PONE-D-19-31921

Quality of and Barriers to Routine Childbirth Care Signal Functions in Primary Level Facilities of Tigray, Northern Ethiopia: Mixed Method Study

PLOS ONE

Dear Haftom Gebrehiwot Weldearegay 

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Sharon Mary Brownie

Academic Editor

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: Yes

Reviewer #2: Yes

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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: Overall the paper is good. The authors have successfully addressed the main objective of the paper. They have applied different data collection techniques and triangulate those very appropriately. Ethical procedure was followed rightly for protocol and obtaining written consent during data collection. It was easy to follow as the introduction, method, result and conclusion section were well organized and supported every section. However, some of the section; particularly in the methodology section should be clearer.

Major issues:

In the methodology section, overall line numbers 118-173 for qualitative part should rewrite; for example, data collection methods, participants’ category and data organization should write consistently and detail.

Specifically, line numbers 118-119, 155-158, please check the sentences and make consistence when you write about the study participants. In the first sentence you have written about applying qualitative approach among Skilled Birth Attendant and in the sentences lines 155-158 you have mentioned about 12 key informants. So, there has two types of participants and you have used two type data collection tools for qualitative data collection, but you have written separately which is confusing.

In the line numbers 229-233 Please write more detail about qualitative data preparation, coding, theme selection and content analysis. Did you use any software for data coding or analysis? If so, please mention.

Minor issues:

i.In the abstract; line number 30, you have mentioned focus group , it’s actually Focus Group Discussion (FGD) a specific method name. Please write Focus Group Discussion.

ii. Line no 31-32, you have used validated tools. Would you please explain how the tools were validated. If it is through field test prior to use for filed data collection you should mention it here.

iii. Did you prepare any verbatim transcript for interpretation? Verbatim interpretation words are not clear. Line number 34-35

iv. The Abstract needs some modification, in result section while stating the predictors of quality of care, in bracket including the p values along with coefficient value and confidence intervals would portray the predictors more clearly [line 37 to line 42].

v. Line 49-59 conclusion section can be a bit shorter focusing the main points in few sentences.

vi. Line 79 Please use capital letter before the writer name, Donabedian

vii. Line 84 please write quality of care instead of only quality

viii. Line 121-122, 49.7% population are male? Why did you use this data, not clear.

ix. Title: Line number 275, as you have described barrier of providers in this section. Could you please include the word into your title? It might give idea about the section to the reader when they will see the title of the paragraph.

x.You have given reference for some quotation; for instance Line no 300. Reference interview 6 . Instead of interview 6, can you please write the interview of skilled birth attendants or a key informant interview.

xi. In Result section, while interpreting Table 6 i.e. Barriers for Quality of Routine Childbirth Care Signal Functions, interpretation could be written differently, instead of stating the results in same way, for some variables you could interpret as, due to change in independent variable the predicted variable increased significantly or otherwise [line 320 to line 337]. It is not mandatory to mention the adjusted coefficient value each time. Moreover, while you are stating the 95% confidence interval and p-value, you should also include the beta value i.e. co-efficient value. I think this section needs some tightening.

xii.Line number 370 write mixed method approach

xiii. In line number 373 you can write over patient flow for delivery instead of delivery load.

Other comments: In addition, please check formatting and some spelling while you go through the paper.

Reviewer #2: This is an interesting manuscript. However, there are some issues that need to be addressed

1. There are a lot of grammatical errors in the manuscript and I recommend revising the entire manuscript, see examples below:

- A total of twelve interviewee were conducted (page 14, lines 157-158).

- We were used principal component analysis (page 15, line 184)

- In addition, PCA was done to create an index score. Prior to perform PCA, the suitability of data was assessed (page 16, lines 219-220).

2. The authors should consider presenting the results of the qualitative data analysis separate from that of the quantitative data, and in doing do should provide additional information of the participants and not just FGD participant or Interviewee 6. For example highlighting their role/occupation.

3. In addition, when presenting the results of the qualitative interviews, the authors should separate the responses of participants, for example on page 20, the authors lumped together the responses for interviewee 6 and 8.

4. The authors should consider providing a Good Reporting of A Mixed Methods Study (GRAMMS) checklist.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Review report_PLOS One D- 19-31921.docx

Quality of and barriers to routine childbirth care signal functions in primary level facilities of Tigray, Northern Ethiopia: Mixed method study

PONE-D-19-31921R1

Dear Dr. Haftom Gebrehiwot Weldearegay,

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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With kind regards,

Sharon Mary Brownie

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers comments have been addressed.

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: Overall the manuscript is well. The data collection process, analysis has been written logically which supported the main ideas of the manuscript. I made some major and minor comments in my first review that had been attached here; I found that all the comments have been addressed very nicely. I accept this paper without further any comments.

Reviewer #2: Thank you for taking time to address the reviewers comments. The manuscript has been strengthened further.

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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: Yes: RASHIDA AKTER

Reviewer #2: No