PGPH-D-21-00572

Impact of the COVID-19 pandemic on daily life among mothers in Bhaktapur, Nepal

PLOS Global Public Health

Dear Dr. Ranjitkar,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’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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We look forward to receiving your revised manuscript.

Kind regards,

Rachel Hall-Clifford

Academic Editor

PLOS Global Public Health

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Additional Editor Comments (if provided):

This is an important contribution to our understanding of the COVID-19 pandemic on daily life and well-being. In addition to the suggestions of the reviewers, I would add:

1) Since your framing of the paper and discussion focus on worry, please title the paper accordingly. This is a very interesting framing, and the title should reflect that. Please further incorporate in the introduction that you are considering "worry" not just about COVID-19 itself but many of its sequelae in Nepal (i.e., financial outcomes, loss of childcare, etc.).

2) Please indicate the age range of children in the abstract. This is very clear in the methods, but after reading the abstract, I thought certainly outcomes would vary by age of children (which turned out to not be relevant as I saw the study design).

3) In the discussion, please include more thinking about the gendered experience of women.

Thank you for this submission!

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

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: Yes

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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 requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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

PLOS Global Public Health does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This study uses cross-sectional survey data to assess the impact of the COVID-19 pandemic on various aspects of daily life for mothers in Bhaktapur, Nepal. While previous studies in Nepal have assessed psychological impacts during the early pandemic period, this study centers on a later phase of the pandemic (September 2020–February 2021, prior to the predominance of the SARS-CoV-2 Delta variant). Findings of higher pandemic-associated worry in mothers with higher educational attainment and socioeconomic status are concordant with a prior, national-level study assessing pandemic distress in April-May 2020 (Shrestha et al. 2020). Readers of PLOS Global Public Health may be interested in implications of these findings for health education efforts in Nepal, as well as suggestions for addressing these psychological impacts.

Major and minor comments for the authors are provided below.

INTRODUCTION

The authors provide a comprehensive overview of previous literature on the impact of COVID-19 on psychological health in general and in Nepal specifically.

Additional contextual information about Bhaktapur municipality (e.g. population demographics, geographical location within Nepal) would be appreciated in the Introduction, as well as in the Discussion of the study findings.

METHODS

The authors have clearly described the participant recruitment strategy and reasons for loss to follow up.

Definition of variables is easily understood, but what is meant by “age category of family members” is not immediately clear.

The methods for statistical analysis are technically sound, although authors should discuss explicitly their strategy for handling any missing data.

The authors received ethical approvals from the Nepal Health and Research Council (NHRC) and Regional Committee for Medical and Health Research Ethics (REC) and described obtaining written consent from study participants. Authors have made data available upon request in accordance with requirements of NHRC and REC.

RESULTS

Results are communicated clearly.

Did the authors note any difference in key findings (negative impacts of COVID-19) by mode of data collection (phone vs. in-person interview)?

TABLES

Tables 1-5 and Supplemental Table 1 are well-organized and easily comprehensible.

DISCUSSION/CONCLUSIONS

The authors appropriately situate their findings within a broader discussion of previous literature on pandemic distress in Nepal and in other LMICs.

Authors have thoughtfully considered the Strengths and Limitations of the study, including generalizability, variability in the mode of data collection (phone and in-person interviews), and inability to collect data on depressive symptoms through clinical interview. Authors should additionally address how the study setting in Bhaktapur affects generalizability.

Authors should expound on implications of their findings for readers of PLOS Global Public Health. What are the implications for health education efforts in Nepal if those least concerned about COVID-19 are those who with the lowest educational attainment? What should public health practitioners consider when aiming to address the psychological impacts the findings highlight?

FIGURES

Figure 1 is easily comprehensible. The title should be reworded to reflect the participants of the current study, e.g. “Recruitment of mothers in Bhaktapur, Nepal”.

MINOR COMMENTS:

Use of the term “Corona” should be replaced with “Coronavirus” or “COVID-19,” including in the title of Table 2.

This article satisfies the below criteria for acceptance to PLOS Global Public Health:

1. The study presents the results of primary scientific research.

2. Results reported have not been published elsewhere.

3. Experiments, statistics, and other analyses are performed to a high technical standard and are described in sufficient detail.

4. Conclusions are presented in an appropriate fashion and are supported by the data.

5. The article is presented in an intelligible fashion and is written in standard English.

6. The research meets all applicable standards for the ethics of experimentation and research integrity.

7. The article adheres to appropriate reporting guidelines and community standards for data availability.

Reviewer #2: The authors present findings of a study that assessed effect of COVID-19 in an urban district of Nepal. The article is largely coherent however it would benefit with some specific detail in few places. I would strongly recommend the article to be professionally edited for language as there are typos and grammatical errors in the article (e.g., line 90, 207, 255-256).

Line number Comments

103 Suggest to include some information on characteristics of respondents who were lost to follow up. Was it different from the final sample?

106 Need to specific and consistent in using the term. Caregivers or mothers. Grandparents, father or other members of an extended family can also be a caregiver

113 What was the definition for” no work” specially for mothers (57.8%)? Did it also include housewife or household work? Strongly suggest to use alternative word

135 Recommend including information tool development of Corona Exposure questionnaire. Was this questionnaire pre-tested?

213-215 Convoluted sentence. Please make this sentence easier to read

269 What could be the possible explanation about the low prevalence of sleep problem – What do authors think about that? - more resilience because of repeated stressors? or taking COVID-19 lightly?

287-289 Argument here is really not clear. Please add more reasoning about why they could be less sensitive

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Reviewer #1: No

Reviewer #2: No

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Impact of the COVID-19 pandemic on daily life and worry among mothers in Bhaktapur, Nepal

PGPH-D-21-00572R1

Dear Mr. Ranjitkar,

We are pleased to inform you that your manuscript 'Impact of the COVID-19 pandemic on daily life and worry among mothers in Bhaktapur, Nepal' has been provisionally accepted for publication in PLOS Global Public Health.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

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Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Global Public Health.

Best regards,

Rachel Hall-Clifford

Academic Editor

PLOS Global Public Health

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Reviewer Comments (if any, and for reference):