Reviewer’s report
Title: 
Addressing the interaction between food insecurity, depression risk and
informal work: findings of a cross-sectional survey among informal women
workers with young children in South Africa.
Version: 
0 
Date: 
13 May 2020
Reviewer's report:
* Line 128 which says "Health care for pregnant women and children is
provided free of charge in PHC clinics, and there are high rates of antenatal
clinic attendance (94%) and facility-based delivery (96%)" appears to contradict
line 110 which states "Women who work in the informal economy in SA are
largely invisible in maternal and child health programmes and in efforts for
equitable economic development." Please clarify how health care and health
programmes are different. 
* Given the high burden of HIV incidence among young women in Durban, it
would be better if there was an updated citation for #35.
* The authors mention the perinatal as well as postnatal period in the
introduction without defining what time frame that encompasses. No definition
of postnatal seems to support looking at women with children aged 0-3 years old.
Perhaps the authors can explain why they chose this extended period, and what
the potential impacts are on 1) external validity of the depression measure and 2)
how it may bias the results. 
* The exclusion criteria mentioned excluding women who had been in the
informal sector for less than six months. Please explain the rationale for this.
Could it be that women after giving birth (and due to the many pressures
mentioned earlier in the introduction) are more likely to become informal
workers? If so, this could introduce a form of selection bias in the sample.
* The recruitment and sampling section is well detailed, however is missing one
crucial element—where were the women sampled from? Did it occur in door-to
door sampling, clinic based sampling, snowball method, or what?
* The methods section should have more detail. Generally the main variables are
separated from the data analysis section and include more detail. For example,
was the EPDS examined dichotomously or continuously? If the former, what
was the cut-off used and why? What about the Whooley Score? If both (which
appears to have been what was done), when was it used each way and why? Has
this scale been validated for use in SSA, South Africa, and or women living with
HIV? Same information needed for HFIAS and covariates. Some researchers
categorize binary food security scores as none vs. any (mild, moderate, or
severe). The authors should explain why they chose to categorize any and mild
together. Lastly, the details about the predictor -work type—should be described
in methods but outside of analysis. 
* The researchers say they use Stata V13 in line 165 and V15 in line 184. 
* It is advisable to try to map out the analysis section to mirror the aims of the
paper and the results section. For example, saying "first we look at background
characteristics. Then we did (step 2), then (step 3). This should match tables and
results. 
* Table 2 needs further clarification in the title and labeling, specifically of the X
axis (childcare). I suspect it is duration of leave taken but that should be
confirmed in the table title. 
* Table four is a bit busy. 
The denominator listed in the "Proportion in each
category" may be enough and is not needed for each cell but I understand why it
is there. It is confusing to say "Sub-categories of own account workers" as they
are not a sub-category of any of the above three categories of work. Could
perhaps just label Informal traders as "Own account: Informal traders". 
* Authors should avoid use of the word "many" (lines 252, 259, etc.) and "some"
(line 269) when describing a sample and instead use objective terms like
"approximately one-third" or "nearly half" which are more informative and less
subjective. 
* The authors refer to the child as "baby" in line 263 which is not consistent with
the use of "child" throughout the manuscript. 
* In line 293 the authors refer to EPDS as "risk of depression." It is technically
risk of postnatal depression and should be referred to as such. If it is validated
with women in a certain perinatal period, I do not think the authors should
include it for the entire sample and should just use the Whooley score. 
* Authors should explain why they used a cutoff of ≥13 if EDPS recommends a
cutoff of ≥10. Also this information belongs in the methods, not the results.
Further, many depression scales remove somatic items that may be related to
HIV when assessing depression among people living with HIV. Was a sensitivity
analysis considered using a modified version of either depression score?
* Line 300: a rate should be used when time is a denominator. For a cross-
sectional study, this should be prevalence. 
* Line 310 is the first mention of confounders—these should be described in the
methods. 
* Table 6: Please report OR, 95% CI, and then the p-value. 
o Why is age categorized as <30 and 30-47? Would be better to look at
continuously and perhaps instead of by year by every 5 years (if beta is very
small) and report the beta coefficient instead of OR. 
o Please review for basic grammar (mothers -> mother's) and correct use of
symbols (>= should be ≥ and used consistently; for example for income not clear
where 3000 goes). 
o Why is no/NA in the same category for father giving support and child
support? I am assuming cells are too small but that should be described in the
methods. 
o Not sure what the HFIA (actually referred to as HFIAS) corr in the bottom of
table 6 is for. Please elaborate. 
* In line 329, the authors use the term "interaction." I would caution and advise
against use of this term as it has a statistical meaning which does not reflect the
analyses done in this paper. 
* In line 345 the authors use the term "peri-partum" for the first time; like
perinatal and post-partum, these terms should be defined and consistency in
terms is encouraged. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
No
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
Yes
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
I am able to assess the statistics
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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