PONE-D-19-30011

Prevalence of malnutrition and associated factors among adult patients on Antiretroviral Therapy follow up care in Jimma Medical Center, Southwest Ethiopia.

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PLOS ONE

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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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: No

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: General

The article address a major issue among HIV infected patients, especially in Africa and other low income settings. The study hypothesis and objectives are well stated. The authors have evaluated the prevalence and risk factors of under nutrition among patients receiving ART at a university hospital in Ethiopia. They found a high (36%) prevalence of under nutrition ; associated with marital status (widow), advance WHO clinical stage (III-IV), and low CD4 count (<200 cell/ul). While this topic has already being studied in several settings, local data are crucial to design local actions.

Major comments

The reference to malnutrition is sometimes confusing as it include both undernutrition and overweight. Reader may feel more comfortable if authors focus on undernutrition (the main topic of the study). This could be stated already in the title.

Authors state malnutrition as The main problem among people living with HIV. Maybe this statement could be attenuated, indicating food security and under nutrition as a major threat to HIV programs.

It would have been interesting to have information about diet, food security and incomes (eg. Wealth index) as these factors are known to affect nutritional status. Advance HIV status and low cd4 count found in this study, as well as under nutrition, may all be surrogates of poverty or deficient diet.

With the high prevalence (55.8%) of patients with less than 200 CD4, it would be interesting to indicate the prevalence of patients in treatment failure. The observed severe under nutrition could be a wasting syndrome related to a treatment failure and disease progression.

The study design is stated as cross-sectional. Readers may have difficulties to understand the patients inclusion process. It may be useful to clarify this section, especially the used "lottery method" (random selection ?) and the "Kth records identified for abstraction", lines 111-113.

The authors seem to make a confusion between prevalence in a study group and weight of the group within the whole population. Thus, most of the undernourished being married (table 3) does not necessarily mean that undernutrition is most prevalent among married as stated at line 173. This mistake apply to other variables mentioned in the paragraph "Prevalence of malnutrition". Conversely, in paragraph addressing factors associated with malnutrition, authors should use "proportion" instead of "number" (line 186 and beyond).

Table 1,2 and 3 can be merged to keep only two tables, with 3 results columns each: 1- Normal nutritional status, 2- Under nutrition and 3- total

To ensure easy reading of the paper, English language should be improved.

Minor comments

Details about countries prevalence and the risks factors of malnutrition discussed in the introduction (lines 58-60 and 63-69) would be more useful in the discussion

Line 151: Readers may be interested to know why 9% of the records were not completed (missing data?)

Line 54: Food insecurity (and not malnutrition by itself) increases high risk sexual behaviors

Line 72: author may state the overweigh is also "a major" problem and not "the main"

Line 121: "data abstraction tool" here probably refer to a "data collection tool"

Line 142: the section about patients confidentiality may be simplified.

Reviewer #2: No research has been done to this scope, wide range of duration and large sample size in Ethiopia. Because of limited number of researches are there to establish volume of evidences for different contradicting findings regarding the factors, it contributes to conduct valid systematic review and Meta analysis. The authors should revisit the method section so that it will be clear for readers. Write population, inclusion and exclusion criteria and the analysis section clearly. Let the language experts edit the manuscript. Discussion should address some plausible scientific explanation in addition to comparison. Finally if these comments are refined, I wish it will be accepted publication.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PONE-D-19-30011_reviewer (1).pdf

Prevalence of malnutrition and associated factors among adult patients on Antiretroviral Therapy follow-up care in Jimma Medical Center, Southwest Ethiopia.

PONE-D-19-30011R1

Dear Dr. Daka,

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.

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With kind regards,

Simeon-Pierre Choukem

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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: 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: (No Response)

Reviewer #2: (No Response)

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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: No