PONE-D-20-04617

Prevalence and correlates of multimorbidity among adults in Botswana: A cross-sectional study

PLOS ONE

Dear Dr Keetile,

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PLOS ONE

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Additional Editor Comments (if provided):

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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: 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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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?

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: 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: The authors present a cross-sectional study of 1178 persons aged >=15 years examining the socioeconomic and behavioural factors associated with multimorbidity in Botswana. They find women, those consuming excessive alcohol and are overweight/obese to be at higher odds of reporting being multimorbid.

1. Abstract & Introduction: Multimorbidity and adjustment covariates could be defined in the abstract. The authors have not provided Botswana specific estimates with regards to burden of non-communicable disease. The study fails to address findings from previous literature to make a stronger case for their research question.

2. Methods: The authors could mention the inclusion and exclusion criteria for population. This section could be more concise.

3. Statistical analysis: The text seems unclear on what is the dependent variable. The authors should specify the tests used to create table 1 and 2. There is no clear mention if statistical tests to assess the fit of logistic model were assessed. Adjustments covariate. The authors should clarify what they mean by “Δcomplex sample module from SPSS was adoptedΔ”

4. Tables & Results: The authors use Multinomial logistic regression analysis for table 3 analysis. The write-up of results including table 3 content appear more to be multivariable logistic regression rather than multinomial logistic regression. In table 3, the multiple categories of age, work status and wealth status could be collapsed. Model 2 of table 3 is adjusted for Multiple NCD risk factors score, which created using of daily smoking, consuming less than 5 servings of fruit and vegetables per day, low physical activity, high body mass index (=>25), and self-reported diagnosis of hypertension. The model 2 is also then adjusted for some of the individual variables. The footnotes of all tables could be more elaborative.

5. Discussion: The language of discussion appear to be more like the results section. Strengths and limitations of the study have not been mentioned. This section could be rewritten taking into consideration recent publications.

6. References: In some places, references have not been added even though they have been mentioned. For example: page 4: “ΔThese were mainly based on the WHO Training Manual on the Study on Global Ageing and Adult Health (SAGE) and other documents were used for reinforcementΔ”.

7. Writing Quality: The authors could revise the manuscript for readability, as in the current version there are typos and grammatical mistakes.

Reviewer #2: a) In introduction in line 11-12 you have mentioned about the increasing burden of NCDs, it would be better if you can explain with some sought of existing data available on this issue.

b) In introduction, explain the reasons behind NCDs in little explicit manner, such as how rapid unplanned urbanization is linked to NCDs. (so that it would be easy for reader to have a knowledge regarding that issue)

c) Reason behind taking wealth status not wealth index.

d) Part of the article where you are explaining socio demographic and behavioral correlates of multi morbidity, you can mention the impact of residence and education as well.

e) Conclusion and recommendation can have more points in relation to the present change in Botswana and as a developing nation what actions can be taken.

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Reviewer #1: No

Reviewer #2: No

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Prevalence and correlates of multimorbidity among adults in Botswana: A cross-sectional study

PONE-D-20-04617R1

Dear Dr. Keetile,

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,

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: (No Response)

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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: Partly

**********

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

Reviewer #1: (No Response)

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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: No

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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