PONE-D-22-16684A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, RwandaPLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

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Reviewer #1: General Comments:

Overall, the manuscript is well written. However, the meaning certain abbreviations should be clearly defined such L & D.

Specific Comments

Study design:

Although the choice of case-control study design was appropriate for the users and non-users of postpartum IUD, the sampling techniques and the ratio of users and non-users selected for study was not stated.

Results Section:

The tables referenced in the result section were not available for review in the submitted manuscript.

Reviewer #2: A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda

This study which aimed to ascertain factors that influenced postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda is quite relevant towards improving PPIUD uptake in developing countries which is vital for reduction of preventable maternal deaths.

Overall, the article has been fairly well written but there are sections that needs to be revised to improve the quality of the manuscript.

The quick point subsection should

Abstract

Abstract has not been written in accordance with journal specification for the subsections under the abstract. Please change discussion to conclusion

The result section stated that factors associated with PPIIUD (P-value <0.1) was what was used to make inferences. This should be reviewed and aligned with what has been written in the main text in which P-value P value <0.1 was considered for adjusted logistic regression analysis and not at the bivariate level

Conclusion is misleading due to the value of level of significance for which the null hypothesis will be rejected or accepted. (High chance of making type II error)

METHODS

Page 6, Lines 48-51: Paraphrase to:

Sites were selected because they were high volume facilities where CHWs and trained PPFP providers rendered PPFP services that included counseling in ANC, labor and delivery, postpartum (before discharge) and at 6-week infant vaccination visits

Page 9, lines 94-96:

Comment: The number of participants in this FGD seems too many to allow for a controlled and enabling focused discussion. Ideally it should not be more than 10 participants per FGD group. This is because large groups are difficult to control and they limit each person’s opportunity to make their observations or give their perspectives. This should be mentioned as a limitation to the study. How did the authors overcome this challenge?

Page 11, line 113

Comment: The reason for the compensation should be justified with a sentence.

Page 11, line 114-115

Comment: This was a case-control study; Therefore, the reports should be comparing the cases and the controls. Was the over 22% amongst women using PPPIUD currently or the non-users?

Page 13, lines 174-175

Comment: Rather than lump them as others which is not entirely true based on the responses. For example, not knowing or remembering a side effect doesn’t make it "others" and saying that there are no side effects doesn’t make it a type of side effect.

Page 14, line 198: Variables significant at P<0.01

Comment: This different from P<0.1 earlier presented in the methodology section. Please reconcile the two statements

Qualitative data:

This has not been reported appropriately: Please use the COREQ checklist and attach same as an appendix.

One important group which will answer the research question in the qualitative component of the study was conspicuously missing. This are the women who are eligible for PPIUD insertion. The omission of this group was a missed opportunity for a rich qualitative data from the perspective of the patients. This can be included in the limitation section

Tables

This was not attached in the manuscript

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Reviewer #1: No

Reviewer #2: Yes: Dr Godwin Akaba,MBBS,MSc,MPH,FWACS

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Attachments

Attachment

Submitted filename: Edit_PPIUD_Manuscript_09Jun22.doc

A mixed-methods study of factors influencing postpartum intrauterine device uptake after family planning counseling among women in Kigali, Rwanda

PONE-D-22-16684R1

Dear Dr. Wall,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Kehinde Sharafadeen Okunade

Academic Editor

PLOS ONE

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