Dear Dr Gichuki,

Thank you very much for submitting your manuscript "Using Community-Based Participatory Approaches to Improve Access to Mass Drug Administration for Trachoma Elimination in a Pastoral Conflict Area of Kenya" 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.

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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,

Elsio A Wunder Jr, DVM, Ph.D.

Section Editor

PLOS Neglected Tropical Diseases

Elsio Wunder Jr

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: (No Response)

Reviewer #2: (No Response)

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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: (No Response)

Reviewer #2: (No Response)

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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: (No Response)

Reviewer #2: (No Response)

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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)

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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: (No Response)

Reviewer #2: Dear Editorial Team / Authors,

I have reviewed the manuscript titled “Using Community-Based Participatory Approaches to Improve Access to Mass Drug Administration for Trachoma Elimination in a Pastoral Conflict Area of Kenya” (Manuscript Number: PNTD-D-24-00973). The study addresses an important public health issue, but there are several areas that could benefit from revisions to improve clarity, coherence, and scientific rigor. Below are my detailed comments and recommendations:

1. Abstract:

1.1. Clarity and Focus (Line 1): The first sentence, “Trachoma, a neglected tropical disease (NTD) is the leading infectious cause of blindness in sub-Saharan Africa,” is quite general and familiar to the journal’s readership. I suggest rephrasing it to focus more on the study’s context. For instance: “In Baringo County, Kenya, trachoma remains endemic despite repeated mass drug administration (MDA) efforts, with coverage consistently falling short of WHO targets.”

1.2. Methods Section: The methods section of the abstract could be more explicit. Please specify the participatory approaches employed—was it qualitative? Were focus groups or surveys utilized? Briefly outline how stakeholders were identified and involved.

1.3. Results Section: While the results are well-stated, the phrase *“community-based participatory approaches significantly increased trachoma MDA coverage”* is somewhat vague. If space allows, provide additional details on the specific interventions or changes that contributed to this improvement.

1.4. Conclusion: The conclusion is clear but would be strengthened by a sentence discussing the broader implications for future MDA campaigns or for other neglected tropical diseases (NTDs).

2. Introduction:

2.1. Clarifying the Knowledge Gap: While the introduction provides a broad overview of trachoma and its control, it would benefit from clearly articulating the knowledge gap this study addresses. What makes the participatory approach novel in this context compared to traditional MDA campaigns? Explicitly stating this would strengthen the study’s rationale.

2.2. Emphasizing Participatory Approaches: The introduction could introduce community-based participatory research (CBPR) earlier and explain why it is particularly suited for this context. Additionally, highlighting how CBPR improves upon previous MDA strategies would better justify the need for this study.

2.3. Expand on Pastoralist Dynamics: The section on pastoralist migration patterns is essential for understanding the challenges of MDA delivery. Consider expanding this by discussing how migration affects public health interventions, potentially referencing similar studies on health delivery in migratory communities.

3. Discussion:

3.1. Improve Flow and Coherence: The discussion moves between various topics (stakeholder engagement, social mobilization, migration) without a clear structure. I recommend organizing the section into distinct sub-sections, such as “Stakeholder Engagement,” “Social Mobilization,” “Logistical Planning,” and “Addressing Pastoral Migration.”

3.2. Repetition of Concepts: Some points, especially those related to social mobilization and communication strategies, are repeated. Consolidating these discussions will make the manuscript more concise and focused.

3.3. Balancing Strengths and Challenges: While the discussion highlights the successes of the intervention, a more balanced perspective that acknowledges challenges and unexpected difficulties would strengthen the scientific rigor of the paper.

3.4. Expand on the Role of Security and Migration: The involvement of security forces and the timing of the MDA campaign during the rainy season are presented as key strategies, but further explanation is needed. Did security involvement build community trust? Were there any resistance or challenges related to security? How did participation in the rainy season compare to past campaigns?

4. Limitations:

4.1. Broaden the Scope of Limitations: The limitation mentioned is valid but could be expanded to address additional points:

4.2. Selection Bias in Stakeholder Engagement: Were all community sub-groups adequately represented in the participatory process? If not, how might this have affected the outcomes?

4.3. Generalizability: Given that this study focuses on a specific pastoralist community, discuss how transferable the findings are to other regions or contexts, particularly those with different migration or conflict dynamics.

4.4. Unintended Consequences: Were there any unintended negative outcomes from involving security forces, or other elements of the strategy? For instance, did the presence of security create tension or fear within certain population groups?

4.5. Long-Term Sustainability: Address the sustainability of these participatory approaches. Will the community maintain high levels of participation in future MDAs without continued intensive engagement?

5. Conclusion: The last sentence, “Community-based participatory approaches should be adopted for other health interventions,” is somewhat broad. I suggest rephrasing it to be more specific: “Future public health interventions, particularly those targeting neglected tropical diseases and community-driven health issues, should integrate participatory approaches to ensure long-term success and sustainability.”

Best regards,

Reviewer

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Reviewer #1: Yes: Margaret Baker

Reviewer #2: Yes: Hamidreza Hasani

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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: PLOS NTDs Sept 2024.docx

Attachment

Submitted filename: Review-MDA Trachoma_PLOS.pdf

Dear Dr Gichuki,

We are pleased to inform you that your manuscript 'Using Community-Based Participatory Approaches to Improve Access to Mass Drug Administration for Trachoma Elimination in a Pastoral Conflict Area of Kenya' 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,

Elsio A Wunder Jr, DVM, Ph.D.

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

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