“I Have Never Visited a Health Center”: Ethiopian Centenarians’ Perceptions of Their Health Conditions

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The paper is too long with too many repetitions. Readability and reader interest would increase if it were more concise and organically written. For example, in the Introduction, it is stated that 47% of Greek centenarians experienced urinary incontinence and 23% had fecal incontinence, and then in the Discussion, it is mentioned that 47% had hypertension. A possible suggestion is to more concisely address the published studies on centenarians in the Introduction, and then, in Discussion,  briefly discuss them in relation to the diseases/disorders reported in Ethiopian centenarians.  

The last two paragraphs of the Introduction should form the Methods section.

Snowball sampling is a non-probability sampling technique often used in hard-to-reach populations. Initial subjects are selected who then refer other subjects. This process continues, creating a "snowball" effect as the sample grows. So, it does not provide a random sample, meaning results may not be generalizable to the entire population but can provide deep insights into specific groups. Furthermore, only one region of Ethiopia was selected, and data from eight males and only one female are reported. Finally, it is clear that the process of age-validation is very approximate. All these significant limitations must be reported and discussed in a specific paragraph, always emphasizing that the age of the centenarians is presumed.

 

Comments on the Quality of English Language

NONE

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This study employed a qualitative case study design to examine the health conditions, including sensory and cognitive function, of centenarians in Ethiopia. The paper is well-structured, with clear language and detailed documentation of methodology and results. 

Several aspects of the paper are particularly noteworthy: 

1) It focuses on a previously under-studied population, the centenarians in Ethiopia, marking it as one of the initial studies to explore the aging demographic in this region. 

2) The qualitative study design enabled thorough investigations into the life courses and health status of the centenarians. 

 

Below are some suggestions for improving the current work: 

1) A significant area for enhancement is clarifying the implications of the study. Specifically, what can we learn from the findings? How might these insights inform future policymaking, intervention design, and health communication within this community? Although the results section provides a detailed depiction of the findings, I propose the following insights for further discussion: 

a) The current health status, sensory, and cognitive functions of the centenarians are heterogeneous—indicating that while some enjoy a high quality of life, others may experience lower quality (e.g., those with difficulty moving indoors). This aligns with discussions of compressed or expanded morbidity in demographics. The authors touch upon this in the discussion, but a deeper exploration of quality of life and healthy aging would enhance connections to existing literature. 

b) The findings suggest varying perceptions of illness among interviewees, emphasizing that quality of life is more important than mere life expectancy or mortality risk. This finding invites further exploration into the role of quality of life in aging, beyond morbidity and mortality. The influence of traditional culture or community norms on these perceptions could also be explored further. 

c) The study reveals insights into the regularity and limitations of medical check-ups. While discussed, these findings are not prominently reported in the results section. 

d) It would be beneficial to investigate what distinguishes 'Escapers' in terms of their life course, socio-demographic, or occupational factors. Such analysis could provide valuable information for future quantitative studies, yet this discussion is currently missing. 

e) The authors make cross-country comparisons and discuss differences. It would be enlightening to consider how differences in the macro level factors (economic, cultural, historical status), meso level factors (healthcare and pension systems), and micro level factors (individual health behaviors) across countries inform the aging management and healthcare planning in Ethiopia. A comprehensive analysis might be beyond the scope of the available data, but highlighting key learnings about population health and healthy aging in the region would be highly informative. 

 

2) Additionally, considering Ethiopia's demographic and epidemiological transitions, what implications do the health statuses of these centenarians have for the country? 

3) Discussions on healthcare-seeking behaviors and perceptions of health and illness are noted but not reflected in the results section. 

4) Please ensure that Table 1 is fully visible and clearly presented to maintain the clarity of data presentation. 

5) The 9 interviewees are with 8 males and 1 female, even though females have longer life expectancy in general. Please discuss the potential limitations due to the lack of female participants in the study.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for the opportunity to review this manuscript. Overall, i found it to be very interesting work and quite well written. The introduction is good, and provides good reasoning for the study. The aim is clear. The last 2 paragraphs of the introduction are actually the methods section and a relevant heading should be included here. See further comments below regarding your methods. 

The results are generally well presented - The table was good and provided a good visual of your data. The discussion is fair, although some changes could be made to improve this. In particular, what does this information mean? How will it be used to improve centenarians life experience/health experience/access to services etc.. I have made some further specific comments below. 

Lines 85 - 103 This should be a methods section.

Line 89 - Some further information about the recruitment process would be beneficial. Who recruited and how did this occur through woredas? 

Line 101 - Where did the interviews take place? How was data collected? 

Line 231 and Lines 245 - 256  - The problems with sight, hearing, smell and taste should be part of the "decline of sensory functioning" paragraph, rather than Cognitive functioning. 

Some of the discussion is actually results (mostly in the first paragraph) - I would not include any quotes in the discussion. 

The conclusion is good, but should not contain references. Most of this belongs in the discussion. Keep the conclusion to 2-3 sentences only, summarising your work. 

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

AUTHORS HAVE REPLIED POSITIVELY TO MY SUGGESTIONS.

Author Response

Thank you very much.