Evaluating Value-Based Maternal Healthcare in Sub-Saharan Africa: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors,

This is my constructive feedback for the improvement of your manuscript:

1. Introduction:
• The introductory section effectively presents logically structured, well-organized, and up-to-date information about the topic under investigation. It also includes extensions of the topic to societal and public health realms, providing valuable context for readers.
2. - The methodology provides all the necessary information in detail. Though, references to the results (e.g. Table 1), should be removed from the Methods. 
   - The results section requires a significant revision: Table 1 should be strongly revised: 
   1. An evaluation score for each study should be added.
   2. The “study design” column should include more focused information, eg: what does it mean to have a cohort based implementation study? Why was study nr 4 included in your research given that it is  a review (and thus should have been excluded).  
   3. Some numerical data, a summary of the measurements conducted in the original papers should be included and discussed. This will increase the reliability of your actual findings. 
   
   The discussion does not seem to have a direct connection with the findings of the study;  
3. Discussion:
• The discussion lacks a direct connection with the findings of the study. It would benefit from aligning more closely with the results obtained, addressing their implications and relevance to the research objectives.

Author Response

Dear Independent Reviewer 1,

We thank you for the insightful and constructive feedback on our manuscript titled "Evaluating Value-Based Maternal Health Care: A Systematic Review in sub-Saharan Africa", which we have since revise the title to " Evaluating Value-Based Maternal Health Care in sub-Saharan Africa: A Systematic Review ". Your expert evaluations has provided valuable perspectives for enhancing the quality and impact of our work. We have addressed each of your comments and suggestions, ensuring that our manuscript not only aligns more closely with the journal's standards but also contributes more effectively to the understanding of how value based maternal health care in sub-Saharan Africa.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors

Thank you for the opportunity to read your manuscript, which I read with great interest.

The manuscript has a very interesting theme, however, it needs some changes that will significantly improve it. Below you will find some points in the manuscript that need clarification, refinement, re-analysis, re-writing and/or additional information and suggestions on what can be done to improve it.

Title - I suggest the following change “Evaluating Value-Based Maternal Health Care in sub-Saharan Africa: A Systematic Review”.

Abstract - the abstract should be structured, namely presenting the objective, methodology, results and conclusion. The objective should always be written in the same way throughout the article.

The keywords mostly follow MeSH terminology. I suggest changing “Value-Based Healthcare” to “Value-Based Health Care” and removing the acronyms (SSA) and (VBHC). The acronyms should appear and be decoded the first time they appear in the text, but from the introduction onwards, never in the abstract and keywords.

Section 1 (Introduction) - this section needs some adjustments, as some information and/or points are missing or unclear, and should be included or better written, I will present some items:

- You present two objectives at the end of the introduction, however they are both different from the objective presented in the abstract. As mentioned above, the objective(s) should always be referred to in the same way throughout the article.

Section 2 (Materials and Methods) - in this section some points should be clarified and improved, namely:

- What is the research question?

- They used the SPICE methodology to construct the research question, but they don't present the research question...I ask what is the research question?

- Inclusion and exclusion criteria and search terms for each term in the mnemonic:

S	P	I	C	E
Setting (where?)	Perspective (for whom?)	Intervention (what?)	Comparison (compared with what?)	Evaluation (with what result?)

 

- Figure 1 shows the reasons for excluding 932 studies.

- In point 2.7 they state that they used the “Quality Assessment Tool for Quantitative Studies”, but they used the SPICE mnemonic which is for qualitative evidence...it needs to be clarified what type of studies will be included in the review...

Section 3 (Results) - in this section some points should be clarified and improved, namely:

This section could also be improved, namely in Table 1 the “study design” column should be improved, namely presenting the type of study, quantitative, qualitative, or mixed methodology.

Section 4 (Discussion) - The discussion should be linked to the themes presented in section 3 (results).

Section 5 (conclusion) - the conclusion seems fine at first glance, but with clarification of the above, it will then be checked whether it has the right conclusion.

Author Response

Dear Independent Reviewer 2,

We thank you for the insightful and constructive feedback on our manuscript titled "Evaluating Value-Based Maternal Health Care: A Systematic Review in sub-Saharan Africa", which we have since revise the title to " Evaluating Value-Based Maternal Health Care in sub-Saharan Africa: A Systematic Review ". Your expert evaluations has provided valuable perspectives for enhancing the quality and impact of our work. We have addressed each of your comments and suggestions, ensuring that our manuscript not only aligns more closely with the journal's standards but also contributes more effectively to the understanding of how value based maternal health care in sub-Saharan Africa.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for the opportunity you have given me to review this interesting article. The topic addressed is very pertinent since there are few studies on it. The contextualization is correct and based on appropriate and current references. The review is well justified. The objective is well stated and in such a way that it can be answered with the method chosen for the study (a review of the literature). The results are adequate. The discussion is correct. The conclusion answers the objective. The article would improve readability and be more aesthetic if a few small changes were made. These suggestions are the following:

-Table 1 contains too much text and makes reading difficult

-No data analysis is carried out, so this subsection is not appropriate.

-The term narrative review can cause confusion. The terms systematic review and narrative review are mixed. The most appropriate thing would be to use the term systematic review.

-The authors report that they have evaluated the quality of the studies but this information, that is, the quality of each study, is not included in the article.

Author Response

Dear Independent Reviewer 3,

We thank you for the insightful and constructive feedback on our manuscript titled "Evaluating Value-Based Maternal Health Care: A Systematic Review in sub-Saharan Africa", which we have since revise the title to " Evaluating Value-Based Maternal Health Care in sub-Saharan Africa: A Systematic Review ". Your expert evaluations has provided valuable perspectives for enhancing the quality and impact of our work. We have addressed each of your comments and suggestions, ensuring that our manuscript not only aligns more closely with the journal's standards but also contributes more effectively to the understanding of how value based maternal health care in sub-Saharan Africa.

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors

Thank you for the changes made, however it seems to me that in relation to the PRISMA flowchart you should improve it according to the indications of the methodology, I attach an image and a link from where you can get the information, but I would like to say again that the flowchart should include the main reasons for the exclusion of articles, as shown in one of the boxes of the flowchart.

 

https://www.prisma-statement.org/prisma-2020-flow-diagram

 

I'm sorry, but I couldn't understand the changes in table 1 regarding the study design information.

Comments for author File: Comments.pdf

Author Response

Dear Reviewer 2,

Thank you for your continued feedback on our manuscript. We appreciate your suggestion to enhance the clarity of our PRISMA flowchart.

In response to your recommendation, we have revised Figure 1, the PRISMA diagram, to include a detailed depiction of the main reasons for the exclusion of articles. We have carefully considered the methodology guidelines provided in the link you attached, ensuring that our flowchart now accurately reflects these standards.

We believe that these adjustments improve the transparency and reproducibility of our systematic review process, and we hope that the updated figure now meets the expectations outlined in your feedback.

Thank you once again for your constructive comments and for aiding in the improvement of our manuscript.

Round 3

Reviewer 2 Report

Comments and Suggestions for Authors What I suggested was that the PRISMA Flowchart should be in accordance with the original, which I inserted in my review, but which still needs to be filled in with the authors' data.

 

Author Response

Dear Reviewer,

We apologize for the oversight regarding the PubMed database results, where a typo indicated 322 instead of the correct 55 (lines 158 to 159).   We have corrected this in the PRISMA diagram. All other sections referring to the PRISMA diagram contained accurate data. Thank you for your diligence in identifying this issue and ensuring the quality of our manuscript.

Author Response File: Author Response.pdf

Round 4

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,
Thank you for the changes made to improve your manuscript, however, and I apologize for my insistence, the PRISMA flowchart needs to be corrected, that is, the part corresponding to “Identification of studies via other methods” does not have selected articles, so there is no shortage of flowchart. Only the part corresponding to “Identification of studies via databases and records” should be included, where the articles screened, excluded and those that were included in the review are described.

Author Response

Comment 1; Dear Authors,
Thank you for the changes made to improve your manuscript, however, and I apologize for my insistence, the PRISMA flowchart needs to be corrected, that is, the part corresponding to “Identification of studies via other methods” does not have selected articles, so there is no shortage of flowchart. Only the part corresponding to “Identification of studies via databases and records” should be included, where the articles screened, excluded and those that were included in the review are described.

Response to Reviewer comment 1;

Dear Reviewer,

Thank you for your detailed feedback and your patience. We have carefully revised the PRISMA flowchart as per your instructions. The updated flowchart now exclusively reflects the identification of studies via databases, excluding the section for "Identification of studies via other methods," as no articles were identified through these methods in our study. The revised PRISMA is now on lines 158 to 160

Round 5

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors

Thank you very much for responding to my comments.

The manuscript has improved substantially.