Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey

Getnet Gedefaw; Martha H. Goedert; Eskeziaw Abebe; Asmamaw Demis

doi:10.1371/journal.pone.0244229

Peer Review History

Original SubmissionAugust 12, 2020
27 Oct 2020 Decision Letter - Hein Min Tun, Editor PONE-D-20-25202 Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey PLOS ONE Dear Dr. Gedefaw, 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 24 Nov 2020. 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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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, Hein Min Tun, B.V.Sc., M.Sc., Ph.D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. For more information on PLOS ONE's expectations for statistical reporting, please see https://journals.plos.org/plosone/s/submission-guidelines.#loc-statistical-reporting. Please update your Methods and Results sections accordingly. 3. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. [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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 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: No ****** 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 ******** 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: Comments to the Author In the current study, the authors investigated the relationship between caesarean section and breastfeeding initiation of 7115 participants from the 2016 Ethiopian Demographic Health Survey (EDHS). The authors found that caesarean section was associated with late initiation of breastfeeding. The work is interesting and important for maternal and child health in Ethiopian, and I have a positive view of the manuscript. However, I have some comments that I would like to share with the authors and in my view, they can help to improve the manuscript. Background section 1. The authors stated research supports that delayed breastfeeding initiation was associated with caesarean delivery, but it lacked of citing higher level evidence to support this given that there are some well conducted systematic reviews in this field recently (see10.3945/ajcn.111.030254 and 10.1007/s10995-017-2369-x). 2. The authors need to clarify the public health implementation of investigating the relationship between caesarean delivery and early breastfeeding initiation, particularly in the setting of Ethiopia, and need to clarify the potential difference between higher income countries and low-middle income countries. Methods section 3. Please cite the source of definition of initiation of breastfeeding. Is it from WHO or UNICEF definition? 4. Please clarify what are covariates and what are confounders as these are two different conceptions in association analysis. 5. Please use univariable logistic regression and multivariable logistic regression throughout the manuscript. 6. The authors used a p-value of less than 0.25 as a cut-off to select candidate variables for further multivariable regression analysis, but this lack of reference to support this procedure. Thus, please cite relevant statistical analysis reference after this statement. Results section 7. It’s a bit confusing in the result part that the main research question to be answered should be the relationship between caesarean section and breastfeeding initiation other than the associated factors of breastfeeding initiation. Please focus on the research question and discuss potential roles of confounders and covariates in Discussion part. Discussion section 8. The prevalence of delayed or late initiation of breastfeeding among women who delivered by caesarean section reported in the second paragraph of Discussion section was wrong, although this figure should have been reported in Results section. It actually should be calculated as 101/(101+64) 100% if figures in Table 3 were correct. Please double check similar wrong calculations throughout the manuscript. 9. Please clarify why associated factors of breastfeeding initiation (i.e., primipara women, unplanned pregnancy and maternal age) were discussed in the manuscript. Instead, the roles of these factors on the pathway between caesarean section and breastfeeding initiation should be thoroughly discussed. ******* 6. 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 [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. 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Revision 1
5 Nov 2020 Author Response Manuscript Number: PONE-D-20-25202 Effect of cesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey Dear Academic Editor PLOS ONE We thank ‘PLOS ONE’ for giving us the opportunity to resubmit this manuscript and we thank the reviewers for their constructive comments and feedbacks. We confirm that we have read the instructions for the authors and respond below to the comments on point-by-point basis. Changes are shown in track changes in the text. We hope you will find our responses satisfactory, and hope that you will find this manuscript acceptable for publication in your journal. On behalf of all the authors Getnet Gedefaw Woldia University, College of Health Sciences, Department of Midwifery gedefawget@gmail.com Response for Reviewers Comment (Reviewer #1) In the current study, the authors investigated the relationship between caesarean section and breastfeeding initiation of 7115 participants from the 2016 Ethiopian Demographic Health Survey (EDHS). The authors found that caesarean section was associated with late initiation of breastfeeding. The work is interesting and important for maternal and child health in Ethiopian, and I have a positive view of the manuscript. However, I have some comments that I would like to share with the authors and in my view, they can help to improve the manuscript. Thank you very much for your appreciation for our work. 1. The authors stated research supports that delayed breastfeeding initiation was associated with caesarean delivery, but it lacked of citing higher level evidence to support this given that there are some well conducted systematic reviews in this field recently (see10.3945/ajcn.111.030254 and 10.1007/s10995-017-2369-x). Response: Your feedback is appreciated. We read them carefully and updated our background using these recent evidences. 2. The authors need to clarify the public health implementation of investigating the relationship between caesarean delivery and early breastfeeding initiation, particularly in the setting of Ethiopia, and need to clarify the potential difference between higher income countries and low-middle income countries. Response: thank you very much for your suggestion. We amended according to your comments under the section of introduction 3. Please cite the source of definition of initiation of breastfeeding. Is it from WHO or UNICEF definition? Response: Thank you very much. We have cited it and taken from WHO 4. Please clarify what are covariates and what are confounders as these are two different conceptions in association analysis. Response: Thank you very much. Covariates are independent variables that may predict the outcome of interest and covariates may not be confounders. Furthermore, to control confounders we used multiple variable logistic regressions during the analysis phase. 5. Please use univariable logistic regression and multivariable logistic regression throughout the manuscript. Response: Thank you very much. We strongly accepted your suggestion 6. The authors used a p-value of less than 0.25 as a cut-off to select candidate variables for further multivariable regression analysis, but this lack of reference to support this procedure. Thus, please cite relevant statistical analysis reference after this statement Response: Thank you. We cited and put the reference 7. It’s a bit confusing in the result part that the main research question to be answered should be the relationship between caesarean section and breastfeeding initiation other than the associated factors of breastfeeding initiation. Please focus on the research question and discuss potential roles of confounders and covariates in Discussion part. Response: Your feedback is appreciated. We amended it accordingly. We move down to the discussion section of the manuscript. 8. The prevalence of delayed or late initiation of breastfeeding among women who delivered by caesarean section reported in the second paragraph of Discussion section was wrong, although this figure should have been reported in Results section. It actually should be calculated as 101/(101+64) 100% if figures in Table 3 were correct. Please double check similar wrong calculations throughout the manuscript Response: Exactly you are correct. We made error while we calculate in cross tab. 9. Please clarify why associated factors of breastfeeding initiation (i.e., primipara women, unplanned pregnancy and maternal age) were discussed in the manuscript. Instead, the roles of these factors on the pathway between caesarean section and breastfeeding initiation should be thoroughly discussed. Response: Thank you very much. We have accepted and modified it. Attachments Attachment Submitted filename: Response to reviewers.docx* https://doi.org/10.1371/journal.pone.0244229.r002
7 Dec 2020 Decision Letter - Hein Min Tun, Editor Effect of cesarean section on initiation of breast feeding : Findings from 2016 Ethiopian Demographic and Health Survey PONE-D-20-25202R1 Dear Dr. Gedefaw, 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, Hein Min Tun, B.V.Sc., M.Sc., Ph.D. 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: No ****** 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) ****** 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.0244229.r003
Formally Accepted
9 Dec 2020 Acceptance Letter - Hein Min Tun, Editor PONE-D-20-25202R1 Effect ofcesarean section on initiation of breast feeding: Findings from 2016 Ethiopian Demographic and Health Survey Dear Dr. Gedefaw: 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. Hein Min Tun Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244229.r004

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