This reviewer was puzzled by the lack of any information regarding the needs for prenatal care among the rural Hondurans that were the focus of the research.  The mean age of the patient population was noted to be 40 for the women, but this does suggest that there were younger participants.  Were the two clinics surveyed known locally as being for general medical needs with a separate and different (unsurveyed) clinic being known locally as the prenatal clinic?  This needs to be made clearer.

The methods with respect to how the 2008-2009 needs assessment information was reconciled to the 2010 AHI database are only sketchily described.  In terms of cross referencing the diagnostic categories, were mutliple individual used to cross-validate this cross-referencing?  Was a random sample drawn to determine that the cross-referencing categories used were checked for inter-rater reliability?  If only one or two individuals were involved in this cross-referencing then this is a potential limitation of the research.  Inter-rater reliability of this cross-referencing and coding could have been done and Kappa statistics of inter-reliability reported.

I have experience in maternal child and family health (hence the comments about the prenatal clinics) as well as experience with psychometrics and measurement (inter-rater reliability) as well as community-based research and program evaluation.