Title: Effectiveness of health education intervention on intention not to perform female genital
mutilation/cutting in the future among key decision-makers: A Systematic Review and Meta-
Analysis
Version: 3 Date: 12 Sep 2024
Reviewer:  Ditte Søndergaard Linde
Reviewer's report:
Dear authors
It was a great pleasure reading this manuscript, which highlights how health education can help
combat the global issue of FGM. Well done for conducting an important and thorough study. I
will recommend the following changes to the manuscript before it is ready for publication:
Minor changes
1. Please specify if your protocol was registered on PROSPERO prior to study conduct or after
the study was started.
2. There are minor deviations from the protocol and the manuscript, e.g., according to the
protocol your primary objective is your second objective whilst secondary objectives are not
mentioned in the paper. Please clarify for the deviations from the protocol.
3. Please specify the dates for when the literature searches were conducted.
4. I suggested to restructure your methods section so that it alligns with the PICO-
SD (population-intervention-comparator-setting-design) order. Please state inclusion/exclusion
criteria under each element rather than stating exclusion criteria in one separate section.
5. Table 1 should be  a supplementary file. And supplementary file 1 should be table 1 and be
placed in the result section. It is much more interesting to get an overview of the included studies
than the specific search strategy.
6. Write out word, e.g. "can't tell" should be "cannot tell"
7. Please clarify how you made the judgment of what an "adequate sample size" was in relation
to excluding studies in your sensitivity analysis. I can see from your figures that you excluded
both very small and very large studies. Why did you exclude the large studies?
8. Figure 1: Please order boxes and arrows so that they all allign.
9. In the end of methods section it is stated that "The review included a total sample of 13,326
participants from all the included primary studies". We already know that you only included
primary studies from your methodology description above. Please delete "primary" in order to
avoid confusion.
10. Please specify how the randomised studies were randomised (individual or cluster
randomisation).
11. Please correct English to British English rather and American.
12. Please state the mean or median duration of the interventions in the result section.
13. The p-values stated in table 3 are unclear to me. I suggest that you report the p-values of
whether the difference between the individual subgroups are significant.
14. I suggest to order the discussion as such: Summary of key findings; Comparison with other
literature;  Strengths and limitations; Conclusions and recommendations.
Major changes
1. Seeing that "health education" is the main focus of the paper, I was surprised that there was no
elaboration of which type of health education the studies provided and the format of the health
education (e.g., digital, flyers, group sessions). This would be really interesting to know and
great interest to all readers. I highly recommend that  you add this description to your "new"
table 1.
2. You could consider to have another cut-off in your subgroup analysis of duration as below
6 months categorisation is a wide category that also contains very brief interventions of only a
few days. Further, you could consider having another cut-off for publication period and have
+/-10 years seeing the groups become very small in the current division.
3. The way that I read your funnel plot, the studies are not symmetrically. Please revisit this.