Title: Factors associated with Female Genital Mutilation/Cutting in Tanzania: Insights from
Tanzania Demographic and Health Survey 2022
Version: 6 Date: 05 Jan 2025
Reviewer:  Violet Kimani
Reviewer's report:
Reviewer: Violet N Kimani
Manuscript Revised Review Report, Dec 2024
Corresponding Author: Pankras Luoga
Manuscript Title: Factors Associated with Female Genital Mutilation/Cutting in Tanzania:
Insights from Tanzania Demographic and Health Survey 2022
Re-review of the revised Manuscript
Introduction
In the introduction, the manuscript is approached from a global perspective of public health,
authors are adamant about the Tanzania situation, based purely on secondary data. However,
despite the change of title from “Prevalence and factors associated with female genital
mutilation/Cutting...” to the above, the manuscript content has not changed.
Judging from responses to my first review report the authors appear bent on defending their
case rather than addressing the broader global perspective of risks of FGM in Tanzania.
Understandably secondary data has limitations and possible bias, especially where the
respondent may not be certain whether or not the answer yes or no might be used against them.
Discussions and conclusions inferred purely from statistics, are left wanting.  According to the
authors, there is limited empirical literature on the prevalence and associated factors of Female
Genital Mutilation and associated factors in Tanzania, and the manuscript is intended to fill
this gap. Other than describing the four types of female genital mutilation, the reader remains
unapprised of the real social factors associated with FGM in Tanzania.
Survey Methods: The manuscript used secondary data from the Tanzania Demographic Survey,
2022. A weighted sample of 7678 women and girls in the age group (15-49) years was analysed,
from a total population of 15,254.  The data was collected from simple Yes or No codes,
without any probing for detailed reasons why FGM practice remains in Tanzania.  Independent
variables included age, education levels, marital status, type of residence, geographical zones,
wealth quintiles, current work status, distance to health facility, permission to access health care,
frequency of watching and listening to mass media, ever heard of Female Genital Mutilation,
FGM requirement by Region and whether or not FGM should continue.
It is unclear whether the individual women and girls reported their data or the mother reported
on behalf of herself and the younger female members of her household.
Distance is also vaguely reported, for instance, not a big problem remains vague or meaningless.
Analysis: Authors could consider further such as zones against education levels, poor, poorer,
medium and rich, richer, richest
of these variables may not mean much for readers unfamiliar with local terms like Region, and
wealth. Poor, poorer, and poorest.
In response to whether or not the investigating team participated in the demographic and health
survey data collection, the statement is no.
Results: Results are presented n statistical significance, determined at p value below 0.05. These
are presented in tables. Odds ration etc. statistical significance yes, but in reality associated
factors of FGM remain unconvincing.
A prevalence of 8.2% was established, previously at 17.9% in 1996, a decline of 50%. At
face value this is excellent effort. However without probes on how and why this decline was
achieved, the question of reliability remains how unanswered as Yes or No answers marginalise
respondents.
Discussions:  Discussions in this manuscript are based on inferences from the statistics. I agree
the authors did not engage respondents to seek answers to why and how, thus proposed a
participatory study could have updated information regarding reason for FGM decline. This
could easily have been obtained from a representative sample of women and girls from the
various regions.
Conclusions: The study established a national prevalence of (8.2%). Among women who had
undergone FGM, flesh removed was a dominant type of FGM practice by 89.2%. Women’s
socio-demographic factors associated with FGM include older age, rural residency, lower or
no education, poorest wealth quintile and being married were associated with reporting to
have undergone FGM. The authors recommend that the government, in collaboration with
stakeholders, develop tailored programs targeting zones with high FGM prevalence aiming
at empowering women through initiatives such as increasing educational opportunities and
improving their economic status, enabling them to combat FGM.
The term female genital mutilation might be unacceptable locally, according to the authors,
however female circumcision is technically incorrect. The authors should consistently use either
female genital mutilation or female genital cutting, rather than both, interchangeably.
In my view the manuscript has neither addressed perceptions of FGM nor added anything new
to the body of knowledge in the subject of FGM, globally or regionally. I am unconvinced the
manuscript earns status for publication in BMC Women Health journal.
Verdict: Reject the manuscript