Health Risks in Our Environment: Urban Slum Youth’ Perspectives Using Photovoice in Kampala, Uganda
Round 1
Reviewer 1 Report
An area where the background/ methods could be improved is with the inclusion of photovoice and some literature on youth in urban settings. The background needs to introduce the study design in some capacity and make an argument as to why the authors chose to focus on youth or young adult - and what kinds of urban health risks are associated with this population (versus elderly for example).
In the methods, particularly on the study design piece, some detailed explanation of photovoice is needed and there is a lot of literature in which this has been proven as a tool that is particularly successful with the elicitation of key data and qualitative description/explanation from youth. Photovoice is a very powerful elicitation tool and it is used in a participatory capacity - how is that being addressed here? why was it chosen? can you provide examples of other studies that used this methodology and how is your study contributing to that literature? These are all questions that need to be addressed before publication.
Another major issue is the definition of 'inclusion criteria' for the youth category. Most age cohorts for youth are rarely into the late 20's and hardly ever include the 30's. The UN defines youth as 15-24 years and WHO defines "adolescents" as 10-19 years. The African Youth Charter defines youth as 15-35, which may be the category that is being used here. But this needs to be defined and explained because the age range for what is typically seen in the literature would not consider 6 of the 10 participants to be classified as "youth". If you are using the African Youth Charter category, then it is necessary to inform the reader about this charter and why the categories are as wide versus other categories for youth.
Finally, the sample size seems small for some of the results that are being clarified. There needs to be some explanation in the methods and sample section to define why a N=10 is appropriate and can be used to draw conclusions. Again, I think this can be resolved with more literature and deeper explanation of photovoice as a methodology but ultimately, in the current draft, it seems too small.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
I have selected no answer because I need more explanation. My main question is how the use of Photovoice added to knowledge about living conditions in the slum and told us something that we don't already know? What is Photovoice, and why employ it in this case and other instances of documented unhygienic and squalid conditions? How is this different from photojournalism? What resulted from the discussion that took place every two weeks?
Why are people who are 18 to 35 referred to as youths, which usually means not yet 20 years of age?
The article is well written and the photos are informative, but what was the larger purpose of this undertaking? How can it ameliorate conditions?
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
Overall, the manuscript is poor and needs extensive revision before publishing.
First, a better international framework should be given. A total of bibliographic items seem to me a bit odds considering the important issue at stake.
Second, the representativeness of the sample should be clarified
Third, a take home message in the discussion should be clarified.
Forth, the abstract's structure is not adequate to Sustainability formats.
Fifth, a better description of the study area is necessary. Is the area representative of what?
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
Much improved overall! I really enjoy this article and will likely share it with my colleagues and peers. Including more methodological description elevates the manuscript in so many ways. Great job and I appreciate all the consideration that the authors gave the earlier review.
Author Response
Thank you very much for the positive feedback.
Reviewer 2 Report
Most of the issues have been addressed, except for the use of the word youth. That doesn't apply to people who are over 30, so find a more appropriate term.
Author Response
We appreciate your concern. However, as stated in our previous response to your comments, we used the Africa Youth Charter definition. It refers to youths as every person between the ages of 15 and 35 years. This description has been incorporated in methods section under the selection of study participants section. See page 4, line 131-133.
Reviewer 3 Report
I think that part of my comments were not addressed in the present version. I would encourage authors to revise their paper more extensively! Thank you.
Author Response
Response to Reviewer Three Comments
I think that part of my comments were not addressed in the present version. I would encourage authors to revise their paper more extensively!
Unfortunately, the Reviewer did not specify which comments were not addressed. However, I have taken effort to strengthen our response to comments.
|
No. |
Comment |
Response |
Page number |
Line Number |
|
1. |
A better international framework should be given. |
Thank you for the concern. The doughnut economics model focusses on the world can grow economically while meeting the needs of all people living on the planet. Health is a multidisciplinary and multisectoral entity that requires all life boxes to be ticked. As such, we used the model in this study to demonstrate slum needs that jeopardize dwellers living conditions and put their health at risk. Therefore, we believe that this is a good international model that demonstrates well the health risks in slums that moderately or severely affect slum dwellers’ health. |
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|
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2. |
A total of bibliographic items seem to me a bit odds considering the important issue at stake. |
Thank you for the observation. The reference that are old are largely key papers in the area of photovoice research methodology and urbanization in Uganda that we have made reference to. We wish to emphasize that where these references have been used, they were the most recent ones that could be found. |
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|
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3. |
The representativeness of the sample should be clarified |
Under the sub-section of selection of study participants in the methods section, we have clarified how the participants were selected to ensure representatives as follows: “The criteria for selecting the ten participants included selecting a diverse range of men and women in terms of age, marital status and geographical location in the area. This helped ensure a wide variety of perspectives from the participants as was the case in previous photovoice studies [20, 21]”. |
4 |
136 – 138 |
|
4. |
A take home message in the discussion should be clarified. |
Thank you for the concern. In the discussion we have raised several take home messages based on the implications of our findings. In addition, we have also provided a general take home message in the conclusion section as follows: Therefore, there is need for all stakeholders to ensure that urban areas are adequately planned to enable sustainable growth. |
18 |
479 – 480 |
|
5. |
The abstract's structure is not adequate to Sustainability formats. |
The abstract has been revised to fit the format of the journal. |
1 |
12-31 |
|
6. |
A better description of the study area is necessary. Is the area representative of what? |
Thank for the comment. We feel that we have adequately described the study area especially with regards to the focus of our study as it contains population size, nature of settlement, terrain / topography, access to the road networks, economic activities, access to health care, nature of structures, authors previous work in the study area. |
3 – 4 |
116 – 128 |
Round 3
Reviewer 3 Report
The authors provided a letter explaining their changes, but not a specific track-change file to assess the main changes in situ. So the reading is still difficult and, in my opinion, some of the changes requested were developed in a poor manner.
After reading the track-change manuscript, I confirm the previous review. In my opinion, the authors performed only minor, estetical revisions, by addying few comments along the article. Some literature was added, without giving a direct link with the specific issue at stake. After revision, my impression is that, overall, the paper is relatively modest for an international journal such as Sustainability. However, this evaluation can be driven by my quantitative point of view and, for this reason, I don't want to release a too strict negative evaluation of a truly qualitative paper. For this reason, I marked minor revisions, giving you the opportunity to heard from other independent reviewers and to leave open any possible decision on this paper.
Author Response
Response to Reviewer Three Comments
After reading the track-change manuscript, I confirm the previous review. In my opinion, the authors performed only minor, esthetical revisions, by adding few comments along the article. Some literature was added, without giving a direct link with the specific issue at stake. After revision, my impression is that, overall, the paper is relatively modest for an international journal such as Sustainability. However, this evaluation can be driven by my quantitative point of view and, for this reason, I don't want to release a too strict negative evaluation of a truly qualitative paper. For this reason, I marked minor revisions, giving you the opportunity to heard from other independent reviewers and to leave open any possible decision on this paper.
I wish to emphases that reviewer 3 needs to specify what comments in particular we did not respond to sufficient. We as authors believe that we have made sufficient responses to his concerns as stated the table below. With regards to comment 1, we have made given reasons as to why we think that the framework we used was the most suitable (see comment 1 in the table).
For comment 2 regarding old literature we have also stated the reason why we used those publications (See table below).
Comment 3 on representativeness of the sample, we have also made clear response to that on page 4, line 136 – 138. To the reviewer’s point, we performed a major and not a minor revision as he states.
For comment 4, we raised implications and recommendations for each finding we discussed but also made a strong recommendation in the conclusion section as we have highlighted in our response.
We revised the manuscript to fit the journal structure in our response to comment 5 in the table.
For comment 6, based on our knowledge of the study area and experience we though that we had exhausted all the descriptions we required features of the study area that are relevant to the study.
All the changes and argument we have made are highlighted in within the tracked and clean manuscripts attached. Otherwise, we ask reviewer 3 to provide more details with regards to the responses he would wish us to clarify.
|
No. |
Comment |
Response |
Page number |
Line Number |
|
1. |
A better international framework should be given. |
Thank you for the concern. The doughnut economics model focusses on the world can grow economically while meeting the needs of all people living on the planet. Health is a multidisciplinary and multisectoral entity that requires all life boxes to be ticked. As such, we used the model in this study to demonstrate slum needs that jeopardize dwellers living conditions and put their health at risk. Therefore, we believe that this is a good international model that demonstrates well the health risks in slums that moderately or severely affect slum dwellers’ health. |
|
|
|
2. |
A total of bibliographic items seem to me a bit odds considering the important issue at stake. |
Thank you for the observation. The reference that are old are largely key papers in the area of photovoice research methodology and urbanization in Uganda that we have made reference to. We wish to emphasize that where these references have been used, they were the most recent ones that could be found. |
|
|
|
3. |
The representativeness of the sample should be clarified |
Under the sub-section of selection of study participants in the methods section, we have clarified how the participants were selected to ensure representatives as follows: “The criteria for selecting the ten participants included selecting a diverse range of men and women in terms of age, marital status and geographical location in the area. This helped ensure a wide variety of perspectives from the participants as was the case in previous photovoice studies [20, 21]”. |
4 |
136 – 138 |
|
4. |
A take home message in the discussion should be clarified. |
Thank you for the concern. In the discussion we have raised several take home messages based on the implications of our findings. In addition, we have also provided a general take home message in the conclusion section as follows: Therefore, there is need for all stakeholders to ensure that urban areas are adequately planned to enable sustainable growth. |
18 |
479 – 480 |
|
5. |
The abstract's structure is not adequate to Sustainability formats. |
The abstract has been revised to fit the format of the journal. |
1 |
12-31 |
|
6. |
A better description of the study area is necessary. Is the area representative of what? |
Thank for the comment. We feel that we have adequately described the study area especially with regards to the focus of our study as it contains population size, nature of settlement, terrain / topography, access to the road networks, economic activities, access to health care, nature of structures, authors previous work in the study area. |
3 – 4 |
116 – 128 |
