Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya

Godfrey Shichenje Mutakha; Emily Mwaliko; Philip Kirwa

doi:10.1371/journal.pone.0243166

Peer Review History

Original SubmissionJune 2, 2020
27 Aug 2020 Decision Letter - Onikepe Oluwadamilola Owolabi, Editor PONE-D-20-16619 CLINICAL BLEEDING PATTERNS AND MANAGEMENT TECHNIQUES OF ABNORMAL UTERINE BLEEDING IN WESTERN KENYA. PLOS ONE Dear Dr. Mutakha, 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 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. 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We will update your Data Availability statement to reflect the information you provide in your cover letter. [Note: HTML markup is below. Please do not edit.] 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? 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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: Discussing AUB in Kenya is a matter of interest, however, conclusions based on 108 reported cases give a weak and no representative information for that. In INTRODUTION, authors should sate the interest of the present study, but that information is not clear. For example: the difference between patterns of bleeding and causes of AUB seems confusing. OBJECTIVES are not well defined. It’s not clear what the authors really intent to investigate In MATERIALS and METHODS is missing important information, like the adopted definitions of AUB patterns and software used for statistical analysis of the data. In RESULTS, characteristics of the studied population raise some doubts (64,8% had secondary level of education, but only 10,2% have an employment – this should be discussed). In AUB medical management is stated that 78,7% of the patients received antibiotics: this should be discussed. In DISCUSSION, results are compared with those reported with other studies, but there is no explanation about the results obtained by the authors (why analgesics were given to nearly all patients? why myomectomy was performed in 69,9% of the patients? and so on…) In CONCLUSIONS, the only one conclusion of this manuscript is that PALM-COEIN Guidelines are rarely used in Western Kenya, as in many parts of the world. Thinking about knowledge and clinical practice applicability this study doesn’t bring anything new, however the data obtained by the authors is interesting and liable for constructing an informative and didactic paper. ****** 6. 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Revision 1
29 Sep 2020 Author Response Comment 1: Discussing AUB in Kenya is a matter of interest, however, conclusions based on 108 reported cases give a weak and no representative information for that. This study was conducted in a teaching and referral hospital in Western Kenya. The tertiary healthcare facility offers clinical management for abnormal uterine bleeding alongside other gynaecological interventions to women from the greater Western Kenya. This makes the sample representative of the population, however not the whole country. To clarify this further, we have modified the study title to read “Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya.” Comment 2: In INTRODUTION, authors should state the interest of the present study, but that information is not clear. For example: the difference between patterns of bleeding and causes of AUB seems confusing. This has been modified appropriately. The interest of the study has been highlighted in the second paragraph of the introduction. The difference between patterns and causes of bleeding have been differentiated as: “Clinical bleeding patterns are determined by the heaviness, duration of flow, regularity, and frequency. The causes of AUB can either be structural (PALM) or non-structural (COEIN). Management on the other hand includes the diagnostic techniques and therapeutic interventions offered to the affected women.” Comment 3: OBJECTIVES are not well defined. It is not clear what the authors really intent to investigate. This has been modified as “This study aimed to determine the clinical bleeding patterns and management of AUB among women in their reproductive age. Specifically, it determined level of adherence to PALM-COEIN diagnostic guidelines for uterine bleeding, diagnostic tests ordered, medical and surgical management offered for women presenting with abnormal uterine bleeding.” Comment 4: In MATERIALS and METHODS is missing important information, like the adopted definitions of AUB patterns and software used for statistical analysis of the data. Abnormal uterine bleeding has been defined as: “an episode of bleeding in a woman of reproductive age, who is not pregnant and is of sufficient quantity to require immediate intervention to prevent further blood loss.” Bleeding Patterns were either heavy, light, frequent, infrequent, regular, irregular, prolonged or short. Data analysis was conducted using statistical package for social sciences (SPSS) version 22 software. Comment 5: In RESULTS, characteristics of the studied population raise some doubts (64.8% had secondary level of education, but only 10.2% have an employment – this should be discussed). In AUB medical management is stated that 78.7% of the patients received antibiotics: this should be discussed. These have been discussed as follows: “Nearly two-thirds of the study participants had a minimum of secondary education; however only one-tenth of those enrolled were engaged in formal employment. This could be attributed to the low unemployment rates in Kenya especially among women of reproductive age who mainly engage in informal businesses or take care of their families as housewives. This was confirmed by a national survey of Kenyan youth (aged 18-35 years) where 62% of women were unemployed compared to an average unemployment rate of 15% among youths with a minimum of secondary education.” “Because majority of the women presented with intense abdominal pain, they were prescribed for analgesics at the initial stage of treatment alongside antibiotics because of pyrexia and other infection symptoms.” Comment 6: In DISCUSSION, results are compared with those reported with other studies, but there is no explanation about the results obtained by the authors (why analgesics were given to nearly all patients? why myomectomy was performed in 69,9% of the patients? and so on…) This has been modified appropriately as follows: “Abdominal pain coupled with per vaginal bleeding are the common clinical presentation of abnormal uterine bleeding. Because majority of the women presented with intense abdominal pain, they were prescribed for analgesics at the initial stage of treatment alongside antibiotics because of pyrexia and other infection symptoms.” “Myomectomy was done in more than two-thirds of those who received surgical management due to the fact that fibroids was the most common structural cause of bleeding; its fertility sparing benefit and popularity among the study participants who were women of reproductive age.” Comment 7: In CONCLUSIONS, the only one conclusion of this manuscript is that PALM-COEIN Guidelines are rarely used in Western Kenya, as in many parts of the world. The conclusion section has been expanded to include a second conclusion. Furthermore, the study recommendations have also expanded and modified appropriately. Other comments: i. The manuscript structure has been updated in line with all PLoS requirements. ii. Dataset has been uploaded for review. iii. The study’s questionnaire has been appended as additional information. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0243166.r002
17 Nov 2020 Decision Letter - Onikepe Oluwadamilola Owolabi, Editor Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya. PONE-D-20-16619R1 Dear Dr. Mutakha, 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, Onikepe Oluwadamilola Owolabi 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: 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: The study is interesting and didatic. All my questions have been well answered. I have no other comments ****** 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: No https://doi.org/10.1371/journal.pone.0243166.r003
Formally Accepted
20 Nov 2020 Acceptance Letter - Onikepe Oluwadamilola Owolabi, Editor PONE-D-20-16619R1 Clinical bleeding patterns and management techniques of abnormal uterine bleeding at a teaching and referral hospital in Western Kenya. Dear Dr. Mutakha: 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. Onikepe Oluwadamilola Owolabi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0243166.r004

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