PNTD-D-24-01118

Navigating the Cholera Elimination Roadmap in Zambia - a Scoping Review (2013-2023)

PLOS Neglected Tropical Diseases

Dear Dr. Mbewe,

Thank you for submitting your manuscript to PLOS Neglected Tropical Diseases. After careful consideration, we feel that it has merit but does not fully meet PLOS Neglected Tropical Diseases'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 submit your revised manuscript within 60 days May 24 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 plosntds@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pntd/ 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'. This file does not need to include responses to any formatting updates and technical items listed in the 'Journal Requirements' section below.

* 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'.

If you would like to make changes to your financial disclosure, competing interests statement, or data availability statement, please make these updates within the submission form at the time of resubmission. 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,

Jeffrey H Withey

Academic Editor

PLOS Neglected Tropical Diseases

Victoria Brookes

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

Additional Editor Comments (if provided):

Please respond to each of the reviewers' comments and indicate where changes have been made in the revised manuscript. Please note that one reviewer has comments in the attachment and the other in the body of this email.

In particular, please note that the methods must reflect those of a scoping review, i.e. PRISMA-ScR guidelines, to ensure accuracy and reproducibility of findings.

Journal Requirements:

1) Please ensure that the CRediT author contributions listed for every co-author are completed accurately and in full.

At this stage, the following Authors/Authors require contributions: Nyuma Mbewe. Please ensure that the full contributions of each author are acknowledged in the "Add/Edit/Remove Authors" section of our submission form.

The list of CRediT author contributions may be found here: https://journals.plos.org/plosntds/s/authorship#loc-author-contributions

2) We ask that a manuscript source file is provided at Revision. Please upload your manuscript file as a .doc, .docx, .rtf or .tex. If you are providing a .tex file, please upload it under the item type u2018LaTeX Source Fileu2019 and leave your .pdf version as the item type u2018Manuscriptu2019.

3) We do not publish any copyright or trademark symbols that usually accompany proprietary names, eg ©,  ®, or TM  (e.g. next to drug or reagent names). Therefore please remove all instances of trademark/copyright symbols throughout the text, including:

- ® on pages: 16, 17, 20, 30, and 32.

4) Please upload all main figures as separate Figure files in .tif or .eps format. For more information about how to convert and format your figure files please see our guidelines: 

https://journals.plos.org/plosntds/s/figures

Reviewers' Comments:

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: (No Response)

Reviewer #2: The Methods need to be clarified, coherence with the research questions defined in introduction and the structure of the Results section improved, and further details provided on how data were analysed or synthesised. The PRISMA check-list (for scoping or systematic review) is a useful guide to structure the manuscript - it is mentioned in Results (L. 122) but not adhered to.

The terms "scoping review" and "narrative review" are used interchangeably in the manuscript to refer to the work. However, the research questions defined at L. 97-99 require synthesising evidence on (i) cholera in Zambia and (ii) cholera control strategies, and they would be best addressed through a systematic review (see Munn et al., BMC Medical Research Methodology, 2018).

L. 112: the search terms included "Zambia" and articles not related to Zambia were excluded. This makes the scope of the review very specific to the Zambian context and prevents identification of relevant evidence from similar settings to address the research question.

L. 109 / 118: what is the point of mentioning Embase if this database could not be accessed? Consider moving to discussion / limitations rather than keeping this in Methods and Results.

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: (No Response)

Reviewer #2: The Results section summarises findings from studies included in the review but does not include any assessment of the strength of evidence. This is related to my comment above; a systematic review with a risk-of-bias assessment would be more appropriate approach to synthesise evidence and formulate recommendations on that basis.

L. 111: what was done with the 11,300 records from Google Schholar and why are they not reflected in Fig 1? It is difficult to reconcile the manuscript text with Fig 1, as several numbers do not match.

L. 123-126: this belongs to Methods.

L. 147-148: only two papers in Table 1 appear to include more than one year of cholera surveillance and support this statement, and there is likely an issue with the reference number (Table 1 vs. text).

L. 148-152: this sentence is unclear, especially "...the proportion of clinically suspected cholera cases and not all confirmed by culture..." - are many cases confirmed by culture outside clinical settings?

L. 187, 189: I believe 'Vibrio' is used instead of 'vibriones/vibrioni' in Englishs - to be checked.

L. 213-217: how many studies is this estimate of 45% facility vs. 55% community deaths based on, and which time period does it refer to? Include references.

L. 223: "antimicrobial resistance" is vague - does it have any implications for patient management / treatment?

L. 235: don't you mean that reported administrative coverage is higher than actual coverage?

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: (No Response)

Reviewer #2: It is not entirely clear how the Discussion and Conclusions are supported by the Results. For instance:

- The statement at L. 314-316 may be sensible but how it is supported by evidence (from the Results section) on the effectiveness of decentralised surveillance and case-area targeted interventions

- Fig 2 shows that there are very few publications on Community Engagement - but this is not reflected upon in Discussion (for identifying future research needs)

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 Response)

Reviewer #2: See above.

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: (No Response)

Reviewer #2: This review is relevant in the context of cholera resurgence in Zambia and across the continent. However, a systematic review including an assessment of the strength of evidence related to the effectiveness of different intervention strategies would more appropriate to address the research questions and inform the development of a sound strategy for cholera elimination. The inclusion from other settings outside Zambia should also be considered to strengthen the evidence synthesis and inform the prioritisation of interventions. I have provided more detailed comments under the respective manuscript sections.

Details

L. 68: there is an issue with the citation

L. 74: the abbreviation WASH is already defined at the beginning of this paragraph

Fig. 2: typo

PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: Yes:  Md Taiufiqul Islam

Reviewer #2: No

[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.]

Figure resubmission:

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. If there are other versions of figure files still present in your submission file inventory at resubmission, please replace them with the PACE-processed versions.

Reproducibility:

To enhance the reproducibility of your results, we recommend that authors of applicable studies deposit 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

Attachments

Attachment

Submitted filename: Review.Comments.PNTD-D-24-01118.docx

Dear Dr Mbewe,

We are pleased to inform you that your manuscript 'Navigating the Cholera Elimination Roadmap in Zambia - a Scoping Review (2013-2024)' 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,

Jeffrey H Withey

Academic Editor

PLOS Neglected Tropical Diseases

Victoria Brookes

Section Editor

PLOS Neglected Tropical Diseases

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-4304-636XX

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

orcid.org/0000-0003-1765-0002

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