Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea

Mahfuza Islam; Mahbubur Rahman; Leanne Unicomb; Mohammad Abdullah Heel Kafi; Mostafizur Rahman; Mahfuja Alam; Debashis Sen; Sharmin Islam; Amy J. Pickering; Alan E. Hubbard; Stephen P. Luby; Benjamin F. Arnold; John M. Colford Jr.; Ayse Ercumen

doi:10.1371/journal.pone.0236163

Peer Review History

Original SubmissionFebruary 5, 2020
1 Apr 2020 Decision Letter - William Joe, Editor PONE-D-20-03333 Child defecation and child feces management practices in rural Bangladeshi households: Associations with fecal contamination of hands and stored drinking water, observed hand cleanliness and child diarrhea PLOS ONE Dear Mrs Islam, 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 May 16 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, William Joe Academic Editor PLOS ONE 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 https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following in the Acknowledgments Section of your manuscript: 'This study was funded by National Institute 435 of Health (NIH), grant number R01HD078912.' 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): [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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: Yes Reviewer #2: Yes ****** 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 this is a good study but needs to be reviewed and toned down by the authors for the following checks: 1. Title/s: The authors may revise the language of the title/s to improve readability 2. The review of literature needs to be more critically written: from global statistics, it can be narrowed down to Bangladesh, and more data should be provided particularly in terms of low- and middle-income countries. The gap in literature needs to be highlighted more. Line 52 and 53 – repetition. Overall, the literature review section needs to be worked upon, especially the language to improve readability 3. In the study design section of methodology, line 78 – Instead of ‘longitudinal environmental assessment’, can be mentioned only as Longitudinal study. The study design needs explicit description. 4. In the results section, line number 205 – ‘Human faeces were observed in <1% (n=21) of households’: The sentence is not clear, may be reframed. 5. In Table 1: Enrolment characteristics of study households with at least one child <5 years in rural Bangladesh (N=360), what does ‘Female” in child characteristics denote? Is it percentage of female child in the house? If yes, then why just female and not the male child percentage? – This table needs to be reworked, the variables under each head needs to be reviewed. For example, under ‘Child characteristics’, there is ‘mother’s age in years’, which should go under a different head. Reviewer #2: The manuscript is technically sound it tends to explain the objective of the study and how they have selected cluster for the observation of sanitation practices. It is aptly written, however i will suggest that they should mention gaps in the existing literature in the initial part of the paper. Further the writing part in the study design, sample collection, and analysis can be simplified for the wider audience for instance using the term index children can be explained and why they have used that term. Over all the paper present clear picture of sanitation practices in Bangladesh. ****** 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: Yes: Poulami Dasgupta 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. https://doi.org/10.1371/journal.pone.0236163.r001
Revision 1
21 Apr 2020 Author Response Editor PLOS ONE Thank you for your helpful comments and suggestions. Please find attached our responses to reviewers’ comments. Under each response, we have also included the relevant excerpt from the revised manuscript to facilitate reviewing. Thank you for your consideration, and we look forward to your decision. Sincerely, Mahfuza Islam 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 Response: We have followed PLOS ONE’s required style including formatting and file naming. 2. Thank you for stating the following in the Acknowledgments Section of your manuscript: 'This study was funded by National Institute 435 of Health (NIH), grant number R01HD078912.' 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.' Response: We have removed the funding related text from the “Acknowledgement” section of the manuscript. Please revise our Funding Statement in the online system as follows. 'This study was funded by National Institutes of Health (NIH) grant number R01HD078912.The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.' RESPONSES TO REVIEWERS: RESPONSES TO REVIEWER #1: Overall this is a good study but needs to be reviewed and toned down by the authors for the following checks: 1. Title/s: The authors may revise the language of the title/s to improve readability Response: We have revised the study title as follows. Manuscript Revision: “Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea” 2. The review of literature needs to be more critically written: from global statistics, it can be narrowed down to Bangladesh, and more data should be provided particularly in terms of low- and middle-income countries. The gap in literature needs to be highlighted more. Line 52 and 53 – repetition. Overall, the literature review section needs to be worked upon, especially the language to improve readability Response: We have revised the sentence (line 52 and 53) as follows. We have also expanded the literature review in the introduction and discussion sections and improved the language. Manuscript Revision: “…Young children frequently place their hands in their mouths, and in Bangladesh, it is also common to eat and to be fed by hand (8). Previous studies in Bangladesh demonstrated that caregiver’ and children’s hands can contain fecal indicator organisms at concentrations of >100 colony forming units (CFU) per two hands (9)...” Expanded literature in the introduction section “…However, several recent sanitation trials have shown mixed impact from latrine provision on health outcomes (3-7) and studies that measured fecal contamination at potential household exposure points found little or no effect of sanitation interventions in reducing fecal indicator bacteria (8-10), suggesting other sources of fecal contamination that are not adequately eliminated by typical sanitation interventions. One potential source is child open defecation, which remains common in low-income countries....” “…Poor child feces management could be a potential contributor to health risk as young children with poorly developed immune systems have higher incidence of enteric infections than other age groups (12) and their feces are also more likely to contain higher quantities of transmissible pathogens (13)....” Expanded literature in the discussion section “…Our findings of increased fecal contamination associated with unsafe child feces management are consistent with evidence from other settings. A study in India found that E. coli counts on household floors and in soil increased by up to an order of magnitude following child defecation on these surfaces after the feces were removed (33). A study in Kenya using microbial source tracking methods to distinguish the feces of young children from the feces of older children and adults found that fecal contamination from young children dominated samples collected within the domestic environment, such as hands and surfaces (35)...” “…A study in India found an increase in E. coli counts on hands of caregivers after they handled child feces with unsafe methods but not with safe methods (33). This study measured caregiver hand contamination immediately following feces handling events while we collected hand rinses at an arbitrary time during the interview. Our sampling method likely missed spikes in caregiver hand contamination associated with unsafe feces handling due to temporal variability...” “…A study of Demographic and Health Survey (DHS) data from 34 countries also showed improved child growth associated with safe disposal of child feces (57)...” 3. In the study design section of methodology, line 78 – Instead of ‘longitudinal environmental assessment’, can be mentioned only as Longitudinal study. The study design needs explicit description. Response: We have added additional details of the study design and changed the wording to longitudinal study. We have also added citations for previous publications that describe additional details of the study design and implementation. Manuscript Revision: “…We conducted a longitudinal study within a randomized controlled trial in rural Bangladesh (WASH Benefits Bangladesh trial, ClinicalTrials.gov NCT01590095). The parent trial was conducted in the Gazipur, Kishoreganj, Mymensingh and Tangail districts of rural Bangladesh (18, 19). The trial randomly assigned geographically pair-matched clusters of pregnant women to water, sanitation, hygiene and nutrition intervention vs. control arms and followed their birth cohort of “index children” (children of enrolled pregnant women were in utero at the time of enrollment) for approximately two years to assess intervention impacts on child growth, diarrhea and enteric infections. Additional details of the study design and interventions have been described elsewhere (18-20)...” 4. In the results section, line number 205 – ‘Human faeces were observed in <1% (n=21) of households’: The sentence is not clear, may be reframed. Response: We have revised the sentence as follows. Manuscript Revision: “…Fewer than 1% of households (n=21) had human feces observed in the compound area...” 5. In Table 1: Enrolment characteristics of study households with at least one child <5 years in rural Bangladesh (N=360), what does ‘Female” in child characteristics denote? Is it percentage of female child in the house? If yes, then why just female and not the male child percentage? – This table needs to be reworked, the variables under each head needs to be reviewed. For example, under ‘Child characteristics’, there is ‘mother’s age in years’, which should go under a different head. Response: Yes, it is the percentage of female children of the households which was 49%, and the rest of the 51% were male children. We have added the percentage of the male children to the table. We have also changed the heading to “Characteristics” instead of “Child characteristics”. RESPONSES TO REVIEWER #2: Reviewer #2: The manuscript is technically sound it tends to explain the objective of the study and how they have selected cluster for the observation of sanitation practices. It is aptly written, however i will suggest that they should mention gaps in the existing literature in the initial part of the paper. Further the writing part in the study design, sample collection, and analysis can be simplified for the wider audience for instance using the term index children can be explained and why they have used that term. Over all the paper present clear picture of sanitation practices in Bangladesh. Response: Thanks for your positive comments. We have simplified the language throughout the manuscript and we have added the definition of “index children” as follows. We have also expanded the literature review in the introduction and discussion sections. Manuscript Revision: “…The trial randomly assigned geographically pair-matched clusters of pregnant women to water, sanitation, hygiene and nutrition intervention vs. control arms and followed their birth cohort of “index children” (children of enrolled pregnant women that were in utero at the time of enrollment) for approximately two years to assess intervention impacts on child growth, diarrhea and enteric infections. Additional details of the study design and interventions have been described elsewhere (18-20)...” Expanded literature in the introduction section “…However, several recent sanitation trials have shown mixed impact from latrine provision on health outcomes (3-7) and studies that measured fecal contamination at potential household exposure points found little or no effect of sanitation interventions in reducing fecal indicator bacteria (8-10), suggesting other sources of fecal contamination that are not adequately eliminated by typical sanitation interventions. One potential source is child open defecation, which remains common in low-income countries....” “…Poor child feces management could be a potential contributor to health risk as young children with poorly developed immune systems have higher incidence of enteric infections than other age groups (12) and their feces are also more likely contain higher quantities of transmissible pathogens (13)....” Expanded literature in the discussion section “…Our findings of increased fecal contamination associated with unsafe child feces management are consistent with evidence from other settings. A study in India found that E. coli counts on household floors and in soil increased by up to an order of magnitude following child defecation on these surfaces after the feces were removed (33). A study in Kenya using microbial source tracking methods to distinguish the feces of young children from the feces of older children and adults found that fecal contamination from young children dominated samples collected within the domestic environment, such as hands and surfaces (35)...” “…A study in India found an increase in E. coli counts on hands of caregivers after they handled child feces with unsafe methods but not with safe methods (33). This study measured caregiver hand contamination immediately following feces handling events while we collected hand rinses at an arbitrary time during the interview. Our sampling method likely missed spikes in caregiver hand contamination associated with unsafe feces handling due to temporal variability...” “…A study of Demographic and Health Survey (DHS) data from 34 countries also showed improved child growth associated with safe disposal of child feces (57)...” Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0236163.r002
4 Jun 2020 Decision Letter - William Joe, Editor PONE-D-20-03333R1 Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea PLOS ONE Dear Dr. Islam, 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. Please submit your revised manuscript by Jul 19 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're 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. 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). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, William Joe Academic Editor PLOS ONE [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: All comments have been addressed Reviewer #2: All comments have been addressed ******** 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: I Don't Know ****** 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: I have attached the manuscript with track changes. There are 2 very small changes from my side which can be included. The paper reads really well and is easily understandable. 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: Yes: Poulami Dasgupta 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.] 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 PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Manuscript PLOS suggestions.docx https://doi.org/10.1371/journal.pone.0236163.r003
Revision 2
11 Jun 2020 Author Response I would like to thank both reviewers for giving time to review this manuscript and for providing their valuable comments to improve this. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0236163.r004
1 Jul 2020 Decision Letter - William Joe, Editor Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea PONE-D-20-03333R2 Dear Dr. Islam, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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 help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- 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. Kind regards, William Joe 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 ******** 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: The paper really reads well now. No further changes from my side. I wish the authors good luck . Best wishes. 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: Yes:** Poulami Dasgupta Reviewer #2: No https://doi.org/10.1371/journal.pone.0236163.r005
Formally Accepted
8 Jul 2020 Acceptance Letter - William Joe, Editor PONE-D-20-03333R2 Child defecation and feces management practices in rural Bangladesh: Associations with fecal contamination, observed hand cleanliness and child diarrhea Dear Dr. Islam: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. William Joe Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0236163.r006

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