Dear Mr. Zewude,

Thank you very much for submitting your manuscript "Neglected Tropical Disease meets Neglected Community: Street Children’s Susceptibility to Scabies in Addis Ababa, Ethiopia" 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. In light of the reviews (below this email), we would like to invite the resubmission of a significantly-revised version that takes into account the reviewers' comments.

We cannot make any decision about publication until we have seen the revised manuscript and your response to the reviewers' comments. Your revised manuscript is also likely to be sent to reviewers for further evaluation.

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

[1] A letter containing a detailed list of your responses to the 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.

Please prepare and submit your revised manuscript within 60 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email. Please note that revised manuscripts received after the 60-day due date may require evaluation and peer review similar to newly submitted manuscripts.

Thank you again for your submission. 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,

Aysegul Taylan Ozkan, M.D., Ph.D.,

Academic Editor

PLOS Neglected Tropical Diseases

Audrey Lenhart

Section Editor

PLOS Neglected Tropical Diseases

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

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: Selection of study participants

1. The authors talk of collecting data about the embodied experience of scabies infestation, street children who had a history of a previous scabies infestation or those who were infested with it during the interview. Was scabies diagnosed clinically (clinician) or just the mere presence of scabies-like skin manifestation? The reader needs to be sure that these street children actually had scabies and not the differential diagnosis (other skin infestations) of scabies.

2. It will be useful for the authors to list the inclusion/exclusion criteria first before explaining each of them.

Method of data collection and analysis

1. The statement “Qualitative data were collected using an in-depth interview method” should read “Qualitative data was collected using in-depth interviews”

2. It will be important to indicate what is contained in the interview guide or refer the reader to it as a supplementary file.

3. Was the interview guide written in the local language or in another language and translated? If you so was the translation done by a professional or how was it done?

4. Were the interviews conducted in the entire December 2023? The authors need to be specific with the dates.

5. The statement “The number of children interviewed was determined based on the principle of theoretical data saturation” is not clear. The need to explain what this theory means in the context of this article and indicate the source as well.

6. Why were most participants getting bored after some minutes of conversation?

7. The data analysis section needs to be rewritten well. For instance how did the authors manage issues of disagreement during coding? It is also not clear how the main themes and sub-themes were arrived at.

8. Was data analysis done inductively or deductively? This needs to come out clearly.

Reviewer #2: (No Response)

Reviewer #3: Methods

The study was conducted in Addis Ababa, focusing on Bole and Kirkos sub-cities. Participants were selected using snowball sampling, with inclusion criteria ensuring diverse representation of street children aged 11-17. The qualitative data were collected through in-depth interviews, and the analysis involved coding and thematic analysis using NVivo 12 software. Ethical considerations were carefully addressed, given the vulnerability of the study population.

Reviewer #4: The study design has been appropriate and the study population has been described.

sample size is a limitation. Nevertheless, the authors have tried to summarize the views of the partcipants

Concerns about ethical and regulatory requirements met

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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: 1. It will be important to include some percentages in the socio-demographic characteristics.

2. It will also be useful for the authors to organize the results into main and sub-themes and clearly stated as such.

3. This section is poorly organized.

4. It is better to present some of the results as figures or percentages so that the reader gets to know what proportion of the participants expressed their views of a particular finding.

Susceptibility to Scabies

1. Please check “•••”(‘ekek’).

2. What makes it clear that street children in Addis Ababa are susceptible to scabies?

3. The authors use the term prevalence loosely. How is susceptibility related to prevalence? The authors must realize that prevalence is a technical term and should be treated as such.

4. Not too sure how physical, social and psychological impacts fall under susceptibility. Similarly same applies to social consequences with psychological consequences.

5. Why talk about prevalence here when the objective of the paper was to explore the susceptibility to scabies and related health-seeking behavior of street children in Addis Ababa?

Did the headings: The role of mutual support or social capital as a street sub-culture; The role of free healthcare services; and Anticipated and experienced negative social reactions from significant others emerge from the data or were predetermined?

Discussion

1. The statement “This study showed that street children in Addis Ababa and possibly in the entire country are highly susceptible to scabies” cannot be arrived at from this type of study.

2. The statement “They reported frequent infestations, which was borne out by observation” is not clear.

3. Since this is not a prevalence study it is inappropriate to compare prevalence of scabies in other areas to that of this study.

Reviewer #2: (No Response)

Reviewer #3: The results section effectively presents the findings, categorized into themes such as susceptibility to scabies, understanding of its causes and symptoms, and health-seeking behaviors. The narrative is enriched with quotes from the participants, providing a vivid account of their lived experiences. The study reveals that street children are highly susceptible to scabies, with significant physical, psychological, and social impacts. The children’s understanding of scabies is linked to their living conditions and hygiene practices, and their health-seeking behavior includes visiting healthcare facilities, traditional healers, and self-care.

Reviewer #4: In the results paragraph, details pertaining to the total number, number and percentage of boys vs girls, youngest age, oldest age have to be mentioned.

results have been presented in a narrative pattern

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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: 1. The study design and limitations of this study does not allow for the statement that “This study has uncovered considerable morbidity ascribable to a neglected tropical disease among a neglected social group”

2. The conclusion should be a brief summary of key findings.

3. The recommendation is not specific and non-targeted. Whom are the recommendations meant for?

Reviewer #2: (No Response)

Reviewer #3: Conclusion

The conclusion highlights the significant morbidity caused by scabies among street children and underscores the need for targeted interventions to improve their living conditions. The study calls for efforts to reunify street children with their families or integrate them into supportive communities, aiming to reduce health disparities and combat neglect.

Reviewer #4: The authors have highlighted the immediate need to address this NTD infection with due importance given to rejoining the street children to their family/homes and deaddiction from glue.

There is an urgent need to find out if the street children in the other sates have access to treatment care as per National policy guidelines.

The results indirectly point out to the need to address water scarcity.

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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 Response)

Reviewer #2: (No Response)

Reviewer #3: Minor revision

Reviewer #4: The authors have taken up this study with a good intention. I have mentioned a few corrections alongside the manuscript, which is in a narrative format.

The manuscript could be made more concise . References need to be inserted, rather than mentioning the authors within the brackets

--------------------

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: 1. The manuscript is saddled with lots grammatical errors and will need substantial English editing.

2. The referencing style of the manuscript doesn’t appear to be that recommended by Plos journals.

3. Line numbering is recommended would have aided easy review.

4. What is the quote (just before background) of page 2 meant for?

5. The entire paper needs extensive formatting.

Background

1. It will be useful to indicate the current prevalence of scabies in Ethiopia instead of stating scabies as being the most common diagnosis in the statement “weighted prevalence of clinically confirmed skin diseases in Ethiopia is 22.5%, with scabies being the most common diagnosis”

2. In the last paragraph the authors state that “The few existing studies are dominated by medical perspectives, and studies undertaken from social science perspectives are lacking”. This justification is not clear or convincing enough. Social science perspective is too broad and hence the need for the authors to be very clear on this.

Reviewer #2: (No Response)

Reviewer #3: General Comments

Relevance: The study addresses a critical intersection of neglected diseases and marginalized populations, providing valuable insights for public health policy and intervention strategies.

Clarity and Structure: The article is well-organized and clearly written, making it accessible to both researchers and policymakers

Recommendations: The recommendations are practical and actionable, focusing on improving living conditions and healthcare access for street children.

Ethical Considerations: The study demonstrates a strong ethical framework, ensuring the safety and confidentiality of the vulnerable participants.

Overall, the article is a significant contribution to understanding and addressing the health challenges faced by street children in Addis Ababa, particularly in relation to scabies.

Reviewer #4: Please address the comments mentioned alongside the manuscript. The manuscript could be made more concise . References need to be inserted, rather than mentioning the authors within the brackets

References could be mentioned in Vancouver style

--------------------

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: Stephen Apanga

Reviewer #2: Yes: Aslan Yürekli

Reviewer #3: Yes: Dr.Fantahun Abza Babeta, Assistant professor, MD, Dermatologist

Reviewer #4: 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

Attachments

Attachment

Submitted filename: Comments_Reviewer 4.docx

Dear Mr. Zewude,

Thank you very much for submitting your manuscript "Neglected Tropical Disease meets Neglected Community: Street Children’s Susceptibility to Scabies in Addis Ababa, Ethiopia" 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,

Aysegul Taylan Ozkan, M.D., Ph.D.,

Academic Editor

PLOS Neglected Tropical Diseases

Audrey Lenhart

Section Editor

PLOS Neglected Tropical Diseases

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

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 #3: Yes

--------------------

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 #3: Yes

--------------------

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 #3: Yes

--------------------

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 #3: Yes

--------------------

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 #3: No comments

--------------------

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: Stephen Apanga

Reviewer #3: Yes: Dr.Fantahun Abza Babeta, MD Dermatologist

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: PNTD-D-24-00471_Review2.docx

Dear Mr. Zewude,

We are pleased to inform you that your manuscript 'Neglected Tropical Disease meets Neglected Community: Street Children’s Susceptibility to Scabies in Addis Ababa, Ethiopia' 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,

Aysegul Taylan Ozkan, M.D., Ph.D.,

Academic Editor

PLOS Neglected Tropical Diseases

Audrey Lenhart

Section Editor

PLOS Neglected Tropical Diseases

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

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)

**********

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)

**********

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)

**********

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)

**********

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)

**********

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: Stephen Apanga