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: 08 Jan 2023
Reviewer's report:
The authors conducted a study aiming to explore the reasons why patients delay seeking
treatment for prolapse in Southern Ethiopia. Overall, this study provides valuable data in a
topic where there is significant scarcity. Although the study was well-designed and strengthened
by utilization of both quantitative and qualitative methods, the manuscript requires significant
revisions with regards to grammar and wording.
1. Please provide more detail discussing how patients were recruited to participate. For
example, the authors state that “respondents were selected using a systematic random sampling
technique”. Please describe this technique in detail.
2. Where these patients recruited at the time of initial clinic visit when POP was diagnosed?
3. What proportion of patients were newly diagnosed with POP upon recruitment vs recurrent
POP vs diagnosed by an outside primary doctor?
4. The authors state that “ qualitative study participants were selected purposively form women
with advance stages of prolapses”. Please provide more detail into how these patients were
selected.
5. Consider providing a table describing the demographics/characteristics of the patients
included for the qualitative portion of the study.
6. The qualitative study participants were selected purposively from women with advanced
stage of prolapses. The interview continued until the information saturates (redundant data was
coming).
7. Can you provide details into what kind of treatments the participants elected to undergo?
8. If possible, please include the BMI or weight of the patients as this helps illustrate differences
among prolapse patients from different regions of the world.
9. If possible, please provide the sympomatology of the included participants? What was the
leading symptom? Vaginal bulge? How many patients also complained of incontinence?
10. The authors defined low income as those who earned less than 1200 ETB. To put this in
context for readers outside of Ethiopia, please provide justification for why this number was
chosen. For example, how does 1200 ETB compare to the median income, etc?
11. Consider ordering the list in table 2 from least to greatest in order of percent.
12. The authors report that “cultural influence” was a leading reason for delay but it is unclear
how this was defined?
13. The numbers and percents listed under the paragraph subheading “Reasons for delay in
seeking treatment for POP” are inconsistent with those listed in Table 2. Please clarify.
14. In the discussion, rather than simply stating that “this finding supports the study conducted
at…”, please describe how it supports the study. Describe your results in the context of the
results of the previous study.
15. The authors state in the conclusions that “Health sectors in the study area with other
concerned organizations are expected to carry out massive and continued behavioral change
communications”. However, it is unclear what this means. Please reword to more clearly
describe this recommendation.