PONE-D-20-25582

Hepatitis B vaccination status and knowledge, attitude, and practice regarding Hepatitis B among preclinical medical students of a medical college in Nepal

PLOS ONE

Dear Dr. Shrestha,

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.

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We look forward to receiving your revised manuscript.

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Isabelle Chemin, PhD

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: No

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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: No

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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 paper reports on a study examining Hepatitis B vaccination status and knowledge, attitudes and practices of Hepatitis B vaccination amongst medical students in Nepal. The manuscript would be strengthened by attention to the following:

1) In the introduction, provide more of an explanation about why it would be important to study medical students’ and their status, knowledge, etc. in Nepal. Does Nepal have a particularly high Hep B infection rate? Would students need to be informed to help provide education to their patients and communities? How would learning about this in the Nepalese context help others who do not live/work/educate students in Nepal. When was the Hep B vaccine introduced in Nepal?

2) I think in the methods the authors intend to state the survey was distributed through e-mail, since it was a Google form that was used.

3) On page 5, there is reference to online sessions regarding study details – can you provide more information about what those were? Were they optional for students/study participants? What information was presented during the session, i.e., purpose of the study and an opportunity to ask questions?

4) While the survey is in a supplemental file (which I could not reach), it would be helpful to provide some more detail about the nature of the questions asked and associated response formats. For the knowledge section, what were the topics, for the attitude section, what were the attitudes/topics, and similarly for the practice questions. What were the options for not getting vaccinated. What were the demographic questions.

5) With respect to the discussion of the findings, would not the medical school curriculum present information about how Hep B is transmitted to students? The respondents in general appear knowledgeable about the cause and mode of transmission, however, given their education as future physicians, I would hope they would all get those questions “correct.” When is infectious disease taught in the curriculum and is Hep B a particular topic?

6) In the discussion and conclusion, address why a reader outside of Nepal would be interested/need to know this information. This relates back to the first suggestion. The authors do include information about studies from other countries in the discussion which is a strength of the discussion. The authors also advocate that vaccination programs should be available for health care workers. While such advocacy is clearly at the national level, would it be helpful if global organizations, such as the World Health Organization, advocated this and/or perhaps provided resources for these programs? I don’t know – I am just speculating and trying to help the authors have their work make more of an impact than at the Nepalese national level.

Reviewer #2: I noted a great deal of simply awkward word choices, and corrected most of them in a copy of the pdf that I added "comments" to. This is not how I usually do it. (I usually copy the sentence and propose the changes in a separate word file, which I then paste the contents of in this box.)

But since I was using that format, I also made 3 or 4 remarks that require some additional writing. I will sommarize them here.

1. Acknowledge that your respondents probably wanted to look good in your eyes, and their teachers' eyes, and their own eyes. "social desirability". So instead of saying "x% of them report needle sticks", say "x% of them SAY THAT they report needle sticks." for example.

I don't know what are the right answers to the knowledge test, what are appropriate attitudes for a physician, and what are the recommended behaviors. You do not identify in the text which items are true and which false, and you do not discuss how you treat the numerical scores on those items. I hope you did not add them all up, true and false together!

You present some summary data - sums of the ratings on items about attitudes, about knowledge. But you do not say what the maximum possible score would be. Are these numbers comparable? The reader can not judge if students are good at knowledge, but poor at translating the knowledge into habitual practice (for example), if you don't say the ranges of the scales. Also, you report an overall scale that combines knowledge, attitude, and behavior into one numerical scale. How should we interpret that? Are they equally weighted? on what basis?

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Reviewer #1: No

Reviewer #2: Yes: Robert M. Hamm

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Attachments

Attachment

Submitted filename: Shrestha PONE-D-20-25582 Hamm suggested changes.pdf

PONE-D-20-25582R1

Hepatitis B vaccination status and knowledge, attitude, and practice regarding Hepatitis B among preclinical medical students of a medical college in Nepal

PLOS ONE

Dear Dr. Shreshta,

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 minor points raised during the review process.

Please submit your revised manuscript by 1month. 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,

Isabelle Chemin, PhD

Academic Editor

PLOS ONE

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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 #2: (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 #2: Yes

**********

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

Reviewer #2: 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 #2: No

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

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

Reviewer #2: 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 #2: My suggestions are basically improvements in English usage. I use my usual method, cut and paste, rather than tags in a pdf.

I think you should reconsider your answer to “data made available”. I think that means that your raw data (suitably anonymized) could be provided to another researcher who might want to check your analyses. You have asserted it is available because you showed the results in your tables, which misses the point. I defer to the editors to explain what they mean by “data made available”.

The figure at the end is so simple, it seems unnecessary. Yes, there are two numbers, and they are different from each other. That could be adequately conveyed with a sentence in the text. But if the editor is happy with it, let it be.

In “medical schools in Munich showed 23 % lifetime prevalence” and at least one other place, remove the space between the number and the % sign.

“was introduced in 2002 AD”. We know it is AD, common era (CE). Don’t need to say it.

“health workers

59 should be vaccinated timely.” Should be “health workers should be vaccinated in a timely manner” in order to be fully grammatically correct.

“There is no replacement to vaccines for effective protection.” Perhaps “no alternative” rather than “replacement”.

P 6. Change “Selected questions in knowledge section” to “Selected questions in the knowledge section”

Change “Knowledge related to Hepatitis B was assessed under five questions with some specific questions giving possible score ranged from 15-75” to “Knowledge related to Hepatitis B was assessed under five questions with some addition subquestions, giving a possible score range from 15-75”. I think that is what you mean. Maybe there were five questions but with 1a, 1b, … 5b, 5c or something.

Change “while questions for attitude and practice section were five making possible score range from 5-25” to “while there were five questions for the attitude and practice sections, making possible score ranges from 5-25”.

P 7. Change “to check the correlation between total score among knowledge and attitude, knowledge and practice, and attitude and practice” to “to check the correlation between total scores of knowledge and attitude, knowledge and practice, and attitude and practice”.

P 16. Change “The studies from Saudi Arabia and Ethiopia showed 86.5% and 84.6% respectively responded that vaccine prevents Hepatitis B” to “The studies from Saudi Arabia and Ethiopia showed 86.5% and 84.6%, respectively, responding that vaccine prevents Hepatitis B”.

P 18. Change “recall bias, information bias and, social desirability bias might have also affected” to ““recall bias, information bias, and social desirability bias might have also affected”. (move the comma)

P 19. I think “consent for publication” means that all the authors agree that it can be published, with their name on it; but maybe not.

Acknowledgements – was there no one who helped with the study, typing things up, or entering data, or facilitating access? Minor things not meriting authorship.

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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 #2: Yes: Robert M. Hamm

[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.

Hepatitis B vaccination status and knowledge, attitude, and practice regarding Hepatitis B among preclinical medical students of a medical college in Nepal

PONE-D-20-25582R2

Dear Dr. Shrestha,

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,

Isabelle Chemin, PhD

Academic Editor

PLOS ONE

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