Reviewer ’s report  
 
Title: Neonatal, Infant, and Child Mortality Among Women Expos ed to Intimate Partner 
Violence  in East Africa: A Multi -Country Analysis  
 
Version: 0 Date: 04 Mar 2019  
 
Reviewer: Angela Taft  
 
Reviewer's report:  
Response to authors  
This is a reasonably well -written paper about a very significant public health issue of the links 
between exposure to intimate partner violence and subsequent neonatal  infant and child 
mortality.  
My suggestions aim to improve clarity and readability. Please add page numbers  
 
ABSTRACT  
1. Background - please use 'low -middle' income countries rather than 'developing' (and in 
body of text)  
2. Methods - you do not need to des cribe the format of variables in an abstract nor say that 
they were extracted from a database. However, for your major exposure variable - IPV, you do 
need to say whether it included physical, sexual and/or emotional abuse.  
3. You do not need to say what s oftware package (STATA) you used in the abstract. You do 
need to describe what analytic method you used - multivariable logistic regression to generate 
your adjusted ORs and preferably what you adjusted for  
4. Did you check for modelling with goodness of f it testing, given the complexity of the 
model across countries and number of variables? If so, this should be stated. If not, why?  
5. Results - start with your primary outcomes not with SES and other data. So begin with 
your final sentence and report the o ther factors that also remained significant after the regression 
modelling. Suggest you do not include BMI as higher or lower than an BMI of 18 seems quite 
arbitrarily low and you do not justify, especially in Africa.  
6. Conclusion - suggest 'preventing an d reducing IPV should be considered etc.  
 
BACKGROUND  
7. Penultimate paragraph, suggest you alter sentences that say By 2030, all forms of 
discrimination, gender mutilation, and all forms of VAW 'will be eliminated' to 'By 2030, it is 
hoped that all forms of  etc…'  
8. Final para, 'change 'the reflection of mother upon child' to 'the impact of mothering on 
child development' or similar.  
METHODS  
9. Suggest DHS study design first or just describe the DHS before your methods of 
secondary data analysis. Explain tha t each country may have different years that they conduct 
DHSs.  
10. Please have a separate section describing how the DHS's include a module on IPV and 
describe how IPV is measured (generally use version of the WHO instrument), as it is your 
primary exposu re variable.  
11. Sample size and sampling techniques - this is where you need to explain that often only 
married women were interviewed for the IPV section and by women and in private (if this is 
true) or describe the differences. Please say whether all su rveys included the IPV subsection. 
Please use country name first and then n= for the number of women. Please include these in the 
tables, so that we can see the proportion of women who were abused in the sample. Did you 
mean that criteria for women include d were based on exposure variable (i.e IPV or outcome 
variables of reproductive outcomes? This needs to be clear.  
12. Conceptual framework and study variables. This section is confusing - I suggest that you 
begin with the framework, and then describe how y ou define the study outcome variables. I also 
strongly recommend you do not use 'success' as a neonatal death (it sounds a little insensitive, 
but I suspect this is a second language issue) but use 'present' and 'absent'.  
13. With the IPV variable, you nee d fewer words if you explain that three questions were 
asked and then list them.  You should then explain how you constructed your variable, do you 
include any incident as IPV being present?  
14. You do not explain why you have included BMI in this study ( yes, relates to birth 
outcomes but reference) and also explain why you chose under or over 18, as this seems very 
low and you should have at least three levels ( &lt;18, 19 -25, ≥26?).  
15. Please comment on levels of missing data for your major variables  
 
 
Results  
16. Please put the n for each country at the top of Table 3 and give more prominence to the 
proportion for IPV - place at top of maternal factors and make bold. This exposure variable is 
fundamental to your research question. Note that it increases  with age of child, as well as 
birthweight of child.  
17. Table 4. Add Pearson Chi2 instead of 'test statistic' as value and only give number and p -
value in columns. It is a very large table and could be omitted and a description of major 
significant factor s made.  
Discussion -  
18. State that the WHO multi -country study measured intimate partner and sexual violence 
against women.  
19. You mention your findings on BMI - how do they compare with other studies?? Please 
cite and reference.  
20. I am surprised that  you don't mention the obvious implications from your study, being 
that health providers (especially midwives and TBAs) require regular training and support to 
identify IPV and that the health system around the providers need to be IPV ready. See Garcia -
Moreno et al in the LANCET.  
https://www.thelancet.com/journals/lancet/article/PIIS0140 -6736(14)61837 -7/fulltext  
  
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the autho rs. 
 
Yes 
 
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 manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects req uire 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:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of  competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, f ees, funding, or salary from an 
organisation that may in any way gain or lose financial ly from the publication of this 
manuscript, eithe r now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents r elating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization t hat 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing inter ests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing inte rests or conflicts.  
 
I agree to the open peer review policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any at tachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be in cluded as confidential comme nts 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal