Peer Review History

Original SubmissionMay 28, 2021
Decision Letter - Michael Marks, Editor

Dear Mr. CHURKO,

Thank you very much for submitting your manuscript "EXPLORING BARRIERS FOR TRICHIASIS SURGERY IMPLEMENTATION IN GAMO ZONE, SOUTHERN ETHIOPIA, 2019" 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. In light of the reviews (below this email), we would like to invite the resubmission of a significantly-revised version that takes into account the reviewers' comments.

We cannot make any decision about publication until we have seen the revised manuscript and your response to the reviewers' comments. Your revised manuscript is also likely to be sent to reviewers for further evaluation.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to the review comments and a description of the changes you have made in the manuscript. Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

Please prepare and submit your revised manuscript within 60 days. If you anticipate any delay, please let us know the expected resubmission date by replying to this email. Please note that revised manuscripts received after the 60-day due date may require evaluation and peer review similar to newly submitted manuscripts.

Thank you again for your submission. 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,

Michael Marks

Deputy Editor

PLOS Neglected Tropical Diseases

Michael Marks

Deputy Editor

PLOS Neglected Tropical Diseases

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

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 of the study are clearly stated. The study population is clearly described. The sample size is also acceptable for such a qualitative study. The FGDs and in-depth interviews were fairly transcribed and analyzed but lacks clarity due to weak translation into English language. Ethical requirements were strictly observed.

Reviewer #2: --No hypothesis but this is a qualitative study

--Study design appropriate but unclear that best practices were followed

--population not clearly described, how people were chosen is not clear

--no discussion about sample size calculations so unclear if the sample size is sufficient

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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: Results were not presented in accordance with the analysis plan. Results of the 3 different FGDs as categorized by their affiliations (operated TT cases, unoperated TT cases and IECWs) should have been presented separately so that the barriers for TT surgery as perceived by these 3 different groups could be clearly understood by readers of the article. Similarly, the key informant interviews should have been presented separately so that the view points expressed by service providers could be clearly understood. The authors have presented the results by thematic areas which makes it difficult for readers to clearly and succinctly identify the real barriers to TT surgery. Recurrent trichiasis appears to be a major problem in the study area but the authors didn't adequately address this critical issue. Overall, the data presented are too shallow and anecdotal. I don't think that the authors have presented strong evidence to make meaningful inferences.

Reviewer #2: --No analysis plan was given. But the pre-specified analysis plan would be a helpful addition

--Results are clear but it is not certain how representative the results are given the lack of clarity on the analysis methods

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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 conclusions are supported by the data presented and the limitations of the study are also described. However, there is a serious problem with the English language.

Reviewer #2: --limitations can be expanded depending on the details of the analysis (see comments below)

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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)

--------------------

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 addresses an important problem for trachoma elimination program. The method used is acceptable. However, the data and evidence presented is so weak and superficial. The data synthesis and analysis also lacks clarity and depth. The manuscript needs complete revision.

Reviewer #2: This is a qualitative research study assessing barriers to trachomatous trichiasis surgery. My main comment is that the authors have not demonstrated scientific rigor with their methods (please see detailed comments below). They provide some quotes from several people but it is unclear how they decided that these were the consensus views of the community. Other comments follow:

Abstract, background: It might be better to specify “trachomatous trichiasis” as the leading infectious cause

Abstract, findings: non-Ethiopians will not know what a “kebele” is; please substitute “communities”

Abstract, conclusion: “the main barriers for trichiasis surgery implementation were from service providers and patients’ side.” � As opposed to what?

Introduction: trachoma is not the leading cause of blindness. Cataract is. You could say “leading infectious cause”?

How was the sample size determined? Were the numbers pre-specified? Or continued until saturation was reached?

How exactly were the participants of the FGDs selected? It says trichiasis patients. From where were they recruited? From a health clinic? From a campaign?

Methods: The methods for analysis are not detailed. Specifically: (A) usually qualitative data is analyzed according to some underlying theoretical model. Did the authors consider any model when analyzing? If not, please state that the analysis was done without considering a specific framework. (B) was coding of transcripts done to classify responses into specific domains? If so, who did the coding? How many people? How did you assure that different graders reached similar conclusions in their coding (eg. Kappa). (C) what software was used? Any software specific to qualitative research (eg atlas.ti or something similar)

It would be good to more clearly state who did the key informant interviews (for example, who are “district key informants”?). Many people outside Ethiopia will not know what a health extension worker is, so please give a brief description of who they are and why we should care about their opinions.

Most readers will not know what a woreda is, please define, maybe just say “(i.e., district)”

Recommendation: what exactly is the recommendation? Are there any barriers that you would prioritize based on your research? Things that would be easy/cheap to do first, then followed by more complicated things?

--------------------

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Reviewer #1: No

Reviewer #2: No

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your 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

Revision 1

Attachments
Attachment
Submitted filename: Response to_review comments22.docx
Decision Letter - Michael Marks, Editor

Dear Mr. CHURKO,

Thank you very much for submitting your manuscript "EXPLORING BARRIERS FOR TRACHOMATOUS TRICHIASIS SURGERY IMPLEMENTATION IN GAMO ZONE, SOUTHERN ETHIOPIA" 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.

When you are ready to resubmit, please upload the following:

[1] A letter containing a detailed list of your responses to all review comments, and a description of the changes you have made in the manuscript.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out

[2] Two versions of the revised manuscript: one with either highlights or tracked changes denoting where the text has been changed; the other a clean version (uploaded as the manuscript file).

Important additional instructions are given below your reviewer comments.

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,

Michael Marks

Deputy Editor

PLOS Neglected Tropical Diseases

Michael Marks

Deputy Editor

PLOS Neglected Tropical Diseases

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

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: I don't think the study design is appropriate to address the stated objectives. The study population has not been clearly described. The authors simply gathered some TT backlog estimates for some selected districts but didn't even present how many of those were operated. Although it is a qualitative study, the sample size of the FGDs, KIIs, etc. should fairly represent the study population. For example, there were only 21 operated TT cases in the FGDs. What was the total number of TT cases operated in the three districts? No data is given. It's not also clear if they have referred to the TT case registers in the health facilities. They were relying on the verbal confirmations provided by the NGO partner (Orbis) and some of the district health office staff.

Reviewer #2: Adequate

--------------------

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 and the analyses presented lack clarity and completeness. The descriptions/explanations provided are weak and not analytic. They are quoting some references in the discussion section that are not relevant to the findings of the study (things like the SDGs). The quotes (translations) from the FGD discussants are not written with good English. Instead of describing the identified barriers to TT surgery, the authors were rather dwelling more on discussing other broader components of the SAFE strategy and government policies for trachoma control.

Reviewer #2: Adequate

--------------------

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 conclusions are, to some extent, supported by the data presented. Some of the limitations of the study are stated.

Reviewer #2: Adequate

--------------------

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: The paper needs thorough revision.

Reviewer #2: (No Response)

--------------------

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 paper needs major revision.

Reviewer #2: The authors have addressed my comments.

--------------------

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: No

Reviewer #2: No

Figure Files:

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org.

Data Requirements:

Please note that, as a condition of publication, PLOS' data policy requires that you make available all data used to draw the conclusions outlined in your manuscript. Data must be deposited in an appropriate repository, included within the body of the manuscript, or uploaded as supporting information. This includes all numerical values that were used to generate graphs, histograms etc.. For an example see here: http://www.plosbiology.org/article/info%3Adoi%2F10.1371%2Fjournal.pbio.1001908#s5.

Reproducibility:

To enhance the reproducibility of your results, we recommend that you deposit your 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

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.

Revision 2

Attachments
Attachment
Submitted filename: AUTHORS RESPONSE2_review comments.docx
Decision Letter - Michael Marks, Editor

Dear Mr. CHURKO,

We are pleased to inform you that your manuscript 'EXPLORING BARRIERS FOR TRACHOMATOUS TRICHIASIS SURGERY IMPLEMENTATION IN GAMO ZONE, SOUTHERN ETHIOPIA' 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,

Michael Marks

Deputy Editor

PLOS Neglected Tropical Diseases

Michael Marks

Deputy Editor

PLOS Neglected Tropical Diseases

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

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: Acceptable

Reviewer #2: Adequate

**********

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: Acceptable

Reviewer #2: Adequate

**********

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: Acceptable

Reviewer #2: Adequate

**********

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: Acceptable

Reviewer #2: (No Response)

**********

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: My comments have been addressed.

Reviewer #2: the authors addressed my previous comments; I continue to think the paper is worthy of dissemination.

**********

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: No

Reviewer #2: No

</span>

Formally Accepted
Acceptance Letter - Michael Marks, Editor

Dear Mr. CHURKO,

We are delighted to inform you that your manuscript, "EXPLORING BARRIERS FOR TRACHOMATOUS TRICHIASIS SURGERY IMPLEMENTATION IN GAMO ZONE, SOUTHERN ETHIOPIA," has been formally accepted for publication in PLOS Neglected Tropical Diseases.

We have now passed your article onto the PLOS Production Department who will complete the rest of the publication process. All authors will receive a confirmation email upon publication.

The corresponding author will soon be receiving a typeset proof for review, to ensure errors have not been introduced during production. Please review the PDF proof of your manuscript carefully, as this is the last chance to correct any scientific or type-setting errors. Please note that major changes, or those which affect the scientific understanding of the work, will likely cause delays to the publication date of your manuscript. Note: Proofs for Front Matter articles (Editorial, Viewpoint, Symposium, Review, etc...) are generated on a different schedule and may not be made available as quickly.

Soon after your final files are uploaded, the early version of your manuscript will be published online unless you opted out of this process. The date of the early version will be your article's publication date. The final article will be published to the same URL, and all versions of the paper will be accessible to readers.

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

Best regards,

Shaden Kamhawi

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

Paul Brindley

co-Editor-in-Chief

PLOS Neglected Tropical Diseases

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