Factors Related to the Implementation of Preconception Care Recommendations in Selected Districts of Limpopo Province: A Qualitative Study

Round 1

Reviewer 1 Report

Healthcare-2561381-peer-review-v1

It is a qualitative study that aimed to determine the implementation of preconception care recommendations in health facilities in selected districts of the Limpopo province and associated factors.

In this study, the bias of seropositive women was not considered, so it cannot be assured that in women of childbearing age, who are not seropositive, the implementation of the recommendations is also partial.

Why not consider that the bias of the recommendations is due to the management protocol for fertile HIV-positive women, which was implemented much earlier, and not to the implementation of the recommendations for preconception care that the WHO recommended and supposedly implemented in 2016 in South Africa?

 

Observations for the authors

1.     What was the rationale for conducting the study in the Limpopo province? Not having carried out a study on the implementation of preconception care in the Limpopo province is not a justification.

2.     How was the sample size of 29 professional nurses and 51 women of childbearing age calculated?

3.     How many of these women were HIV positive?

4.     What were the characteristics of the interviewers?

5.     What was the guideline for conducting the in-depth interview?

6.     What was the interview guide in the focus groups?

7.     The interviewers were the same in the case of in-depth interviews and focus groups.

8.     The interviewers were either part of the community or were staff from outside the community.

9.     What was the argument for having used the in-depth interview in the case of the nurses? When the information expressed by the group is specified in a structured context, in addition, the testimonies offered by six or eight participants are richer in meaning than those offered in an individual interview, with the consequent optimization when comparing the time required to carry out six or eight individual interviews and work in a group session.

10.  For the analysis of the information, a computer program was used, in the case of having used it, it must be mentioned what it was.

11.  What was the comparison parameter to consider that the implementation of the recommendations was partial?

12.  The bias of seropositive women was considered.

13.  You can ensure that for women of childbearing age who are not HIV positive, the implementation of the recommendations would also be partial.

14.  Why not consider that the bias of the recommendations is due to the management protocol for fertile HIV-positive women, which was implemented much earlier, and not to the implementation of the recommendations for preconception care that the WHO recommended and supposedly implemented in 2016 in South Africa?

15.  What does the abbreviation PHC stand for?

16.  Why do you think that only by increasing the number of participants could your results be generalized to the whole country?

 

Author Response

All the comments were effected thank you for reviewing our article 

Author Response File: Author Response.pdf

Reviewer 2 Report

Dear authors,

Your study is well-planned and interesting to read. Please consider the following improvements:

The abstract is extensively lengthy and could be made shorter.

The tables need to be reformatted to improve the presentation of data. For Table one, put "gender" and "age" variables into rows. Similarly, for Table 2, put "Age", "Parity", and "Language" into rows.

You can include the guide used for in-depth interviews and focus groups as an Annex.

I would not agree that a small sample size is a study limitation since this prevents generalizability. This is a qualitative study, not a quantitative one, and it is not implemented with the purpose to obtain representative findings, but to gain in-depth understanding of different factors behind insufficient implementation of preconception services. So, it would be better to remove this from the list of study limitations.

Author Response

we addressed all the suggested changes 

Author Response File: Author Response.pdf

Reviewer 3 Report

In general,

 

The manuscript entitled  “Associated Factors Related to the Implementation of Preconception Care Recommendations in Selected Districts of Limpopo Province: a Qualitative Study” to determine the implementation of PCC recommendations at health facilities in the selected districts of Limpopo province and associated factors.

 

The instrument is well described, the materials and methods are clear and the conclusions are valuable and useful for many in the field interested in the analysis.

 

However, it would be valuable to address the following comments:

 

In introduction&background should be written as mellitus.

 

In problem statement the first line appears aligned to the left.

In methodology clearly define the abbreviation for FGD.

In measures to ensure trustworthiness change A. which appears in red.

In findings from professional nurses change A. which appears in red.

In theme 2.Knowledge regarding PCC the first line appears aligned to the left.

In theme 2. Knowledge regarding PCC aparece among amongst, is ths expression correct?

 

Sub-theme 4.2.2.1.: Knowledge GAP regarding PCC recommendations identified amongst professional nurses…it is aligned to the left.

 

Author Response

All changes effected 

Author Response File: Author Response.pdf

Reviewer 4 Report

The authors describe their assessment to what extent the WHO preconceptional care guidelines have been implemented in Limpopo Province of South Africa, and what the possible reasons are for the limited implementation.

 

General comments:

The manuscript is generally well written and reads easily. The introduction is structured and gives sufficient background for the study. The methods are sufficiently described, as are the results. The discussion is relevant and various explanations for the limited implementation of the guidelines are discussed. The conclusions are relevant to the outcomes of the study.

 

Specific comments:

I would recommend adding the WHO preconceptional care guidelines as additional information for the interested readers.

Table 1: <50 should probably read >50. Is that correct?

The manuscript is generally well written and reads easily. Minor grammatical changes are needed.

Author Response

All changes effected thank you for giving yourself time to review our article 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Observations for the authors

The comments made to the authors were partially answered.

The lines to which the authors refer do not coincide with the information that supports their answers.

The rationale for why the study was carried out in Limpopo should be reflected in the text.

“The rationale for conducting the study was to determine what was happening in Limpopo in terms of implementation of the WHO recommendations on preconception care since Limpopo was among the top three out of nine provinces of South Africa in terms of perinatal mortality according to Statistics South Africa, 2018”.

The characteristics of the interviewers should be included in the text.

“The interviewers were the researchers themselves with a help of research assistants. All are conversant with conducting in-depth interviews as well as focus group discussions. All were briefed prior to engaging into the activity of data collection. They all reside in Limpopo province and know the languages spoken by participants, thus able to interview participants in their own language”.

It is necessary to mention it in the text.

“That the sample size was estimated using the concept of data saturation”.

The authors' response to comment 8 should be included in the text.

The interviewers were the researchers who were not part of all the communities where the research was conducted even though they reside in one of the districts of Limpopo province because the study was carried in three districts of the province and in each district, there were number of clinics or Community health centers included the study.

It is necessary to include in the text the justification of why the in-depth interview was used in nurses and in the case of women the focus group discussion.

Author Response

Thank you for reviewing our article 

Author Response File: Author Response.pdf