PNTD-D-25-00265Community surveys of the prevalence, distribution, and coinfection of helminth and protozoan infections in semiurban and rural areas of Gabon, Central AfricaPLOS Neglected Tropical Diseases  Dear Dr. Dejon Agobé, 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 30 days Jun 23 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, Maria AlmeriaGuest EditorPLOS 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 see reviewer 1's comments. In addition, please respond to the Scientific editor comments:

Scientific editor comments:The manuscript “Community surveys of the prevalence, distribution, and coinfection of helminth and protozoan infections in semiurban and rural areas of Gabon, Central Africa” by Dejon Agobé et al. is a cross-sectional study of 1,084 participants, aimed to describe the distribution of helminth and protozoan infections in the Moyen-Ogooué province of Gabon, where there is near 70,000 inhabitants. The results indicated a moderate prevalence of helminths and protozoa in that community, with age, gender, and location playing a significant role in the parasitic distribution. Although some parasite intensity of infection was mostly light, the intensity of Schistosoma haematobium was heavy in 35% of the cases, which is of concern, particularly when affected women of reproductive age that can have female genital schistosomiasis. A high number of different helminths and protozoa (3 participant were infected with six different species), parasites were observed in coinfections. It is the first study in that province in Gabon. Previous studies were performed in other provinces of Gabon (references 24 and 31, line 429, also reference 17). It is of interest that lower parasites seem to be related to the widespread use of anthelmintics in the country. The cross-sectional study was conducted with great care, including sample size calculation and sampling procedures.

Line 132-133. Did the authors analyze the presence of parasites in relation to the rainy seasons (2) or dry seasons (2)?

Line 137. Clarify that the semi urban area mentioned for Lambarene is area 1 of the study.

Line 147. The considered prevalence of 50% was higher than that observed. Would that modify the number of samples needed? Since the study collected much more than the samples needed, this is just a comment for personal interest.

Section on laboratory analysis, could give some more details on the specific methods used. As indicated all the analysis were based only on microscopy.

Any staining techniques performed to visualized acid-alcohol resistant protozoa?

Line 183- Thet text mentions “coproculture” for hookworms. Were any hookworms identified to the genera/species level?

Line 182. Spell out TBS.

Statistical consideration. The tests used for statistical analysis could be indicated. E.g. anova, t-test, Ch-square….

Line 236. Were the two cases of Enterobius vermicularis related to age?

Tables. Authors could add an asterisk in those parasites and factors that were statistically significant to easier understanding of differences.

Titles of lines 245, 260 and 272. Please change “Distribution” by “Prevalence”.

Lines 256-257 and lines 257-258. Please include p-values in the results statistically significant. Same for other sections.

Lines 278 and 280. “More prevalent” but statistically significant?

Line 283. Modify “trichuriasis” by “trichiura”

Line 285. The heaviest infections by S. haematobium seemed to occur in age 1-4 years and older than 50 years. Is this correct? Please indicate in text.

Line 309. Higher prevalence, but statistically significant?

Line 322. Where filarial infections found in areas where their vectors are more frequently found?

The discussion is sometimes a repetition of the results and could be reduced.

Line 396. Change “aera” by “area”.

Line 449. Indicate the common risk factors for those parasites.

The title of Suplementary table S1 do not correspond to the data shown in that table. Journal Requirements:

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2) In the online submission form, you indicated that "Data are available from the Centre de Recherce Medicale de Lambarene(email:admin@cermel.org) for researchers who meet the criteria for access to confidential data.". All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either

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- State the initials, alongside each funding source, of each author to receive each grant. For example: "This work was supported by the National Institutes of Health (####### to AM; ###### to CJ) and the National Science Foundation (###### to AM)."

- State what role the funders took in the study. If the funders had no role in your study, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.".

If you did not receive any funding for this study, please simply state: u201cThe authors received no specific funding for this work.u201d

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: The objectives are clearly stated which is to describe the distribution of helminth and protozoan infections in the Moyen-Ogooue province of Gabon with a clear hypothesis. The study design was appropriate to address the stated objective.

The population was clearly defined as “all individuals aged one year and older living in the study areas for at least one year”. What was the exclusive criteria for the study?

The population size, was appropriate. A minimum size of 816 participants was obtained after sample size calculation. Correct Descriptive statistical analysis was used and confidence intervals to estimate precision of prevalence rates to support conclusions. Ethical requirements were met. No new analysis/experiments are required.

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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 presented match the analysis plan. The results are well presented. Most of the Figures are clearly presented except for Figure 6.

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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 data presented supports the conclusion which shows moderate prevalence of helminths. Interpretation of prevalence of Protozoans should be in the context of regional epidemiological data stating the percentage. The authors have clearly discussed the importance of these data and its public health relevance.

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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: Authors to correct the following:

Line 86- Remove ‘for example’ in the sentence

Line 93- spelling error – platyhelminths instead of plathelminths

Line 102- spelling error – mastigophora instead of mastigora

Line 119- correct the cause of filariasis. It is caused by Wuchereria bancrofti, Brugia malayi and Brugia timori not Onchocerca volvolus

Line 144- State the exclusive criteria in the study

In Table 1- Female to sex ratio should be 1:15 not 1.15

Line 228-229 – The prevalence of 36% (357/980, 95% CI: 18 – 23) NOT ‘IC’ should be stated in Fig 2 under the total number for helminths as this is not seen anywhere in the tables. This should also be done for Protozoans.

Line 231 – Insert Table 3- after (94/1084,95%CI: 7-10) Table 3.

Line 247 – Prevalence rate was rounded up to 8% instead of 8.3%. I suggest Prevalence rates be left as it is.

Line 265 – Prevalence rate is 9.4% not 8% as written

Line 266 – Prevalence rate of M. perstans is 4.2% for males vs 1.6% for females

Line 278 – Prevalence of 18% not 16%

Line 279 – Prevalence of 5% and not 16%

Line 291 – 293 There is no information in Table 5 that gives the data of 28 (20%) infected participants presenting with fever at the time of inclusion and 34 (24%) reporting a history of fever over the 3 past days from the day of inclusion. Is there a supporting document for this?

Line 294 – 300 talks about the different parasites as shown in Figure 2. Insert Fig 2 after the sentence in in line 294 for clarification.

Line 305 – 310 contains information in Table 5. Insert Table 5 to indicate this.

Line 330 – 341 has no Table or Figure to support the information given about Helminths and Protozoan coinfections. A table should be included for this.

Fig.6 is not clear. There is a need for a sharp and clearer figure

Line 499 – Insert the names of the authors in the reference

I recommend minor revision of the manuscript.

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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: The study has provided epidemiological data on helminth and protozoan infection in the community. Authors need to do minor corrections.

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Reviewer #1: Yes:  Lydia Etuk Udofia

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Dear Dr Dejon Agobé,

We are pleased to inform you that your manuscript 'Community surveys of the prevalence, distribution, and coinfection of helminth and protozoan infections in semiurban and rural areas of Gabon, Central Africa' 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,

Maria Almeria

Guest Editor

PLOS Neglected Tropical Diseases

Jong-Yil Chai

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

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

The authors made all the necessary changes, and the manuscript can now be considered acceptable for publication.

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