PONE-D-24-35959Burden and Determinants of Self-Reported High Blood Pressure Among Women of Reproductive Age In Tanzania: Evidence from 2022 Tanzania Demographic and Health SurveyPLOS ONE

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Academic Editor

PLOS ONE

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Additional Editor Comments:

- In the logistical regression authors compare self-health status very bad to very good when there are only 4 very bad answers which leads to significant uncertainty. It might be useful to combine very bad with bad.

- Please proofread the entire manuscript for language corrections (there are some typos).

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: I Don't Know

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3. Have the authors made all data underlying the findings in their manuscript fully available?

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1:  Dear Editors and Authors,

Thank you for giving me the opportunity to review the manuscript, titled “Burden and Determinants of Self-Reported High Blood Pressure Among Women of Reproductive Age In Tanzania: Evidence from 2022 Tanzania Demographic and Health Survey”.

The authors of the study chose a very important topic related to high blood pressure (HBP) in reproductive age women. The authors used data from over 15,000 women from the Tanzania DHS 2022, and by employing a binary logistic regression model, the authors assessed predictors of self-reported HBP. They found that 6.6% of women, with mean age of 29.3 years, had HBP. In terms of predictors of HBP, older age women had higher BP, women with secondary education had higher BP, married and widow women had higher BP, richer women had higher BP, and women with self-reported poor health and recent visits to health facilities had higher BP.

My assessment of the manuscript is that it is well written and is well organized. The findings from this study have the potential to impact health interventions and policy to improve clinical guidelines on BP management and control, and to improve women’s health as a whole. However, the authors need to address the following issues before the paper can be considered for publication.

Abstract

The word “bracket” can be changed to “group” here, and elsewhere in the manuscript.

In the conclusion, it says “This study highlights the substantial burden of …”, and I’m not sure whether the 6.6% burden is substantial. The authors may opt to delete the word “substantial”.

Introduction

The introduction section starts well; however, when it narrows down on identifying the research gap, it fails to provide relevant and convincing evidence to justify the study, which is to examine the prevalence and predictors of HBP in women of reproductive age who are mainly young women 15-49 years old. Considering HBP is more prevalent in older people, mainly 50+ years, the authors need to provide strong justification for choosing this study population and examining HBP among them.

Methods

Under “study population and sample size” the authors should provide some narrative on what the study power is, using the sample size of 15254 women.

If there is a question on use of anti-hypertensive medications in the TDHS2022, the authors may use it to define their outcome, in the addition to the question “whether a participant reported having HBP”.

Results

Under “burden and determinants of self-reported HBP” the authors do not need to report p-values for aORs. However, aORs (95%CI) are enough in the narrative, and aORs (95%CI) and p-values can be kept in the tables. In Table 2, the authors should report aORs for “Wealth status”, Smoke cigarette, Self-report health status, Birth in last 5-years, because currently the authors have deleted them.

Discussion

The discussion needs to start from “The study found a 6.6% prevalence of ….”. Please delete the sentences about this, as they are unnecessary and redundant.

Under “strengths and limitations”, please start by stating the strengths of the study first; then write the limitations. One of the limitations that the authors did not discuss is the lack of data on BMI (or other measures of obesity), on dietary habits, diabetes, and on daily exercise. These are important confounders of HBP. Furthermore, the authors stated that this sampled population may genuinely represent the Tanzania population. I do not think this is correct, given the sample covers only women 15-49 years old, with mean age 29.3 years. The sample seems to be from a younger population, and we know that HBP is more prevalent in older people (e.g., 50+ years). In addition, this sample covers only women. There is evidence that sex is associated with HBP. Thus, this sample cannot be a reprehensive sample of the Tanzania population. The authors should acknowledge this as a limitation.

Reviewer #2:  Dear Authors,

The manuscript discussed the prevalence and determinants of self-reported high blood pressure among women of reproductive age in Tanzania. The authors provided good information about the prevalence and the determinants of HBP based on the data from a national population-based survey with good number of samples. However, the authors need to revise the manuscript as below points to improve the quality of this paper.

Introduction

1- Please add a paragraph on why it is important to investigate the prevalence of high blood pressure among women of reproductive age. Why you chose this age group? And please provide a literature review of similar studies about prevalence and determinants of high blood pressure about women of reproductive age.

Result

1- In table 1, you can delete the frequency and percent for answer “No” to the self-reported high BP. Presenting data for yes, can show the frequency and percentage for “no” answer as well. I have the same comment for table 2. I recommend you present the bivariate analysis results in table 1 and the results of multivariate regression analysis in table 2.

Discussion

1- I recommend comparing the result of your study with the result of studies that reported the prevalence of high blood pressure in the same age group of female patients in Tanzania. It will show the difference between prevalence based on self-reported HBP and health facility reported HBP. In addition, I recommend discussing more on the trend of HBP prevalence among women till 2030 and connect your recommendations to the Sustainable Development Goals.

Reviewer #3:  Dear Editors and Authors,

Thank you for the opportunity to review the manuscript titled "Burden and Determinants of Self-Reported High Blood Pressure Among Women of Reproductive Age in Tanzania: Evidence from the 2022 Tanzania Demographic and Health Survey."

Overall, the manuscript is well-crafted, logically structured, and addresses a significant public health issue. The findings have the potential to inform health interventions, clinical guidelines, and policies focused on blood pressure management to enhance women's health in Tanzania. However, I have made some detailed observations, some of which may require minor revisions to strengthen the paper.

Title and Abstract:

• The title is clear and informative, accurately reflecting the study's focus on high blood pressure among women of reproductive age in Tanzania.

• The abstract provides a comprehensive summary, covering the background, methods, results, and conclusion. It presents the study's importance, data sources, sample size, and key findings effectively.

Introduction:

• The introduction has several strengths, including a clear emphasis on the global significance of hypertension and its impact on women of reproductive age. It effectively outlines key risk factors and highlights the burden of hypertension in low- and middle-income countries.

• To further enhance the introduction, it would be helpful to include information on Tanzania's health indicators, such as the current prevalence of hypertension and the challenges within the healthcare system. Adding a brief overview of Tanzania's current efforts or policies to manage hypertension would also provide important context.

• Concluding the introduction with a statement addressing the knowledge gap would strengthen the argument for the study's importance. For example, "While previous studies have explored hypertension in various populations, limited research has focused specifically on women of reproductive age in Tanzania, using recent, nationally representative data."

• In line 97, there is a small formatting issue as the space is missing between “reach1.56billion”.

Methods

• The study design (population-based cross-sectional) and the use of national survey data (TDHS 2022) are appropriate for the research question.

• Sampling procedures, data collection methods, and the definition of the outcome variable (self-reported high blood pressure) are clearly described.

• Statistical analysis is detailed, including the use of multivariable logistic regression and the presentation of adjusted odds ratios with confidence intervals.

Results:

• There are some sections where sentence structure can be simplified for better clarity and help convey the study’s key findings more effectively.

Discussion

• The discussion clearly explains the findings and compares the findings with those of previous research in Tanzania and other countries. It provides a detailed analysis of factors associated with high blood pressure in the study population.

• However, it would benefit from integrating more context-specific information about Tanzania. For example, including information on how limited access to antenatal care services in rural Tanzania affects pregnancy-related hypertension risks would provide readers with a clearer understanding of the study's outcomes.

• The first two sentences in the discussion are repetitive as they already mentioned in the introduction. It may be helpful to paraphrase these sentences, start with a different sentence, or make them shorter.

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Reviewer #1: Yes:  Dr Essa Tawfiq

Reviewer #2: Yes:  Narges Neyazi

Reviewer #3: Yes:  Massoma Jafari

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Submitted filename: comments on PONE-D-24-35959.docx

Burden and Determinants of Self-Reported High Blood Pressure Among Women of Reproductive Age In Tanzania: Evidence from 2022 Tanzania Demographic and Health Survey

PONE-D-24-35959R1

Dear Dr. Musilanga,

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,

Muhammad Haroon Stanikzai

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

A reviewer and myself found your responses and edits to the manuscript to be adequate and recommend acceptance for publication.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

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

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #2: Yes:  Narges Neyazi

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