PONE-D-19-27356

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Mr. Ayele,

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 Mar 20 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.

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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,

Sphiwe Madiba, DrPH

Academic Editor

PLOS ONE

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2. 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. If you developed and/or translated 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.

Additional Editor Comments

1. Please revise the introduction to provide a generalized background vasectomy and its utilization, benefits, family planning, involving men in reproductive health, factors associated with low uptake of vasectomy and opinions and attitudes of men about vasectomy. There is adequate and recent data on the topic in sub Saharan Africa
2. I am recommending the following articles;

Please read Shattuck et al, A review of 10 years of vasectomy programming and research in low-resource settings. Glob. Health: Sci. Pract. 2016, 4, 647–660 for the global statistics on vasectomy,

Also read Shongwe et al, Assessing the Acceptability of Vasectomy as a Family

Planning Option: A Qualitative Study with Men in the Kingdom of Eswatini, nt. J. Environ. Res. Public Health 2019, 16, 5158. Please tell us about the factors associated with the low uptake of vasectomy

Barriers to O_ering Vasectomy at Publicly Funded Family Planning Organizations in Texas. Am. J. Men Health 2017,

Please read, Kısa et al. Opinions and attitudes about vasectomy of married couples living in Turkey. Am. J. Men Health 2017, 11, 531–541

Mar, S.O.; Ali, O.; Sandheep, S.; Husayni, Z.; Zuhri, M. Attitudes towards vasectomy and its acceptance as a method of contraception among clinical-year medical students in a Malaysian private medical college

Methods

1. Please follow the journal’s standard subheadings for the methodology.
2. Integrate the operational definitions with the measures and data analysis, write as a narrative, and remove the bolding from the words.

Data collection

1. Provide details on the tool and type of questions that were asked. Was the tool validated, how was intention measured-the type of question, what does future intention mean- is there a time factor on the future?

Results

1. Please follow the standardized categories for age and reanalyse the data accordingly, correct for all the tables and narratives in the document.

Discussion

1. The discussion need a revision in line with the introduction
2. Please tell us about those who intended to use vasectomy-what were their demographics before you do the comparisons with other studies, first in Ethiopia and other countries
3. You spend too much effort of why your study findings are different from those of others and not on the implications of your findings.

Conclusion

1. Improving level of knowledge and attitude towards vasectomy is an essential strategy-details on how this will be done
2. The document should be copy edited for language and grammar by a professional language editor before submitting your revised manuscript.  

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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: No

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

Reviewer #1: I Don't Know

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: No

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: This paper addresses an important topic – vasectomy and whether men would be willing to use the method and the characteristics of men expressing such willingness. The title of the manuscript is misleading = it says “intention” but the variable in the paper is “willingness” – those are not the same thing. The authors should be clear what the men were asked out (intention or willingness – and say in the paper the question/questions asked about willingness or intention to use.

Knowledge of vasectomy: The authors say that knowledge of vasectomy was measured through 9 questions – but do not say what those questions are. The questions should be included in the paper.

Attitudes about vasectomy: It is not clear how knowledge scores can translate into positive or negative attitudes towards vasectomy. One could have good knowledge and still have a negative attitude about the method.

What does “emotional support” from their partners to use vasectomy mean? How was this question asked? Were the men asked about current contraceptive use by themselves or their wives/partners?

Willingness (or intention?) to use: The authors should explain whey they did not ask the men if they knew where they could get a vasectomy and what would prompt them to actually have a vasectomy in the future.

Furthermore, the findings of willingness or intention need to be put in the context of the availability of vasectomy in the country. Without available services, men will not be able to act on their willingness or intentions.

The current comparison of the findings with findings from studies in other countries is interesting, but ultimately without expanded services, knowledge and willingness (or intention) is not sufficient. The authors could use the findings that are fairly consistent across studies to say that their seems to be latent interest in vasectomy that is not being satisfied with programming.

The authors should note that the sample in this study are highly educated (63% have a college education or above, and half the wives also have a college education or above) – what is the percent of the population in Ethiopia with a college education? The authors should explain why the town of Debre Tabor was selected for the study.

With that said, the men in this study could be vanguard users of vasectomy, so the findings are useful for advocating for expansion of vasectomy services in Ethiopia. It would be useful for the authors to refer to Ethiopia’s FP Costed Implementation Plan 2016-2020 to see if vasectomy is covered in it (http://www.healthpolicyplus.com/ns/pubs/2021-2030_EthiopiaCIPNov.pdf). FHI360 has prepared a brief on promoting vasectomy in Ethiopia that also might be helpful (https://www.fhi360.org/sites/default/files/media/documents/resource-vasectomy-evidence-ethiopia-final.pdf).

References should be listed by Last Name, First name (currently first names and last initial are included in the references).

This paper would benefit from a more thorough literature review on vasectomy and programming for men. Some other references to consider:

Vasectomy: A Long, Slow Haul to Successful Takeoff, James D Shelton and Roy Jacobstein, Global Health: Science and Practice December 2016, 4(4):514-517; https://doi.org/10.9745/GHSP-D-16-00355 Glob Health Sci Pract. 2016 Dec 23; 4(4): 647–660.

A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings, Dominick Shattuck, Brian Perry, Catherine Packer, and Dawn Chin Quee , Global Health: Science and Practice, Published online 2016 Dec 23. doi: 10.9745/GHSP-D-16-00235

Hardee, K, M Croce-Galis, and J Gay. 2017. “Are Men Well Served by Family Planning Programs?” Reproductive Health. 14(14). DOI: 10.1186/s12978-017-0278-5.

Ross, J, and K Hardee. 2016. “Use of Male Methods of Contraception Worldwide.” 2016. Journal of Biosocial Science. Published online.

Reviewer #2: Even though the topic is of public health importance as we strive to promote the use of male methods in the family planning method mix, the manuscript as it is now is very poorly written. It is extremely difficult to understand the content because of the poor quality of English. Additionally, the sampling procedure is inadequately explained - for example how was the first household selected in each kebele and how was the sample size for each kebele arrived at? It is also unclear how 'the next eligible household located in the clockwise direction was visited..' Another issue is that the authors did not provide an operational for 'intention to use vasectomy' and the Table titles are inappropriate.

The manuscript as it stands now will require major revisions, and should be seen by an English proof-reader before re-submission

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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: Yes: Karen Hardee

Reviewer #2: Yes: Easmon Otupiri

[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.]

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PONE-D-19-27356R1

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Mr. Ayele,

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 Jun 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,

Wen-Jun Tu

Academic Editor

PLOS ONE

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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)

**********

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: Partly

**********

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

Reviewer #1: 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

**********

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

**********

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 authors have addressed the reviewers’ comments on the original manuscript for the most part. A few issues are still outstanding. The authors describe intention to use vasectomy as “willingness of respondent to use vasectomy as a contraceptive method for future time.” This mixed intention and willingness, which are not the same things. Intention is stronger than willingness and implies that the man is planning to use vasectomy. Willingness implies that he might be interested in using it at some time in the future. The authors need to be clear what was asked – otherwise this seems like a vague outcome that might be more due to respondent courtesy bias than actual interest in using the method.

Is there a reason the men were not asked if they (their wives) were currently using a contraceptive method? Most of the men said they had completed their family size, so it would be important to know if they / their wives were currently doing something to avoid pregnancy.

Figure 2 is labeled “reason not to use vasectomy for future life” – is that how the question on intention to use was asked? This is likely a translation issue – what does it mean to use a method for future life?

Figure 2 shows that 74% said the reason not to use vasectomy was lack of awareness – yet 46.6% said they had heard of vasectomy according to Table 3. If nearly half of the men said they had heard of vasectomy, how could three-quarters say unfamiliarity with the method was a reason not to use it?

The discussion would be strengthened if it focused less on how the findings of the study match other studies and more on the programmatic implications for Ethiopia – how can the findings from this study improve access to and use of vasectomy in Ethiopia.

The manuscript still needs English language editing.

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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

[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-19-27356R2

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Dr. Ayele,

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 11 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,

Wen-Jun Tu

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: (No Response)

**********

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: Partly

**********

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

Reviewer #1: No

**********

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

**********

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

**********

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: This version of the manuscript has not addressed completely the comments I made on the second revision and I’ve noticed some additional issues.

Table 3 shows that 53.4% of the men had NOT heard about vasectomy. I should have caught this the first time I reviewed the paper. These men should have been skipped out of responding to other questions about vasectomy – if they haven’t heard of the method, how can they respond to specific questions about the method? The rest of the analysis should only be done on the 46.6% of the men who had heard of vasectomy. The conclusion that lack of knowledge about the method is an impediment to expanding use of vasectomy is still important. And then knowing what men with knowledge of the method think about it and their intention of using it will be programmatically useful.

Also, something I noticed rereading the paper – what does it mean in Table 2 that 74% said they got emotional support from their partners to use vasectomy? Again, how could they get support from their partners that they haven’t heard of?

The discussion section is still weak – it still focuses too much on comparison of findings from Ethiopia and other countries and not enough on how the findings are useful for Ethiopia’s program. I am recopying my previous comments:

I had previously suggested that the authors put the findings in the context that the sample is highly educated - 63% have a college education or above, and half the wives also have a college education or above – which is higher than Ethiopia’s average educational attainment. The men in this study could be vanguard users of vasectomy, so the findings are useful for advocating for expansion of vasectomy services in Ethiopia. It would be useful for the authors to refer to Ethiopia’s FP Costed Implementation Plan 2016-2020 to see if vasectomy is covered in it (http://www.healthpolicyplus.com/ns/pubs/2021-2030_EthiopiaCIPNov.pdf). FHI360 has prepared a brief on promoting vasectomy in Ethiopia that also might be helpful (https://www.fhi360.org/sites/default/files/media/documents/resource-vasectomy-evidence-ethiopia-final.pdf).

In my first review, I had suggested looking at additional references on vasectomy, which I note the authors have not included in the references, so it appears they did not review them. My comment still stands that this paper would benefit from a more thorough literature review on vasectomy and programming for men. For example,

Vasectomy: A Long, Slow Haul to Successful Takeoff, James D Shelton and Roy Jacobstein, Global Health: Science and Practice December 2016, 4(4):514-517; https://doi.org/10.9745/GHSP-D-16-00355 Glob Health Sci Pract. 2016 Dec 23; 4(4): 647–660.

A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings, Dominick Shattuck, Brian Perry, Catherine Packer, and Dawn Chin Quee , Global Health: Science and Practice, Published online 2016 Dec 23. doi: 10.9745/GHSP-D-16-00235

Hardee, K, M Croce-Galis, and J Gay. 2017. “Are Men Well Served by Family Planning Programs?” Reproductive Health. 14(14). DOI: 10.1186/s12978-017-0278-5.

Ross, J, and K Hardee. 2016. “Use of Male Methods of Contraception Worldwide.” 2016. Journal of Biosocial Science. Published online.

Also, while the English is better, the manuscript still needs editing for English language usage.

**********

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

[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.

PONE-D-19-27356R3

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Dr. Beyene,

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 Aug 03 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,

Wen-Jun Tu

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 #3: (No Response)

**********

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 #3: Yes

**********

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

Reviewer #3: 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 #3: 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 #3: No

**********

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 #3: This is a valuable empirical contribution to an understanding of men's potential use of vasectomy, in Ethiopia but in international scope too. I did not review earlier version(s) of the manuscript. My overall sense is that the research design is satisfactory, that the findings follow from the design, and that the key findings stand out clearly.

My major concern is that the writing quality is inadequate for the journal, and that a more professional editorial process is necessary before a final version can be accepted. To illustrate some examples of spelling or grammatical concerns that are of scientific merit in how the findings are reported, Vass difference should be vas deferens; alive children would be better phrased living children; and I atttempt my own version of the Abstract and Key Words (cut and pasted below) that I think illustrates what would be a more polished version than the current one. In a related vein, the formatting of the Tables and Figure needs to be improved (e.g., columns don't align), and any acronymy (e.g., EDHS) should be written out the first time introduced.

I also suggest several additions to the Introduction and Discussion as follows. a) Please discuss in the Discussion the high educational attainment and prevalent civil servant occupations of this sample: how do these compare with national Ethiopian data (perhaps compare with EDHS data, if available), and how generalizable or not are the current data? b) Perhaps also note what percent of men have 0, 1, 2 and 3 children just to share empirical data within the category of men having 3 or fewer children. c) In the Introduction when presenting data on Ethiopian family planning patterns, please also share some information about the prevalence of specific types of family planning such as condoms, tubal ligation, etc. d) In a related vein, in the Discussion, might another factor relevant to why men 40+ have lower vasectomy intent than men 30-39 be age- and fertility-related patterning of their wives' family planning (e.g., do older men's wives more often use tubal ligation, and does that mean that men's vasectomy decisions are somewhat contingent upon those of their wives). e) Please state the age range of male participants, in the Abstract and Results. I am guessing that these are men aged 20 years and older, but whether men in their teens were excluded was not noted in the Methods, nor is the upper limit of male ages specified.; f) in the Methods section, please craft a clearer sentence that specifies what the cutoffs are for differentiating good and poor knowledge. g) Does the item "Get emotional support from partner" refer to emotional support generally, or specifically to family planning support?

Background: Vasectomy is one of the most effective and permanent male contraceptive methods, and involves cutting and ligating the vas deferens to make the semen free of sperm during ejaculation. Although it is effective, simple and safe, it is not well known and practiced in the majority of our community. This study assessed intention to use vasectomy and its associated factors among married men in Debre Tabor Town, North West Ethiopia, 2019.

Methods: A community based cross-sectional study was conducted among 402 married men from March 05 to April 15, 2019. Simple random sampling technique was employed to select the study participants. Data were collected by face-to-face interview using a structured and pre-tested questionnaire. Questions concerned sociodemographic and reproductive variables and views on vasectomy. The association between variables was analyzed using bivariable and multivariable logistic regression model.

Results: A total of 402 participants were included with response rate of 98.75%. The mean participant age was 37.12 (SD ± 6.55) years. The prevalence of intention to use vasectomy was 19.6% with 95%CI (15.6%-23.4%). Multivariable logistic regression showed that age from 30-39 years (AOR=3.2 (95% CI: 1.19-8.86)), having more than three living children (AOR=2.5 (95% CI: 1.41-4.68)), good knowledge of vasectomy (AOR=3.4 (95%CI: 1.88-6.40)) and positive attitude toward vasectomy (AOR=4.8 (95% CI: 2.61-8.80)) were significantly associated with intention to use vasectomy.

Conclusion and recommendation: Intention to use vasectomy was comparable with findings in four regions of Ethiopia (Amhara, Oromia, SNNP and Tigray). Age, number of living children, knowledge and attitude were significantly associated with the intention to use vasectomy. Improving level of knowledge and attitude towards vasectomy is an essential strategy to scale up intention of men to use vasectomy.

Key words : Vasectomy, male contraception, family planning, fertility, Ethiopia

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Reviewer #3: No

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PONE-D-19-27356R4

Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PLOS ONE

Dear Dr. Beyene,

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.

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Wen-Jun Tu

Academic Editor

PLOS ONE

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Reviewer #3: (No Response)

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Reviewer #3: Yes

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

Reviewer #3: Yes

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Reviewer #3: Yes

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Reviewer #3: Yes

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Reviewer #3: The authors have addressed adequately the few substantive questions/comments I raised in the last round of review. I do not request any additional substantive edits. However, I still feel that the manuscript needs copyediting before it could be published. I do not know if PLoS ONE provides that service. If not, then it is worth noting that some formatting issues and grammatically awkward phrases remain in this revision. I don't believe this is the task of a reviewer to undertake all of these, as I illustrated previously with edits to the Abstract. I thus would ask that some formal copyediting process beyond what the authors have done be undertaken to ensure a final polished version of the manuscript.

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Reviewer #3: No

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Intention to use vasectomy and its associated factors among married men in Debretabor Town, North West Ethiopia, 2019.

PONE-D-19-27356R5

Dear Dr. Beyene,

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.

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Kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

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