The Progress of Tobacco Control Research in Sub-Saharan Africa in the Past 50 Years: A Systematic Review of the Design and Methods of the Studies

Round 1

Reviewer 1 Report

Review report IJERPH: The progress of tobacco control research in Sub-Saharan Africa in the past 50 years: A systematic review of the design and methods of the studies

 

The authors conducted in their paper a systematic literature review of articles that are related to tobacco control in the Sub-Saharan African context. They focused in their analyses on the research design and methods of the articles. Results showed that only few articles were published, but that the number of articles increased in recent years, particularly after the ratification of the FCTC by most African countries.

The topic addressed, i.e. an overview of research evidence in a region with low- and middle-income countries where the tobacco-related burden is still highest, is very important. Strengths of the paper are that it is very well written and that appropriate methods, such as triangulation, were applied. Furthermore, very clear and informative figures were used that are helpful to interpret the findings. However, I also have some questions and suggestions for the authors:

Introduction: The relevance or aim of the study is not yet fully clear to me. It is clear that the authors want to determine the design and methods of the available research, but is the aim of this to determine overall quality of the research and give recommendations about design and methods of future studies? In other words, how do the authors expect that their results can be used?

Methods: in lines 129 to 132, the authors describe which data were extracted. Why were not all of these reported in the results afterwards?

Figure 1: the “n=123” additional articles identified through other sources is missing.

Methods: in the section about quality appraisal, the authors state that they assume that the quality was acceptable in all articles. However, I think it is very relevant to determine the quality, especially if the authors focus on design and methodology. For example, if they conclude that many studies had been conducted, but all of them were of low quality (for example, underpowered), this is an important finding as well.

Methods: the section about the data analysis needs some specification. Which data exactly were analyzed and how?

Results: the first paragraph (lines 150 to 175) seems to be background information. If that is the case, it should be part of the introduction in my opinion. Or was this information extracted from the selected articles?

Results: line 180: what is meant with “had only one study”?

Discussion: line 282: the authors describe that most articles were cross-sectional and thus relied on subjective self-reports. What is the link between cross-sectional studies and subjective measures? Actually, self-reports are also very often used for longitudinal research.

Discussion: the conclusion is merely focused on the quantity of articles published. While I agree that it is important to do a lot of research, that conclusion is not fully logical in my opinion. It might be sufficient to have some high-quality, very informative and relevant papers instead of many, low-quality papers. More papers does not necessarily lead to stronger tobacco control policies. More papers also have to be read by policymakers and translated into practice. So, are there any other implications or conclusions that can be drawn from these results?

Author Response

Please see the attached file for the detailed response to the reviewer's comments. Thank you.

Author Response File: Author Response.pdf

Reviewer 2 Report

This study reports on the findings from a massive undertaking. The authors reviewed hundreds of articles on tobacco control research from SSA.

I think that this is a meaningful, strong manuscript.

I only have a few minor suggestions:

What are the possible implications by focusing on articles in English only? Some countries' main language is not English.

Would the authors suggest that there might be a need to for a grey literature review? I'm wondering if you they encountered reports that might add to our understanding.

The flow chart could be strengthened by:

adding reasons for exclusion with Ns

specifying that bibliographies were used to retrieve additional sources.

Specify how many articles were added through other sources.

reverse the arrow from "Additional articles" to indicate that articles were added

The map (Figure 2) could be improved by:

adding Ns for SA and Nigeria rather than grouping them.

Is there no country with 18-34 publications? If so, I would add a note as people might think that there is an error in the color coding.

I'm not sure why countries that are not Sub-Saharan are included in the "No Data" category rather then marking them in another way.

For reporting on urban/rural settings, it would be meaningful to add population % for Sub-Saharan Africa and maybe SA & Nigeria as well to provide context.

Author Response

Please see the attached for the response to the reviewer's comments.

Author Response File: Author Response.pdf