Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys

Eugene Budu; Eugene Kofuor Maafo Darteh; Bright Opoku Ahinkorah; Abdul-Aziz Seidu; Kwamena Sekyi Dickson

doi:10.1371/journal.pone.0239754

Peer Review History

Original SubmissionApril 8, 2020
21 May 2020 Decision Letter - Yacob Zereyesus, Editor PONE-D-20-10150 Trends and determinants of complete immunization coverage among Children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys PLOS ONE Dear Mr Budu, 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 Jul 05 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. 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Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No ****** 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 ****** 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 ****** 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: Title: Trends and determinants of complete immunization coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Comments to the Authors: General Comments: Immunization is essential for better health outcomes, particularly, in children. This topic is very relevant to many countries and global health. Therefore, this paper contributes to the discussion on vaccinations and overall acceptance. However, the inconsistent spelling of some words (e.g. immunization vs immunization or trend vs trends), unclear use of “immunization” or “vaccination”, discrepancies between the present results on full immunization (85.1% to 95.2%) and the 2008 GDHS or 2014 GDHS fully immunized coverage (e.g.79% or 77% respectively). These should be revised or explained to improve the quality of the manuscript. In addition, the language standard should be improved. Thus, major revisions are necessary. Title: The title is very clear. However, the word “trends” could be changed to “trend” since there is figure 1 which depicts fully immunization. Abstract: 1. The title used the word “immunization” while the first sentence under the background of the abstract is “vaccination”. The authors should consider this rephrasing either title on the first sentence under the background. 2. On the title, the word “trends” is used while “trend” is applied under background. 3. Inconsistency in the use of “immunization” vs “immunisation” and “full childhood vaccination” vs “full immunization coverage” and “worldwide” vs “globally”. The authors should be consistent. 4. The sentence “Both bivariate and multivariate analysis were….” The word “analysis” should be changed to “analyses”. 5. The logistic results (Odds Ratio and 95%CI) are inaccurate and not found in table 2. Moreover, the table2 has adjusted Odds Ratio (aOR). It is unclear whether the results under the abstract are from crude Odds Ratio (OR). 6. The sentence “The study revealed that there has been an increase in the coverage of complete immunization …. with incomplete vaccination declining”. The second part of the sentence should be removed. 7. From 1998 to 2014, there was about 10.0% improvement in full immunization (85.1% to 95.2%), how did the authors determine “substantial gains”? 8. The “Ethical Review Committee of Ghana Health Service” should be changed to the “Ghana Health Service Ethics Review Committee” often written as GHSERC. Main Manuscript: Introduction: 1. The sentence “Adhering to these vaccines for children….. deaths among children globally”. Repeated use of the same word in one sentence affects the quality. The authors should revise this sentence and similar sentences (e.g. “… led to increased globally attention which led to…” to improve the quality of the paper. 2. There is the need for consistency in the use of percentage (e.g. “From 47% in 1988 to 79 percent…” and “.. in 1974 where less than five percent…” 3. The sentences “There was, however, …” and “The present study, therefore,…”should be revised. Methods: 1. The study site or setting is missing in the methods section. This should be included. 2. The authors should be consistent in the use of terms: “complete vaccination” vs “full immunization coverage” vs “full immunization” vs “full childhood vaccination”, 3. The in-text citation varies between numbers (e.g. [2,3]) and names (Armah et al., 2016). This should be revised appropriately. 4. This sentence is unclear “At the multivariate analysis, a Binary Logistic Regression Model was fitted”. The use of capital letters and clarity of the sentence should be review. 5. In addition, the authors did not show the crude odds ratio before presenting their adjusted logistic regression results. This may be confusing to the readers. 6. The institution that approved is the “Ghana Health Service Ethics Review Committee” not Ethical Review Committee of Ghana Health Service”. Results: 1. The sentence “From the Figure, it was seen that complete vaccination has increased over the years while income vaccination has been reducing”. This needs revision. 2. The authors have used the word “respondents” inappropriately in the description of the results. (e.g. “More than half of respondents (66.2%) had mothers from rural areas”). This implies that children (12-23 months of age) were the respondents. Rather the mothers were the respondents in the current study. Thus, the entire description of table 1 should be revised. 3. There are many inaccuracies between the description of the results and figures found on tables 1 (e.g. 66.2% instead of 69.2%) 4. Another example, “More than 42 percent instead of 41.2%”. Thus, the presentation of the results under table 1 should be carefully done. 5. The authors also started a couple of sentences with percentages. E.g. 75.2% of the respondents ….., 13.2% of children …, 32.4% of the respondents…”. The authors should consider reviewing the results section of the paper. 6. The authors presented some p-values as “P<0.000”. They should revise it to p<0.001. 7. Both the presentation of the multivariate results in table 2 and the description of the same findings need improvement. The quality of the table is low. Discussion: 1. Overall, the discussion is short and unclear. 2. The sentence “We aimed at assessing the trends and determinates ….”. The word “determinates” should be revised 3. The sentences “It was seen from the findings…from 1998 to 2014” and “That is, there was increase from 85.1% in 1998 to 95.2% in 2014”. This should be revised. 4. The sentence “…areas had a low odd of getting vaccination…” should also be revised. 5. There are problems with the in-text citation under the discussion. This needs attention and revision. 6. The sentence “This finding confirms the results of a study conducted by [27, 30]”. This sentence is incomplete. Limitations: The authors should limit the study limitations to their study. For example, “There is the possibility of social desirability bias…” This may not be appropriate for the present study based on the methods. Abbreviations: 1. Some abbreviations were not defined at first use e.g. SNNPRS. References: 1. The references need formatting. For example, it is unclear to know the author of the first reference. 2. The same author is presented in three different formats e.g. World Health Organization, WHO and W.H.O. The authors should use one format. 3. There are also different in-text citations in the paper. The authors should address the inconsistencies. ****** 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: Martin Nyaaba Adokiya [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. 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Revision 1
10 Jun 2020 Author Response AUTHORS’ RESPONSE TO REVIEWS Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Dear Editor and Reviewer (s), On behalf of all authors, I convey our gratitude to you for the critical and constructive review that has led to the improvement of our paper entitled “Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys”. We have revised the manuscript based on the comments raised. In the following detailed response, we address each comment calling for changes point-by-point, indicating where relevant additional texts have been added to the body of the manuscript. Most of the changes have been indicated in yellow colour. We believe the manuscript has improved substantively and will be published in your reputable journal, PLOS ONE Version:1 Manuscript ID: PONE-D-20-10150 Date: 9/06/2020 Reviewer #1: Title: Trend and determinants of complete immunization coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Comments to the Authors: General Comments: 1. Comment: Immunization is essential for better health outcomes, particularly, in children. This topic is very relevant to many countries and global health. Therefore, this paper contributes to the discussion on vaccinations and overall acceptance. However, the inconsistent spelling of some words (e.g. immunization vs immunization or trend vs trends), unclear use of “immunization” or “vaccination”, discrepancies between the present results on full immunization (85.1% to 95.2%) and the 2008 GDHS or 2014 GDHS fully immunized coverage (e.g.79% or 77% respectively). These should be revised or explained to improve the quality of the manuscript. In addition, the language standard should be improved. Thus, major revisions are necessary. Response: Thank you for the comments. We have revised the manuscript to take care of all the inconsistencies. Title 2. Comment: The title is very clear. However, the word “trends” could be changed to “trend” since there is figure 1 which depicts fully immunization. Response: The authors have changed the word “trends” to “trend” in the title. Abstract: 3. Comment: 1. The title used the word “immunization” while the first sentence under the background of the abstract is “vaccination”. The authors should consider this rephrasing either title on the first sentence under the background. Response: The authors have addressed this comment by rephrasing the title (see page 1) 4. Comment: 2. On the title, the word “trends” is used while “trend” is applied under background. Response: The authors have addressed this inconsistency. 5. Comment: 3. Inconsistency in the use of “immunization” vs “immunisation” and “full childhood vaccination” vs “full immunization coverage” and “worldwide” vs “globally”. The authors should be consistent. Response: The authors have addressed the inconsistencies in the entire manuscript. 6. Comment: 4. The sentence “Both bivariate and multivariate analysis were….” The word “analysis” should be changed to “analyses”. Response: The authors have changed the world “analysis” to “analyses” [see page 1] 7. Comment: 5. The logistic results (Odds Ratio and 95%CI) are inaccurate and not found in table 2. Moreover, the table2 has adjusted Odds Ratio (aOR). It is unclear whether the results under the abstract are from crude Odds Ratio (OR). Response: We have corrected the logistic results [see page 1]. Also, the results from the abstract are adjusted odds ratio and not crude odds ratio. 8. Comment: 6. The sentence “The study revealed that there has been an increase in the coverage of complete immunization …. with incomplete vaccination declining”. The second part of the sentence should be removed. Response: The authors second part of the sentence has been removed. 9. Comment: 7. From 1998 to 2014, there was about 10.0% improvement in full immunization (85.1% to 95.2%), how did the authors determine “substantial gains”? Response: The authors have addressed and revised the statement. 10. Comment: 8. The “Ethical Review Committee of Ghana Health Service” should be changed to the “Ghana Health Service Ethics Review Committee” often written as GHSERC. Response: The authors have addressed this comment by changing “Ethical Review Committee of Ghana Health Service” to “Ghana Health Service Ethics Review Committee (GHS-ERC)”(see page 5, line 186). Main Manuscript: Introduction: 11. Comment: 1. The sentence “Adhering to these vaccines for children….. deaths among children globally”. Repeated use of the same word in one sentence affects the quality. The authors should revise this sentence and similar sentences (e.g. “… led to increased globally attention which led to…” to improve the quality of the paper. Response: The authors have addressed this comment [see page 1, line 26 and page 2, line 67-69]. 12. Comment: 2. There is the need for consistency in the use of percentage (e.g. “From 47% in 1988 to 79 percent…” and “.. in 1974 where less than five percent…” Response: The authors have addressed this comment [see page 2, line 75-77]. 13. Comment: 3. The sentences “There was, however, …” and “The present study, therefore,…”should be revised. Response: The authors have revised these sentences [see page 2, line 85-87]. Methods: 14. Comment: 1. The study site or setting is missing in the methods section. This should be included. Response: The authors have included the study site in the methods section [see page 3, lines 93-117]. 15. Comment: 2. The authors should be consistent in the use of terms: “complete vaccination” vs “full immunization coverage” vs “full immunization” vs “full childhood vaccination”, Response: The authors have addressed this comment to take care of the inconsistencies in the entire manuscript. 16. Comment: 3. The in-text citation varies between numbers (e.g. [2,3]) and names (Armah et al., 2016). This should be revised appropriately. Response: The authors have appropriately revised all the references in the manuscript to meet the journal’s requirements. 17. Comment: 4. This sentence is unclear “At the multivariate analysis, a Binary Logistic Regression Model was fitted”. The use of capital letters and clarity of the sentence should be review. Response: The authors have reviewed the sentence [see page 4, line 179]. 18. Comment: 5. In addition, the authors did not show the crude odds ratio before presenting their adjusted logistic regression results. This may be confusing to the readers. Response: The authors have added the crude odds ratio to the Table 2. 19. Comment: 6. The institution that approved is the “Ghana Health Service Ethics Review Committee” not Ethical Review Committee of Ghana Health Service”. Response: The authors have addressed this comment by changing “Ethical Review Committee of Ghana Health Service” to “Ghana Health Service Ethics Review Committee (GHS-ERC)”(see page 5, line 186). Results: 20. Comment: 1. The sentence “From the Figure, it was seen that complete vaccination has increased over the years while income vaccination has been reducing”. This needs revision. Response: We have revised the sentence [see page 5, line 197-198]. 21. Comment: 2. The authors have used the word “respondents” inappropriately in the description of the results. (e.g. “More than half of respondents (66.2%) had mothers from rural areas”). This implies that children (12-23 months of age) were the respondents. Rather the mothers were the respondents in the current study. Thus, the entire description of table 1 should be revised. Response: The authors have revised the results section [see page5- 6] 22. Comment: 3. There are many inaccuracies between the description of the results and figures found on tables 1 (e.g. 66.2% instead of 69.2%) Response: The authors have revised the section to address all the inaccuracies [ see page 5-6]. 23. Comment: 4. Another example, “More than 42 percent instead of 41.2%”. Thus, the presentation of the results under table 1 should be carefully done. Response: The authors have revised the manuscript to address all the inaccuracies. 24. Comment: 5. The authors also started a couple of sentences with percentages. E.g. 75.2% of the respondents ….., 13.2% of children …, 32.4% of the respondents…”. The authors should consider reviewing the results section of the paper. Response: The authors have reviewed and addressed all the sentences that were started with percentages. 25. Comment: 6. The authors presented some p-values as “P<0.000”. They should revise it to p<0.001. Response: We have addressed the p-values of the manuscript (see page 11-14] 26. Comment: 7. Both the presentation of the multivariate results in table 2 and the description of the same findings need improvement. The quality of the table is low. Response: The authors have improved the quality of the Table 2 Discussion: 27. Comment: 1. Overall, the discussion is short and unclear. Response: The authors have addressed this comment by revising the discussion section of the manuscript [see page 7-8]. 28. Comment: 2. The sentence “We aimed at assessing the trends and determinates ….”. The word “determinates” should be revised Response: The authors have revised the word “determinates” to “determinants”. 29. Comment: 3. The sentences “It was seen from the findings…from 1998 to 2014” and “That is, there was increase from 85.1% in 1998 to 95.2% in 2014”. This should be revised. Response: The authors have revised and addressed this [see page 5]. 30. Comment: 4. The sentence “…areas had a low odd of getting vaccination…” should also be revised. Response: The authors have addressed this comment [see page 6]. 31. Comment: 5. There are problems with the in-text citation under the discussion. This needs attention and revision. Response: The authors have resolved the problems with the in-text citation under the discussion section of the manuscript[see page 6-7] 32. Comment: 6. The sentence “This finding confirms the results of a study conducted by [27, 30]”. This sentence is incomplete. Response: The authors have addressed this comment to make this sentence complete [see page 6, line 262-264]. Limitations: 33. Comment: The authors should limit the study limitations to their study. For example, “There is the possibility of social desirability bias…” This may not be appropriate for the present study based on the methods. Response: The limitation section has been revised [see page 8] Abbreviations: 34. Comment: 1. Some abbreviations were not defined at first use e.g. SNNPRS. Response: The abbreviation has been specified in the manuscript (page 7 line 269]. References: 35. Comment: 1. The references need formatting. For example, it is unclear to know the author of the first reference. Response: The authors have checked and formatted the references accordingly 36. Comment: 2. The same author is presented in three different formats e.g. World Health Organization, WHO and W.H.O. The authors should use one format. Response: This reference has been formatted accordingly to make it consistent 37. Comment: 3. There are also different in-text citations in the paper. The authors should address the inconsistencies. Response: The authors have revised the entire manuscript to correct all the in-text citations https://doi.org/10.1371/journal.pone.0239754.r002
28 Jul 2020 Decision Letter - Yacob Zereyesus, Editor PONE-D-20-10150R1 Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys PLOS ONE Dear Dr. Budu, 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 Sep 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, Yacob Zereyesus, 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 ******** 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 ****** 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: Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Comments to the Authors: General Comments: The authors have addressed the comments. However, minor issues were found for consideration. Title: The title is very clear. However, the word “trends” could be changed to “trend” since there is figure 1 which depicts fully immunization. Addressed adequately Abstract: 1. The title used the word “immunization” while the first sentence under the background of the abstract is “vaccination”. The authors should consider rephrasing either on the title or the first sentence under the background. Adequately addressed 2. On the title, the word “trends” is used while “trend” is applied under background. Adequately addressed 3. Inconsistency in the use of “immunization” vs “immunisation” and “full childhood vaccination” vs “full immunization coverage” and “worldwide” vs “globally”. The authors should be consistent. Adequately addressed. However, the sentence starting with “Information about 5,119 children aged 12-23…” needs revision (Page 1, line 31). 4. The sentence “Both bivariate and multivariate analysis were….” The word “analysis” should be changed to “analyses”. Adequately addressed 5. The logistic results (Odds Ratio and 95%CI) are inaccurate and not found in table 2. Moreover, the table2 has adjusted Odds Ratio (aOR). It is unclear whether the results under the abstract are from crude Odds Ratio (OR) or adjusted Odds Ratio (aOR). Adequately addressed 6. The sentence “The study revealed that there has been an increase in the coverage of complete immunization …. with incomplete vaccination declining”. The second part of the sentence should be removed. Not adequately addressed. The above sentence is still found on the conclusion section of the paper. 7. From 1998 to 2014, there was about 10.0% improvement in full immunization (85.1% to 95.2%), how did the authors determine “substantial gains”? Adequately addressed 8. The “Ethical Review Committee of Ghana Health Service” should be changed to the “Ghana Health Service Ethics Review Committee” often written as GHSERC. Adequately addressed Main Manuscript: Introduction: 1. The sentence “Adhering to these vaccines for children….. deaths among children globally”. Repeated use of the same word in one sentence affects the quality. The authors should revise this sentence and similar sentences (e.g. “… led to increased globally attention which led to…” to improve the quality of the paper. Adequately addressed. However, the sentence starting with “According to the GDHS 2014 report, there has been in increase in vaccination coverage…” should be revised (page 2, line 75) 2. There is the need for consistency in the use of percentage (e.g. “From 47% in 1988 to 79 percent…” and “.. in 1974 where less than five percent…” The authors have addressed it. 3. The sentences “There was, however, …” and “The present study, therefore,…”should be revised. Adequately addressed Methods: 1. The study site or setting is missing in the methods section. This should be included. Adequately addressed 2. The authors should be consistent in the use of terms: “complete vaccination” vs “full immunization coverage” vs “full immunization” vs “full childhood vaccination”, The authors have addressed it. 3. The in-text citation varies between numbers (e.g. [2,3]) and names (Armah et al., 2016). This should be revised appropriately. Adequately addressed 4. This sentence is unclear “At the multivariate analysis, a Binary Logistic Regression Model was fitted”. The use of capital letters and clarity of the sentence should be review. Adequately addressed. However, the word “crosstabulation” should be changed to “cross tabulation” (page 4, line 175) 5. In addition, the authors did not show the crude odds ratio before presenting their adjusted logistic regression results. This may be confusing to the readers. Adequately addressed 6. The institution that approved is the “Ghana Health Service Ethics Review Committee” not Ethical Review Committee of Ghana Health Service”. Adequately addressed Results: 1. The sentence “From the Figure, it was seen that complete vaccination has increased over the years while incomplete vaccination has been reducing”. This needs revision. Not adequately addressed. This study can be found under conclusion of the paper (page 7, line 306 and 307). The use of socio-demographic characteristic twice in a sentence affects the quality. Please, revise “Table 1 presents the results on socio-demographic characteristics and the proportion of childhood vaccination across socio-demographic characteristics” (Page 5, line 207 and 208). 2. The authors have used the word “respondents” inappropriately in the description of the results. (e.g. “More than half of respondents (66.2%) had mothers from rural areas”). This implies that children (12-23 months of age) were the respondents. Rather the mothers were the respondents in the current study. Thus, the entire description of table 1 should be revised. Adequately addressed 3. There are many inaccuracies between the description of the results and figures found on tables 1 (e.g. 66.2% instead of 69.2%) Adequately addressed 4. Another example, “More than 42 percent instead of 41.2%”. Thus, the presentation of the results under table 1 should be carefully done. Adequately addressed 5. The authors also started a couple of sentences with percentages. E.g. 75.2% of the respondents ….., 13.2% of children …, 32.4% of the respondents…”. The authors should consider reviewing the results section of the paper. Adequately addressed 6. The authors presented some p-values as “P<0.000”. They should revise it to p<0.001. Adequately addressed 7. Both the presentation of the multivariate results in table 2 and the description of the same findings need improvement. The quality of the table is low. Adequately addressed Discussion: 1. Overall, the discussion is short and unclear. Adequately addressed 2. The sentence “We aimed at assessing the trends and determinates ….”. The word “determinates” should be revised Adequately addressed 3. The sentences “It was seen from the findings…from 1998 to 2014” and “That is, there was increase from 85.1% in 1998 to 95.2% in 2014”. This should be revised. Adequately addressed 4. The sentence “…areas had a low odd of getting vaccination…” should also be revised. Adequately addressed 5. There are problems with the in-text citation under the discussion. This needs attention and revision. Adequately addressed 6. The sentence “This finding confirms the results of a study conducted by [27, 30]”. This sentence is incomplete. Adequately addressed Limitations: The authors should limit the study limitations to their study. For example, “There is the possibility of social desirability bias…” This may not be appropriate for the present study based on the methods. Adequately addressed Abbreviations: 1. Some abbreviations were not defined at first use e.g. SNNPRS. Adequately addressed References: 1. The references need formatting. For example, it is unclear to know the author of the first reference. 2. The same author is presented in three different formats e.g. World Health Organization, WHO and W.H.O. The authors should use one format. 3. There are also different in-text citations in the paper. The authors should address the inconsistencies. Adequately addressed ****** 7. 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Revision 2
28 Jul 2020 Author Response AUTHORS’ RESPONSE TO REVIEWS Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Dear Editor and Reviewer (s), On behalf of all authors, I convey our gratitude to you for the critical and constructive review that has led to the improvement of our paper entitled “Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys”. We have revised the manuscript based on the comments raised. In the following detailed response, we address each comment calling for changes point-by-point, indicating where relevant additional texts have been added to the body of the manuscript. Most of the changes have been indicated in yellow colour. We believe the manuscript has improved substantively and will be published in your reputable journal, PLOS ONE Version:2 Manuscript ID: PONE-D-20-10150_R1 Date: 28/07/2020 Reviewer #1: Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Comments to the Authors: General Comments: The authors have addressed the comments. However, minor issues were found for consideration. Title: The title is very clear. However, the word “trends” could be changed to “trend” since there is figure 1 which depicts fully immunization. Addressed adequately Abstract: 1. The title used the word “immunization” while the first sentence under the background of the abstract is “vaccination”. The authors should consider rephrasing either on the title or the first sentence under the background. Adequately addressed 2. On the title, the word “trends” is used while “trend” is applied under background. Adequately addressed 3. Inconsistency in the use of “immunization” vs “immunisation” and “full childhood vaccination” vs “full immunization coverage” and “worldwide” vs “globally”. The authors should be consistent. Adequately addressed. However, the sentence starting with “Information about 5,119 children aged 12-23…” needs revision (Page 1, line 31). Response: This has been revised. See page 1 line 31-32 4. The sentence “Both bivariate and multivariate analysis were….” The word “analysis” should be changed to “analyses”. Adequately addressed 5. The logistic results (Odds Ratio and 95%CI) are inaccurate and not found in table 2. Moreover, the table2 has adjusted Odds Ratio (aOR). It is unclear whether the results under the abstract are from crude Odds Ratio (OR) or adjusted Odds Ratio (aOR). Adequately addressed 6. The sentence “The study revealed that there has been an increase in the coverage of complete immunization …. with incomplete vaccination declining”. The second part of the sentence should be removed. Not adequately addressed. The above sentence is still found on the conclusion section of the paper. Response: This has been addressed. See page 7 line 307-308. 7. From 1998 to 2014, there was about 10.0% improvement in full immunization (85.1% to 95.2%), how did the authors determine “substantial gains”? Adequately addressed 8. The “Ethical Review Committee of Ghana Health Service” should be changed to the “Ghana Health Service Ethics Review Committee” often written as GHSERC. Adequately addressed Main Manuscript: Introduction: 1. The sentence “Adhering to these vaccines for children….. deaths among children globally”. Repeated use of the same word in one sentence affects the quality. The authors should revise this sentence and similar sentences (e.g. “… led to increased globally attention which led to…” to improve the quality of the paper. Adequately addressed. However, the sentence starting with “According to the GDHS 2014 report, there has been in increase in vaccination coverage…” should be revised (page 2, line 75) Response: This has been addressed. See Page 2 line 75-76. 2. There is the need for consistency in the use of percentage (e.g. “From 47% in 1988 to 79 percent…” and “.. in 1974 where less than five percent…” The authors have addressed it. 3. The sentences “There was, however, …” and “The present study, therefore,…”should be revised. Adequately addressed Methods: 1. The study site or setting is missing in the methods section. This should be included. Adequately addressed 2. The authors should be consistent in the use of terms: “complete vaccination” vs “full immunization coverage” vs “full immunization” vs “full childhood vaccination”, The authors have addressed it. 3. The in-text citation varies between numbers (e.g. [2,3]) and names (Armah et al., 2016). This should be revised appropriately. Adequately addressed 4. This sentence is unclear “At the multivariate analysis, a Binary Logistic Regression Model was fitted”. The use of capital letters and clarity of the sentence should be review. Adequately addressed. However, the word “crosstabulation” should be changed to “cross tabulation” (page 4, line 175) Response: This has been revised. See Page 4 line 175. 5. In addition, the authors did not show the crude odds ratio before presenting their adjusted logistic regression results. This may be confusing to the readers. Adequately addressed 6. The institution that approved is the “Ghana Health Service Ethics Review Committee” not Ethical Review Committee of Ghana Health Service”. Adequately addressed Results: 1. The sentence “From the Figure, it was seen that complete vaccination has increased over the years while incomplete vaccination has been reducing”. This needs revision. Not adequately addressed. This study can be found under conclusion of the paper (page 7, line 306 and 307). Response: This has been revised. See Page 7 line 306-307. The use of socio-demographic characteristic twice in a sentence affects the quality. Please, revise “Table 1 presents the results on socio-demographic characteristics and the proportion of childhood vaccination across socio-demographic characteristics” (Page 5, line 207 and 208). 2. The authors have used the word “respondents” inappropriately in the description of the results. (e.g. “More than half of respondents (66.2%) had mothers from rural areas”). This implies that children (12-23 months of age) were the respondents. Rather the mothers were the respondents in the current study. Thus, the entire description of table 1 should be revised. Adequately addressed 3. There are many inaccuracies between the description of the results and figures found on tables 1 (e.g. 66.2% instead of 69.2%) Adequately addressed 4. Another example, “More than 42 percent instead of 41.2%”. Thus, the presentation of the results under table 1 should be carefully done. Adequately addressed 5. The authors also started a couple of sentences with percentages. E.g. 75.2% of the respondents ….., 13.2% of children …, 32.4% of the respondents…”. The authors should consider reviewing the results section of the paper. Adequately addressed 6. The authors presented some p-values as “P<0.000”. They should revise it to p<0.001. Adequately addressed 7. Both the presentation of the multivariate results in table 2 and the description of the same findings need improvement. The quality of the table is low. Adequately addressed Discussion: 1. Overall, the discussion is short and unclear. Adequately addressed 2. The sentence “We aimed at assessing the trends and determinates ….”. The word “determinates” should be revised Adequately addressed 3. The sentences “It was seen from the findings…from 1998 to 2014” and “That is, there was increase from 85.1% in 1998 to 95.2% in 2014”. This should be revised. Adequately addressed 4. The sentence “…areas had a low odd of getting vaccination…” should also be revised. Adequately addressed 5. There are problems with the in-text citation under the discussion. This needs attention and revision. Adequately addressed 6. The sentence “This finding confirms the results of a study conducted by [27, 30]”. This sentence is incomplete. Adequately addressed Limitations: The authors should limit the study limitations to their study. For example, “There is the possibility of social desirability bias…” This may not be appropriate for the present study based on the methods. Adequately addressed Abbreviations: 1. Some abbreviations were not defined at first use e.g. SNNPRS. Adequately addressed References: 1. The references need formatting. For example, it is unclear to know the author of the first reference. 2. The same author is presented in three different formats e.g. World Health Organization, WHO and W.H.O. The authors should use one format. 3. There are also different in-text citations in the paper. The authors should address the inconsistencies. Adequately addressed AUTHORS’ RESPONSE TO REVIEWS Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Dear Editor and Reviewer (s), On behalf of all authors, I convey our gratitude to you for the critical and constructive review that has led to the improvement of our paper entitled “Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys”. We have revised the manuscript based on the comments raised. In the following detailed response, we address each comment calling for changes point-by-point, indicating where relevant additional texts have been added to the body of the manuscript. Most of the changes have been indicated in yellow colour. We believe the manuscript has improved substantively and will be published in your reputable journal, PLOS ONE Version:2 Manuscript ID: PONE-D-20-10150_R1 Date: 28/07/2020 Reviewer #1: Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Comments to the Authors: General Comments: The authors have addressed the comments. However, minor issues were found for consideration. Title: The title is very clear. However, the word “trends” could be changed to “trend” since there is figure 1 which depicts fully immunization. Addressed adequately Abstract: 1. The title used the word “immunization” while the first sentence under the background of the abstract is “vaccination”. The authors should consider rephrasing either on the title or the first sentence under the background. Adequately addressed 2. On the title, the word “trends” is used while “trend” is applied under background. Adequately addressed 3. Inconsistency in the use of “immunization” vs “immunisation” and “full childhood vaccination” vs “full immunization coverage” and “worldwide” vs “globally”. The authors should be consistent. Adequately addressed. However, the sentence starting with “Information about 5,119 children aged 12-23…” needs revision (Page 1, line 31). Response: This has been revised. See page 1 line 31-32 4. The sentence “Both bivariate and multivariate analysis were….” The word “analysis” should be changed to “analyses”. Adequately addressed 5. The logistic results (Odds Ratio and 95%CI) are inaccurate and not found in table 2. Moreover, the table2 has adjusted Odds Ratio (aOR). It is unclear whether the results under the abstract are from crude Odds Ratio (OR) or adjusted Odds Ratio (aOR). Adequately addressed 6. The sentence “The study revealed that there has been an increase in the coverage of complete immunization …. with incomplete vaccination declining”. The second part of the sentence should be removed. Not adequately addressed. The above sentence is still found on the conclusion section of the paper. Response: This has been addressed. See page 7 line 307-308. 7. From 1998 to 2014, there was about 10.0% improvement in full immunization (85.1% to 95.2%), how did the authors determine “substantial gains”? Adequately addressed 8. The “Ethical Review Committee of Ghana Health Service” should be changed to the “Ghana Health Service Ethics Review Committee” often written as GHSERC. Adequately addressed Main Manuscript: Introduction: 1. The sentence “Adhering to these vaccines for children….. deaths among children globally”. Repeated use of the same word in one sentence affects the quality. The authors should revise this sentence and similar sentences (e.g. “… led to increased globally attention which led to…” to improve the quality of the paper. Adequately addressed. However, the sentence starting with “According to the GDHS 2014 report, there has been in increase in vaccination coverage…” should be revised (page 2, line 75) Response: This has been addressed. See Page 2 line 75-76. 2. There is the need for consistency in the use of percentage (e.g. “From 47% in 1988 to 79 percent…” and “.. in 1974 where less than five percent…” The authors have addressed it. 3. The sentences “There was, however, …” and “The present study, therefore,…”should be revised. Adequately addressed Methods: 1. The study site or setting is missing in the methods section. This should be included. Adequately addressed 2. The authors should be consistent in the use of terms: “complete vaccination” vs “full immunization coverage” vs “full immunization” vs “full childhood vaccination”, The authors have addressed it. 3. The in-text citation varies between numbers (e.g. [2,3]) and names (Armah et al., 2016). This should be revised appropriately. Adequately addressed 4. This sentence is unclear “At the multivariate analysis, a Binary Logistic Regression Model was fitted”. The use of capital letters and clarity of the sentence should be review. Adequately addressed. However, the word “crosstabulation” should be changed to “cross tabulation” (page 4, line 175) Response: This has been revised. See Page 4 line 175. 5. In addition, the authors did not show the crude odds ratio before presenting their adjusted logistic regression results. This may be confusing to the readers. Adequately addressed 6. The institution that approved is the “Ghana Health Service Ethics Review Committee” not Ethical Review Committee of Ghana Health Service”. Adequately addressed Results: 1. The sentence “From the Figure, it was seen that complete vaccination has increased over the years while incomplete vaccination has been reducing”. This needs revision. Not adequately addressed. This study can be found under conclusion of the paper (page 7, line 306 and 307). Response: This has been revised. See Page 7 line 306-307. The use of socio-demographic characteristic twice in a sentence affects the quality. Please, revise “Table 1 presents the results on socio-demographic characteristics and the proportion of childhood vaccination across socio-demographic characteristics” (Page 5, line 207 and 208). 2. The authors have used the word “respondents” inappropriately in the description of the results. (e.g. “More than half of respondents (66.2%) had mothers from rural areas”). This implies that children (12-23 months of age) were the respondents. Rather the mothers were the respondents in the current study. Thus, the entire description of table 1 should be revised. Adequately addressed 3. There are many inaccuracies between the description of the results and figures found on tables 1 (e.g. 66.2% instead of 69.2%) Adequately addressed 4. Another example, “More than 42 percent instead of 41.2%”. Thus, the presentation of the results under table 1 should be carefully done. Adequately addressed 5. The authors also started a couple of sentences with percentages. E.g. 75.2% of the respondents ….., 13.2% of children …, 32.4% of the respondents…”. The authors should consider reviewing the results section of the paper. Adequately addressed 6. The authors presented some p-values as “P<0.000”. They should revise it to p<0.001. Adequately addressed 7. Both the presentation of the multivariate results in table 2 and the description of the same findings need improvement. The quality of the table is low. Adequately addressed Discussion: 1. Overall, the discussion is short and unclear. Adequately addressed 2. The sentence “We aimed at assessing the trends and determinates ….”. The word “determinates” should be revised Adequately addressed 3. The sentences “It was seen from the findings…from 1998 to 2014” and “That is, there was increase from 85.1% in 1998 to 95.2% in 2014”. This should be revised. Adequately addressed 4. The sentence “…areas had a low odd of getting vaccination…” should also be revised. Adequately addressed 5. There are problems with the in-text citation under the discussion. This needs attention and revision. Adequately addressed 6. The sentence “This finding confirms the results of a study conducted by [27, 30]”. This sentence is incomplete. Adequately addressed Limitations: The authors should limit the study limitations to their study. For example, “There is the possibility of social desirability bias…” This may not be appropriate for the present study based on the methods. Adequately addressed Abbreviations: 1. Some abbreviations were not defined at first use e.g. SNNPRS. Adequately addressed References: 1. The references need formatting. For example, it is unclear to know the author of the first reference. 2. The same author is presented in three different formats e.g. World Health Organization, WHO and W.H.O. The authors should use one format. 3. There are also different in-text citations in the paper. The authors should address the inconsistencies. Adequately addressed https://doi.org/10.1371/journal.pone.0239754.r004
25 Aug 2020 Decision Letter - Yacob Zereyesus, Editor PONE-D-20-10150R2 Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys PLOS ONE Dear Dr. Budu, 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 Oct 09 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, Yacob Zereyesus, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (if provided): Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Comments to the Authors: General Comments: The authors have addressed the comments. However, minor issues were found for consideration. Title: The title is very clear. However, the word “trends” could be changed to “trend” since there is figure 1 which depicts fully immunization. Addressed adequately Abstract: 1. The title used the word “immunization” while the first sentence under the background of the abstract is “vaccination”. The authors should consider rephrasing either on the title or the first sentence under the background. Adequately addressed 2. On the title, the word “trends” is used while “trend” is applied under background. Adequately addressed 3. Inconsistency in the use of “immunization” vs “immunisation” and “full childhood vaccination” vs “full immunization coverage” and “worldwide” vs “globally”. The authors should be consistent. Adequately addressed. However, the sentence starting with “Information about 5,119 children aged 12-23…” needs revision (Page 1, line 31). 4. The sentence “Both bivariate and multivariate analysis were….” The word “analysis” should be changed to “analyses”. Adequately addressed 5. The logistic results (Odds Ratio and 95%CI) are inaccurate and not found in table 2. Moreover, the table2 has adjusted Odds Ratio (aOR). It is unclear whether the results under the abstract are from crude Odds Ratio (OR) or adjusted Odds Ratio (aOR). Adequately addressed 6. The sentence “The study revealed that there has been an increase in the coverage of complete immunization …. with incomplete vaccination declining”. The second part of the sentence should be removed. Not adequately addressed. The above sentence is still found on the conclusion section of the paper. 7. From 1998 to 2014, there was about 10.0% improvement in full immunization (85.1% to 95.2%), how did the authors determine “substantial gains”? Adequately addressed 8. The “Ethical Review Committee of Ghana Health Service” should be changed to the “Ghana Health Service Ethics Review Committee” often written as GHSERC. Adequately addressed Main Manuscript: Introduction: 1. The sentence “Adhering to these vaccines for children….. deaths among children globally”. Repeated use of the same word in one sentence affects the quality. The authors should revise this sentence and similar sentences (e.g. “… led to increased globally attention which led to…” to improve the quality of the paper. Adequately addressed. However, the sentence starting with “According to the GDHS 2014 report, there has been in increase in vaccination coverage…” should be revised (page 2, line 75) 2. There is the need for consistency in the use of percentage (e.g. “From 47% in 1988 to 79 percent…” and “.. in 1974 where less than five percent…” The authors have addressed it. 3. The sentences “There was, however, …” and “The present study, therefore,…”should be revised. Adequately addressed Methods: 1. The study site or setting is missing in the methods section. This should be included. Adequately addressed 2. The authors should be consistent in the use of terms: “complete vaccination” vs “full immunization coverage” vs “full immunization” vs “full childhood vaccination”, The authors have addressed it. 3. The in-text citation varies between numbers (e.g. [2,3]) and names (Armah et al., 2016). This should be revised appropriately. Adequately addressed 4. This sentence is unclear “At the multivariate analysis, a Binary Logistic Regression Model was fitted”. The use of capital letters and clarity of the sentence should be review. Adequately addressed. However, the word “crosstabulation” should be changed to “cross tabulation” (page 4, line 175) 5. In addition, the authors did not show the crude odds ratio before presenting their adjusted logistic regression results. This may be confusing to the readers. Adequately addressed 6. The institution that approved is the “Ghana Health Service Ethics Review Committee” not Ethical Review Committee of Ghana Health Service”. Adequately addressed Results: 1. The sentence “From the Figure, it was seen that complete vaccination has increased over the years while incomplete vaccination has been reducing”. This needs revision. Not adequately addressed. This study can be found under conclusion of the paper (page 7, line 306 and 307). The use of socio-demographic characteristic twice in a sentence affects the quality. Please, revise “Table 1 presents the results on socio-demographic characteristics and the proportion of childhood vaccination across socio-demographic characteristics” (Page 5, line 207 and 208). 2. The authors have used the word “respondents” inappropriately in the description of the results. (e.g. “More than half of respondents (66.2%) had mothers from rural areas”). This implies that children (12-23 months of age) were the respondents. Rather the mothers were the respondents in the current study. Thus, the entire description of table 1 should be revised. Adequately addressed 3. There are many inaccuracies between the description of the results and figures found on tables 1 (e.g. 66.2% instead of 69.2%) Adequately addressed 4. Another example, “More than 42 percent instead of 41.2%”. Thus, the presentation of the results under table 1 should be carefully done. Adequately addressed 5. The authors also started a couple of sentences with percentages. E.g. 75.2% of the respondents ….., 13.2% of children …, 32.4% of the respondents…”. The authors should consider reviewing the results section of the paper. Adequately addressed 6. The authors presented some p-values as “P<0.000”. They should revise it to p<0.001. Adequately addressed 7. Both the presentation of the multivariate results in table 2 and the description of the same findings need improvement. The quality of the table is low. Adequately addressed Discussion: 1. Overall, the discussion is short and unclear. Adequately addressed 2. The sentence “We aimed at assessing the trends and determinates ….”. The word “determinates” should be revised Adequately addressed 3. The sentences “It was seen from the findings…from 1998 to 2014” and “That is, there was increase from 85.1% in 1998 to 95.2% in 2014”. This should be revised. Adequately addressed 4. The sentence “…areas had a low odd of getting vaccination…” should also be revised. Adequately addressed 5. There are problems with the in-text citation under the discussion. This needs attention and revision. Adequately addressed 6. The sentence “This finding confirms the results of a study conducted by [27, 30]”. This sentence is incomplete. Adequately addressed Limitations: The authors should limit the study limitations to their study. For example, “There is the possibility of social desirability bias…” This may not be appropriate for the present study based on the methods. Adequately addressed Abbreviations: 1. Some abbreviations were not defined at first use e.g. SNNPRS. Adequately addressed References: 1. The references need formatting. For example, it is unclear to know the author of the first reference. 2. The same author is presented in three different formats e.g. World Health Organization, WHO and W.H.O. The authors should use one format. 3. There are also different in-text citations in the paper. The authors should address the inconsistencies. Adequately addressed [Note: HTML markup is below. Please do not edit.] [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. https://doi.org/10.1371/journal.pone.0239754.r005
Revision 3
4 Sep 2020 Author Response AUTHORS’ RESPONSE TO REVIEWS Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Dear Editor and Reviewer (s), On behalf of all authors, I convey our gratitude to you for the critical and constructive review that has led to the improvement of our paper entitled “Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys”. We have revised the manuscript based on the comments raised. In the following detailed response, we address each comment calling for changes point-by-point, indicating where relevant additional texts have been added to the body of the manuscript. Most of the changes have been indicated in yellow colour. We believe the manuscript has improved substantively and will be published in your reputable journal, PLOS ONE Version:3 Manuscript ID: PONE-D-20-10150_R2 Date: 28/07/2020 Reviewer #1: Title: Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Comments to the Authors: General Comments: The authors have addressed the comments. However, minor issues were found for consideration. Title: The title is very clear. However, the word “trends” could be changed to “trend” since there is figure 1 which depicts fully immunization. Addressed adequately Abstract: 1. The title used the word “immunization” while the first sentence under the background of the abstract is “vaccination”. The authors should consider rephrasing either on the title or the first sentence under the background. Adequately addressed 2. On the title, the word “trends” is used while “trend” is applied under background. Adequately addressed 3. Inconsistency in the use of “immunization” vs “immunisation” and “full childhood vaccination” vs “full immunization coverage” and “worldwide” vs “globally”. The authors should be consistent. Adequately addressed. However, the sentence starting with “Information about 5,119 children aged 12-23…” needs revision (Page 1, line 31). Response: This has been revised. See page 1 line 31-32 4. The sentence “Both bivariate and multivariate analysis were….” The word “analysis” should be changed to “analyses”. Adequately addressed 5. The logistic results (Odds Ratio and 95%CI) are inaccurate and not found in table 2. Moreover, the table2 has adjusted Odds Ratio (aOR). It is unclear whether the results under the abstract are from crude Odds Ratio (OR) or adjusted Odds Ratio (aOR). Adequately addressed 6. The sentence “The study revealed that there has been an increase in the coverage of complete immunization …. with incomplete vaccination declining”. The second part of the sentence should be removed. Not adequately addressed. The above sentence is still found on the conclusion section of the paper. Response: This has been addressed. See page 7 line 307-308. 7. From 1998 to 2014, there was about 10.0% improvement in full immunization (85.1% to 95.2%), how did the authors determine “substantial gains”? Adequately addressed 8. The “Ethical Review Committee of Ghana Health Service” should be changed to the “Ghana Health Service Ethics Review Committee” often written as GHSERC. Adequately addressed Main Manuscript: Introduction: 1. The sentence “Adhering to these vaccines for children….. deaths among children globally”. Repeated use of the same word in one sentence affects the quality. The authors should revise this sentence and similar sentences (e.g. “… led to increased globally attention which led to…” to improve the quality of the paper. Adequately addressed. However, the sentence starting with “According to the GDHS 2014 report, there has been in increase in vaccination coverage…” should be revised (page 2, line 75) Response: This has been addressed. See Page 2 line 75-76. 2. There is the need for consistency in the use of percentage (e.g. “From 47% in 1988 to 79 percent…” and “.. in 1974 where less than five percent…” The authors have addressed it. 3. The sentences “There was, however, …” and “The present study, therefore,…”should be revised. Adequately addressed Methods: 1. The study site or setting is missing in the methods section. This should be included. Adequately addressed 2. The authors should be consistent in the use of terms: “complete vaccination” vs “full immunization coverage” vs “full immunization” vs “full childhood vaccination”, The authors have addressed it. 3. The in-text citation varies between numbers (e.g. [2,3]) and names (Armah et al., 2016). This should be revised appropriately. Adequately addressed 4. This sentence is unclear “At the multivariate analysis, a Binary Logistic Regression Model was fitted”. The use of capital letters and clarity of the sentence should be review. Adequately addressed. However, the word “crosstabulation” should be changed to “cross tabulation” (page 4, line 175) Response: This has been revised. See Page 4 line 175. 5. In addition, the authors did not show the crude odds ratio before presenting their adjusted logistic regression results. This may be confusing to the readers. Adequately addressed 6. The institution that approved is the “Ghana Health Service Ethics Review Committee” not Ethical Review Committee of Ghana Health Service”. Adequately addressed Results: 1. The sentence “From the Figure, it was seen that complete vaccination has increased over the years while incomplete vaccination has been reducing”. This needs revision. Not adequately addressed. This study can be found under conclusion of the paper (page 7, line 306 and 307). Response: This has been revised. See Page 7 line 306-307. The use of socio-demographic characteristic twice in a sentence affects the quality. Please, revise “Table 1 presents the results on socio-demographic characteristics and the proportion of childhood vaccination across socio-demographic characteristics” (Page 5, line 207 and 208). 2. The authors have used the word “respondents” inappropriately in the description of the results. (e.g. “More than half of respondents (66.2%) had mothers from rural areas”). This implies that children (12-23 months of age) were the respondents. Rather the mothers were the respondents in the current study. Thus, the entire description of table 1 should be revised. Adequately addressed 3. There are many inaccuracies between the description of the results and figures found on tables 1 (e.g. 66.2% instead of 69.2%) Adequately addressed 4. Another example, “More than 42 percent instead of 41.2%”. Thus, the presentation of the results under table 1 should be carefully done. Adequately addressed 5. The authors also started a couple of sentences with percentages. E.g. 75.2% of the respondents ….., 13.2% of children …, 32.4% of the respondents…”. The authors should consider reviewing the results section of the paper. Adequately addressed 6. The authors presented some p-values as “P<0.000”. They should revise it to p<0.001. Adequately addressed 7. Both the presentation of the multivariate results in table 2 and the description of the same findings need improvement. The quality of the table is low. Adequately addressed Discussion: 1. Overall, the discussion is short and unclear. Adequately addressed 2. The sentence “We aimed at assessing the trends and determinates ….”. The word “determinates” should be revised Adequately addressed 3. The sentences “It was seen from the findings…from 1998 to 2014” and “That is, there was increase from 85.1% in 1998 to 95.2% in 2014”. This should be revised. Adequately addressed 4. The sentence “…areas had a low odd of getting vaccination…” should also be revised. Adequately addressed 5. There are problems with the in-text citation under the discussion. This needs attention and revision. Adequately addressed 6. The sentence “This finding confirms the results of a study conducted by [27, 30]”. This sentence is incomplete. Adequately addressed Limitations: The authors should limit the study limitations to their study. For example, “There is the possibility of social desirability bias…” This may not be appropriate for the present study based on the methods. Adequately addressed Abbreviations: 1. Some abbreviations were not defined at first use e.g. SNNPRS. Adequately addressed References: 1. The references need formatting. For example, it is unclear to know the author of the first reference. 2. The same author is presented in three different formats e.g. World Health Organization, WHO and W.H.O. The authors should use one format. 3. There are also different in-text citations in the paper. The authors should address the inconsistencies. Adequately addressed https://doi.org/10.1371/journal.pone.0239754.r006
14 Sep 2020 Decision Letter - Yacob Zereyesus, Editor Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys PONE-D-20-10150R3 Dear Dr. Budu, 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, Yacob Zereyesus, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0239754.r007
Formally Accepted
17 Sep 2020 Acceptance Letter - Yacob Zereyesus, Editor PONE-D-20-10150R3 Trend and determinants of complete vaccination coverage among children aged 12-23 months in Ghana: Analysis of data from the 1998 to 2014 Ghana Demographic and Health Surveys Dear Dr. Budu: 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. Yacob Zereyesus Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0239754.r008

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