Title: Knowledge of the ovulatory cycle and its determinants among adolescent females in
Ghana
Version: 0 Date: 24 Aug 2024
Reviewer's report:
Dear editor, thank you so much for inviting me to review the manuscript. The study on
knowledge about the ovulatory cycle and its determinants among adolescent females is
informative. It has the potential to provide valuable insights for policymakers aiming to reduce
adolescent pregnancy rates in Sub-Saharan Africa, where there is a large adolescent population.
However, there are several points that need to be addressed before the study can be accepted
for publication.
Title- Title is bit long and would be better if you limit word counts.
Abstract
Method
• The phrase "All variables are considered statistically significant at 95% confidence level" is
unclear and should be rephrased to be more understandable.
• Include the 95% confidence interval (CI) for the finding (26.5%).
• Replace "multivariate logistic regression" with "multivariable logistic regression" to avoid
confusion, as "multivariate" suggests multiple outcomes.
• Ensure consistent use of either "AOR" or "aOR" throughout the document.
• The odds ratios (OR) should be reported to two decimal places.
• The statement that "women who used traditional contraceptives (AOR=1.542; CI=1.001–
2.375) were more likely to have accurate knowledge about the ovulation cycle compared to
others" is unclear. Please specify which types of traditional contraceptives are being referred to.
• In the results section of the abstract (page 1, line 26), the confidence interval (CI) is missing
and should be reported.
• Add a comma before the variable "used traditional contraceptives (CC)."
Introduction
Page 2 line 59, please revise the citation style
Methods
Could you please provide additional details on the sample size and the process by which it
was determined? Clearly reporting the sampling procedure is crucial to justify the statistical
methods used for analysis. If possible, could you also illustrate the sample selection process
with a diagram?
Regarding the outcome definition, I suggest replacing the terms "accurate" and "inaccurate"
knowledge with "good" or "poor" knowledge. The term "accurate knowledge" may overestimate
the respondents' level of understanding.
Another issue is about data analysis. As you know, the sampling method of the DHS is
based on a two-stage sampling technique, where households are selected from enumeration
areas, and participants are then selected from these households. This method inherently
introduces correlation, as participants are nested within both households and enumeration areas.
Additionally, there is variability between cluster level and the individual level. To properly
account for this variability and the correlation within clusters, the data analysis should follow
specific steps, and the model used should be determined by the data characteristics rather than
being chosen arbitrarily by the researcher.
Therefore, my question is: did you check for any correlation in the data? If so, what process
did you use, and which method was applied? Furthermore, given the multilevel nature of the
data, using standard logistic or linear regression models may underestimate the clustering effect.
Could you explain why multilevel analysis was not employed in your analysis?
Result
Table 1: Change "formal education" to "level of education." Additionally, it would be better to
include the frequency alongside the percentage, as you have only reported the percentage.
Table 2: You have labeled the analysis as "Binary logistic regression," but you reported Adjusted
Odds Ratios (AOR). Please clarify whether you used binary logistic regression or multivariable
logistic regression. Also, explain the use of both binary and multivariable logistic regression in
the methods section.
For both Table 1 and Table 2, consider making the tables more visually attractive. For instance,
merge the cells for the main variables instead of leaving them empty.
Discussion
Full stop page 10, line 195.
The discussion lacks depth. For instance, you mentioned that differences in accurate knowledge
are attributed to variations in the study population, educational level, and geographical and
cultural contexts. Could you elaborate on how these factors contribute to differences in the level
of knowledge? This question applies to all the variables you discussed.