PONE-D-19-24295

Prevalence and determinants of modern contraceptive utilization among Women in the Reproductive Age Group in Edaga-hamus Town, Eastern zone, Tigray Region, Ethiopia, June 2017.

PLOS ONE

Dear Mr Gebremeskel

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’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.

==============================

It is very important topic particularly for policy developers and decision maker in the region and nationally at large. I would like to thank you all for dedicating your time to be part of the solution.

Being said all these here are some of my opinion and feedbacks regard to your work. In general, the paper still more look like a thesis than a manuscript. It needs a major reform and modification from abstract to the final conclusion.

Abstract:

The introduction and objective part need to be merged and try to make as brief as possible at least to deliver the right message. The methods is disorganized. It looks more like a copy and paste from the original thesis. The result and conclusion might need some change and more focus on the relevant result to convey the right information to readers.

Introduction:

It has tried to demonstrate the broad area of contraceptive from global to national and regional perspective. However, since this topic is one of the most studied topic in Ethiopia I believe you would have gotten more literature that could be included and provide profound insight for your work. I am a bit surprised the literature included in this section very limited and out dated, at the same time, not included studies that has been conducted in Tigery region. As to my knowledge enormous studies has been carried out the last ten years in Tigery and other part of Ethiopia, which have helped the effective implementation of the national contraceptive program. I, therefore, would like to recommend you to include those up to date studies for the credibility of your work, since most of the literature included in this section a bite old and insignificant for the area of the study.

Methods:

As I mentioned above, this paper more looks like a thesis and you need to revise each and every section. The sample size determination not clear. You have said a sample size of 383 was determined by using sample size formula. What does this mean? What kind of sample size formula did you employee? Why you choose probable sampling technique to select study participant? You indicated modern contraceptive utilization is the dependent variable, but you have tried to defined utilization only. You must define the right variable that would help you clarify in the result section. You need to vividly define the dependent and independent variables clearly. How do you measure you dependent variable? There is no single sentence that shows how you measure depend variable. How did you measure the validity and reliability of your data collection tools? All these and others will spark additional questions if you don’t address these and associated issues come with the methods section.

Result:

How did you manage to get a 100% respond rate? On the knowledge, attitude and practice subtopic, it is not clear how you measure knowledge, attitude and practice. You need to show clearly how knowledge is measured in this study. Overall, this section needs major revision, it seems to have a jargon of information with no direction. I recommend you to start the major revision at the method section, in order to be able to have a clear answer for the questions would arises associate to your analysis.

Discussion:

It is admirable to observe you have tried to make argument based on comparison with similar study conducted at various places. As I have mention above due to insufficient literature, especially excluding those studies carried out at local and national level, the arguments you laid out appears to be very shallow and weak. Moreover, you have not discuss or made argument on the results indicated on the result section that makes the argument weak. You must discuss based on the findings of this study. You argument also must be supported by scientific studies.

Conclusion:

This section is so weak and frail. It doesn’t even show the major finding in this study.

In general, the manuscript lacks consistence, incoherence and disorganize. The entire section needs further revamp and more work to make the manuscript sound and informative.

==============================

We would appreciate receiving your revised manuscript by Nov 11 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable 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. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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.

We look forward to receiving your revised manuscript.

Kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

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1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Thank you for including your ethics statement:

"Ethical clearance was obtained from the Ethical Review Board of ADU, College of Medicine and Health Sciences and it is also got granted from the Health office of Adigrat hospital. Verbal and written consents were obtained after explaining their full right to refuse, withdraw any time, without any explaining or giving reasons. Information's obtained from individuals’ participants was kept secure and confidential. Names and other identifying data of respondents were made by using code throughout the study process to obtain confidentiality. Finally, data were collected according to the standard questionnaire prepared.".

i) Please amend your current ethics statement to include the full name of the ethics committee/institutional review board(s) that approved your specific study.

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3. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service.  

Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services.  If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free.

Upon resubmission, please provide the following:

• The name of the colleague or the details of the professional service that edited your manuscript
• A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a *supporting information* file)
• A clean copy of the edited manuscript (uploaded as the new *manuscript* file)

4. We noticed minor instances of text overlap with the following previous publication(s), which need to be addressed:

https://globaljournals.org/GJMR_Volume13/4-Prevalence-and-Associated-Factors.pdf

https://www.longdom.org/open-access/prevalence-and-associated-factors-of-modern-contraceptive-utilization-amongmarried-women-in-reproductive-age-group-in-misha-woreda-2167-0420-1000372.pdf

https://jbino.com/docs/Issue03_04_2014.pdf

The text that needs to be addressed involves the Introduction (first 2 references) and the Abstract (bottom reference).

In your revision please ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

5. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

6. In your Methods section, please provide additional information about the participant recruitment method and the demographic details of your participants. Please ensure you have provided sufficient details to replicate the analyses such as: a) the recruitment date range (month and year), b) additional details describing any inclusion/exclusion criteria that were applied to participant recruitment, d) a statement as to whether your sample can be considered representative of a larger population, e) a description of how participants were recruited, and f) descriptions of where participants were recruited and where the research took place.

7. Thank you for stating the following in the Acknowledgments Section of your manuscript:

"Adigrat University was our fund agent to conduct this study. The role of Adigrat University was

providing appropriate training to develop the proposal, funding money to our data collectors and

following how the study is going on, finally, our University provides us basic training which was

helpful for our study."

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

"The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

Additional Editor Comments (if provided):

It is very important topic particularly for policy developers and decision maker in the region and nationally at large. I would like to thank you all for dedicating your time to be part of the solution.

Being said all these here are some of my opinion and feedbacks regard to your work. In general, the paper still more look like a thesis than a manuscript. It needs a major reform and modification from abstract to the final conclusion.

Abstract:

The introduction and objective part need to be merged and try to make as brief as possible at least to deliver the right message. The methods is disorganized. It looks more like a copy and paste from the original thesis. The result and conclusion might need some change and more focus on the relevant result to convey the right information to readers.

Introduction:

It has tried to demonstrate the broad area of contraceptive from global to national and regional perspective. However, since this topic is one of the most studied topic in Ethiopia I believe you would have gotten more literature that could be included and provide profound insight for your work. I am a bit surprised the literature included in this section very limited and out dated, at the same time, not included studies that has been conducted in Tigery region. As to my knowledge enormous studies has been carried out the last ten years in Tigery and other part of Ethiopia, which have helped the effective implementation of the national contraceptive program. I, therefore, would like to recommend you to include those up to date studies for the credibility of your work, since most of the literature included in this section a bite old and insignificant for the area of the study.

Methods:

As I mentioned above, this paper more looks like a thesis and you need to revise each and every section. The sample size determination not clear. You have said a sample size of 383 was determined by using sample size formula. What does this mean? What kind of sample size formula did you employee? Why you choose probable sampling technique to select study participant? You indicated modern contraceptive utilization is the dependent variable, but you have tried to defined utilization only. You must define the right variable that would help you clarify in the result section. You need to vividly define the dependent and independent variables clearly. How do you measure you dependent variable? There is no single sentence that shows how you measure depend variable. How did you measure the validity and reliability of your data collection tools? All these and others will spark additional questions if you don’t address these and associated issues come with the methods section.

Result:

How did you manage to get a 100% respond rate? On the knowledge, attitude and practice subtopic, it is not clear how you measure knowledge, attitude and practice. You need to show clearly how knowledge is measured in this study. Overall, this section needs major revision, it seems to have a jargon of information with no direction. I recommend you to start the major revision at the method section, in order to be able to have a clear answer for the questions would arises associate to your analysis.

Discussion:

It is admirable to observe you have tried to make argument based on comparison with similar study conducted at various places. As I have mention above due to insufficient literature, especially excluding those studies carried out at local and national level, the arguments you laid out appears to be very shallow and weak. Moreover, you have not discuss or made argument on the results indicated on the result section that makes the argument weak. You must discuss based on the findings of this study. You argument also must be supported by scientific studies.

Conclusion:

This section is so weak and frail. It doesn’t even show the major finding in this study.

In general, the manuscript lacks consistence, incoherence and disorganize. The entire section needs further revamp and more work to make the manuscript sound and informative.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1. There are abbreviations in the “abstract” section but there shouldn’t be abbreviations in the abstract. In the other sections of the manuscript, you need to write the full phrase before abbreviation.

2. There is spelling, grammar problems e.g. In the abstract under “objective” you state “stud” instead of “study”. Please revise the whole manuscript to correct such errors.

3. The adjusted odds ratio for educational status in the abstract section is 0.901 and the 95%Cl is 1.340, 4.107. The AOR is out of the 95% CI which is incorrect. I suggest the authors to revise all AOR and their 95%CI.

4. The conclusion and recommendations are very vague and they are not based on the findings of the study.

5. In the introduction part, the gap is not clearly stated and how your study is going to help to address the gap/s. please use recent finding in the introduction section.

6. Please include exclusion criteria.

7. Put the necessary formula and steps of sample size determination. The reference cited to calculate sample size is for oromia not for Tigray region. Revise this.

8. Please include how you identified households with reproductive age women.

9. Please revise variables, data collection tools and techniques, data quality control, data analysis and others. Please read the author information of this journal and follow it.

10. In the analysis, did you check multi-collinearity, model goodness of model? Please include this.

11. In the result section, there are grammar problems, citation of tables and figures need revision.

12. Revise all tables especially the table for the result of logistic regression. What dose * mean?

13. The discussion needs revision. Synthesize the result of other study findings and discuss the implications of your study findings.

14. Please revise the limitation. It has two similar sentences.

15. Revise the references

Reviewer #2: General comments for the manuscript:

The comments are not limited to the summary bellow (there are comments in the pdf; the author can click on each sticky note to see the comments)

Introduction part:

Grammar, logical flow and focus problems

Methods part:

I have hesitation on sampling method, inclusion criteria versus sampling procedure and sample size calculation seems wrong.

Some meaningless phrases and initial words need capitalization

Result part:

The measurement of knowledge and attitude is not correct

The interpretation of the association is not clear and authors may not understand the reference variables

Different font size, repetition of words, wrong quantifiers, inclusion of study time in title of tables, and wrong grammars are there.

Discussion part:

Some incomparable and less justified differences

Some need of re writing

Difficult to differentiate result and discussion (especially at the last paragraph of the discussion)

**********

6. 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

[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 to be viewed.]

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. Registration is free. 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. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: 2. Manuscript Reviewed PONE-D-19-24295_reviewer.pdf

PONE-D-19-24295R1

Prevalence and determinants of modern contraceptive utilization among Women in the Reproductive Age Group in Edaga-hamus Town, Eastern zone, Tigray Region, Ethiopia, June 2017.

PLOS ONE

Dear Mr.Teferi Gebru Gremeskel,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’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.

==============================

Thank you again for trying to incorporate the comments provided before. There are still several points you need to address to proceed to next level. Here are some of my comments and suggestions you need to pay attention.

Abstract:

• The introduction in the abstract section should be revised again. It has inconclusive and fragmented information. Similarly, you need to rewrite the conclusion in this section. “Modern contraceptives found below”. What does this means? You have gotten similar such meaningless paragraphs throughout the manuscript that needs immediate corrective action.

Introduction:

• As I have tried to indicate on the previous comment the literatures used in the introduction were very out dated and I can say some of them not correctly cited, for instance, the population of Ethiopia in the year 2017 was 105 million according to Ethiopian Demographic Survey and other sources, however, in your case looks below the true number. At least you need to include literatures that is relevant for the discussion.

Methods:

• Operation definition for Knowledge and attitude looks like explanation after analysis. I recommend you to write a definition employed before you got started the research. So that, you could have a clear definition for knowledge and attitude.

Result:

• This section still have several redundancy and inconsistencies. I recommend you to evaluate critically and correct each and every statements to give meaningful information. For instance, you began the statement with “some of the respondents (74.4%) reported that they had pregnancy while 98 (25.6%) had no pregnancy”.  What is the number for some of the respondents???
• Why you choose to write both pregnant and non-pregnant at the same time. It is obviously known the number of non-pregnant women if you mentioned the pregnant women in your analysis. Which have in fact created redundancy in your paragraphs.

Discussion:

• This section still needs strong argument based on clear scientific evidence. At the same time, you must address all the variables analyzed in this study. There are plenty of research articles published in various region of Ethiopia which would be very helpful to make a strong point to compare with your findings. However, the literature employed in this section appears very scanty and shallow for comparison. On the other hand, the limitation that has been indicated is not clear. Why children ????? What is the reference is all about….???? You need to have a good explanation for that…..?????

Conclusion:

• You need to correct the first sentences.” Modern contraceptive utilization was found below.” What kind of message do you really want to convey??

Final note:

Before resubmitting the manuscript again you must critically evaluate each section and read similar articles that has been published, therefore, you can see the shortcoming of this research and would help you bridge the gap already existed in this manuscript.

==============================

We would appreciate receiving your revised manuscript by Dec 01 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable 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. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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.

We look forward to receiving your revised manuscript.

Kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Thank you again for trying to incorporate the comments provided before. There are still several points you need to address to proceed to next level. Here are some of my comments and suggestions you need to pay attention.

Abstract:

- The introduction in the abstract section should be revised again. It has inconclusive and fragmented information. Similarly, you need to rewrite the conclusion in this section. “Modern contraceptives found below”. What does this means? You have gotten similar such meaningless paragraphs throughout the manuscript that needs immediate corrective action.

Introduction:

- As I have tried to indicate on the previous comment the literatures used in the introduction were very out dated and I can say some of them not correctly cited, for instance, the population of Ethiopia in the year 2017 was 105 million according to Ethiopian Demographic Survey and other sources, however, in your case looks below the true number. At least you need to include literatures that is relevant for the discussion.

Methods:

- Operation definition for Knowledge and attitude looks like explanation after analysis. I recommend you to write a definition employed before you got started the research. So that, you could have a clear definition for knowledge and attitude.

Result:

- This section still have several redundancy and inconsistencies. I recommend you to evaluate critically and correct each and every statements to give meaningful information. For instance, you began the statement with “some of the respondents (74.4%) reported that they had pregnancy while 98 (25.6%) had no pregnancy”. What is the number for some of the respondents???

- Why you choose to write both pregnant and non-pregnant at the same time. It is obviously known the number of non-pregnant women if you mentioned the pregnant women in your analysis. Which have in fact created redundancy in your paragraphs.

Discussion:

- This section still needs strong argument based on clear scientific evidence. At the same time, you must address all the variables analyzed in this study. There are plenty of research articles published in various region of Ethiopia which would be very helpful to make a strong point to compare with your findings. However, the literature employed in this section appears very scanty and shallow for comparison. On the other hand, the limitation that has been indicated is not clear. Why children ????? What is the reference is all about….???? You need to have a good explanation for that…..?????

Conclusion:

- You need to correct the first sentences.” Modern contraceptive utilization was found below.” What kind of message do you really want to convey??

Final note:

Before resubmitting the manuscript again you must critically evaluate each section and read similar articles that has been published, therefore, you can see the shortcoming of this research and would help you bridge the gap already existed in this manuscript.

[Note: HTML markup is below. Please do not edit.]

[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 to be viewed.]

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. Registration is free. 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. Please note that Supporting Information files do not need this step.

PONE-D-19-24295R2

Prevalence and determinants of modern contraceptive utilization among Women in the Reproductive Age Group in Edaga-hamus Town, Eastern zone, Tigray Region, Ethiopia, June 2017.

PLOS ONE

Dear Mr, Teferi Gebru,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’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.

==============================

Thank you again for your dedication to improve this manuscript. I have noticed the effort you have put together to incorporate comments and suggestions that have been given by the reviewers. Despite the fact that you have worked to improve the manuscript, there are still comments and feed backs that you need to address before we move forward to the next step. Please try to read similar published articles to identify the gaps existed in this manuscript and bridge the gap.  At the meantime, make sure you encompass the comments that have been given by the reviewers. Please look back the following issues take appropriate corrective action.

Abstract:

This section has improved at many perspective. However, the conclusion and recommendation very shallow. Make sure your conclusion and recommendation must be drawn based on the result.

Methods:

The operation definition that has been given for attitude still needs further detail. What is about the mean? What is your cut off point? How you draw the mean?

Result:

Use appropriate topic; for instance, it isn’t clear why you used “Reproductive related and socio-psychological variable”. Make sure you choose representative subtopic than inscribing non-sense phrases. On top of this separate Knowledge and attitude, since both are different variable.

Discussion:

You need to remove the first paragraph that depicts the modern contraceptive and purpose of the study. I don’t see any relevance.  As I have tried to mention on my last comment, the argument on each topic need to be drawn based on evidence not based on your general knowledge. For instance, you mentioned “Mothers have several children, 1-3 and 4-5 were eleven and three times more likely to used modern contraceptive than who went 6 and above children. It might be to attain their desired number of children and the spacing and timing of their births.” You need to find a proper citation that supports your argument.

==============================

We would appreciate receiving your revised manuscript by Dec 22 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable 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. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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.

We look forward to receiving your revised manuscript.

Kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Thank you again for your dedication to improve this manuscript. I have noticed the effort you have put together to incorporate comments and suggestions that have been given by the reviewers. Despite the fact that you have worked to improve the manuscript, there are still comments and feed backs that you need to address before we move forward to the next step. Please try to read similar published articles to identify the gaps existed in this manuscript and bridge the gap. At the meantime, make sure you encompass the comments that have been given by the reviewers. Please look back the following issues take appropriate corrective action.

Abstract:

This section has improved at many perspective. However, the conclusion and recommendation very shallow. Make sure your conclusion and recommendation must be drawn based on the result.

Methods:

The operation definition that has been given for attitude still needs further detail. What is about the mean? What is your cut off point? How you draw the mean?

Result:

Use appropriate topic; for instance, it isn’t clear why you used “Reproductive related and socio-psychological variable”. Make sure you choose representative subtopic than inscribing junky phrases. On top of this separate Knowledge and attitude, since both are different variable.

Discussion:

You need to remove the first paragraph that depicts the modern contraceptive and purpose of the study. I don’t see any relevance. As I have tried to mention on my last comment, the argument on each topic need to be drawn based on evidence not based on your general knowledge. For instance, you mentioned “Mothers have several children, 1-3 and 4-5 were eleven and three times more likely to used modern contraceptive than who went 6 and above children. It might be to attain their desired number of children and the spacing and timing of their births.” You need to find a proper citation that supports your argument.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Partly

Reviewer #3: No

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: Yes

Reviewer #3: No

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: Yes

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: No

Reviewer #3: No

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: General comments for the manuscript:

The comments are not limited to the summary bellow (there are comments in the pdf; the author can click on each sticky note to see the comments)

Abstract:

1. The prevalence is low --- so need to give emphasis for several children --- senseless

2. Needs to determine the associated factors

Introduction part:

The use of abbreviation without first use of full text is uncommon, which is not corrected from the previous comment

Methods part:

1. Using manual, the sample size is not correct, See the formula, but the result is still 385.5

2. Advice: Logically - first assumption, then formula and result is better, and even the first statement is enough for manuscript.

3. The variable practice is still not clear. Because utilization is outcome variable and practice of modern contraceptive is utilization. I don't know, what do the author what to say?----which is not corrected from the previous comment

Result part:

1. Measurement of attitude is not corrected from the previous comment. 58.5% utilizer means not attitude.

2. Diploma and above variable has a p value of 0.104 under the AOR column. it is clear that there is no association in this variable

3. Advice: please use the correct reference variable.

Discussion part:

1. In discussion, the values could not be included, otherwise there is no difference between result and discussion, which is not corrected from the previous comment.

Conflict of interest:

I have no any conflict interest that can influence me to review the manuscript

Over all comment:

1. There are many corrections made on the previous manuscript.

2. Still many grammatical and logical problems

3. sample size calculation, measurement of attitude and interpretation of association are major concerns

Conclusion:

When comparing with the PLOS ONE, research articles publication criteria, I can say about:

• The study presents the results of original research

• Analyses partially not performed to a high technical standard. Example- attitude measurement and Odds ratio interpretation

I recommend to be accepted with minor correction.

Reviewer #3: Tahnk you dear author. It is revelant areas of research.

Although i read and commented the paper during first submission, i were not able to submitt my comments by the time due to lack of access to internate. I observe some modiffication to this submission. Therefore, here are my comments to the current manuscript. Look at the attached PDF file too. I advise you to use a line number to make the review easy.

Title: Capitalize each word except the preposition

Abstract:(1.The introduction requiers editorial 2. The statment "although the family planning services are available in most places, thenational, as well as the regional CPR, is still low, besides, there is an insufficient

distribution of modern contraception and wide range of modern contraceptive choice is

also lacking to meet the demand of clients" is contradictory/Non coherent. 3. CPR should be written full as it appears first time.4. Try to link the problem to your study area. 5. There is spelling erro and capitalization problem to objective. E.g. stud; y is missed and Hamus; H is small letter, Contraceptive, years are missed. 6, Methodology same erros as objective

7. Reult and conclussion section of abstract has also is full of errors.

For comments from introduction to conclussion f the body(see the attached PDF file)

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Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: 2. second reviewed Manuscript Reviewed PONE-D-19-24295_reviewer.pdf

Attachment

Submitted filename: PONE-D-19-24295_R2_reviewer comment.pdf

PONE-D-19-24295R3

Prevalence and determinants of modern contraceptive utilization among Women in the Reproductive Age Group in Edaga-hamus Town, Eastern zone, Tigray Region, Ethiopia, June 2017.

PLOS ONE

Dear Teferi,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’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.

==============================

I would like to thank the authors participated in this research and for the hard work to improve the manuscript.

Overall, the manuscript appears to be improving and you have tried to encompass the feed backs and comments provided by the reviewers. However, still there are issues you need to address at the result and discussion section. For instance, under the subtitle “Knowledge, attitude and utilization” the variables are not vividly stated. You need to depict significant variables that has been used to measure either knowledge or other variables than simply generalizing knowledge or attitude or utilization. Preferably, try to put them as a separate topic at least to address the objectives of your study in a very clear way using appropriate table, graph or chart or texts. But, in this manuscript you have attempted to point out this variables as one that doesn’t give a clear picture at all.

Similarly, the discussion section need further revamp. As I have tried to pin point the flaw of this section on the previous comments, you need to have a clear and evidence based justification for each of your argument. I have noticed some of the statements incorporated unnecessarily, for instance, the capital city of Ethiopia. It is not clear why you want to include this sentences at the middle of the discussion. I couldn’t find a reason why Addis Ababa mentioned as a capital city here. There are similar problems in this section as well.

Please before resubmit the manuscript you need to make necessary changes and read thoroughly the entire manuscript. Consult all the authors involved in this study at the same time read similar published article to improve your paper. Again I would like to inform you that the entire manuscript need aggressive editorial.

==============================

We would appreciate receiving your revised manuscript by Dec 28 2019 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable 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. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

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• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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.

We look forward to receiving your revised manuscript.

Kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

[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 to be viewed.]

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. Registration is free. 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. Please note that Supporting Information files do not need this step.

PONE-D-19-24295R4

Prevalence and determinants of modern contraceptive utilization among Women in the Reproductive Age Group in Edaga-hamus Town, Eastern zone, Tigray Region, Ethiopia, June 2017.

PLOS ONE

Dear Mr Teferi Gebru,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’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.

==============================

Thank you for your time and energy to improve the manuscript. I would like to inform you that your last re-submission exactly the same as the previous submission with no change made on the manuscript. Either wrong document attached or some other reason. Please pay attention to the previous comments that had been given and make necessary changes before re-submission.

==============================

We would appreciate receiving your revised manuscript by Jan 11 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable 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. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled '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.

We look forward to receiving your revised manuscript.

Kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Thank you for your time and energy to improve the manuscript. I would like to inform you that your last re-submission exactly the same as the previous submission with no change made on the manuscript. Either wrong document attached or some other reason. Please pay attention to the previous comments that had been given and make necessary changes before re-submission.

[Note: HTML markup is below. Please do not edit.]

[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 to be viewed.]

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. Registration is free. 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. Please note that Supporting Information files do not need this step.

Prevalence and determinants of modern contraceptive utilization among Women in the Reproductive Age Group in Edaga-hamus Town, Eastern zone, Tigray Region, Ethiopia, June 2017.

PONE-D-19-24295R5

Dear Dr. Teferi Gebru,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

With kind regards,

Solomon Assefa Woreta

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: