PONE-D-19-23907

Determinants of stunting among children aged 6-59 months in Kemissie City Administration, North Eastern Ethiopia: A community-based matched case-control study

PLOS ONE

Dear Dr Adane (PhD),

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Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

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: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Review: Determinants of stunting among children aged 6-59 months in Kemissie City Administration, North Eastern Ethiopia: A community-based matched case-control study

Summary: The authors examine stunting in Ethiopia with a case-control method. Find that maternal nutritional status, child’s food priority, duration of breastfeeding, child meat-eating, and diarrheal episodes are associated with stunting.

Recommendation:

Minor revision

General Notes:

• Overall the study does not provide novel insights into the determinants of stunting, but it provides additional evidence of factors that have been previously shown to be associated with stunting. However, the study appears to be well done.

• Eliminate causal language (e.g. abstract, throughout the discussion and conclusion including line 216 “causes of stunting”)

Specific Notes:

Check for typos throughout

Reviewer #2: This manuscript represents a community based individual matched case control study (with

107 cases and 214 controls) where the authors find associations between being stunted among children under 5 hears of age and maternal BMI, food priority, exclusive breast feeding,

consumption of meat and experiencing diarrhea. While the authors have an appropriate and succinct argument for the importance of this study in the introduction, and they also seemed to have responded to the first round of comments, the manuscript requires further revisions to represent an important and novel addition to the literature on child undernutrition.

1. How were data cleaned? Particularly the anthropometric data collection? How were outliers addressed?

2. Were any children missing observations on any of the variables included.

3. Greater description of the explanatory factors including in this study is needed. Such information should not only be relegated to category labels in the tables. Moreover, justification is needed for the specific variables included.

4. Did the authors think about conducting a logistic regression analysis with stunting as the outcome pooling all the data and (as a sensitivity analysis doing a linear regression analysis with the HAZ score as the outcome)? It might make results clearer.

5. Did the authors adjust for the Kebele in the model? Past research has found that variation in undernutrition outcomes can be attributed to higher geographic administration levels.

6. Some English editing is required in the paragraph about the wealth index.

7. What additional factors were included in the regression analyses based on results presented in Table 4? More details about the analysis and the factors included should be part of the table information. For example, were any economic household characteristics or WASH variables included?

8. The authors need to re-structure their results. Cut-down the amount of descriptive statistics presented. Mention a few and then refer readers to those tables. Then, the rest of the results section should focus on estimates from the adjusted regression analyses as those respond to the research questions set up in this manuscript.

9. No new results should be presented in the discussion section. Anything that the authors feel is of importance currently being mentioned in the discussion only for the first time should instead be placed in the results section instead.

10. The first paragraph of the discussion should summarize the study design and the 2-3 main findings and why important/novel. The following paragraphs can be discussion about how the results are similar to or different from past work.

11. The study requires a limitation paragraph within the discussion section.

12. The first sentence of the conclusion needs to be re-written as the authors cannot truly claim that the factors they identified are indeed the main causes of stunting. In addition, they need to localize their findings. Also, the last sentence is too long. Break it up. Consider mentioning specific areas for further research and what are the policy/public health implications of their findings.

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Reviewer #1: No

Reviewer #2: No

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Determinants of stunting among children aged 6-59 months in Kemissie City Administration, North Eastern Ethiopia: A matched case-control study

PONE-D-19-23907R1

Dear Dr. Adane (PhD),

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.

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Kind regards,

Tamar Ringel-Kulka

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

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

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

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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

**********

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)

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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