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JMIRx Med
JMIRx Med
JMIRxMed
xmed
34
JMIRx Med
2563-6316
JMIRx Med

10.2196/57935
57935
Peer-Review Report
Peer Reviews
Peer Review of “Eye Care Service Use and Associated Health-Seeking Behaviors Among Malawian Adults: Secondary Analysis of the Malawi Fifth Integrated Household Survey 2019-2020”
Anonymous
Meinert Edward
None declared.

2024
9 4 2024
5 5793529 2 2024
29 2 2024
Copyright © Anonymous. Originally published in JMIRx Med (https://med.jmirx.org)
2024
https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIRx Med, is properly cited. The complete bibliographic information, a link to the original publication on https://med.jmirx.org/, as well as this copyright and license information must be included.

Keywords

access to health
health service utilization
eye care use
health-seeking behavior
sociodemographic determinant
visual impairment
social support
women empowerment
education
eye care
pediatric
eye
ophthalmology
visual
ECU
eye service
utilization
Malawi
empowerment
health service use
use
Corresponding author for proofs404136
ccc-integration-statusSuccess
Planned CE AssigneeJoshua Dykas
CE Triage CompleteYes
pap2024-04-08 11:05:57
pap2024-04-09 17:23:39
==== Body
pmc This is the peer-review report for “Eye Care Service Use and Associated Health-Seeking Behaviors Among Malawian Adults: Secondary Analysis of the Malawi Fifth Integrated Household Survey 2019-2020.”

Round 1 Review

General Comments

This paper [1] is a secondary analysis of a Malawian household survey exploring associations of patients who self-reported as having used formal eye care services. It is a useful idea to use this survey data for this purpose, but the author needs to check that they are using the correct source numbers for their statistical analysis and only report the numbers actually surveyed—not the national estimated numbers derived from these.

Specific Comments

Major Comments

1. “In Malawi, 3.3% of the population is blind compared to 1.01% in America [23].” There is no way 3% of Malawi is blind. (Half of Malawi’s population are children, so if 3% of Malawi was blind, that would be about 1 in 20 adults—not possible.) Check your references.

2. The abstract needs improving to give the definition of eye care use (ECU). In the results, it says “The prevalence of ECU was 60.6%,” which is not really a prevalence unless you give a clearer definition, for example “of those with eye symptoms, what proportion have access formal eye care services in the two weeks prior to the survey date.”

3. The sample was 28,388 adults? You cannot, then, in the results’ “Characteristics of study participants” section say there were 6 million young adults involved or that 5,660,836 (56%) of the adults were married. You also can’t say that “27,336 (0.3% of 2,734,768) complained of ocular symptoms.” This is the main problem with the report—you need to give the actual numbers of people surveyed who reported ocular symptoms—presumably 0.3% of 28,388—which is only 85 people. Thus your CIs/other statistical analyses around estimates with a sample of 85 people reporting eye symptoms will be quite different than if you extrapolate to the whole population of Malawi.

Minor Comments

4. “We entered the variables...”: Who is “we”? I only see one author

5. “Sort care” should be “sought care”: This is used 5 times in the paper so should be changed at all uses

6. There are some random capital letters in various places: “that In Malawi”—why has “In” got a capital?

Abbreviations

ECU eye care use
==== Refs
References

1. Mzumara T Kantaris M Afonne J Eye care service use and associated health-seeking behaviors among Malawian adults: secondary analysis of the Malawi Fifth Integrated Household Survey 2019-2020 JMIRx Med 2024 5 e44381 doi 10.2196/44381 38602316
2. Kalua K Lindfield R Mtupanyama M Mtumodzi D Msiska V Findings from a rapid assessment of avoidable blindness (RAAB) in Southern Malawi PLoS One Apr 25 2011 6 4 e19226 doi 10.1371/journal.pone.0019226 Medline 21547074
3. Flaxman AD Wittenborn JS Robalik T et al Prevalence of visual acuity loss or blindness in the US: a Bayesian meta-analysis JAMA Ophthalmol 07 1 2021 139 7 717 723 doi 10.1001/jamaophthalmol.2021.0527 Medline 33983373
