PONE-D-20-24723

Erectile dysfunction and its associated factors among the male population in Adigrat Town, Tigrai Region, Ethiopia: A cross-sectional study

PLOS ONE

Dear Dr. Gebremedhin,

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.

In particular, both reviewers make the point that ED prevalence is rather low, which is likely due to the age of the study participants and the inclusion criteria. This needs further discussion.

Please submit your revised manuscript by Nov 13 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.

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We look forward to receiving your revised manuscript.

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Sabine Rohrmann

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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

Reviewer #1: This is an interesting study assessing the prevalence of ED in an Ethiopian population. The authors found a prevalence of ED of approximately 25%. Furthermore, the authors found that ED is associated with depression, arterial hypertension and physical inactivity, findings that are in line with the literature.

Some points need to be addressed

1. The prevalence of ED is rather low. This theoretically is attributed to the generally low age of study participants. Indeed this rate is in line with studies assessing the ED prevalence in younger populations. A comment should be made in the discussion section stating that the age of the study participants is rather low and thus the true ED prevalence may be underestimated.

2. Dyslipidemia is a common risk factor for ED. Are there any data regarding the prevalence of dyslipidemia in the study participants? And if yes, was there any association with ED prevalence and severity?

3. Depression is commonly associated with increased risk for ED. Drugs for the treatment of depression are often accompanied by ED as a side effect. Was there any relevant association?

4. Several drugs for the treatment of cardiovascular diseases and risk factors (such as beta-blockers and diuretics) are related with increased risk for ED. If fdata are available, please provide any relevant information regarding the use of such drugs and potential relation with ED prevalence.

5. The manuscript is in need of grammatical revision. Please check.

Reviewer #2: Important is the study by Gebremedhin et. al., which focuses on an often neglected health problem. Often the focus is on diseases that are life-threatening in low-income countries, while the morbidity rate attributable to other non-life-threatening problems is also too high.

- Include the confidence interval of the prevalence in the abstract.

- Census 2007 is too old for a rapidly growing population. Please use predicted population.

- " Who had been engaged in sexual activity in a preceding month " is a defining term for the inclusion of your study participants. This is a strong term that may have excluded many people with erectile dysfunction (ED), which would have increased the prevalence if they had been included. Do not believe that your findings could show a severely underestimated prevalence.

- While your target study participants were individuals, you targeted at a household. This looks a bit superfluous and unnecessary. Other options will have been sought.

- Why was "bivariate regression"? That somehow looks like a tradition. This is necessary if you have a smaller sample but more variables and want to select fewer variables. This is to counteract unstable estimates when you fit more variables into a small sample. However, you have a sufficient sample size for the number of variables. This tradition is also problematic. For example, a variable may not be significant if you perform bivariate regression, but it could have an important interaction effect if you use it with other variables. Do not follow this tradition.

- Minor: I think you can reduce the content of your tables (e.g. in table 2 you can have only one column and one row for each variable. The answers 'Y/N' are not necessary. And you also make the frequency and percentage in one column)

- Quality of life pie chart is not necessary

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Reviewer #1: Yes: Konstantinos Imprialos

Reviewer #2: No

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Erectile dysfunction and its associated factors among the male population in Adigrat Town, Tigrai Region, Ethiopia: A cross-sectional study

PONE-D-20-24723R1

Dear Dr. Gebremedhin,

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

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Sabine Rohrmann

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

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

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

Reviewer #1: 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: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Konstantinos Imprialos