Dear Prof Agampodi,

Thank you very much for submitting your manuscript "The Stigma Associated with Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. The reviewers appreciated the attention to an important topic. Based on the reviews, we are likely to accept this manuscript for publication, providing that you modify the manuscript according to the review recommendations.

Please prepare and submit your revised manuscript within 30 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to all review comments, and a description of the changes you have made in the manuscript.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

Thank you again for your submission to our journal. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Felix Bongomin, MB ChB, MSc, MMed, FECMM

Academic Editor

PLOS Neglected Tropical Diseases

Charles Jaffe

Section Editor

PLOS Neglected Tropical Diseases

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Reviewer's Responses to Questions

Key Review Criteria Required for Acceptance?

As you describe the new analyses required for acceptance, please consider the following:

Methods

-Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

-Is the study design appropriate to address the stated objectives?

-Is the population clearly described and appropriate for the hypothesis being tested?

-Is the sample size sufficient to ensure adequate power to address the hypothesis being tested?

-Were correct statistical analysis used to support conclusions?

-Are there concerns about ethical or regulatory requirements being met?

Reviewer #1: The methods are clear and articulate; appropriate design, sufficient sample size and correct statistical analyses were employed. The study was registered.

Reviewer #2: The objectives of the study arre clearly articulated and the study design is appropriate to address the stated objectives

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Results

-Does the analysis presented match the analysis plan?

-Are the results clearly and completely presented?

-Are the figures (Tables, Images) of sufficient quality for clarity?

Reviewer #1: The analysis plan matches the actual analysis; results clearly presented; however the figures attached in the appendices seem blury,it would be good to use clearer figures as in the body of the manuscrpit

Reviewer #2: The results are clearly and completely presented. Figures and tables included are sufficient

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

-Do the authors discuss how these data can be helpful to advance our understanding of the topic under study?

-Is public health relevance addressed?

Reviewer #1: The conclusion is subtle and clearly describes a summary of the data, limitations, public health implications of the study.

Reviewer #2: The conclusions are supported by the data presented

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Editorial and Data Presentation Modifications?

Use this section for editorial suggestions as well as relatively minor modifications of existing data that would enhance clarity. If the only modifications needed are minor and/or editorial, you may wish to recommend “Minor Revision” or “Accept”.

Reviewer #1: No recommendations to submit

Reviewer #2: Minor revision: A discrepancy is found between the articles included for the synthesis referred to in the text as mentioned in the comments to the authors.

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Summary and General Comments

Use this section to provide overall comments, discuss strengths/weaknesses of the study, novelty, significance, general execution and scholarship. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. If requesting major revision, please articulate the new experiments that are needed.

Reviewer #1: -I am concerned that this same study has already been published as below https://doi.org/10.1371/journal.pone.0285663

http://www.ncbi.nlm.nih.gov/pmc/articles/pmc10174477/

-Could there be any reason why this paper is undergoing a review for publication again? or could this be an issue of ethical concern

Reviewer #2: Comments to the authors

The bibliographic search article includes an appropriate methodology and all articles included in the manuscript are referenced. Nevertheless, a discrepancy is found between the included articles for the synthesis referred to in the text (16 articles, lines 157, 158, 177, …) and those of studies included in the review in Figure 1 (20 articles).

Specific comments

Abstract

Do not include abbreviations in the summary, or do so for all concepts introduced (MMAT, ...).

Introduction

� Include a more recent WHO reference regarding the clinical manifestations of leishmaniasis and its geographical distribution. In any case, as it is in general, it should not be limited, like the one included (ref. 1), to a cutaneous leishmaniasis reference nor to the eastern Mediterranean region. Also, usually three main clinical manifestations of leishmaniasis are considered: cutaneous, mucocutaneous and visceral. PKDL is a known complication of VL, as LCD or other complications are from LC. Perhaps because of this, the authors do not include studies that specifically deal with PKDL.

� Lines 99 and 103: In line 99 it is mentioned the study of Bos et al. (ref. 15), in relation to the stigma types related to the impact of public stigma, but at the end of the phrase (line 103) there are included three references (15,16,17). Should it be replaced “Bos et al.” by “Some authors”?

Methods – Eligibility criteria

Change “Qualitative, quantitative, cross-sectional, mixed-method, and ethnographic/anthropological studies were included, but articles targeting veterinary studies, vector studies, laboratory-based research, clinical trials, diagnostic or treatment methods for CL and MCL and articles that explore stigma only in VL or PKDL were excluded.” by “Qualitative, quantitative, cross-sectional, mixed-method, and ethnographic/anthropological studies on human leishmaniasis were included, but articles targeting laboratory-based research, clinical trials, diagnostic or treatment methods for CL and MCL and articles that explore stigma only in VL or PKDL were excluded.”

Include some explanation on the types of studies: qualitative, quantitative, cross-sectional, mixed-method, and ethnographic/anthropologica.

Study design

- Line 178: is reference 37 included among the mixed methods studies?

- Line 179: Replace “The majority” by “Five out of 11”

Results

- Table 1 and 2: include the reference number next to the author, as done in the table 3.

- Figure 3: The font size of the figure could be enlarged?

- Starting from line 245 of the results, and to improve tracking, include in the text references next to the authors and remove the references from the end of the sentence. Follow the examples, line 245: Studies by Bennis, Thys, et al. in Morocco [45,46] … for divorce.” and line 248 “Studies by Stewart & Brieger [37] and Reithinger et al. [36] in Afghanistan …. because of CL”.

- Line 408: Replace “Multiple” by “Two”.

Discussion

Given that the authors previously published an article on a protocol for a systematic review of the stigma associated with cutaneous leishmaniasis and mucocutaneous leishmaniasis, it would be of interest to include some discussion of the gaps and difficulties encountered in the application of said protocol in the bibliographic search just carried out and how they could be solved.

References

- Include complete reference for reference 16.

- Review the reference 22.

- Reference 38 cannot be consulted with the information included.

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Reviewer #1: No

Reviewer #2: No

Figure 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. 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 us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

References

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.

Dear Prof Agampodi,

Thank you very much for submitting your manuscript "The Stigma Associated with Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review" for consideration at PLOS Neglected Tropical Diseases. As with all papers reviewed by the journal, your manuscript was reviewed by members of the editorial board and by several independent reviewers. The reviewers appreciated the attention to an important topic. Based on the reviews, we are likely to accept this manuscript for publication, providing that you modify the manuscript according to the review recommendations.

There are additional editor comments to be addressed.

Please prepare and submit your revised manuscript within 30 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to all review comments, and a description of the changes you have made in the manuscript.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

Thank you again for your submission to our journal. We hope that our editorial process has been constructive so far, and we welcome your feedback at any time. Please don't hesitate to contact us if you have any questions or comments.

Sincerely,

Felix Bongomin, MB ChB, MSc, MMed, FECMM

Academic Editor

PLOS Neglected Tropical Diseases

Charles Jaffe

Section Editor

PLOS Neglected Tropical Diseases

***********************

There are additional editor comments to be addressed.

Figure 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. 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 us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. Additionally, PLOS ONE offers an option to publish peer-reviewed clinical study protocols. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols

References

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.

Attachments

Attachment

Submitted filename: Revised article with changes highlighted_AE comments.docx

Dear Prof Agampodi,

We are pleased to inform you that your manuscript 'Stigma Associated with Cutaneous and Mucocutaneous Leishmaniasis: A Systematic Review' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

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.

Should you, your institution's press office or the journal office choose to press release your paper, you will automatically be opted out of early publication. We ask that you notify us now if you or your institution is planning to press release the article. All press must be co-ordinated with PLOS.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Felix Bongomin, MB ChB, MSc, MMed, FECMM

Academic Editor

PLOS Neglected Tropical Diseases

Charles Jaffe

Section Editor

PLOS Neglected Tropical Diseases

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