Title: Pathways to medical abortion self-use (MASU): Results from a cross-sectional survey of
women's experiences in Kenya and Uganda
Version: 1 Date: 20 Nov 2022
Reviewer's report:
What is the underlying reason for including Uganda and Kenya in this study? And why those
districts?
I am confused about what their data are. Pharmacists and private providers each answered a
survey ? Or the data from providers was only registers? And the women coming to pharmacies
and clinics respond to a survey? Did they have to give consent? The specific data collection
methods need to be spelled out clearly. Two surveys and focus groups? And why do a purposive
sample? Their reason for doing so was never justified.
Why were qualitative data only collected in Kenya? Do the authors hypothesize that the
pathways are identical in Kenya and Uganda? Their other data say otherwise. Why is the sample
so incredibly unbalanced between the two countries? Were the qualitative respondents only
individuals who had used MA or also individuals who had inquired about MA? The text says
both. Transcripts were back-translated? That is highly irregular—why did the authors feel that
was necessary? How much difference did they find between the original and the back-translated
version? Was the analysis, then, done in Swahili? Why bother, otherwise? Who conducted
the focus groups? (“Providers”? Which providers? And that should be in the Methods, not
Discussion.) How were they trained? It’s unclear form “Outcome measures” which data they
are drawing on to measure those things. Suggestion to strengthen the manuscript: remove the
Uganda data.
Their results on the high proportion of women who received post-MA contraception is
anomalous. Also, I don’t understand these results: “Most MA clients (n=1,560, 89.6%) received
pain management (Kenya; 89.8% and Uganda; 89.0%). In addition, the majority (n=1,410, 81%)
were followed up for complications, (see Figure 1). Uganda reported the lowest rate of client
follow-up (54.5%).” From women simply buying MA from a pharmacy? That doesn’t make
any sense.
Always include line numbers and page numbers.
Their qualitative results are only from MA users, their interpretation of their data must make
clear that their results are from women who have overcome those barriers.
Abstract:
Poor sentence structure: “Communities are an important MA information source and need the
right information.”
“Low clients’ follow-up rates accentuate…”
Failing to construct parallel structure in sentences: ”Significantly more women were referred
for MA in Kenya (49.9%) than in Uganda (p<0.05).”
The English is incorrect: “Of 2,366 women, 73.6% accessed MA in both Kenya (79%) and
Uganda (21%).”
Keywords: MASU is used as a keyword before it’s even defined. “information,” is not a good
keyword, “pain management” is also too general.
Incorrect statements/poor writing: “unintended pregnancies have contributed to rising cases of
unsafe abortion”—why rising? “unsafe abortion continues to be a leading cause of maternal
death”—in Uganda and Kenya? “barriers to safe abortion still exist, with the need for a
clinical visit being a key impediment”—of access to MA… ”Many women and girls still resort
to informal sector abortion providers”—why “still”? “The need for information on SRHR
including contraception and medical abortion has grown among the youth,”—why “grown”?
“pharmacies…who” Focus group discussions are not “interviews.” “for combi pack” Incorrect
use of “On the other hand,” “one of the girls from FGDs” “pharmacists were not keen on
gestational age,” “more significantly unlikely” “data was”
“Results from the project indicated that the provision of accurate information and social/
emotional support to women and girls may enhance self-care.” This must be cited.
Where was BI3 implemented?
Missing punctuation: “with medical abortion use in Kenya and Uganda“ “and walk-ins Data
cleaning”
Incorrect possessive apostrophe: “pharmacies’ proprietors”
Redundant: “This cross-sectional survey on women's experiences with medical abortion self-use
at pharmacies in Kenya and Uganda was conducted to explore Kenyan and Ugandan women’s
experiences with medical abortion self-use.” And “40 girls and women who were MA users were
identified through the pharmacy where they had purchased MA drugs to participate in FGDs”
& “with a total of 40 MA users identified through the pharmacy where they had purchased MA
drugs.”
Pharmacies offering postabortion care services?
I don’t understand: “Ipas staff collected the quantitative data in the medical record registers from
registered pharmacists and trained healthcare providers at the private clinics selling MA pills to
women of reproductive age (WRA) and offering post-abortion care (PAC) services.” Were they
recording data from registers or administering surveys?
Incorrect verb tense: “Descriptive analyses for both dependent and independent variables were
performed and [ARE] presented in tables and graphs.”
I don’t understand Figure 1. The titles don’t make sense; the Ns should be included. I don’t
know what data source is.
When they say “the median cost of misoprostol,” how many misoprostol pills are they talking
about?
How are women getting IUDs from pharmacies?
I don’t understand: “The use of digitized data collection minimized opportunities for information
bias arising from transcription errors…” What was digitized and how did that minimize errors?
Missing closed parentheses: “MARS (Ipas Mobile Application Reporting System (MARS)”
References are incomplete. Missing journal names, Vol, No., etc.