Peer Review History
Original SubmissionFebruary 26, 2020 |
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PONE-D-20-05601 Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative PLOS ONE Dear Dr. Nabulsi, 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:
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, Thach Duc Tran, M.Sc., Ph.D. 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 2. Please amend your current ethics statement to address the following concerns: Please explain why written consent was not obtained, how you recorded/documented participant consent, and if the ethics committees/IRBs approved this consent procedure. 3. 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. For instance, if you developed 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. If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible. 4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. [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 Reviewer #3: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: I Don't Know ********** 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 Reviewer #3: No ********** 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 Reviewer #3: 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: The article is well written with appropriate research methodology and the findings will be beneficial to the vitalization of BFHI in Lebanon. One issue is the statement on lines 78 and 79 that the majority of BFHI hospitals are in Quebec, Canada. Baby-Friendly hospitals are distributed around the world with the highest number reported by country in China. Quebec may certainly have the most in Canada, but not the world! Reviewer #2: Overall the paper has provided a good data with an appropriate analysis. As a second language, English language in this paper seems to be standard. I recommend some references from other Middle East countries should be added. Reviewer #3: Responses to points above: 1. With further explanation of the method and analysis it is likely the paper will meet this criteria, but there are gaps at the moment. More specific comments are provided below. 2. The statistical test seems appropriate – however I have asked for clarification around the use of “knowledge of baby friendly hospitals” to be a marker for “knowledge of BFHI practices”. The aim of the study is stated refers to broader issues than knowing “what Baby Friendly hospitals are” so it is not clear why this is the only factor investigated in the bivariate analysis. 3. At this point all data is not available however the authors state that the data will be publicly available from PLOS ONE upon acceptance. 4. While I have ticked “yes” there are some minor grammatical errors that should be corrected by proof reading. Thank you for the opportunity to review this paper on the Knowledge and attitudes of Lebanese women towards the Baby Friendly Hospital Initiative. This study presents the results of original research that as far as I am aware has not been published elsewhere. The paper makes a compelling case for the research in the context of the current literature and in the face of low breastfeeding rates in Lebanon. It outlines the importance of breastfeeding and the established role of BFHI practices in increasing breastfeeding rates internationally. The methodology is appropriate for gaining knowledge of women’s views and beliefs and the findings support the need for national education aimed at improving knowledge of BFHI practices with a view to increasing breastfeeding within Lebanon. The study was approved by the Institutional Review Board of the American University of Beirut and all participants provided oral consent. This study builds on previous research in Lebanon on the subject. The survey methodology is appropriate for answering the research question - including the mix of (apparently) yes/no responses and (apparently) the option to add comments. The detail of the survey requires further explanation as indicated below. An interesting aspect is that education was provided following phase one of the survey and then participants were asked to respond to further questions. The findings provide rich data on issues that could be addressed in national education to improve breastfeeding rates and thus the health of women and babies. The paper is mostly well written and easy to follow, although there are some minor errors in grammar that require correction. The discussion captures the findings in relation to existing literature and explores issues raised in a clear and engaging way. In particular exploration of the cultural issues are very informative and open possibilities for ensuring messages are appropriately targeted. A strength of the study is that over 500 participants representing all six governorates (Mouhafaza) of Lebanon completed the questionnaire. The conclusion is based on the findings but needs rewording to ensure it aligns directly with the aims of the study – please see below. I have identified broad areas that I suggest need expansion or restructuring to improve the paper. 1. Please consider providing further explanation about the BFHI practices, the 10 steps to successful breastfeeding, and the process of accreditation as a Baby Friendly hospital in the introduction. Two practices: skin to skin and kangaroo care have been targeted in the survey. It would be helpful to define these two practices and then to explain why they have been targeted in the survey as they only constitute one of the 10 steps. Was there a particular reason why you wanted to highlight these practices in your aim and not the other BFHI practices? 2. I suggest the conclusion, “Such knowledge will facilitate the implementation of BFHI in Lebanon” requires rephrasing. My understanding is that the hospitals would drive the process of implementing the BFHI practices but if women had a greater understanding they might more readily engage in these practices. This just needs a small modification of the language. 3. Methods: In general there is insufficient detail to understand the specifics of the consent process (why was this an oral process?), the precise nature of the question types, length of the questionnaire and administration of the questionnaires. Considerable detail is lacking from this section. Eg Please explain the nature of the open ended questions eg did they ask about benefits of breastfeeding etc 4. More detail about analyses is also required for both the statistical analysis and the content analysis – how was this completed? 5. Results: The results section could also be reported in more detail. The reader could better understand the findings if it was stated that they are reported with reference to both the quantitative data and the content analysis of the qualitative data to provide a narrative of the key findings. The purpose of Table two is clear but it would be helpful, as stated above, if a description of the questionnaire was included in the methods. This would then give context to the table. The bivariate analysis would benefit from more description. Line 239 refers to knowledge of BFHI practices while the question from the survey asks about knowledge of baby friendly hospitals. This must be consistent as I suggest the two things are not the same. Similarly Table 3 refers to BFHI practices while the question from the survey asks about knowledge of baby friendly hospitals. There is no rationale for why this question from the questionnaire was used for this particular analysis. The aim of the study is stated refers to broader issues than knowing “what Baby Friendly hospitals are” so it is not clear why this is the only factor investigated in the bivariate analysis. Further explanation is required. 6. Discussion is well written and situates the results in the context of the literature. There are very interesting cultural issues discussed which puts the findings in the local context. I suggest a further comment on the impact of the obstetrician’s views and the family views. Evidence is provided that shows both to be strongly influential. It would add value if the authors could comment on the possible conflict of differing views by medical staff and family and how a mother may resolve such conflict. Nabulsi et al (2019) describe the importance of combining antenatal breastfeeding education with peer and professional lactation support to improve breastfeeding rates. Perhaps this concept could be expanded in the current paper. Specific points 7. Please state why written consent was not required. 8. It is not clear how the complete data set will be made available to meet the statement: The data will be publicly available from PLOS ONE upon acceptance. 9. Table 1 reports median (SD) for some items. I suggest median(IQR) or mean (SD). 10. Line 23 Introduction. I suggest changing the term designated as Baby Friendly to accredited as baby friendly – unless there is a reason for using the term designated. 11. Line 25 Aim. I suggest a rearrangement of the aim to improve understanding. The aim stated in the manuscript lines 116 – 117 is structured more appropriately. Please consider using this to replace the current aim in the abstract. Thank you 12. Abstract Results: minor grammatical errors 13. Line40- 41: the phrase “and their numerous advantages” does not make it clear what “their” is referring to and thus could be misleading. Suggest: “There is a need for national awareness campaigns that address both the numerous advantages of BFHI practices and Lebanese women’s knowledge gaps about these practices.” 14. Line 42 suggest adding and thus “through increased breastfeeding” positively impact 15. Please consider including the ideas expressed in lines 118 – 121 as part of the conclusion of the abstract. 16. Line 129 states clinics while line 130 states licensed obstetricians. Should clinics be the consistently used term here for consistency? As part of this description please state the process for random identification of the clinics and also the total number of clinics from which the 50 clinics were chosen. Thank you 17. Line 138; please state the criteria for consecutive recruitment eg when did this recruitment start and was it the same time frame for each clinic? 18. Line 141. Please clarify why verbal and not written consent was obtained. Also clarify if the questionnaire was written and if self administered did the participant take the questionnaire away or answer in the clinic. Was there any involvement of the staff? How long was the questionnaire expected to take and how many questions and what type of responses were included. Later in the section open ended questions are described. Generally more detailed information is required in this section. “Participants were asked” may be misleading could you rephrase to ”The questionnaire asked participants about…” 19. Line 150 were participants briefed after they completed the first part of the questionnaire? Please make explicit and include a statement about who briefed the participants eg Obstetrician etc 20. Line 152 again please clarify if these questions were verbally asked or if the statement refers to the written questions in the survey. 21. Line 157 I note medians are also included in Table 1but not stated in this section. 22. Line 255. Please clarify if it is only mothers with poor knowledge who would birth their baby in a Baby Friendly Hospital next time. I suspect this is about the phrasing of the sentence rather than the data as the next sentence describes this. Can you change the order of the sentences to make this clearer? 23. Line 313 Comment as for the conclusion in the abstract. The authors provide evidence that family and peers may be influential in breastfeeding practices and thus I suggest this is also addressed in terms of increasing their knowledge. Many thanks. ********** 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: No Reviewer #2: No Reviewer #3: 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.
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Revision 1 |
PONE-D-20-05601R1 Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative practices PLOS ONE Dear Dr. Nabulsi, Thank you for submitting your manuscript to PLOS ONE. 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 Oct 04 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:
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, Thach Duc Tran, M.Sc., Ph.D. 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 Reviewer #3: 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: (No Response) Reviewer #2: Yes Reviewer #3: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes Reviewer #3: 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: (No Response) Reviewer #2: Yes 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 #1: (No Response) Reviewer #2: Yes Reviewer #3: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: The Author replied and revised all of my comments and in fact the Author satisfied me. Thank you for this. Reviewer #3: Thank you for the detailed and comprehensive responses to the points raised in the review. This has significantly improved the manuscript and it now represents your research in a clear and articulate manner. One minor point is that in line 186 the word "Consequently" is probably not the appropriate term. I suggest something like 'Once participants had responded to questions xxx the trained research assistant..." Otherwise - very well done. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: 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.
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Revision 2 |
Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative practices PONE-D-20-05601R2 Dear Dr. Nabulsi, 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, Thach Duc Tran, M.Sc., Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: |
Formally Accepted |
PONE-D-20-05601R2 Knowledge and attitudes of Lebanese women towards Baby Friendly Hospital Initiative practices Dear Dr. Nabulsi: 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. Thach Duc Tran Academic Editor PLOS ONE |
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