Effects of COVID-19 on Kenya’s Healthcare System: Healthcare Providers’ Experiences with Maternal Health Services Utilization in Coastal Kenya
Round 1
Reviewer 1 Report
The article explores the effects of COVID-19 on Kenya's healthcare system. The paper's introduction and literature review are well-written, and the logical flow is cogent. However, the paper is only descriptive, has a small sample, and has little value in contributing to the healthcare field. Normally, studying a new context is not a significant contribution, especially the sample for this study is very small and lacks data-driven policy implications (both big and thick data).
If the special issue does not require "Novelty" and "Significant field contribution", the paper might be publishable after some revisions.
I would suggest the authors follow COREQ Report Guidelines to elaborate and justify their study design more rigourously and transparently. Please see:
Tong, A., Sainsbury, P., Craig, J., 2007. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19, 349–357. https://doi.org/10.1093/intqhc/mzm042
Since the sample is very small, does the qualitative study reach saturation? The Language needs some minor editing. The discussion is not strong as the authors only cited and mentioned previous papers but failed to mention how their results add new values to the field. Moreover, due to data scarcity (only two quotes per the main theme), the discussion and inference for policy are very "stretched."
Personally speaking, I would encourage the researchers to take a further step to perform a complimentary qualitative study to strengthen their claims and findings or at least increases the interview size and reach saturation. In the current form and without further work with data, I would be very reservations about recommending this manuscript to be published.
Author Response
Dear Reviewer,
On behalf of my colleague, I would like to say thank you. We are so much grateful for the insights and comments you gave us. We are so glad your comments contributed greatly to making our article better. We have carefully addressed all the comments. Kindly find the attached document.
Regards
Stephen
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The paper entitled "Effects of COVID-19 on Kenya’s Health Care System: Healthcare providers’ experiences on maternal health services utilization in Coastal Kenya" is in general well-written, but there are some major concerns, especially in presenting the results and in the description of the research procedure.
1. Please check all your abbreviations. Some of them (e.g., WHO) were applied incorrectly or were provided twice. Please make appropriate changes.
2. The citation format APA is not appropriate for the whole paper. Please check the journal's guidelines on this issue.
3. Line 85: an inappropriate semicolon.
4. Line 88: "Africa has an inadequate health structure and workforce" seems disrespectful. This must be edited.
5. Line 115. What does the FMC mean. See my comment 1 regarding abbreviations.
6. Lines 140-144: This is irrelevant information regarding this study.
7. Lines 145-155: This information is not related to the 2. Materials and Methods section and should be moved to the introduction section.
8. The methods, participants and procedure section are very poor and have no relevant information. Please describe clearly the participants and their demographics characteristics, procedure (e.g., time period), how you analyzed the data, your methods etc. In the present form, your description is insufficient. This is a very major methodological concern. See this article as an example how to present data clearly and precisely (https://www.mdpi.com/1660-4601/19/22/14894). See their Supplementary materials with the qualitative data. Please prepare this material for your paper.
9. COVID-19 or covid-19 are used inconsistently. Please chose one for and use it logically. I prefer COVID-19.
10. Lines 231-235: different fonts should be corrected.
11. Lines 241-244: When you quote statements, please use quotation marks. Here and in other places in the manuscript.
12. The discussion section should be more structured with subsections. See this article (https://www.mdpi.com/1660-4601/19/22/14894) as an example of very good structure of article.
I believe if you do these corrections, your paper will be good and may be published. I am waiting for your revision. Please address my concerns carefully.
Have a nice day!
Author Response
Dear Reviewer,
On behalf of my co-author, I would like to say thank you. We are very grateful for the wonderful and insightful comments and suggestions that have not only improved our article but also in terms of rigor. We have attended to the corrections and addressed them point by point.
Kindly find the attached,
Regards
Stephen
Author Response File: Author Response.pdf
Reviewer 3 Report
This is a timely and interesting study. The article would benefit from more links with the recent covid-19 literature. Some relevant papers for the study are:
Ramkissoon, H. (2021). Social bonding and public trust/distrust in COVID-19 vaccines. Sustainability, 13(18), 10248.
Ramkissoon, H. (2022). COVID-19 adaptive interventions: Implications for wellbeing and Quality-of-Life. Frontiers in Psychology, 13.
The discussion needs to be further linked to the literature. I recommend revisions, thank you.
Author Response
Dear Reviewer,
We have carefully considered the articles suggested and now they are included in the discussion section and marked in Yellow highlighter.
Thank you for the suggestions
Round 2
Reviewer 2 Report
The paper was revised, but some major concerns still remain even after revision, because they were not addressed adequately after first revision. The changes provided after first revision are very minor. There are only some changes highlighted in red, but the concerns in review form 1 were major.
1. Please check all your abbreviations. Some of them were applied incorrectly. Please make appropriate changes.
2. The citation format APA is not appropriate for the whole paper and is not according to the journal's guidelines. However, the authors may not address this concern. I believe the editors are responsible for this issue.
3. The methods and procedure section are somewhat poor and have no relevant information. Please describe the procedure (e.g., time period) clearly, how you analyzed the data, your methods etc. When the study was conducted? In the present form, your description seems insufficient. This is a very major methodological concern. See this article as an example how to present data clearly and precisely (https://www.mdpi.com/1660-4601/19/22/14894). See their Supplementary materials with the qualitative data. Please prepare this material for your paper.
4. Data availability statement? Supplementary materials?
5. The discussion section should be more structured with subsections. See this article (https://www.mdpi.com/1660-4601/19/22/14894) as an example of very good structure of article.
The authors did not provide subsections and did not structure the paper. In general, it has a lot of information, but there are no clear results and conclusions.
Please address my concerns carefully. I believe this paper may be publishable, but more should be done before its endorsing.
Have a nice day!
Author Response
Dear Reviewer,
We are very grateful for your useful comments and insights, which have enabled us to structure our article properly. We appreciate your effort and patience in this process. We have addressed the concerns now in tracked changes in the main manuscript. We have also prepared the supplementary material (research tool) pasted at the end of the main mauscript.
DETAILED RESPONSE:
- Please check all your abbreviations. Some of them were applied incorrectly. Please make appropriate changes.
Authors response: Thank you. We have corrected all the abbreviations and revised grammar for clarity, see the manuscript with tracked changes.
- The citation format APA is not appropriate for the whole paper and is not according to the journal's guidelines. However, the authors may not address this concern. I believe the editors are responsible for this issue.
Authors' Response: We are grateful for this comment; we believe editors will give the final article a recommended format.
- The methods and procedure section are somewhat poor and have no relevant information. Please describe the procedure (e.g., time period) clearly, how you analyzed the data, your methods etc. When the study was conducted? In the present form, your description seems insufficient. This is a very major methodological concern. See this article as an example how to present data clearly and precisely(https://www.mdpi.com/1660-4601/19/22/14894).
Authors' Response: we are so grateful for the comments. We have described the methodology in detail ad believe it is now adequate in form and content.
We have added the missing information in the data collection procedure (clearly stating the time period for this study). Data analysis is now updated (see the main manuscript with tracked changes).
See their Supplementary materials with the qualitative data. Please prepare this material for your paper.
Authors' Response: We have prepared the supplementary materials, especially for the research questions.
- Data availability statement? Supplementary materials? Authors Response: We have added the supplementary material (the instrument of data collection at the end of the main manuscript).
- The discussion section should be more structured with subsections. See this article (https://www.mdpi.com/1660-4601/19/22/14894) as an example of very good structure of article.
Authors Response: Thank you so much. This article has been useful and we have now re-structured our discussion with subsections (see main manuscript with tracked changes)
The authors did not provide subsections and did not structure the paper. In general, it has a lot of information, but there are no clear results and conclusions.
Authors Response: Thank you for your comment. We have now revised the discussion section and considered your recommendations.
Please see the attachment for more clearer additional information.
Stephen
Round 3
Reviewer 2 Report
In general, the revised paper is good. Please indicate your data availability statement.
Author Response
Dear Reviewer,
We would like to thank you so much for your patience with us and reading our manuscript. Your comments have been super useful and they have enriched our manuscript.
We have added a data availability statement just after authors' contribution. It reads 'Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to participants privacy.'
