PONE-D-20-30229

Grief reaction and psychosocial impacts of child death and stillbirth on bereaved North Indian parents

PLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

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

Reviewer #1: N/A

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: This is a well-written qualitative paper which aims to study the social, emotional, and psychological impact of child death and stillbirths on parents and their families along with the coping strategies in North Indian context. I appreciate the authors for their commendable work as this is particularly important and less investigated topic of women and child health.

Comments

Title

I would suggest the authors to add “a qualitative study” at the end of the title as the readers will know the type of study was conducted for this research question.

Abstract

The abstract summarizes the rationale for the study and the methods used for this study, as well as the key findings.

Introduction

The introduction includes important information about the global burden of neonatal and infant mortality, the bereavement and grief caused to the mother and family after infant death and shows the paucity of information on the social and psychological impact after child death in North India.

Line 54- I would suggest the authors to write few more lines on the epidemiology of child death in India.

At the end of line 54, authors should discuss about the consequences of child death in the family and then the statements on bereavement and grief should be discussed, as it would give the readers a sense of continuity. Right now, it looks separate because the burden was discussed in the initial few lines of Introduction followed by definition of bereavement and grief.

Line 85- Authors had mentioned “causes of a large proportion of child, infant deaths and stillbirths remain unknown”. This statement should be removed as the leading causes of infant and neonatal deaths are well-documented. I would suggest the authors to write a few lines on the common causes of neonatal and infant deaths in India along with the description of epidemiology of child deaths in the 1st paragraph of Introduction.

Methods

The methods section provide details on how the participants were chosen, how the interview was conducted, and all the required information needed to understand the whole process of the study.

Line 114- I would suggest the authors to provide some information on how many refused to participate in the study among those who were contacted to find whether there is any systematic difference in the socio-demographic characteristics between the participants and non-participants.

Line 143- There is no information on the internal validity (Cronbach’s alpha) of the scale used in this study.

I suggest the authors to comment on the fidelity of the transcription. Whether it was read out to participants after each session to check for correctness or any other method was adopted.

There is no information regarding whether any reimbursement/ incentives were given to the participants (E.g. For transport, refreshments etc.) and also, I request the authors the mention a word on how data saturation was reached in the interviews and discussion.

Though it was mentioned in the study’s protocol, it is worth mentioning who were the study participants for 8 FGDs in the methods section (Men and women with under-five children and older family members fathers, mothers and their family members) for easy understanding of the readers.

The authors should describe the distribution of participants in the FGD, whether any group (mothers/ grandparents/fathers) dominated the discussion. It is important to mention this in the methods section as it is susceptible to bias. The group and individual opinions can be swayed by dominant participants. Also, it is good to mention how this was taken care during the FGDs.

Results

The data appear to be sound and the results section elaborately presents the output of the processes described in the methods section.

Line 176- There is a discrepancy in the number of participants for FGDs. In methods section line 131, says 8-11 participants. This should be corrected.

Table 1- Point 1.4, Literacy of father, the 3rd column does not add up to 46. The sub-heading age in years and median (IQR) and n (%) should be shifted to 3rd column for easy understanding.

Line 172- I would suggest the authors to mention the cause of death as per the hospital record for all the 25 child deaths, to understand the leading cause of death among the children of recruited family.

Line 189- It would be good to show the coding tree to describe how the codes that were generated from the data were translated into categories and then to themes.

Line 284- “Mothers were supported by husbands and family members”. Does it include in-laws as well? I would suggest the authors to mention whether any support was given to the mothers from their in-laws during the grief period.

Table 2- It is better to use test of significance to find whether there is statistically significant difference exists among the groups.

The discussion and conclusion are well balanced and adequately supported by the data.

Lines 510 and 527- should be specific and not generic. I suggest the authors to write specific recommendations at the family level, community level and health system level and what should be done to address various factors as mentioned in the results section associated with grief, by whom and at what level of healthcare system this should be implemented.

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Reviewer #1: No

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Grief reaction and psychosocial impacts of child death and stillbirth on bereaved North Indian parents

PONE-D-20-30229R1

Dear Dr. Das,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Vijayaprasad Gopichandran

Academic Editor

PLOS ONE

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