PONE-D-20-14571

Assessment of knowledge, practice, and status of food handlers toward Salmonella, Shigella, and intestinal parasites: A cross-sectional study in Tigrai prison centers, Ethiopia, 2019

PLOS ONE

Dear Dr. landu,

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Iddya Karunasagar

Academic Editor

PLOS ONE

Additional Editor Comments:

Three reviewers have commented on the manuscript and number of deficiencies have been pointed out. There are discrepancies in the number of samples tested and number stated in text and figures. Methodology used for identification of Salmonella is inadequate and the isolates can be termed "presumptive Salmonella". There are number of other comments made by the reviewers to address. Please revise the manuscript addressing all comments point by point.

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2. Thank you for stating in the text of your manuscript "Institutional Review Board (IRB) of Tigray Health Research Institute (THRI) has approved the study (THRI/4031/0393/2018). " Please also add this information to your ethics statement in the online submission form."

Please describe in your methods section how capacity to provide consent was determined for the participants in this study. Were there any actual or perceived negative impacts of not participating? How were those mitigated? Were the participants made aware of potential risks of participating or not participating in this study such as differential treatment?

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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?

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Reviewer #1: Partly

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: 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 have conducted institutional based cross-sectional study among food handlers in prison centers. Although numbers of samples are less but the data generated is having public health significance. However, editing of language/ recasting of sentences are required to bring more clarity in the presentation. Length/size of table/presentation of data shall be reduced. Instead of giving all data/questionnaire as table, only selected /significant findings shall be given. There are many parameters/observations presented in tables 1and 3, which have not been discussed at all. Such insignificant observations may be deleted from tables.

At many places, authors have indicated that 66 volunteers participated in the study but 59 have given stool samples (eg. line 192) but at some places authors have indicated that 59 of the 66 samples examined were positive for one or more intestinal parasites (eg. line 236). This is confusing. Authors are requested to recheck and make necessary changes in calculation of percentages/presentation of data.

Similarly, in table 1 and table 3 and discussion, it is indicated that 66 participants participated in the study(eg line 182), but data given in column three (presence of foodborne pathogens) is not tallying with column 2.

Table 1, Gender, total male are 40, 20 are aware of foodborne pathogens but 13 are not?.

Similarly in other parameters eg Age in years, education level, marital status, experience, job division etc data is not tallying. In table 1, column 2, n is 66 but column 3 contains information related to only 59 respondents. Table 3 also contains responses from all 66 volunteers. There is need to bring clarity in presentation.

There were only two isolates for Salmonella and two for Shigella. It is not proper to indicate “all the isolates” (eg line 40, 203) of Salmonella or Shigella species were 100% or 50% sensitive/resistance for selected antibiotics. Instead of “two” isolates (line 208), words like both isolates/one isolate etc shall be used.

Lines 170- 179: require recasting to bring clarity in the presentation.

Table 1: Line 2, instead of using “n” twice ie (n,%), n=66, capital letter should be used for total number of samples (eg. N=66).

Table 2: Line 2, words like S, R, shall be elaborated (sensitive /resistant?) or given as foot note

Table 3, Line 20: Statement incomplete (Do you know……….).

Title shall be brief; year (2019) may be deleted.

Pl consult journal for presentation of references especially from Sl no. 1to 5, 7,10,14,18,19,20 and 40.

Thus there is need to recheck presentation of data and bring clarity in presentation/language before accepting for publication.

Reviewer #2: The study is carried out to assess the knowledge, practice, and magnitude of Salmonella, Shigella, and intestinal parasites among food handlers in Eastern Tigrai prison centers, Northern Ethiopia.

Food handlers have an important role in the spread of food-borne diseases. The personal hygiene and health status as well as their knowledge about various food-borne pathogens and good hygienic practices is important for prevention of spread of food-borne infections. A large number of food-borne outbreaks are reported from Ethiopia and the mortality due to these diseases is high. Therefore, the manuscript provides a valid rationale for the proposed studies, with clearly identified and justified research questions.

Authors have collected data using a structured questionnaire regarding the demographic characteristics, knowledge, and practice of participants on food safety and food-borne diseases. They have also analyzed stool samples for intestinal parasites and Salmonella and Shigella species from 66 food handlers, those outside the prison involved in the preparation of food and people inside the prison involved in food distribution.

The method followed for isolation and identification of Salmonella and Shigella is incomplete. Direct spreading of stool samples on Salmonella Shigella Agar, isolation of typical colonies from the plates and further biochemical identification can only result in presumptive identification of these pathogens. It is well proven by studies that a number of bacteria in stool samples or food or environmental samples can form typical colonies on Salmonella Shigella Agar, FDA BAM protocol, therefore, suggests use of three different selective media after prior enrichment in selective broth. Further, a number of these non Salmonella / Shigella cultures can give typical biochemical results. Therefore, it is necessary to carry out serological or molecular diagnostic tests to confirm the identity of these presumptive positive isolates. Therefore, the conclusion drawn only from biochemical identification about presence of Salmonella and Shigella in stool samples may be erroneous. Also, antimicrobial sensitivity studies with these presumptive isolates are not useful if these isolates are not pathogens claimed.

Authors are advised to test the presumptive positive isolates either by serology or by molecular diagnostic tests and resubmit the manuscript with the confirmatory test results.

Reviewer #3: comments are enclosed

Reviewer comments for manuscript entitled "Assessment of knowledge, practice, and status of food handlers toward Salmonella, Shigella, and intestinal parasites: A cross-sectional study in Tigrai prison centers, Ethiopia, 2019".

In this study, the authors have assessed the knowledge, practice and magnitude of foodborne pathogens like salmonella, shigella and intestinal parasites among food handlers. They had undertaken this study in Eastern Tigrai prison centres, Ethiopia. They have used structured questionnaires to collect demographic, characteristic, knowledge and practices of the participants on food safety with foodborne diseases. Authors observed that 62% of participants were found to harbour one or more intestinal parasites and nearly 7% were positive for one of the pathogens. However, Entamoeba spp was the most abundant parasite detected in nearly 25% of the population. Both the pathogen showed desirable antibiogram pattern. Authors also reported that 60% of participants had good knowledge of foodborne pathogens and nearly 52% were aware of food safety practices. The manuscript prepared by the authors had good study design, selection of area as well as study duration and enrollment of participant and had a good sample size and data collection. The standard procedure was followed for parasite identification and susceptibility testing. The standard statistical method was followed. Accordingly, the authors concluded that foodborne pathogens are the major concern among food handlers. Health, education and training programs are needed to improve the level of knowledge of food handlers. Other amenities like soap are recommended to enhance personal hygiene. The study is important in terms of food safety and hygiene and sufficient recommendations were made. The study done highlights the measures to be taken to educate and training of personnel. Hence, this manuscript is suitable for publication.

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Reviewer #1: No

Reviewer #2: Yes: Dr. Jayant R. Bandekar

Reviewer #3: No

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Assessment of knowledge, practice, and status of food handlers toward Salmonella, Shigella, and intestinal parasites: A cross-sectional study in Tigrai prison centers, Ethiopia

PONE-D-20-14571R1

Dear Dr. landu,

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,

Iddya Karunasagar

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All reviewer comments have been addressed.

Reviewers' comments: