24 hours).” Please clarify if the latter
figure (40.93%) is out of the 43.2% who attended PNC or the total population.
In the results the authors reported some mothers (of higher age from hindu
region, from richer, etc) were more likely to attend the PNC visit. Compared to
what? The comparison group for each of these should be reported. In addition
the sentence should be broken into three or more for easy read and these
sentences should be well connected. Furthermore, the grammar and structure of
the sentence should be edited.
Conclusion
Insert “of the” between “half and mother” to read “…half of the mothers…”
The issues about mothers-in-law is definitely important in Nepal and some Asian
countries but the present study did not investigate the role of mothers-in-law
hence the conclusion should be based on the present findings
Keywords
Delete “cross sectional survey from the keywords”
Main manuscript
Introduction
Second paragraph
“For these reasons, postnatal has been proved to be an effective means to
reduce maternal mortality by providing message on danger signs, assessing and
managing the danger sings, providing education on family planning,
immunization, breastfeeding and personal hygiene.” Please provide reference.
Last paragraph
“There are only few researches from the developing countries but clearly show
the evidence that only few women recieve postnatal care in developoing
countries.” Apart from typo errors, this sentence is not clear. Please clarify.
Over all, the rationale for the present study needs to be strengthened in the
introduction.
Methods
The authors should describe the variables before statistical analysis
Statistical analysis
The first sentence is not clear. Please clarify.
There are also typo errors just as in the entire manuscript.
What kind of multilevel did the authors use? Do the authors mean multilevel?
Further, the rational for the use of the multilevel analysis and well as the
level/clusters with the data should be stated. There are repetitions of the
information presented under outcome variables.
Second paragraph of statistical analysis. The authors stated “Within the health
care factors, the place of delivery is likely to have the strongest effect on the
attending postnatal care.” This is a confusing statement that needs clarification.
The last paragraph of this section should be placed at the end of the description
of the data.
Outcome variables
A said earlier, this should be presented before statistical analysis section.
Explanatory variables
The section on ethnicity is not clear. Please reword.
That section also needs language editing.
Results
Characteristics of the respondents
Please edit the language to make this section meaningful.
Factors associated with attending postnatal visit
The first two sentences of the first paragraph is a bit of methods and should be
presented at the statistical analysis section.
This section too needs language editing.
The result section of poorly presented. For example the authors presented a long
change of OR ratios for various variables and stated compared to their counter
parts. But it is unclear who these counter parts are. The authors should revise
entire results section, particularly, the presentation of the logistic regression
results.
Discussion
The first paragraph. The authors should reword the first sentence to emphasise
that these diseases and mortalities can be prevented during PNC.
Second paragraph what do the authors refer to as low status utilisation of PNC
visits?
Third paragraph
The sentence “When the place of delivery was not in model, birth order was also
a significant factor assoicated with immediate PNC visit.” is confusing. Please
clarify.
Similarly, the sentence “Remoteness is an outcome of geographic difficulties,
access to the services and availability of the livelihood opportunities,” in the
fourth paragraph does not make sense. Please clarify how remoteness after
availability of livelihood opportunities.
The authors should explain further how economic disadvantage can affect PNC
visits, particularly in the context of Nepal. The entire discussion section lacks the
contextualisation of the findings.
The last but one paragraph on age is not coherent.
Conclusion
The three sentences of the first paragraph of this section are unnecessary
repetitions of the results
Again this section needs language editing.
Tables
Table 1. Are the p-values indicating the statistical significance of the main
effects? Please indicate in footnote what the p-values are for
Tables 2 and 3. Please add “among Nepalese, Demographic and Health Survey
2011” to the titles.
References
This section needs corrections. For example, the authors names are not correctly
presented in the following references: Neupane S, Teye Doku D: Determinants of
Time of Start of Prenatal Care and Number of Prenatal Care Visits During
Pregnancy Among Nepalese Women Journal of Community Health 2011.
19. Doku D, Subas Neupane S, Doku P: Factors associated with reproductive
health care utilization among Ghanaian women. BMC International Health and
Human Rights 2012, 12(29).
20. Chakraborty N, Ataharul Islam N, Chowdhury R, Bari W: Utilisation of
postnatal care in Bangladesh: evidence from a longitudinal study. Health and
Social Care in the
Community 2002, 10(6):492–502.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, and I have assessed the statistics in my report.