Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis

Sofonyas Abebaw Tiruneh; Yeaynmarnesh Asmare Bukayaw; Seblewongel Tigabu Yigizaw; Dessie Abebaw Angaw

doi:10.1371/journal.pone.0244642

Peer Review History

Original SubmissionJanuary 16, 2020
11 Jun 2020 Decision Letter - R. Jay Widmer, Editor PONE-D-19-34928 Prevalence and determinants of hypertension in Ethiopia. Systematic review and meta-analysis PLOS ONE Dear Dr. Tiruneh, 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. ============================== Multiple reviewers have made comments on this manuscript, and are interested in the theme. However, serious concerns have arisen, and each of these must be handled individually. Please indicate how each of these points have been addressed to improve the quality of the paper. ============================== Please submit your revised manuscript by Jul 26 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. 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, Jay Widmer Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. 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. Please upload a copy of Figure 1, to which you refer in your text on page 6. If the figure is no longer to be included as part of the submission please remove all reference to it within the text. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 4. Please correct your reference to "p=0.000" to "p<0.001" or as similarly appropriate, as p values cannot equal zero. [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 Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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: Yes Reviewer #2: Yes ****** 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: No Reviewer #2: No ****** 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: Language: Please have the paper read and corrected by native English. Currently, language needs to be reviewed Introduction: Hypertension is defined and diagnosed if the systolic blood pressure readings ≥ 140 mmHg and/or the diastolic blood pressure readings ≥ 90 mmHg (1,2) • This definition with numbers is controversial (See AHA/ACC guidelines) and does not add anything in the introduction. Authors should either adopt a conceptual definition or cancel it. The introduction could simply start by acknowledging the magnitude of the problem Methods • Definition of hypertension with numbers comes back and is inappropriate for such a systematic review. Authors did not defined hypertension but instead relied on definition given across studies and the variation of these defintions should be presented in tables because it could affect the results/prevalence • Inclusion criteria. Given the differences in methodology and the large time interval between the first and the latest study, the variation of the definition of hypertension across studies, the sampling method etc…it would have been more rigorous to add a criteria like a minimum sample size to reduce study bias. Should authors have considered sample size across studies, arbitrarily I would think a minimum sample size of 1000 would be advisable. Would the results be different? Currently 308 to 9788 with HT prevalence ranging from 9 to 41%. Heterogeneity handling alone cannot control all these bias. Results section This systematic review and meta-analysis include published articles on the prevalence and determinates of hypertension in Ethiopia. We used PubMed, Hinari, Google Scholar, and grey literature search to find potential studies for this systematic review and meta-analysis. • Repetition of the aim and method, not necessary Figures Figure 1 not provided Choose between 5 and 7 Don’t see the added value of 10 and 11 Titles: a figure beind a stand alone, titles should be comprehensive enough. Indicating year is not really informative here. Eg, figure 1 could read : Prevalence of hypertension among people with hypertension in Ethiopia. Blue boxes represent the effect estimates (prevalence) and the horizontal bars about are for the 95% confidence intervals (CIs). The size of the boxes is proportional to the inverse variance. The diamond is for the pooled effect estimate and 95% CI, and the plain red vertical line centered on the diamond has been added to assist visual interpretation. Effect estimates are provided as proportions. Discussion • This pooled prevalence is low when compared to continental (Ataklte F, et al. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension 2015; 65: 291–98.) pooled prevalence and shall be discussed. Limitations are several: • Studying just the prevalence, not awareness and treatment to define a response strategy to hypertension burden would be limited, one really needs to know all these components to define a response • Non comprehensive search strategy (language bias, Only English was consider) might not have traced all studies. • Substantial heterogeneity across the studies, this has surely affected the pooled prevalence • Differences in individual studies’ methodology and population structures • Methods for assessing hypertension prevalence across studies. How could any of the study use a standardize method like the WHO-STEP??? • Information on the use of antihypertensive medications is crucial because it could have affected the 140/90. • Did authors search for unpublished data to reduce publication bias?. Referencing • References selection is too comprehensive but not always pertinent. Authors should read references and select the best ones, not exceeding 50 references for such a paper • A key paper in the field is not cited: Ataklte F, Erqou S, Kaptoge S, Taye B, Echou o-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension 2015; 65: 291–98. Reviewer #2: General comment This systematic review and meta-analysis is interesting in view of a rising burden of hypertension in LMICs and increasing number of publications. The analysis was handled very well and results presented appropriately. However, the written part especially in the introduction and discussions is rather sloppy. A lot of this is due to language difficulties which I’m sure can be addressed by hiring a native English speaker to edit. I have specific comments for each section as follows: Introduction Apart from the common grammatical errors; the presentation of the literature on the burden needs to be re-organized in paragraphs into four main themes. 1-The Big picture (Burden of hypertension) 2- The specific problem (Literature about hypertension systematic reviews in Ethiopia and what the burden is) 3- The GAP (need to show the missing information in previous systematic reviews) and how this one fills the gap. 4- How this review fills the gap. One obvious reason is updating the previous reviews (I found 2 of them all published in 2015) and also state what you do to handle the review differently. In the current form the is a mix of literature and sometimes contradicting information from two sources is posted but not explained example For example the articles cited below speak about the same thing but are not brought together in a coherent way. “Approximately 970 million people worldwide have high blood pressure and 1.56 billion adults will be living with hypertension by 2025 (3)” “Globally around 1.13 billion people live with hypertension, which is two-thirds of them from low and middle-income countries (5).” The statement that no systematic reviews were available to the knowledge of the authors is not true. I came across two systematic reviews on hypertension in Ethiopia and no mention of these were made apart from one that appeared in the discussion. The authors need to be honest about the scientific premise and show what gaps were in the previous review to warrant their review. See below the two reviews I came across 1-Kibret, K. T., & Mesfin, Y. M. (2015). Prevalence of hypertension in Ethiopia: a systematic meta-analysis. Public Health Reviews, 36(1), 14 2- Molla, M. (2015). Systematic reviews of prevalence and associated factors of hypertension in Ethiopia: finding the evidence. Sci J Public Health, 3(4), 514-9. Methods Just checking on the sensitivity of the search criteria: a synonym for high blood pressure “raised blood pressure” should have been indicated in the search terms. It is possible some articles could have been missed if they only used this terminology. Inclusion criteria Why did you choose 2000 as the earliest year to limit your search? Please give the rationale for selecting articles from this year. Quality assessment The statement below is confusing. Please clarify “Based on the score of the quality assessment tool the highest score from nine questions declared low risk of bias” this is not clear. This would mean the highest score had the minimum risk yet the proceeding statement says the opposite Results You are silent about grey literature in your reporting yet you did mention an attempt to search for this in the methods section. Pease clarify if any grey literature was found and how it was handled. Discussion In the discussion section, a good attempt is made to interpret the findings but the language makes it rather sloppy. Need to hire the services of a native English speaker for language edits. The comment in the limitation section about social desirability of the study is erroneous. The phrase social desirability bias is not appropriately used. I do not think cross sectional studies lead to social desirability. This could as well happen in longitudinal studies. “Social desirability bias refers to the tendency of research subjects to give socially desirable responses instead of choosing responses that are reflective of their true feelings. The bias in responses due to this personality trait becomes a major issue when the scope of the study involves socially sensitive issues such as politics, religion, and environment, or personal issues such as drug use, cheating, and smoking. This is usually resolved by use of a well‐trained interviewer or collection of data through methods that do not require presence involvement of an interviewer can help avoid this bias to some extent. Properly identified options to questions vulnerable to social desirability effect is another means of tackling this issue” ****** 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 Reviewer #2: 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. 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. Attachments Attachment Submitted filename: Review_comments.docx https://doi.org/10.1371/journal.pone.0244642.r001
Revision 1
23 Jul 2020 Author Response 1. When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Noted, thank you! We had tried to make it fine according to PLOS One requirements. 2. Please upload a copy of Figure 1, to which you refer in your text on page 6. If the figure is no longer to be included aspart of the submission please remove all reference to it within the text. Noted it was updated! 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Yes, updated accordingly. 4. Please correct your reference to "p=0.000" to "p<0.001" or as similarly appropriate, as p values cannot equal zero. Noted, Thank you! It was updated according to the comment. Reviewers' comments: Reviewer #1: Language: Please have the paper read and corrected by native English. Currently, language needs to be reviewed Thank you! We had tried to correct the English language intensively by reading again and again. Introduction: Hypertension is defined and diagnosed if the systolic blood pressure readings ≥ 140 mmHg and/or the diastolic blood pressure readings ≥ 90 mmHg (1,2) • This definition with numbers is controversial (See AHA/ACC guidelines) and does not add anything in the introduction. Authors should either adopt a conceptual definition or cancel it. The introduction could simply start by acknowledging the magnitude of the problem Noted, Thank you! Accepted accordingly. Methods • Definition of hypertension with numbers comes back and is inappropriate for such a systematic review. Authors did not defined hypertension but instead relied on definition given across studies and the variation of these definitions should be presented in tables because it could affect the results/prevalence Yes! Accepted accordingly. • Inclusion criteria. Given the differences in methodology and the large time interval between the first and the latest study, the variation of the definition of hypertension across studies, the sampling method etc…it would have been more rigorous to add a criteria like a minimum sample size to reduce study bias. Should authors have considered sample size across studies, arbitrarily I would think a minimum sample size of 1000 would be advisable. Would the results be different? Currently 308 to 9788 with HT prevalence ranging from 9 to 41%. Heterogeneity handling alone cannot control all these bias. Thank you for the comment. We had tried to handle the heterogeneity even with sample size category by a cut point greater than 500, 1000; But the heterogeneity still their; finally, we state as limitation of the study. Besides, to include studies sample size less than 1000 might be mandatory since the maximum sample size for prevalence studies is 384 at a proportion value 50%. Results section This systematic review and meta-analysis include published articles on the prevalence and determinates of hypertension in Ethiopia. We used PubMed, Hinari, Google Scholar, and grey literature search to find potential studies for this systematic review and meta-analysis. • Repetition of the aim and method, not necessary Thank you! corrected accordingly. Figures Figure 1 not provided Thank you, corrected accordingly. Choose between 5 and 7 Don’t see the added value of 10 and 11 Titles: a figure behind a standalone, titles should be comprehensive enough. Indicating year is not really informative here. Eg, figure 1 could read: Prevalence of hypertension among people with hypertension in Ethiopia. Blue boxes represent the effect estimates (prevalence) and the horizontal bars about are for the 95% confidence intervals (CIs). The size of the boxes is proportional to the inverse variance. The diamond is for the pooled effect estimate and 95% CI, and the plain red vertical line centered on the diamond has been added to assist visual interpretation. Effect estimates are provided as proportions. Thank you! Corrected accordingly. Discussion o This pooled prevalence is low when compared to continental (Ataklte F, et al. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension 2015; 65: 291–98.) pooled prevalence and shall be discussed. Thank you! Corrected and cited. Limitations are several: o Studying just the prevalence, not awareness and treatment to define a response strategy to hypertension burden would be limited, one really needs to know all these components to define a response o Non comprehensive search strategy (language bias, Only English was consider) might not have traced all studies. o Substantial heterogeneity across the studies, this has surely affected the pooled prevalence o Differences in individual studies’ methodology and population structures o Methods for assessing hypertension prevalence across studies. How could any of the study use a standardize method like the WHO-STEP??? o Information on the use of antihypertensive medications is crucial because it could have affected the 140/90. o Did authors search for unpublished data to reduce publication bias? Noted, accepted thank you! We, act accordingly the comment. Referencing • References selection is too comprehensive but not always pertinent. Authors should read references and select the best ones, not exceeding 50 references for such a paper • A key paper in the field is not cited: Ataklte F, Erqou S, Kaptoge S, Taye B, Echou o-Tcheugui JB, Kengne AP. Burden of undiagnosed hypertension in sub-saharan Africa: a systematic review and meta-analysis. Hypertension 2015; 65: 291–98. Noted! Reviewer #2: General comment This systematic review and meta-analysis is interesting in view of a rising burden of hypertension in LMICs and increasing number of publications. The analysis was handled very well and results presented appropriately. Noted, Thank you! However, the written part especially in the introduction and discussions is rather sloppy. A lot of this is due to language difficulties which I’m sure can be addressed by hiring a native English speaker to edit. Noted, we have read again and again to improve the quality of the English writing roblem, as well we had invited for English editors in our University. I have specific comments for each section as follows: Introduction Apart from the common grammatical errors; the presentation of the literature on the burden needs to be re-organized in paragraphs into four main themes. 1. The Big picture (Burden of hypertension). 2. The specific problem (Literature about hypertension systematic reviews in Ethiopia and what the burden is) 3. The GAP (need to show the missing information in previous systematic reviews) and how this one fills the gap. 4. How this review fills the gap. One obvious reason is updating the previous reviews (I found 2 of them all published in 2015) and state what you do to handle the review differently. Noted, thank you very much for this wonderful comment and it was updated accordingly. In the current form the is a mix of literature and sometimes contradicting information from two sources is posted but not explained example For example the articles cited below speak about the same thing but are not brought together in a coherent way. “Approximately 970 million people worldwide have high blood pressure and 1.56 billion adults will be living with hypertension by 2025 (3)” “Globally around 1.13 billion people live with hypertension, which is two-thirds of them from low and middle-income countries (5).” Noted, Thank you! Corrected accordingly. The statement that no systematic reviews were available to the knowledge of the authors is not true. I came across two systematic reviews on hypertension in Ethiopia and no mention of these were made apart from one that appeared in the discussion. The authors need to be honest about the scientific premise and show what gaps were in the previous review to warrant their review. See below the two reviews I came across 1-Kibret, K. T., & Mesfin, Y. M. (2015). Prevalence of hypertension in Ethiopia: a systematic meta-analysis. Public Health Reviews, 36(1), 14 2- Molla, M. (2015). Systematic reviews of prevalence and associated factors of hypertension in Ethiopia: finding the evidence. Sci J Public Health, 3(4), 514-9. Noted, Thank you! Yes, there are two reviews by the year 2015. But these two reviews did not account factors that affect the pooled prevalence of hypertension, as well as 20 (52.60%) studies, had been published after 2016. Therefore, this review gives updated information for interventions. Methods Just checking on the sensitivity of the search criteria: a synonym for high blood pressure “raised blood pressure” should have been indicated in the search terms. It is possible some articles could have been missed if they only used this terminology. Noted, thank you! The searching strategies was performed accordingly in the MeSH terms using the key terms of hypertension. Therefore, the synonym was performed accordingly the MeSH terms by hypertension. Inclusion criteria Why did you choose 2000 as the earliest year to limit your search? Please give the rationale for selecting articles from this year. Noted, thank you! We interested updated information in the last two decades simply. As well as no relevant studies before 2009 for this review. Quality assessment The statement below is confusing. Please clarify “Based on the score of the quality assessment tool the highest score from nine questions declared low risk of bias” this is not clear. This would mean the highest score had the minimum risk yet the proceeding statement says the opposite Noted, and updated accordingly! Results You are silent about grey literature in your reporting yet you did mention an attempt to search for this in the methods section. Pease clarify if any grey literature was found and how it was handled. Noted, Thank you! Yes, we had include one grey literature (Birhanu Tolera (58)) and it was extracted the same way as the other studies. Discussion In the discussion section, a good attempt is made to interpret the findings but the language makes it rather sloppy. Need to hire the services of a native English speaker for language edits. Noted thank you corrected accordingly. The comment in the limitation section about social desirability of the study is erroneous. The phrase social desirability bias is not appropriately used. I do not think cross sectional studies lead to social desirability. This could as well happen in longitudinal studies. “Social desirability bias refers to the tendency of research subjects to give socially desirable responses instead of choosing responses that are reflective of their true feelings. The bias in responses due to this personality trait becomes a major issue when the scope of the study involves socially sensitive issues such as politics, religion, and environment, or personal issues such as drug use, cheating, and smoking. This is usually resolved by use of a well‐trained interviewer or collection of data through methods that do not require presence involvement of an interviewer can help avoid this bias to some extent. Properly identified options to questions vulnerable to social desirability effect is another means of tackling this issue” Thank you very much for the detail elaboration. Yes, we are go through the limitation and correct according to the comment and that was account. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0244642.r002
13 Aug 2020 Decision Letter - R. Jay Widmer, Editor PONE-D-19-34928R1 Prevalence and determinants of hypertension in Ethiopia. Systematic review and meta-analysis PLOS ONE Dear Dr. Tiruneh, 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 Sep 27 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. 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, Jay Widmer Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] 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: 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 #2: Partly ****** 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: 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 #2: No ****** 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: The language edits are not satisfactory. I doubt if the authors sought services of a native English speaker. I noted several grammatical errors. It appears to me more errors were introduced during the revisions. I have cited some of them here but this is not an exhaustive list. There will be need for a thorough check. I strongly recommend hiring a language editor. Introduction Lines 58-60- According to the World Health Organization (WHO) report in 2019, globally more than 1.13 billion people live with hypertension, of this two-thirds of them from Low and Middle-Income Countries (LMICs) Lines 63-64. According to a systematic study, the overall pooled prevalence of hypertension in Africa raised from 19.7% in 1990, 27.4% in 2000 and 30.8% in 2010 [5]. Line 65: people live with hypertension and it will be projected 3 out of 4 people by the end of 2025 Lines 76-77: increment of non-communicable diseases will lead to greater dependency and rise the costs of health care for patients and their families unless public health interventions. Line 82: Besides, more than half of the studies published after the previous study conducted. Discussion Line 305: Non-communicable disease was a double burden of public health problem in developing countries Line 330: This finding was consistence with a study conducted in Nepal ****** 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: 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. 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. https://doi.org/10.1371/journal.pone.0244642.r003
Revision 2
15 Sep 2020 Author Response Response to Reviewers’ Prevalence and determinants of hypertension in Ethiopia: Systematic review and meta-analysis Sofonyas Abebaw Tiruneh1, Yeaynmarnesh Asmare Bukayaw2, Seblewongel Tigabu Yigizaw2, Dessie Abebaw Angaw2 The authors, extend great thanks for the editors and reviewers as the stand of this review. The comments raised by the reviewers are vital and defiantly it will improve the quality of the manuscript. Stay Safe!!! The Authors. Reviewer #2: The language edits are not satisfactory. I doubt if the authors sought services of a native English speaker. I noted several grammatical errors. It appears to me more errors were introduced during the revisions. I have cited some of them here but this is not an exhaustive list. There will be need for a thorough check. I strongly recommend hiring a language editor. Introduction Lines 58-60- According to the World Health Organization (WHO) report in 2019, globally more than 1.13 billion people live with hypertension, of this two-thirds of them from Low and Middle-Income Countries (LMICs) Lines 63-64. According to a systematic study, the overall pooled prevalence of hypertension in Africa raised from 19.7% in 1990, 27.4% in 2000 and 30.8% in 2010 [5]. Line 65: people live with hypertension and it will be projected 3 out of 4 people by the end of 2025 Lines 76-77: increment of non-communicable diseases will lead to greater dependency and rise the costs of health care for patients and their families unless public health interventions. Line 82: Besides, more than half of the studies published after the previous study conducted. Discussion Line 305: Non-communicable disease was a double burden of public health problem in developing countries Line 330: This finding was consistence with a study conducted in Nepal We noted all the concerns and we have tried to our maximum effort to improve the quality of English writing. We also invited the English exert river in our institution. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0244642.r004
23 Sep 2020 Decision Letter - R. Jay Widmer, Editor PONE-D-19-34928R2 Prevalence and determinants of hypertension in Ethiopia. Systematic review and meta-analysis PLOS ONE Dear Dr. Tiruneh, 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. ============================== The reviewers feel that the editorial changes were not satisfactory to merit publication. Particularly, the authors should pay particular attention to each and every sentence to be sure it has been properly proofed and vetted by a native English speaker for correct grammar and syntax. Without these changes we will be unable to publish this work that has some merit according to the reviewers and editorial staff. Please make these changes at your earliest convenience and resubmit. Thank you. ============================== Please submit your revised manuscript by Nov 07 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. 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, Jay Widmer Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] [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. https://doi.org/10.1371/journal.pone.0244642.r005
Revision 3
20 Oct 2020 Author Response Editors request The reviewers feel that the editorial changes were not satisfactory to merit publication. Particularly, the authors should pay particular attention to each and every sentence to be sure it has been properly proofed and vetted by a native English speaker for correct grammar and syntax. Without these changes we will be unable to publish this work that has some merit according to the reviewers and editorial staff. Please make these changes at your earliest convenience and resubmit. Authors response The authors, extend great thanks for the editors and reviewers as the stand of this review. The comments raised by the editors are valuable and defiantly it will improve the quality of the manuscript. We have addressed the English and grammar problems as per the editor request. Since all authors are from low-income country, we cannot able to proofread the manuscript by fluent in English by payment especially native by English. But we have tried to improve the grammar and punctuation problems through read again and again. Besides, we had invited the manuscript for senior English editors at the University of Gondar and Debre Tabor University, Ethiopia. Those two English experts Lectures review our manuscript by free cost. We hope that the English write up problem improves and will meet the minimum publication criteria of PLOS ONE journal. We look forwarding your excellent comments as usual. The authors, Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0244642.r006
10 Nov 2020 Decision Letter - R. Jay Widmer, Editor PONE-D-19-34928R3 Prevalence and determinants of hypertension in Ethiopia. Systematic review and meta-analysis PLOS ONE Dear Dr. Tiruneh, 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. ============================== The edits are not acceptable as written, and careful attention to correcting the text to ensure readability in the English language is required for further consideration for publication. ============================== Please submit your revised manuscript by Dec 25 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. 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, R. Jay Widmer Academic Editor PLOS ONE Additional Editor Comments (if provided): The scientific merit has certainly been met, however the language simply is illegible by current English standards. This will be the authors final chance to amend the paper so that all grammatical mistakes are corrected and the paper flows in a smooth and readable fashion. For example the second sentence of the abstract reads, "A comprehensive electronic databases". There is a lack of subject/verb agreement, and this phrase is uninterpretable by the reader. Please make this final effort to correct the paper, and we look forward to a thoroughly reviewed next draft. Thank you for your attention to these details. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions 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: I Don't Know ****** 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 ****** 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: I very much appreciate the efforts to address all my comments. However, 1. You probably did not get my comment on the introduction, I would suggest you simply cancel the first sentence of the introduction, it is controversial and adds nothing. 2. The language edits are really far below what is acceptable. My suggestion would be that you have the paper read by a scientific writer. ****** 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 [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. https://doi.org/10.1371/journal.pone.0244642.r007
Revision 4
12 Dec 2020 Author Response Response Letter to editors and reviewers Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis Sofonyas Abebaw Tiruneh1, Yeaynmarnesh Asmare Bukayaw2, Seblewongel Tigabu Yigizaw2, Dessie Abebaw Angaw2 We authors appreciate to the editors and reviewers for this manuscript as the position fourth review. The comments raised by the editors and reviewers are vital and defiantly it will improve the quality of the manuscript. We have addressed all the issues raised by the editors and reviewer's and believed that the revised version of the manuscript is satisfactory and will meet the minimum journal publication requirements. We have updated the manuscript accordingly. Stay Safe!!! The Authors. Additional Editor Comments (if provided): The scientific merit has certainly been met, however, the language simply is illegible by current English standards. This will be the authors final chance to amend the paper so that all grammatical mistakes are corrected and the paper flows in a smooth and readable fashion. For example the second sentence of the abstract reads, "A comprehensive electronic databases". There is a lack of subject/verb agreement, and this phrase is uninterpretable by the reader. Please make this final effort to correct the paper, and we look forward to a thoroughly reviewed next draft. Thank you for your attention to these details. Noted: Thank you! We have made our final attempt as our maximum effort. Review Comments to the Author Reviewer #1: I very much appreciate the efforts to address all my comments. However, 1. You probably did not get my comment on the introduction, I would suggest you simply cancel the first sentence of the introduction, it is controversial and adds nothing. 2. The language edits are really far below what is acceptable. My suggestion would be that you have the paper read by a scientific writer. Noted thank you, We appreciate your comment and We had corrected in the recent version of the manuscript Attachments Attachment Submitted filename: Response Letter to Reviewer.R4.docx* https://doi.org/10.1371/journal.pone.0244642.r008
15 Dec 2020 Decision Letter - R. Jay Widmer, Editor Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis PONE-D-19-34928R4 Dear Dr. Tiruneh, 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, R. Jay Widmer Academic Editor PLOS ONE Additional Editor Comments (optional): The authors are to be congratulated on this work and for such a well written manuscript. https://doi.org/10.1371/journal.pone.0244642.r009
Formally Accepted
18 Dec 2020 Acceptance Letter - R. Jay Widmer, Editor PONE-D-19-34928R4 Prevalence of hypertension and its determinants in Ethiopia: A systematic review and meta-analysis Dear Dr. Tiruneh: 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. R. Jay Widmer Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244642.r010

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