Title: Hospital-based prevalence and predictors of upper gastrointestinal bleeding in Northern
Uganda: A retrospective cross-sectional study
Version: 2 Date: 22 Apr 2025
Reviewer's report:
Major Comments
Study Design Limitations – Causality and Generalizability
The retrospective cross-sectional design limits the ability to establish causal relationships. While
this is acknowledged, the authors should explicitly discuss how this impacts interpretation,
especially regarding predictors like alcohol use and prior UGIB.
Moreover, as a hospital-based study in a specific geographic location, findings may not be
generalizable to the broader Ugandan population. This limitation should be better emphasized
in both the discussion and conclusion.
Missing Clinical Variables – NSAIDs and Medication Use
The omission of NSAID, steroid, or anticoagulant usage data is a significant gap, as these are
well-known risk factors for UGIB. Their exclusion may have introduced residual confounding,
which needs to be addressed more directly in the limitations section.
Diagnostic Methodology of UGIB
The diagnosis of UGIB was made solely on clinical presentation due to lack of endoscopy.
While resource limitations are understandable, the potential for misclassification bias should be
elaborated on, including how this might impact prevalence and outcomes.
Referral Bias and Mortality Rate Interpretation
The exceptionally low mortality rate (1.6%) among UGIB patients contrasts sharply with
regional and global data. The manuscript suggests referral of severe cases may explain this, but
this should be quantified or substantiated with available data, if possible, or discussed more
critically.
Statistical Analysis Clarification
Table 4 includes both bivariate and multivariable analyses but lacks clarity in distinguishing
which variables were retained in the final model. Also, p-values should be aligned with the
corresponding confidence intervals, and insignificant variables should not be overly emphasized.
Justification of Sample Size
While the Kish Leslie formula was applied appropriately, the choice of prevalence (20.3%) as a
base from another setting should be justified more thoroughly, especially considering the study’s
focus on inpatients rather than the general population.
Minor Comments
Title Enhancement
Consider a slightly more specific title for improved clarity and indexing, e.g.,
“Hospital-based prevalence and predictors of upper gastrointestinal bleeding in Northern
Uganda: A retrospective cross-sectional study.”
Abstract – Numerical Inconsistencies
The abstract reports a prevalence of 24.5%, while the results section states 24.7%. Ensure
consistency throughout.
Spelling and Language
Minor typographical errors are present (e.g., “gestational bleeding” instead of “gastrointestinal
bleeding” in the Discussion). A thorough proofread is recommended to ensure clarity and
professionalism.
Data Presentation
Some tables are dense and lack units (e.g., blood transfusion data). Consider reformatting tables
for readability and adding units or clarifying labels where applicable.
Ethics Statement Formatting
The ethical approval section could be made more concise. You might also wish to include a
short sentence confirming confidentiality and anonymity during data extraction.
Figures and Tables
Figures (e.g., Boxplot for age) could be annotated for clarity. Adding exact medians or
interquartile ranges in figure captions would be beneficial.
Literature Contextualization
While the discussion is well-referenced, more comparative context with community-based
studies or Ugandan national data could better situate the findings.
Conclusion Section
The conclusion is somewhat repetitive. Condensing it into clear implications for public health
practice, clinical recommendations, and future research would strengthen the impact.
Title: Hospital-based prevalence and predictors of upper gastrointestinal bleeding in Northern
Uganda: A retrospective cross-sectional study
Version: 2 Date: 22 Apr 2025
Reviewer's report:
Major Comments
Study Design Limitations – Causality and Generalizability
The retrospective cross-sectional design limits the ability to establish causal relationships. While
this is acknowledged, the authors should explicitly discuss how this impacts interpretation,
especially regarding predictors like alcohol use and prior UGIB.
Moreover, as a hospital-based study in a specific geographic location, findings may not be
generalizable to the broader Ugandan population. This limitation should be better emphasized
in both the discussion and conclusion.
Missing Clinical Variables – NSAIDs and Medication Use
The omission of NSAID, steroid, or anticoagulant usage data is a significant gap, as these are
well-known risk factors for UGIB. Their exclusion may have introduced residual confounding,
which needs to be addressed more directly in the limitations section.
Diagnostic Methodology of UGIB
The diagnosis of UGIB was made solely on clinical presentation due to lack of endoscopy.
While resource limitations are understandable, the potential for misclassification bias should be
elaborated on, including how this might impact prevalence and outcomes.
Referral Bias and Mortality Rate Interpretation
The exceptionally low mortality rate (1.6%) among UGIB patients contrasts sharply with
regional and global data. The manuscript suggests referral of severe cases may explain this, but
this should be quantified or substantiated with available data, if possible, or discussed more
critically.
Statistical Analysis Clarification
Table 4 includes both bivariate and multivariable analyses but lacks clarity in distinguishing
which variables were retained in the final model. Also, p-values should be aligned with the
corresponding confidence intervals, and insignificant variables should not be overly emphasized.
Justification of Sample Size
While the Kish Leslie formula was applied appropriately, the choice of prevalence (20.3%) as a
base from another setting should be justified more thoroughly, especially considering the study’s
focus on inpatients rather than the general population.
Minor Comments
Title Enhancement
Consider a slightly more specific title for improved clarity and indexing, e.g.,
“Hospital-based prevalence and predictors of upper gastrointestinal bleeding in Northern
Uganda: A retrospective cross-sectional study.”
Abstract – Numerical Inconsistencies
The abstract reports a prevalence of 24.5%, while the results section states 24.7%. Ensure
consistency throughout.
Spelling and Language
Minor typographical errors are present (e.g., “gestational bleeding” instead of “gastrointestinal
bleeding” in the Discussion). A thorough proofread is recommended to ensure clarity and
professionalism.
Data Presentation
Some tables are dense and lack units (e.g., blood transfusion data). Consider reformatting tables
for readability and adding units or clarifying labels where applicable.
Ethics Statement Formatting
The ethical approval section could be made more concise. You might also wish to include a
short sentence confirming confidentiality and anonymity during data extraction.
Figures and Tables
Figures (e.g., Boxplot for age) could be annotated for clarity. Adding exact medians or
interquartile ranges in figure captions would be beneficial.
Literature Contextualization
While the discussion is well-referenced, more comparative context with community-based
studies or Ugandan national data could better situate the findings.
Conclusion Section
The conclusion is somewhat repetitive. Condensing it into clear implications for public health
practice, clinical recommendations, and future research would strengthen the impact.
Please review this paper.
user
Title: Hospital-based prevalence and predictors of upper gastrointestinal bleeding in Northern
Uganda: A retrospective cross-sectional study
Version: 2 Date: 22 Apr 2025
Reviewer's report:
Major Comments
Study Design Limitations – Causality and Generalizability
The retrospective cross-sectional design limits the ability to establish causal relationships. While
this is acknowledged, the authors should explicitly discuss how this impacts interpretation,
especially regarding predictors like alcohol use and prior UGIB.
Moreover, as a hospital-based study in a specific geographic location, findings may not be
generalizable to the broader Ugandan population. This limitation should be better emphasized
in both the discussion and conclusion.
Missing Clinical Variables – NSAIDs and Medication Use
The omission of NSAID, steroid, or anticoagulant usage data is a significant gap, as these are
well-known risk factors for UGIB. Their exclusion may have introduced residual confounding,
which needs to be addressed more directly in the limitations section.
Diagnostic Methodology of UGIB
The diagnosis of UGIB was made solely on clinical presentation due to lack of endoscopy.
While resource limitations are understandable, the potential for misclassification bias should be
elaborated on, including how this might impact prevalence and outcomes.
Referral Bias and Mortality Rate Interpretation
The exceptionally low mortality rate (1.6%) among UGIB patients contrasts sharply with
regional and global data. The manuscript suggests referral of severe cases may explain this, but
this should be quantified or substantiated with available data, if possible, or discussed more
critically.
Statistical Analysis Clarification
Table 4 includes both bivariate and multivariable analyses but lacks clarity in distinguishing
which variables were retained in the final model. Also, p-values should be aligned with the
corresponding confidence intervals, and insignificant variables should not be overly emphasized.
Justification of Sample Size
While the Kish Leslie formula was applied appropriately, the choice of prevalence (20.3%) as a
base from another setting should be justified more thoroughly, especially considering the study’s
focus on inpatients rather than the general population.
Minor Comments
Title Enhancement
Consider a slightly more specific title for improved clarity and indexing, e.g.,
“Hospital-based prevalence and predictors of upper gastrointestinal bleeding in Northern
Uganda: A retrospective cross-sectional study.”
Abstract – Numerical Inconsistencies
The abstract reports a prevalence of 24.5%, while the results section states 24.7%. Ensure
consistency throughout.
Spelling and Language
Minor typographical errors are present (e.g., “gestational bleeding” instead of “gastrointestinal
bleeding” in the Discussion). A thorough proofread is recommended to ensure clarity and
professionalism.
Data Presentation
Some tables are dense and lack units (e.g., blood transfusion data). Consider reformatting tables
for readability and adding units or clarifying labels where applicable.
Ethics Statement Formatting
The ethical approval section could be made more concise. You might also wish to include a
short sentence confirming confidentiality and anonymity during data extraction.
Figures and Tables
Figures (e.g., Boxplot for age) could be annotated for clarity. Adding exact medians or
interquartile ranges in figure captions would be beneficial.
Literature Contextualization
While the discussion is well-referenced, more comparative context with community-based
studies or Ugandan national data could better situate the findings.
Conclusion Section
The conclusion is somewhat repetitive. Condensing it into clear implications for public health
practice, clinical recommendations, and future research would strengthen the impact.
assistant