Midwifery and Medicinal Plants in the Mazahua and Otomi Indigenous Group of the State of Mexico

Round 1

Reviewer 1 Report

Review comments

Point 1: The abstract should follow the style of structured abstracts.

Point 2: The introduction is well written, and the exposition of scientific problems has strong logic. Yet, the articulation between paragraphs can be smoother.

Point 3: The materials and methods section is well described. My question is since non-probabilistic convenience sampling was used in this study, what is the purpose of sample size estimation according to the sample size estimation method of cross-sectional study design?

Point 4: What were the inclusion and exclusion criteria for study participants?

Point 5: Lack of content for the application of specific statistical analysis methods.

Point 6: The results and the discussion section are mixed, and the two parts should be separated.

Point 7: The limitations of the study should be explained.

Point 8: The conclusions of the study should not be a presentation of results, the conclusion is derived from the results and the interpretation of the results. And what specific specific measure could the authors suggest to the authorities?

Minor editing of English language required.

Author Response

 

Response to Reviewer 1 Comments

 

Point 1: The abstract should follow the style of structured

abstracts.

Response 1: The abstract was modified From: This paper analyzes both the persistence of traditional midwifery practice and the use of medicinal plants in Mazahua and Otomí (MO) indigenous group. A semi-structured survey with qualitative and quantitative information was designed and validated. Data collection was by random convenience sampling among parents, grandparents, and students of the Intercultural Health Degree of the Intercultural University of the State of Mexico. The variables mother language (ML) and births attended by midwifery (BM) were correlated with the generational age (GA) of grandparents, parents, and grandchildren. The ML vs BM curves of people who did not consider themselves to belong to MO indigenous group and of people who belonged to MO indigenous group were superimposed to obtain the difference in midwifery practice in percentage terms. In the MO indigenous groups, the BM and ML vs GA are lost in a proportion of 25.5% and 17.05% respectively. The medicinal plants most used by MO indigenous group are “too” (Montanoa tomentosa Cerv.) and “lengua de vaca” (Rumex crispus L.). The 83.25% of the adults consider that there is a family economy saving between 25% and 75% with birth through the midwifery practice. There is a generational correspondence between the loss of ML and midwifery practice.

By:

The purpose of this study was to analyze the persistence of midwifery and the native language of the Mazahua and Otomi (MO) indigenous community, as well as the benefits to the domestic economy and knowledge of medicinal plants for this traditional medicine activity. A semi-structured survey with qualitative and quantitative information was designed and vali-dated. Data collection was obtained from the students (random sampling for convenience of the student’s enrollment in the Intercultural Health Degree of the Intercultural University of the State of Mexico), their parents and grandparents, as well as people from their community, all of them from the MO ethnic group. The variables mother language (ML) and births attended by midwives (BM) in both MO and non-indigenous people were correlated with the generational age (GA) (grandparents, parents, and grandchildren). In the MO indigenous groups, the BM and ML vs GA are lost in a proportion of 25.5% and 17.05% respectively. There are 23% more mid-wife births in the MO community vs non-ethnic people. The medicinal plants most used by MO indigenous group are “too” (Montanoa tomentosa Cerv.) and “lengua de vaca” (Rumex crispus L.). The 79.3% of the adults consider that there is a family economy saving between 25% and 75% with birth through the midwifery practice. There is a generational correspondence between the loss of ML and midwifery practice

 

 

 

Point 2: The introduction is well written, and the exposition of

scientific problems has strong logic. Yet, the articulation between

paragraphs can be smoother.

Response: The corresponding modifications were made. Modifications are highlighted in yellow

 

Point 3: The materials and methods section is well described. My

question is since non-probabilistic convenience sampling was used

in this study, what is the purpose of sample size estimation

according to the sample size estimation method of cross-sectional

study design?

Among all the young Mazahua Otomies of region (There was previous information that, at the UIEM, most of the students belonged to the Mazahua Otomi ethnic group), only those who are at the Intercultural University of the State of Mexico were surveyed.

 

Point 4: What were the inclusion and exclusion criteria for study

participants?

Response: In the research design section, the inclusion and exclusion criteria for quantitative and qualitative variables are detailed:

A structured survey was designed, validated, and applied to UIEM students (with three sections: students, parents, and maternal and paternal grandparents). Quantitative in-formation was collected (e.g., age, monthly income, perception of savings for being born by midwife, number of medicinal plants used in midwifery, number of people born by midwife in the family, people in the family who practice midwifery, etc.), and qualitative information (e.g., sex, ethnicity, original language or dialect of the stu-dent/parent/grandparents, common names of medicinal plants (MP) used in childbirth, common diseases due to childbirth, birth by midwife, etc.).

 

Point 5: Lack of content for the application of specific statistical

analysis methods.

Response: In methodology, the sample size calculations and formula were detailed

 

 

Point 6: The results and the discussion section are mixed, and the

two parts should be separated.

 

Response: The title of the section was changed from Results to discussion of results

 

Point 7: The limitations of the study should be explained.

Response: The last paragraph of the conclusions indicates the limitations of the studyconclusión:

 

It is recommended that this study be expanded to a random probability sample to compare two populations between those who do not consider themselves to be from any indigenous group and the MO indigenous group (This was a limitation of the research: only UIEM students and their parents and grandparents and information from some people of the MO ethnic group)

Point 8: The conclusions of the study should not be a presentation

of results, the conclusion is derived from the results and the

interpretation of the results. And what specific specific measure

could the authors suggest to the authorities?

 

Response: A last paragraph was added to the conclusions:

It is recommended that the UIEM consider traditional midwifery in its health scienc-es study program. Likewise, this work is taken into account to justify public policies that protect and promote the traditional medicine and the native language of the MO community.

 

Reviewer 2 Report

This is a study in an interesting and important area, and appears to present research information that could be of much importance. However, throughout, it is difficult to understand the discussion of the study and its results. Attention is needed to providing more detailed explanations, avoiding the use of confusing acronyms, and in making the purpose and aim of the study more clear throughout.

Please see detailed comments below.

 

 

Generally: what is the purpose of this article? What are you testing, arguing or proving? This is not clear.

 

It might be helpful to specify which Indigenous groups are being discussed in the introduction, as well as in the abstract. This would help with the clarity of the introduction—otherwise it reads as if it is generally true of all Indigenous groups rather than specific ones.

 

Line 29—make more clear as to what the alternatives are that are being compared—this is not clear.

 

Lines 41-42—how does the use of plants reveal a spiritual dimension? There seems to be some missing information here.

 

Line 64—more information needed on the cultural barrier. How so? How is this evident? What are its specifics?

 

Line 74 –is this referring to traditional midwifery practices or those in Western medicine? This is not clear.

 

Lines 146-151—this discussion is not clear.

 

Line 224-225—not clear what is meant by “a strong link learning process”

 

Lines 270-282—please clarify the meaning of acronyms—this is hard to read and the meaning hard to understand because of the use of so many acronyms.

 

Line 304-305—not clear what generational age you are referring to.

In places, meaning is not clear, and the article should be checked to make sure meaning is clear throughout.

Author Response

Please see attached 

Author Response File: Author Response.pdf

Reviewer 3 Report

 

See file

 

Comments for author File: Comments.pdf

Moderate editing of English language required

Author Response

Please see attached 

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The authors seem to have misunderstood my questions 3-5, 7 and 8.

None.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors do not appear to have responded to my initial review. What is indicated as their response to my review in fact seems to address other reviews, but not the one I made. It seems that no changes were made in response to my first review, so those comments still remain to be addressed.

 

 

The abstract can make more clear why these 3 elements are being analyzed together—this is not clear from the explanation (midwifery, native language, use of traditional medicine). Because this is not clear the aims and the purpose of the study are not clear.

 

Line 33 – should be midwives’ ? plural possessive

 

Paragraph lines 45-59—These ideas do not fit well together—there is no connection between them and the logic of this discussion is difficult to follow.

 

Lines 94-97—It is still not clear why these three elements are being analyzed together, nor what the aims of this study are.

 

Line 169—meaning of this is not clear.

 

Line 228- does “it” refer to decrease in midwifery or in loss of native language? This is not clear.

 

Line 237-239—meaning here is not clear.

 

There are places where the meaning of your discussion is not clear, as detailed in my comments above. Please refer to those to revise your discussion to be more clear.

Author Response

We apologize to the reviewer (there was a mistake in the assigned number). We send the answers corresponding to your suggestions in the first round. Also response to your latest suggestions.

Please see the attachment.

 

 

Author Response File: Author Response.pdf

Reviewer 3 Report

The paper has been improved, especially the results section. However, there are still points which need to be improved.

The introduction needs to be rewritten. It should be better structured. The authors need to link the three issues better — the use of midwifery, the loss of the native language, and the use of medicinal plants related to childbirth. This is key to understand the paper.

Related to this, the paper’s aim and contribution still need to be better outlined. The aim needs to be further elaborated. It needs to be much more concise. The paper encompasses much more than what is stated in lines 94-97.

I still think the argument for the promotion and protection of the practice of midwifery and traditional medicine of the Mazahua and Otomí communities needs to be further elaborated and strengthened. An additional effort is needed.

I would suggest avoiding the use of “vs.” in expressions such as “Native language and births by midwife vs. three generations”. I definitely like better the expression used in the abstract: “The variables mother language (ML) and births attended by midwifery (BM) in both MO and non-indigenous people were correlated with the generational age (GA)”, or expressions such as: “In the Mazahua Otomí indigenous group there is a correspondence between the loss of the native language and birth by midwife” along “three generations”.

I have several additional comments:

Abstract:

·    Lines 4-5: The text reads: “The purpose of this study was to analyze the persistence of midwifery and the native language of the Mazahua and Otomi (MO) indigenous community, as well as the benefits to the domestic economy and knowledge of medicinal plants for this traditional medicine activity”. I would like to see from the very beginning the connection between the two —the persistence of midwifery and the native language. They are connected. Maybe the strong cultural and social connotation of both? Maybe the loss of one is connected somehow to the loss of the other?

·    Lines 10-11: The text reads “all of them from the MO ethnic group”. This seems to contradict the subsequent statement: “in both MO and non-indigenous people”. I would suggest nuancing the first one.

·   Lines 15-16: The text reads “The medicinal plants most used by MO indigenous group are “too” (Montanoa tomentosa Cerv.) and “lengua de vaca” (Rumex crispus L.)”. I would suggest relating this result from the beginning to the use and practice of midwifery.

Introduction:

·       The introduction does not mention the loss of the native language. It is one of the two main focuses of the paper. I would still like to see more of it in the introduction.

·       Lines 23-27: The connection between these two ideas —modesty and prestige— is not that straightforward. I would suggest further elaborating the second sentence.

·       Line 49: The text reads “The (MO) have a vital role”. MO should not be written in brackets. Is the use of MO correct?

·       Lines 94-97: The paper’s aim and contribution still need to be better outlined. As written, it seems as if assessing the loss of the native language was secondary to the research, but in the results section it is given the same importance as the loss of midwifery. The aim definitely needs to be further elaborated.

Materials and methods:

·  Lines 102-103: I would rather say “of the students of the Intercultural University of the State of Mexico (UIEM) and their parents” than “of the students of the Intercultural University of the State of Mexico and their parents (UIEM)”.

·       Figure 1: I would suggest translating all written information into English.

Minor editing of English language required

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 3

Reviewer 1 Report

None.

None.

Author Response

There were no comments

Author Response File: Author Response.pdf

Reviewer 2 Report

The authors have clearly made a great effort to improve this article and provide more clarity about the purpose of this study and its implications.  There remain places where clarity of meaning is needed, but perhaps this can be addressed in the editing process.

 

A reduction in abbreviations throughout the article would be helpful. The abbreviations are numerous and difficult to keep track of conceptually in such numbers. This makes reading the paper very difficult, as it is necessary to keep checking the meanings of abbreviations.

 

Lines 10-11—what is meant by “generational age” is not clear.

 

Line 24-25—meaning is not clear. Is it that prestige is accorded to a woman who is a mid-wife? Or that only a woman of prestige becomes a mid-wife?

 

Line 56—should be “endangered”

 

Line 57—should be “women’s exclusion”?

 

Line 71—reference to “original language” not clear.

 

Overall, the paper is very much improved and the communication within the paper more clear than in earlier versions.

There are still instances where the meaning intended does not come through clearly.  I have noted some of these above. In general, editing is needed as to the use of English to make sure meaning is clear throughout the paper.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf