Response to ReviewersRevised Manuscript with Track ChangesManuscript

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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Reviewers' comments:

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?

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Reviewer #1: Overall the methods are clearly stated and appropriate.

It is not mentioned if the survey approaches/field work needed to be adapted due to insecurity. If they did then this should be documented as an important contribution to these types of areas - which should also flow to results and methods.

Reviewer #2: see summary and general comments

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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 results follow the methods well & clearly presented.

Figure 3 seems to be obtained from another source - can this be clarified.

Reviewer #2: see summary and general comments

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Conclusions

-Are the conclusions supported by the data presented?

-Are the limitations of analysis clearly described?

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-Is public health relevance addressed?

Reviewer #1: Overall the conclusions reflect the findings and present a range of important issues re social mobilisation, reporting daat/coverage surveys/ epilepsy. What is missing is how they did this or needed to adapt the strategies in a conflict/insecure environment. There is little information on this to fully appreciate the context.

Reviewer #2: see summary and general comments

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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: Minor

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: Overall a well written and important paper on factor influencing the increase in MDA for onchocerciasis in South Sudan. It covers many important topics. More on the conflict/insecure environment and how it may have impacted any of the activities would be useful to include as this is a neglected area of NTD research and the more information that is gathered and published, the more that practical strategies may be developed from lessons learned. I don't envisage this addition to be extensive but needs more present to appreciate the context.

Reviewer #2: Fodjo et al. evaluated the impact of onchocerciasis awareness programs combined with biannual ivermectin treatment (CDTI) in the Maridi region of South Sudan. The study demonstrated that integrating reinforced community awareness with biannual CDTI significantly increased ivermectin treatment coverage. This combined approach proved more effective than standard strategies and presents a promising avenue for advancing onchocerciasis elimination efforts in remote and conflict-affected areas of South Sudan.

Major Concerns:

1) Several studies, including some from the same research group, have already reported on the outcomes of awareness programs and biannual CDTI in other countries. However, these publications are not cited, and no comparison is made between findings across different settings. A broader contextualization would strengthen the manuscript and highlight the relevance of the results beyond South Sudan.

2) The same research group previously published a study protocol for biannual CDTI in the same region, but this earlier work is neither cited nor discussed. The manuscript should clarify the relationship between the current study and the published protocol.

3) Figure 3 is blurry and difficult to interpret. A higher-resolution version should be provided to ensure clarity and readability.

4) The full questionnaires used in the study should be included in the supplementary materials to allow for transparency and reproducibility.

5) The authors note that compliance with ivermectin treatment is higher among individuals affected by nodding syndrome (NS) or epilepsy. It would be important to also address other clinical manifestations of onchocerciasis, such as blindness or hyperreactive onchodermatitis. How many individuals in the study area suffer from these or other onchocerciasis-related symptoms? Is treatment compliance similarly higher among these individuals?

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Reviewer #1: No

Reviewer #2: No

Figure resubmission: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-->?>

Dear DR COLEBUNDERS,

We are pleased to inform you that your manuscript 'Community-directed treatment with ivermectin in Maridi, South Sudan: Impact of an onchocerciasis awareness campaign and bi-annual treatment on therapeutic coverage' 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,

Angela Monica Ionica, Ph.D.

Academic Editor

PLOS Neglected Tropical Diseases

Qu Cheng

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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