PONE-D-19-22523

Factors Associated with Intrauterine Contraceptive Device Use among Women of Reproductive Age Group in Addis Ababa, Ethiopia: A Case Control Study

PLOS ONE

Dear Mr. Dereje,

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.

This manuscript requires substantial revision and I ask that the authors consider the points raised by Reviewer 2 and the additional feedback in my comments in the review.  Please also provide a linked source for the data used for the study analysis within the 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'.

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We look forward to receiving your revised manuscript.

Kind regards,

Catherine S. Todd

Academic Editor

PLOS ONE

Additional Editor Comments:

In addition to points raised by the reviewers, I would suggest that the authors re-structure the Discussion to discuss topics in order based on strength of association. Partner support was the strongest determinant of selecting an IUCD but is only discussed midway through this section. The limitations section also do not encompass the full range of limitations, included reported nature of many of the co-variates, the non-representative sample selection and use of non-matched controls that further limit generalizability; please make this section more robust. The manuscript would benefit from review by a native English speaker for editing and flow and the Methods section can be made more concise.

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

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. Please amend your current ethics statement to address the following concerns:

Please explain why was written consent was not obtained, how you recorded/documented participant consent, and if the ethics committees/IRBs approved this consent procedure.

3. 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.  If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible.

4. Please state whether you validated the questionnaire prior to testing on study participants. Please provide details regarding the validation group within the methods section.

5. Please clarify in your Methods section whether the XYZ questionnaire is published under a CC-BY license, or whether you obtained permission from the publisher to reproduce the questionnaire in this manuscript. Please explain any copyright or restrictions on this questionnaire.

6. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 4 in your text; if accepted, production will need this reference to link the reader to the Table.

7. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information

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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: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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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

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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: Yes

Reviewer #2: No

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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: An observation study of 128 cases and 256 controls were selected at a 1:2 ratio to identify factors affecting the use of Intrauterine Contraceptive Devices (IUCDs) among women of reproductive age group in Ethiopia. Logistic regression analysis revealed that literate status, source of information about IUCD being mass media/friends, supportive partners, and women having a perception of IUCD does not cause infection were independent predictive factors of IUCD use when controlling for confounders.

Minor revisions:

1- Abstract: No need to state the sample sizes twice in the abstract.

2- Modify the results and/or conclusion to indicate that the significant factors in the multivariate logistic model were INDEPENDENT predictors of IUCD use.

3- Line 121: Provide additional details for justifying the study’s target sample size. The power calculation should include: sample size, alpha level (indicating one or two-sided), minimal detectable difference and statistical testing method.

4- Lines 173 and 185: The standard terminology for bivariate is univariate logistic regression.

5- Tables: Define all abbreviations and provide only the overall p-values rather than pairwise p-values for variables with more than two categories.

6- Tables: Include percentages corresponding to the frequencies.

7- When discussing the results of the multivariate model, clarify that four factors were significant when adjusted for the nonsignificant factors that were also included in the model. This has been stated properly in the discussion, but should also be included in the results section of the abstract.

Reviewer #2: Reviewer: Mengistu Meskele

Date: 05 October 2019

Title: Factors Associated with Intrauterine Contraceptive Device Use among Women of Reproductive Age Group in Addis Ababa, Ethiopia: A Case Control Study

Manuscript number: PONE-D-19-22523

General comments

Generally, this research title currently a public health important in Ethiopia. Though, it needs further improvement in order to adhere the publication criteria of the journal. My comments are presented below

The study presents the results of original research= Yes

2. Results reported have not been published elsewhere=Yes

3. Experiments, statistics, and other analyses are performed to a high technical standard and are described in sufficient detail. No

4. Conclusions are presented in an appropriate fashion and are supported by the data. No

5. The article is presented in an intelligible fashion and is written in Standard English. No, some improvement is needed.

6. The research meets all applicable standards for the ethics of experimentation and research integrity. Not separately explained in the method section, not ethics approval letter attached

7. The article adheres to appropriate reporting guidelines and community standards for data availability =Yes

Specific comments

� Title and sub-titles should be sentence case and follow journal style of formatting manuscript

� The formatting styles of tables in this manuscript are not suitable for publication. Each variable should be written in cell or should follow the journal style. Also one table should not be presented two to three pages. If possible, it would be each could be table to present in one page?

� Table 4. COR and AOR should be presented along with 95% CI in one cell?

� In table 1,2 and 3 the COR and 95% CI columns should be removed?

� Abstract: should not be more than 300 words?

� Why the definition of cases was only selected from new users of family planning? On other hand your controls were selected both from new and return clients? Definition and selection criteria for cases and controls should be the same. What is your justification for this difference?

From line 123, From all the health centers in Addis Ababa, 20 health centers (two from each sub-city) were selected by employing simple random sampling technique?

� Question: How many health centers were there in AA? Why only 20 were selected?

� Unnecessary capitalization and inconsistency in use of abbreviations are identified. For instance, intrauterine Device/IUCD. Sometimes you use IUCD but other time intrauterine Device. If once you abbreviated it in the first time use, use IUCD throughout?

� Did you check the model fitness test? That means post estimation test? How did you controlled over matching? What about multicolloniarity?

� Letter for Ethical clearance file should be attached as supporting information?

� List of abbreviations should be removed from line numbers 324-331?

� Discussion: You didn’t consider negative finding in your discussion. You discussed only positive finding. If possible consider it.

� Strengths and limitations should be stated at end of discussions?

� Presentation of 95% CI: You put it not consistently in your document throughout, sometimes you used one digit, and other times 2 digits. Be consistent and I recommend 2 digits. It is usually preferable and be consistent?

� Line 236: You used p-value <0.20 in the bivariate analysis. Why p- value < 0.2? Why not 0.25?. If you could have used backward conditional stepwise regression rather than enter method, your multivariable analysis will be very sound, also your table also cannot three to four pages. Consider this?

� References are not completed and an acceptable label.

� References 2, 3,8,9,10,11,16,17,18,22,23,28,29,30,31, are either not completed or URL and accessed dates are missed, also the authors naming are not correct. List of more than 6 authors, you should write the first 6 authors and use et al.?

� Financial disclosure, conflict of interest and source of funding are not mentioned.

Conclusion

� In the conclusion section, the statement “For the fertility rates continue to decline, unintended pregnancies, unsafe abortions and 317 associated mortalities to be reduced the use of contraceptives plays an important role”. This sentence can be removed and the author can bring conclusions from his/her finding rather than stating the above unrelated issues of the study.

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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: Yes: Mengistu Meskele

[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: Reviwers Comment MM PONE-D-19-22523.docx

PONE-D-19-22523R1

Factors associated with intrauterine contraceptive device use among women of reproductive age group in Addis Ababa, Ethiopia: A case control study

PLOS ONE

Dear Mr. Dereje,

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.

We would appreciate receiving your revised manuscript by Feb 21 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,

Catherine S. Todd

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The authors have been largely responsive to previous comments but both reviewers and I note that the authors disregarded responding to several comments in the first review. There was no response to Reviewer 1's critiques; Reviewer 2 noted several comments that did not receive a response, and I note that the Limitations section still does not include some major limitations that were brought to the authors' attention in the first review, namely the reported nature of several of the covariates (e.g., literacy) and the absence of matched controls. Further, though you state the revised manuscript was reviewed by a native English speaker, there remain multiple places where verb tense, punctuation, and other grammatical errors are present or examples of awkward phrasing (which can be adjusted and reduce word count in the abstract). For example: "In each health center, all the eligible cases were included in the study consecutively until the desired sample size was achieved. For each case, two adjacent controls were selected to be included in the study." can be improved to "In each selected health center, all eligible cases were enrolled consecutively until sample size was achieved. Two consecutive controls were selected for each case." Last, there appear to be different fonts within the manuscript and portions do not comply with formatting requirements. Please attend to all of these matters completely and in the response letter, please state what was done in response and provide illustrative text rather than stating the query was addressed, as this was not consistently the case with the last revision. Thus, you are invited to revise and re-submit.

[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 #1: (No Response)

Reviewer #2: All comments have been addressed

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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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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 #1: Yes

Reviewer #2: Yes

**********

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 #1: Yes

Reviewer #2: Yes

**********

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 #1: Minor revisions:

1- Abstract: No need to state the sample sizes twice in the abstract.

2- Modify the results and/or conclusion to indicate that the significant factors in the multivariate logistic model were INDEPENDENT predictors of IUCD use.

3- Line 121: Provide additional details for justifying the study’s target sample size. The power calculation should include: sample size, alpha level (indicating one or two-sided), minimal detectable difference and statistical testing method.

4- Lines 173 and 185: The standard terminology for bivariate is univariate logistic regression.

5- Tables: Define all abbreviations and provide only the overall p-values rather than pairwise p-values for variables with more than two categories.

6- Tables: Include percentages corresponding to the frequencies.

7- When discussing the results of the multivariate model, clarify that four factors were significant when adjusted for the nonsignificant factors that were also included in the model. This has been stated properly in the discussion, but should also be included in the results section of the abstract.

Reviewer #2: Minor comments

1. Contribution: Equal or unequal contribution should be explained at first page?

2. Style: Font style for title and headings should be adhered journal style?

3. Table 5. Cross tabulation for cases and controls should be included?

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7. 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: Yes: Mengistu Meskele

[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: Reviewer MM comment 17 December 2019.docx

Factors associated with intrauterine contraceptive device use among women of reproductive age group in Addis Ababa, Ethiopia: A case control study

PONE-D-19-22523R2

Dear Dr. Dereje,

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.

Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

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,

Catherine S. Todd

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

My thanks to the authors for addressing the remaining concerns from the reviewers and this manuscript is accepted. Upon acceptance, I would recommend professional editing as the manuscript would benefit from further grammatical and phrasing improvements in an effort to make the text more concise.

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 #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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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 #1: (No Response)

Reviewer #2: Yes

**********

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

Reviewer #1: (No Response)

Reviewer #2: Yes

**********

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 #1: (No Response)

Reviewer #2: Yes

**********

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 #1: (No Response)

Reviewer #2: Yes

**********

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 #1: (No Response)

Reviewer #2: (No Response)

**********

7. 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: Yes: Mengistu Meskele