PONE-D-20-03753

Length of stay to recover from severe acute malnutrition and associated factors among under-five years children admitted to public Hospitals in Aksum, Ethiopia

PLOS ONE

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PLOS ONE

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Additional Editor Comments (if provided):

An extensive correction of the language is the first step

Seconding paper not formatted as for PLOS one and many areas incorrectly cited

PLease respond to all queries from both reviewers

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Reviewers' comments:

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Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: No

Reviewer #2: No

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5. Review Comments to the Author

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Reviewer #1: The manuscript has not been formatted or written according to the standard of PlosOne.

Some of the words/sentences used clearly reflects that this was taken directly from a thesis without careful revision by all the authors. This is ridiculous.

Although the study has revealed significant differences in the median LOS to recover among different predictor variables nevertheless, in general the findings are highlighting that the length of stay is in the acceptable range of the international and national set of standards. In addition the findings are more relevant to Hospitals in Askum and not sure if the findings will be impactful/relevant to other regions of Africa /countries experiencing SAM children. Probably this should be highlighted further

Reviewer #2: The aim as stated (line106) “this research was intended to come up with information about length of stay till recovery and associated factors among severely malnourished children admitted to the identified health facilities for the betterment of quality of care.” It was however, not clear whether the intention was to see “the effect of associated factors on the length of stay in the hospital” or “to find out what were the associated factors in children who were admitted with severe acute malnutrition”. Of course, on reading the research paper it becomes clear that the objective is to see the effect.

On page 17 under predictors of length of stay : “eight independent significant predictors of LOS for nutritional recovery were found, which are; diarrhea, HIV sero status, palmar pallor, co-morbidity, blood transfusion, IV fluid infusion, provision of plumpy nut and feeding with the help of NG tube”. I would think diarrhea, HIV sero status, palmar pallor should be included under “co-morbidity” and thus “co-morbidity” per se would not be an independent predictor of the length of stay.

Similarly, “deranged pulse rate”, “severe dehydration,” “altered consciousness”, “shock” and “hypothermia” under the heading “Clinical conditions of patients at admission(page 15, lines 295-308)” would all probably be parts of the same clinical spectrum at admission. These are all analyzed separately for incidence.

Since bilateral edema was seen in 90.5% of patients, it will be interesting to find out the cause of unilateral edema in the undernourished children studied (lines 303-304). It will be nice if this was mentioned too. This may not be related to the present research, but if it is due to cellulitis/ lymphadenitis etc. it would impact the length of stay for recovery.

While quick/ early recovery period from other complications (palmar erythema, co-morbidity, diarrhea) was calculated as percentage (of what? Of total, or those who did recover) the recovery in children who did not require NG tube feeding or I.V. fluids was calculated as “1.9 times and 1.55 times more likely”.

Early/quick recovery has not been defined (Line 337 & 344-45).

“Probability of getting cured fast was reduced by 58.5% (AHR = 0.415; 95% CI: 0.302-0.570) in those admitted with co-morbidity” (Line 424). Are the terms “recovery” and “cure” used interchangeably here?

Some abbreviations are not explained, e.g. “OTP (line96) and NRU (205) which I presume is the therapy unit where the children were admitted.

I thought the references should include the names of journals where they are originally published. They are of course easily traceable.

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Reviewer #1: No

Reviewer #2: Yes: Professor Usha Rani Singh

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Submitted filename: PONE-D-20-03753_reviewer.pdf

Length of stay to recover from severe acute malnutrition and associated factors among under-five years children admitted to public Hospitals in Aksum, Ethiopia

PONE-D-20-03753R1

Dear Dr. Tekia Zafu,

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,

Shamala Devi Sekaran

Academic Editor

PLOS ONE

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