PNTD-D-24-01894

Prevalence and risk factors associated with intestinal parasitosis in children with diarrhoea in the Huambo´s municipality

PLOS Neglected Tropical Diseases

Dear Dr. Chitumba,

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.

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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,

Feng Xue, Ph.D.

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

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: Hermenegildo Osvaldo Chitumba. 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

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https://journals.plos.org/plosntds/s/figures. Please ensure that the figure is labeled as Figure 1.

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Comments to the Authors:

Please note that one of the reviews is uploaded as an attachment.

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: As a result of my examinations made by me, it was concluded that the objectives of the study were clearly stated and an understandable hypothesis was proposed. Considering the study design, it was determined that the planned path was appropriate for realizing the intended objectives.

Even if the sample size selected for the study was not at the desired level, it was considered reasonable, considering the limitations of the study and the fact that they did not receive financial support.

The statistical methods are frequently used in the literature and are preferred in terms of their results.

The authors have no ethical concerns regarding this study. The participants were selected on a voluntary basis, and a consent form was signed. The fact that they also had a valid ethics committee decision on the subject was sufficient to eliminate my concerns.

Reviewer #2: �Are the objectives of the study clearly articulated with a clear testable hypothesis stated?

Yes, the objectives are clear, but a specific hypothesis is not explicitly stated. It would be beneficial to include a testable hypothesis in the introduction.

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

Yes, the study design is appropriate for determining prevalence. However, additional justifications regarding sample selection and potential biases would improve the robustness.

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

Yes, the population (children aged 9 months to 14 years hospitalized with diarrhea) is clearly described and appropriate for the study objectives.

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

The sample size (173 children) seems reasonable for a prevalence study, but the authors do not provide justification for the sample size.

�Were correct statistical analyses used to support conclusions?

Yes, the statistical analyses (descriptive statistics, Chi-square test, Odds Ratio) are appropriate for analyzing risk factors. However, some p-values are close to 1, raising concerns about statistical power.

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

Ethical approval is mentioned, and informed consent was obtained. No major concerns in this area.

Reviewer #3: No considerations to be applied.

Reviewer #4: Methods

The objective is single, and it is clear along with the research question. Perhaps you could add some specific objectives derived from the identification of genera and species (spectrum of parasitic species and their transmission routes).

Population is clearly described but we recommend to join study location with population and sample in just one paragraph.

The sample size sufficient for statistical power and the selected tested were correct.

The study had the approval of the ethical committee

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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 data presented as a result of the analysis conducted within the scope of the research coincided with the plan. The results are clearly and completely presented. Tables and figures were provided to express the results of the research in a comprehensible way and were deemed sufficient.

Reviewer #2: �Does the analysis presented match the analysis plan?

The results align with the methodology, but some statistical findings need clearer interpretation (e.g., why none of the risk factors were statistically significant despite apparent trends).

�Are the results clearly and completely presented?

The results are generally well-presented, though some tables and figures (e.g., Figure 1) would benefit from clearer labeling and descriptions.

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

Tables and figures are informative, but figure quality should be improved for readability.

Reviewer #3: No considerations to be applied.

Reviewer #4: The analysis presented match the objectives.

The results are clearly presented, but we suggest in case of Entamoeba histolytica and Taenia solium diagnostics identified just at gender level not species, because by optical microscopy it not possible to asing species level.

Las figuras are in a correct format, but they are not mentioned in the previous text.

In Table 1, we suggest to delete from the last column the information expressed via 1*. It is not required, just de OR of the comparison is correct.

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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 obtained and presented in this study coincide with data in the literature on the subject. The authors have clearly stated the limitations of the analysis and study, together with the reasons. They have made suggestions for further research on the subject, eliminating the limitations, and continuing with more comprehensive studies.

A fundamental public health issue was addressed when the study was evaluated as a whole. The manuscript addresses the relationship between the subject and public health.

Reviewer #2: �Are the conclusions supported by the data presented?

The conclusions are mostly supported, but the claim that risk factors were not statistically significant could be better contextualized.

�Are the limitations of analysis clearly described?

The limitations (e.g., diagnostic method sensitivity, sample size, geographic restriction) are clearly described, but more discussion on potential confounders (e.g., socioeconomic status) would be beneficial.

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

Yes, the authors discuss the public health implications and the need for further research and interventions.

�Is public health relevance addressed?

Yes, the public health relevance is addressed, particularly in terms of the need for deworming programs and hygiene education.

Reviewer #3: No considerations to be applied.

Reviewer #4: The conclusions are supported by the data presented

The identified clearly the limitations of analysis and make proposals for future research.

This research is valuable, since the results of parasitosis in the area are the first to be reported and would help the Ministry of Health make more targeted interventions for public health.

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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: •The authors should consider adding a hypothesis statement in the introduction to clarify the study’s aims.

•The authors should use italics for scientific names

•Provide a stronger justification for the sample size.

•The study did not report any cases of polyparasitism (co-infections with multiple parasites), which is somewhat surprising given the context. This could be due to the limitations of the diagnostic method used.

•Enhance figure clarity with better labels and descriptions.

•While the authors analyzed various risk factors (e.g., age, sex, water source, hygiene practices), none were found to be statistically significant. Clarify why statistical significance was not observed despite apparent trends in the data.

Reviewer #3: No considerations to be applied.

Reviewer #4: The introduction is very brief and I miss more parasitic information from the country of study.

It would be interesting to share in supplementary table form all the information on parasitic identification

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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: (No Response)

Reviewer #3: The study fully meets the scope of the journal and what is expected in scientific research.

Although it is not new to the field, it is relevant because it sheds light on an important public health condition in Angola.

Reviewer #4: (No Response)

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Reviewer #1: Yes:  Assistant professor Ahmed Galip HALİDİ

Reviewer #2: No

Reviewer #3: No

Reviewer #4: 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.]

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Attachments

Attachment

Submitted filename: Comments on Manuscript PNTD-D-24-01894.pdf

Dear Professor Chitumba,

We are pleased to inform you that your manuscript 'Prevalence and risk factors associated with intestinal parasitosis in children with diarrhoea in the Huambo municipality' 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,

Feng Xue, Ph.D.

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

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

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)

Reviewer #3: Done.

**********

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)

Reviewer #3: Done.

**********

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)

Reviewer #3: Done.

**********

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: Done.

**********

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: (No Response)

Reviewer #3: Done.

**********

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:  Ahmed Galip Halidi

Reviewer #2: No

Reviewer #3: No