PCLM-D-24-00206

Application of the Intergovernmental Panel on Climate Change Risk Framework to Estimate Risk of Weather-Related Diarrheal Disease in Western Kenya

PLOS Climate

Dear Dr. Kowalcyk,

Thank you for submitting your manuscript to PLOS Climate. After careful consideration, we feel that it has merit but does not fully meet PLOS Climate’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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After careful consideration and based on the reviewers' comments, the manuscript should be revised and resubmitted. All the reviewers comments should be addressed and responses to the reviewers submitted along the revised manuscript.

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Please submit your revised manuscript by Dec 14 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at climate@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pclm/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Noureddine Benkeblia, Dr. Sci., Dr. Agr.

Academic Editor

PLOS Climate

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3. The resolution of Figure 3 is very low and somewhat difficult to read. It is important that our Editors and Peer Reviewers are able to read all parts of a submission. Please replace these figures with higher resolution copies.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Climate’s publication criteria?>

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?-->?>

Reviewer #1: Yes

Reviewer #2: N/A

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3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: The manuscript presents a scientific approach to risk assessment calculations and present critical information to support evidence-based policy and interventions to address climate-sensitive diseases. The paper needs a final review for format and grammar, for example, to only spell out acronyms in the first instance and be consistent in use thereafter. The number of components in applied from the IPCC risk tool.

Reviewer #2: Please see attached document for full review as the number of characters exceeds that allowed by this system. Please consider removing the character requirement as a good review of a paper may require more than provided here.

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what does this mean? ). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #2: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: PCLM_D24_00206.docx

PCLM-D-24-00206R1

Application of the Intergovernmental Panel on Climate Change Risk Framework to Estimate Risk of Weather-Related Diarrheal Disease in Western Kenya

PLOS Climate

Dear Dr. Kowalcyk,

Thank you for submitting your manuscript to PLOS Climate. After careful consideration, we feel that it has merit but does not fully meet PLOS Climate’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please find attached the comments of three reviewers. Please include point by point responses. 

Please submit your revised manuscript by May 02 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at climate@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pclm/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Joanna Tindall, PhD

Staff Editor

PLOS Climate

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

Reviewer #4: (No Response)

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publication criteria?>

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?-->?>

Reviewer #1: Yes

Reviewer #3: I don't know

Reviewer #4: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: The manuscript is improved in grammar and format. The analysis is clearly explained and presented.

Reviewer #3: See the attached file for comments

Reviewer #4: A well-written manuscript. I have a few minor comments that the authors may consider addressing before the manuscript is accepted for publication.

1. Figure 2

a) Please define and explain the severe outcomes (e.g., diarrhea) in the Methods section.

b) Atmospheric conditions, such as temperature, are also recognized as causal risk factors for diarrhea, but this aspect is missing from the conceptual diagram. Please consider incorporating it.

2. Data Source Clarification (Lines 114–115)

The authors mention that causal pathway model data were collected from the Kenyan government. Please clearly specify the data source (e.g., Ministry of Health, Ministry of Information and Communications?) and provide details on the data collection process.

3. Variable Units

Please ensure that all variables, particularly weather-related variables, include appropriate units of measurement.

4. Extreme Events Definition (Line 122)

The statement, "Extreme events were measured as the frequency of days over the 95th percentile of precipitation," should be supported by a relevant reference. Please provide an appropriate citation.

5. Kaiser-Meyer-Olkin (KMO) Test (Lines 152–153)

The manuscript states, "If the KMO was below 0.5, variables with the lowest individual KMO were removed." Please specify which variables were removed based on this criterion.

6. Statistical Model Considerations

Incorporating a statistical model that examines diarrheal disease in relation to risk factors, including weather data, could significantly strengthen the study.

7. Conclusion Section

Please include a Conclusion section summarizing the key findings and implications of the study.

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what does this mean? ). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #3: Yes:  Kuku Voyi

Reviewer #4: Yes:  HOSSAIN MD NASIF

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: Comments to the Author.docx

PCLM-D-24-00206R2

Application of the Intergovernmental Panel on Climate Change Risk Framework to Estimate Risk of Weather-Related Diarrheal Disease in Western Kenya

PLOS Climate

Dear Dr. Kowalcyk,

Thank you for submitting your manuscript to PLOS Climate. After careful consideration, we feel that it has merit but does not fully meet PLOS Climate’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

One of the reviewers has left some minor amendments to be addressed in this round. Please provide the appropriate updates to your manuscript and response to reviewer comments document before the date below. 

Please submit your revised manuscript by Jun 11 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at climate@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pclm/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Joanna Tindall, PhD

Staff Editor

PLOS Climate

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

**********

publication criteria?>

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?-->?>

Reviewer #1: Yes

Reviewer #3: N/A

Reviewer #4: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #1: The paper has improved with the additional information and is better aligned with the research objective.

Reviewer #3: 1. Lines 364 -366. This sentence does not read well.

Overall, these results provide useful information to policy makers in Kenya identify sub counties that should be prioritized for climate change adaptation efforts have the most impact, through methods such as a dashboard.

Reviewer suggestion: Break this sentence into two (a) addressing usefulness to policy makers (b) what information will be useful in such an exercise

2. Lines 508 - 513.

S1 Table 1A. Previous Health Oriented Indices for Risk Due to Climate Change in LMICs using IPCC

509 Frameworks

510 S1 Table B2. Selected Variables for Risk Index

511 S1 Table C3. Summary Statistics of Variables Included in the Risk Index

512 S1 Table D7. Risk of Diarrheal Disease for Each Sub-County by County in the Lake Victoria Region Block of

513 Kenya

Reviewer suggestion: This suggested change can be effected throughout the manuscript.

Replace S1 Table 1A, S1 Table B2 etc. with Table S1, Table S2, etc.

Reviewer #4: I want to thank the authors of this manuscript for thoughtfully addressing each of my comments. After reviewing the revised manuscript, I find that I have no additional comments to offer at this time.

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what does this mean? ). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #3: Yes:  Kuku Voyi

Reviewer #4: Yes:  HOSSAIN MD NASIF

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PCLM-D-24-00206R3

Application of the Intergovernmental Panel on Climate Change Risk Framework to Estimate Risk of Weather-Related Diarrheal Disease in Western Kenya

PLOS Climate

Dear Dr. Kowalcyk,

Thank you for submitting your manuscript to PLOS Climate. After careful consideration, we feel that it has merit but does not fully meet PLOS Climate’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

As you will see in the appended reports, Reviewer #3 makes a request for minor revisions, which requires your attention.

Please submit your revised manuscript by Jul 12 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at climate@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pclm/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Jason Morgan

Staff Editor

PLOS Climate

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #3: (No Response)

Reviewer #4: All comments have been addressed

**********

publication criteria?>

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?-->?>

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #3: Yes

Reviewer #4: Yes

**********

Reviewer #1: The manuscript provides useful information and worthwhile for publication.

Reviewer #3: Revise your conclusion, based on the results and limitations of this study. The results from this study are not strong enough for the conclusion written in lines 363 - 365.

The rest of the conclusion agrees with lines 356 - 357.

It could work well to take the contents of 356-357 to replace 363 - 365.

Suggestion: delete the current lines 363-365 and move the text in lines 356-357 into this position as the first sentence of the conclusion

Once this is sorted the abstract, the last two lines can be adjusted to something like: Further research is needed to determine whether modeled risk proves consistent with observed risk of diarrheal disease in relation to weather variables. Additional work is needed to ascertain whether this approach is useful to policymakers.

Reviewer #4: The current manuscript appears to be in good shape. Thank you so much, authors, for addressing all comments. I believe this manuscript will assist policymakers in Kenya and other sub-Saharan African countries in the Climate Change Risk Framework to estimate the risk of weather-related diarrheal diseases.

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what does this mean? ). If published, this will include your full peer review and any attached files.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

Reviewer #3: Yes:  Kuku Voyi

Reviewer #4: Yes:  MD NASIF HOSSAIN

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Application of the Intergovernmental Panel on Climate Change Risk Framework to Estimate Risk of Weather-Related Diarrheal Disease in Western Kenya

PCLM-D-24-00206R4

Dear Dr. Kowalcyk,

We're pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you'll receive an e-mail detailing the required amendments. When these have been addressed, you'll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at https://www.editorialmanager.com/pclm/ click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. For billing related questions, please contact billing support at https://plos.my.site.com/s/.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they'll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact climate@plos.org.

Kind regards,

Jamie Males

Executive Editor

PLOS Climate

Additional Editor Comments (optional):

Reviewers' comments: