PONE-D-23-29229Spatial Distributions and determinants of intimate partner violence among married women in Ethiopia across administrative zonesPLOS ONE

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Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Following Strobe Checklist, these are some comments

1. Introduction:

It is necessary to not only mention that in Ethiopia, the identified prevalence of partner violence varies widely, with physical prevalence ranging from 31% to 76.5%, sexual prevalence from 19.2% to 59%, and emotional prevalence at 51.7%. It is important to specify the social norms and cultural characteristics that are related to this variation and high prevalence. Some of the articles cited by you mention religion, early marriage, and early initiation of sexual relationships as factors, but they are not described in the introduction.

2. A better justification of the research gap is required, to analyzing the data according administrative zones. It is unclear whether these administrative zones encompass different norms, cultures, languages, ethnicities, religions, or socioeconomic levels. It is necessary to describe the actual organization of the population and how there are related to the administrative zones and evaluate whether the analysis should be conducted based on other criteria. If necessary, include this information in the discussion and/or limitations.

3. Specify the study design. Is it a secondary analytical cross-sectional study based on the 2016 Ethiopia Demographic and Health Survey (DHS)?

4. Include general characteristics of the 2016 Ethiopian DHS, such as the complex design being random, two-stage, and balanced. What was the primary sampling unit, the household?

5. There is no information in the manuscript about the population selection criteria for the study (inclusion and exclusion criteria). For example, were women included who were selected for the violence module and were married or cohabiting in the past 12 months? Were women excluded if they did not have privacy when answering violence-related questions? Or if they did not respond to questions about physical, sexual, or emotional violence? Include a flowchart showing the population selection criteria.

6. Statistical power

It is important to describe the statistical power calculation to know if the information on factors associated with intimate partner violence according to administrative areas can include a type II error. It has only been analyzed up to regions, not administrative zones, in other of the articles that you cited that were also secondary analyzes of DHS Ethiopia

7. Specify whether the different types of partner violence were assessed based on the question about violence by the partner in life or in the past 12 months?. Provide more precise operationalization of outcome variables.

8. The independent variables considered in the analysis should be listed based on different studies that are not specified.

9.Statistical analysis

• The level of confidence considered in the statistical analysis is not specified (95%? 99%?)

• It is not specified whether any statistical test, such as the chi-square test with Rao-Scott correction, was used for the bivariate analysis in Table 2. Include the appropriate statistical test if applicable.

• It is not specified what criteria were used to include the adjustment variables in Table 3. Was it based on statistical criteria? If so, specify it. For some forms of violence, different variables were adjusted (e.g., education level for emotional violence, but not for sexual or physical violence). It should be explained in the statistical analysis section whether this was due to multicollinearity or correlation analysis, how it was evaluated, and the criteria used for exclusion.

• Specify the variables used to adjust the comparison model for different types of IPV in the administrative zones.

10. Results.

• Tables.

It is important to mention in the table footer of Table 3 what type of model was used to calculate those models (GLMM?). It would also be helpful to evaluate whether presenting both crude and adjusted models is feasible.

For Table 4, justify whether the power is adequate for comparing zones without a type II error. It may be appropriate to perform an analysis at the regional level. Include in the table footer the specifications used to calculate the analysis, and explain the initials used (BLUP Ranking).

11. Discussion.

It is important to contextualize the findings and discuss whether the geographic delimitation of administrative zones truly reflects the characteristics of partner relationships. Do the 80 ethnic groups in Ethiopia align with this delimitation?

Does partner violence differ within these administrative zones when considering the social determinants model?1 It is possible that some subsets of these zones share common characteristics (social norms, cultural aspects, population structure, religion, socioeconomic level, etc.) and should be analyzed together and contextualized. Additionally, there may be differences within some of these zones.

1Heise L, Greene ME, Opper N, Stavropoulou M, Harper C, Nascimento M, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet. 2019;393(10189):2440-54.

12. It is important to include the study limitations. Some potential limitations could be that the study is based on a cross-sectional design, which only allows for the identification of associations. Additionally, the violence data is self-reported, which may introduce reporting bias due to desirability bias, with individuals more likely to report severe or recent violence,

What happen if there was another person when they asked about intimate partner violence? If there was no privacy, it was recorded in the survey; if so, were they excluded from the analysis?

At Ethiopy DHS the question about violence it is reported who perpetrated the violence. Is it possible that the violence was committed by a former partner and not by his current partner? If there is that possibility, include it in limitations.

Are there any other self-reported variables that may be influenced by desirability bias?

Reviewer #2: Please check the formatting of the manuscript including spacing, punctuation, and grammar.

Methods:

The section should clearly mention that the analysis adjusts for the complex sampling design of the EDHS data by applying sampling weights. It is important to reiterate that all estimates presented are weighted to account for the sampling design

The selection and justification of covariates included in the model are not adequately detailed.

Results:

The interpretation of the spatial distribution results could be more detailed linking them to underlying factors (for example, cultural, socio-economic, regional factors).

Discussion:

While the discussion references existing literature, it could benefit from a more systematic comparison of the study’s findings with those of previous studies in detail. Currently the discussion is brief, but it could be strengthened by a more in-depth analysis of the findings, a clear connection to the Ethiopian context, and should delve into the reasons behind these findings comparing with the previous literature. Furthermore, the strengths and limitations of the study are not clearly outlined.

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Reviewer #1: No

Reviewer #2: No

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Spatial Distributions and Determinants of Intimate Partner Violence among Married Women in Ethiopia across Administrative Zones

PONE-D-23-29229R1

Dear Auhtor,

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