Reviewer's report
Title:Attitude, myths and educational status of women affect women's intention to
use long acting and permanent contraceptive methods in Southern Ethiopia.
Mengistu Meskele1, Wubegzier Mekonnen2 1.School of Public Health,College of
Health Science,Wolaita Sodo University, Wolaita Sodo,Ethiopia 2.School of
Public Health,College of Health Science,Addis Ababa University, Addis Ababa
,Ethiopia
Version:2Date:26 November 2013
Reviewer: mussie alemayehu
Reviewer's report:
General:
The objective of the study is timely and essential for developing country setting
like Ethiopia where maternal mortality is high and CPR is low particular in LAPM.
However the manuscript needs a major revision before it is accepted for
publication.
Here I put comment in three categories
• Major revision
• Discretion revision
• Minor revision
-
Major Compulsory Revisions
On introduction part
• Writing the introduction in the context of the problem(The introduction needs to
be brief and focused)
On Method
• On the first paragraph add the reference
• On the second paragraph what are your key informants here????? On writing
the study period in case of cross sectional to mean that the data collection period
and it should be specified from this to this. If so be consistent here you write
January and on your abstract it say April/2013.So which one time is
correct???????
• On third paragraph it needs more clarification?????? On type of sampling
procedures???Total number of health center found in rural???The approach of
selecting the study participant?? Is that non probability sampling technique which
seems quota sampling technique??? What about case load of the Health
center???? Sampling calculation for the quantitative part?? Sampling technique
for the qualitative part???Number of in-depth interview????? What do you mean
non response in the case of your study?????
• On fourth paragraph add the reference from where you develop your
questionnaire
• What about the information about data quality control mechanism(training,
number of data collector and supervisor with their qualification and pretest)
• On fifth paragraph what was the baseline on category of knowledge as low,
moderate and high knowledge??????The same issue for attitude, what was your
baseline to category as negative Vs positive attitude????Replace the term with
multivariate binary logistic regression with multiple logistic regression models???
Do you check Multicolinarity test??What about the triangulation of the finding of
quantitative with qualitative part???in general add information about operational
definition????
Result
# What was your response rate is rate???? Is that 100%??? On the socio
demographic writing of the result start to write from age, residence, ethnic,
religion, education,
# General comment on writing the result part it is best to write the major result on
the text and include the other part on the table or graph
# Don’t want to have many paragraphs rather together for the information found
on your table in one paragraph???? For example you write here Table 1 more
than one times
• General comment on writing the result part it is best to write the major result on
the text and include the other part on the table or graph. Example on paragraph
one, 126 (30.9%) were from rural areas while the majority 285 (69.3%) were from
urban areas. So what is the importance of writing the information of rural
here????? The same comment throughout the whole document????? Then the
total percent is above 100% which is 100.2 %( 30.9% +69.3%).on the family size
the same comment with the above for the categories of 1-4 and 5 and above.
What is the importance of writing both mean and median here???And use this
typing of writing of standard deviation (SD =1.9) but not (+1.9 SD) or in line with
the writing style of the journal
• On the second paragraph, reparse it like this majority 249 (60.6%) of the
respondent were with the age group of 25-34 with mean age of 26.7(SD =---).why
you are interest to report the age with below mean and above mean????? Why
you write it both protestant Vs orthodox?????no information about this in your
table??? Rephrase it “Almost a great majority 370 (90%)” by almost all 370
(90%)”
• Third paragraph to use the standard one of writing the age of at marriage i.e
(<18 and 18 and above) why you write both mean and median together???
• On the fourth paragraph you put it like this “Seventy four (18%) respondents
experienced miscarriage, abortion, or stillbirth”. How many question are use to
ask this for the participants????? Moreover no information about this in your
table 1?????? Pertaining to the decision try to put the major result only and the
remaining part you can include it on the table??
• On the fifth paragraph add the table number at the end of the paragraph??
Check for the sum of the knowledge category it is 99.9%.on the result part you
can generalize about the finding???Example clients had low awareness on
LAPMs and Knowledge on IUD was poor from the qualitative part???There is
also poor triangulation of the finding of both quantitative and qualitative part and
it needs major modification here???Try to put is the main point rather list down all
the information says by the participants?????put the profile of the participants on
the qualitative based on your sampling procedure on the method part like you
say “One client and a family planning service provider were interviewed from
each selected health center” on your method part to mean that your key
informants were health professional as well as current women user of short
acting contraceptive. If so what was your criteria to select the study participants.
On the last part of the paragraph you say that “Providers also mentioned lack of
awareness on LAPMs in these communities. According to them women knew
implant & IUCD but not vasectomy and female sterilization. What type of
provider? Male/female/age/qualification?? Urban or rural health center???
Attitude part
# On the attitude part it needs rephrasing writing of the sentence in a good
style?????What is the difference b/n attitude/myth/misconception???? The same
comment with the above part??it needs reparsing the writing of the qualitative Vs
quantitative either it supplements or complements???? Some mix with
misconception?????
# At the last paragraph of the attitude……What does it mean with this sentence
“All of the 50 (12.2%) women who used LAPMs in Wolaita zone used implant?
The other LAPMs were not used in the study area” .i thinks your study
populations were those client uses short acting contraceptive????it needs
clarification
On the myth and misconception???
• How you calculate it the respondent who had misconception and myths as you
put it here like this: More than two-third (n=276) of women had different myths
and misconception on LAPMs. Try to reparse it the sentence again and it should
be attractive for reader????
• Don’t put it much more words in one sentence: like you put it here is not easily
understandable for the reader: One hundred nighty one (71%) of women
perceived that implant would cause hypertension while 162(58.7%) believed that
implant could move around freely in the body and lost at the day of removal,
187(67.8%) felt that implant causes illness, 116(42%) thought that IUCD resulted
in illness, 147(53.2%) perceived that implant leads to anemia while 196(71%) of
women believed that implant add body weight. The same comment for the
second paragraph you put here “Moreover, a third (n=32) of women perceived
that implant might cause infertility, 3.2% believed that it would burn the whole
body, 6.4% felt that it changes facial skin color to black while 3.2% believed that
using implant interferes with routine activity for persons engaged in energy
demanding jobs. The same comment for the second paragraph you put here “Yet
again 16% had……………….
• Moreover on the third paragraph of this rather writing of the quantitative and
qualitative part as a separate, best to write it for the idea you mention in the
misconception as well as myths put the qualitative finding either it supplement it
or complement it in a triangulation form in a brief manner and easily
understandable for the reader.
• In general I observe poor triangulation of the finding and vague on the
difference of myth, misconception and attitude???? What is the source of your
questionnaire pertaining to these issues? Is that standard???Is that
pretested?????You develop it personally??
Factors associated with women’s intention to use LAPMs in Wolaita, Southern
Ethiopia
• Do you have information about reproductive history???
• Rearrange it the writing of the result like this
o Women who had positive attitude were 2 times more likely intention to use
LAPM as compared with those who had negative attitude(AOR =2. 47: 95% CI
(1.48, 4.11)
• Is educational status significant at the multiple logistic regressions?????
Discussion
Paragraph one:
• On the justification of the study with Ambo it is not justified well and try to use
your finding for any justification and you say the low intention in this study area
could be due to the prevalence of various myths and misconceptions???? What
about the myths and misconception in Ambo town??
• On the implant intention what is the magnitude in this study??And tell us the
intention of women to use implant for the future in EDHS,2011 rather than putting
in general term
• Do you have finding in case of your study for the justification you put here “This
might be attributed to the trainings given to primary health extension workers on
Implanon insertion
• What is the importance of putting this idea “However, it is in contradiction to the
finding in Pakistan that showed higher level of intention to use female
sterilization” here cause you already put information on the above about implants
• What is the importance of adding reference number 13 here???
Paragraph two:
• Try to put information on the discussion part separately for female sterilization,
male sterilization, implant and IUCD cause it make difficult to understand on the
discussion part. Also include the magnitude of another study on the discussion
part for comparison purpose??? So rephrase it again paragraph 2??
• What are the indication of reference number 10 and 16 here??? What about the
reference for EDHS which is reference number “8” but you don’t put it here.
Paragraph three:
• Is that possible to compare your result based on the qualitative part only and
make it in triangulation form.
Paragraph four:
• What is the magnitude of the study of Pakistan, Rwanda and Mojo???
Paragraph five:
• What is the magnitude of the study of Ambo???
Paragraph six:
• Try to discuss the point you put it at the last of the paragraph??? Women who
had no myths and misconception on LAPMs were (AOR= 1.71 (1.08, 2.72) times
more likely to use LAPMs compared with those who had myths and
misconception.
What is the limitation of this study???????
Conclusion and recommendation
• Best to conclude about your finding after you discuss your finding by searching
additional literature? For me 38% intention might not be low???
• Your recommendation should be in line with your finding?????
-
Discretionary Revisions
• On title; I have suggestion pertaining to modify the topic like this
Intention to use long acting and permanent contraceptive and associated factor
……..
Minor Essential Revisions
On Abstract
• Method part:
o the data collection period should be specified exactly say in April/2013 since
your study design is cross-sectional study
o Add information about the type of sampling technique you employed to select
the study participants
o How it could be you calculate the AOR with binary logistic regression “Binary
logistic regression model with crude and adjusted odds ratio along with their 95%
confidence interval were used to measure degree and significance of
association”.
o add information about data analysis particularly the triangulation form
• Result
o Add information about the response rate
o Be consistent on writing the frequency sometimes you write “Only 156(38%)
women had the intention” and in other case you use “More than half (n=216) had”
throughout the document. I prefer to use number(%) like what you write it in
“Only 156(38%) women had the intention”
o What are the measurement you took measure attitude of the respondent and
make it clear and operational zed it clearly on the method part of your research
o It needs some clarification on the measurement the same to this issue
“Moreover, nearly two-third (n=276) had myths and misconceptions about such
methods”.
o Rearrange it like this “women who had positive attitude were 2 times more
likely intention to use LAPM as compared with those who had negative
attitude(AOR =2. 47: 95% CI (1.48, 4.11) for the sentence you write “The women
who had positive attitude were (AOR =2. 47: 95% CI (1.48, 4.11) times more
likely to desire LAPMs compared with a woman who had a negative attitude on
these methods” the same comment for all cases.
o The odds of women’s intention to use LAPMs were (AOR=2. 10: 95% CI (1.11,
3.98) and AOR=2.80: 95% CI (1.15, 6.77) times higher among women who
attained secondary and higher level of education compared with women with no
education(those women who had no education), respectively.
o Is educational status significant at the multiple logistic regression?????
On background
• In general it does not in line with your topic and try to give emphasis on the
intention and factors associated with it and its consequence and here you mainly
focus on utilization. So consider this again
• On third paragraph the CPR was 29% but not 27%
• On fourth paragraph since it is obvious remove the sentence of “The prevalence
of LAPMs was very low “Don’t try to mix the information of Ethiopia obtained from
EDHS,2011 with finding of report from SSA as you put in reference number
“5”.Here you write reference number “8” more than two times so it is best if you
write it after you finish the idea of interest. Example, in this case the paragraph
starts from “The utilization of contraceptive methods was totally dominated
………..the highest of which was observed for pills (70%), followed by male
condom (62 %)” should put under reference number of 8 but not 5.
• On 5 paragraph rephrase the sentence of “Wolaita Zone, one of thirteen zones
in Southern Ethiopia, is one of the most densely populated parts of the country
with a crude population density of 374.8 persons per square Kilometers”.
• At last of your paragraph add information why you are interested on conducting
this study this means significance of the study
Reference
• Reference Number 6 where is the place???
• Reference Number 10 who is the author of the document FMOH or Worku
K.????
• Reference Number 12 and 22 published or not????
General comment on the table, give emphasis on the calculation of the
percentage to come 100%
Table 1:the table writing style should be in line with the writing style of the journal
and why you put it socio demographic, knowledge and intention together????
• On the age percentage it is 100.1%???
• On education status it is 99.9%
• On the decision on the number of child it is 99.4%
• Is that multiple response in the case of awareness female sterilization, male
sterilization and implant and IUCD???Needs explanation???
• On the method intended to use in the future it is 100.6%
Table 2:
• On the line 2 the calculation of percentage is 97%????? And on the other case
in line 1=101%, line 8=101.1% and line 9 and 10=99.9%?????????? Check it
again??
• Avoid the word above mean and below mean on the category of attitude????
What about those scored exactly to mean????
Table 3:
• You use different number of the participants for the variable. Why???????
• It says two times for the variable of
Implant causes anemia (n=276) 147 53.2
Implant causes anemia (n=276) 97 35.1
• From which do you develop the questionnaire??
• What do you mean other??
General comments:
1. The authors need to have the manuscript edited by a native English speaker.
2. In general the paper is difficult to read and follow.
3. The conclusion and recommendations given are not supported by the results
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
'I declare that I have no competing interests'