PNTD-D-26-00339

Implementing mass dog rabies vaccination through a continuous community-based approach: a socio-anthropological process evaluation

PLOS Neglected Tropical Diseases

Dear Dr. Duamore,

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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Kind regards,

Richard A. Bowen, DVM PhD

Academic Editor

PLOS Neglected Tropical Diseases

Annapaola Rizzoli

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

Additional Editor Comments:

Your manuscript has been reviewed by 3 experts in the rabies field and each considered it a valuable contribution. One reviewer provided some minor suggestions for clarifying a few items - please evaluate those comments, edit your manuscript as you think best and resubmit along with a short "responses to reviewers" document. Thank you.

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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: Rabies is a dangerous disease. Most patients who develop symptomatic rabies die, so prevention is extremely important. Therefore, I believe this study is very valuable. However, the authors could further clarify the following points.

The authors are requested to clearly specify the study design. If this is a randomized controlled trial (RCT), how was it conducted, and what was its impact on the outcomes? If it is not an RCT, but rather a descriptive study on the role of the community and local authorities in rabies prevention conducted alongside an RCT, this should be clearly stated. In that case, the authors should also describe how the RCT was implemented and clarify the roles of the community and local authorities in each study group.

The variables to be collected in the study and their specific definitions.

Reviewer #2: This study employs a mixed-methods design and demonstrates a strong qualitative analytical component. The authors achieve reasonable clarity in presenting the overall framework and analysis plan. However, there appears to be some conceptual overlap between Domains 2 and 3, particularly regarding aspects of community involvement.

In addition, the coding process is not described with sufficient clarity. It remains unclear how the coding framework was developed and how it was systematically aligned with the socio-anthropological framework guiding the analysis.

Reviewer #3: -Are the objectives of the study clearly articulated with a clear testable hypothesis stated? YES

-Is the study design appropriate to address the stated objectives? YES

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

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

-Were correct statistical analysis used to support conclusions? NA

-Are there concerns about ethical or regulatory requirements being met? No

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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: In the Results section, what do the contents of domains 1, 2, 3, 4, and 5 represent, and how do they contribute to the study? They appear to function like a summary table of factors influencing the effectiveness of the vaccination program. However, are there differences in the percentages across regions? If so, do these differences affect the uptake of rabies vaccination in those areas? It seems more like a record of opinions collected from the survey rather than analytical results.

Reviewer #2: The analysis presented matched the analysis plan

The results are clearly presented with good examples of each domain. The topics structure is clear in all domains.

Reviewer #3: The analysis presented match the analysis plan and the results are clearly and completely presented.

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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: In the Discussion section, the authors summarize the findings; however, I do not see sufficient numerical data or supporting explanations to substantiate the points they make. And in the absence of numerical data, it becomes scientifically less convincing to readers.

Reviewer #2: The proposed model (Figure 3) is difficult to follow, as it includes multiple actors and processes, making the overall message unclear. In particular, it is not evident how the model contributes to the optimization of vaccination strategies.

I understood the main message of the article as highlighting that “social science is not finding its way into practice.” In this sense, failures in implementation appear to be driven by micro-level structures in the field, with gaps at this level reflected across the five domains presented in the framework.

Reviewer #3: While the conclusions are supported by the presented data, the limitations of the analysis are not sufficiently articulated. In particular, the applied framework does not account for additional factors that may influence the success of the vaccination program, including dog owners’ perceived behavioral control, attitudes, and challenges in handling dogs during vaccination campaigns. These limitations should be explicitly discussed.

It would be helpful to review the references once more for accuracy. For example, in lines 749–750, the journal name is missing. Similar issues appear in lines 707–708 and 771–773

Sarah Cleaveland is acknowledged as having contributed to the writing, review, and editing of the manuscript; however, her name is not listed among the co-authors. Could you please clarify the reason for her exclusion from the authorship list?

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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: (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: I believe that improving the effectiveness of rabies prevention is extremely important; therefore, this is a meaningful and necessary topic. However, if this study focuses on the impact of a socio-anthropological process evaluation, the authors need to clearly demonstrate how such an evaluation has influenced rabies prevention (i.e., vaccination uptake), with specific variables and quantitative data. This would help to better illustrate the importance of the socio-anthropological approach.

Reviewer #2: (No Response)

Reviewer #3: This study focused on assessing what impacted the implementation processes of the CBC-MDV approach using the socio-anthropological framework. It is a valuable approach to design strategy in improving vaccination coverage in the future. This study showed that considering environmental, socioeconomic and cultural events of targeted communities is important for successful dog vaccination campaigns. Deeper involvement of communities in planning when and how campaigns are conducted, and in the appraisal of outcomes can significantly address barriers to dog-owner participation. Therefore, the results are an important contribution to the knowledge of decision making to design the most efficient and effective strategies for improving dog vaccination coverage in endemic rabies areas like Tanzania. However, the presentation and the accuracy of the paper should be improved and the references need to be double checked before it published.

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Reviewer #1: No

Reviewer #2: Yes: FABIO GHILARDI

Reviewer #3: No

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Dear Duamor,

We are pleased to inform you that your manuscript 'Implementing mass dog rabies vaccination through a community-based continuous approach: a socio-anthropological process evaluation' has been provisionally accepted for publication in PLOS Neglected Tropical Diseases.

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Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Neglected Tropical Diseases.

Best regards,

Max Thomas Eyre, PhD

Section Editor

PLOS Neglected Tropical Diseases

Max Eyre

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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Thank you for the thoughtful revisions to your manuscript in response to reviewer comments.