The impact of community based continuous training project on improving couples’ knowledge on birth preparedness and complication readiness in rural setting Tanzania; A controlled quasi-experimental study

Fabiola V. Moshi; Stephen M. Kibusi; Flora Masumbuo Fabian

doi:10.1371/journal.pone.0244845

Peer Review History

Original SubmissionFebruary 7, 2020
26 Aug 2020 Decision Letter - Florian Fischer, Editor PONE-D-19-30480 The Impact of Community Based Continuous Training Project on Improving Couples’ Knowledge on Birth Preparedness and Complication Readiness in Rural Setting Tanzania; A Controlled Quasi-Experimental Study PLOS ONE Dear Dr. Moshi, 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 10 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, Florian Fischer 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. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. 3.Thank you for stating the following financial disclosure: [NO - Include this sentence at the end of your statement: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.]. At this time, please address the following queries: Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” If any authors received a salary from any of your funders, please state which authors and which funders. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 4. Please include a caption for figure 4 (Figure 3 caption included 2x). 5. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 2 in your text; if accepted, production will need this reference to link the reader to the Table. [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 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: Yes Reviewer #2: 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: Introduction: Line 53 and 54: should be clear and specific where these deaths occurred Study design: Well done Setting: Well done Sampling technique: Line 168: correct the name from Sumawanga to Sumbawanga Line 171: what was the interval used in the systematic sampling in the selection of the households? Line 172: state the inclusion criteria for the study population Line 173: who was responsible for the assessment of signs and symptoms of the pregnancy in each household visited? This needs to be clarified and the signs and the symptoms assessed as well. Line 185: check the value of the power at 90% is not 0.84, please confirm and correct. Line 203: the couples were only visited for two days irrespective of the gestation age, how will this intervention have impact for a couple visited at early stages of gestation age? Line 204: you skipped what happened in step four and went to fifth step, please correct Data collection procedure Line 210: was there any consenting process conducted to the participants? This needs to be stated before the start of data collection. Was the data collected using paper questionnaire or electronically? The author should clarify this. Were there also participants below age 18? Data Processing and analysis the results were well described, how were the assumptions of linear regression verified. the authors also needs to explain whether any statistical method was used to select variables for the multivariable analysis Results: Table 1: what was the lower age limit of the participants that were interviewed? Table 1: Please indicate the exactly P-values whether significant of or not instead of leaving them blank and showing significant one with asterisk. Indicate the number of participants in each of the groups, and the n (%) at the top of each column to show what the values in the table mean Table 2: add the p-values, show the lower limit of the gestation age Table 3: add the exact p-values to the table Discussion: Well explained Were there any strength and limitation for this study? This needs to be explained. Reviewer #2: Thank you for the opportunity to review the manuscript entitled, "The Impact of Community Based Continuous Training Project on Improving Couples' Knowledge on Birth Preparedness and Complication Readiness in Rural Setting Tanzania: A controlled quasi-experimental study." The authors present the effect of the CBCT training on knowledge and complication readiness in rural Tanzania. Based on data presented, there appears to be improvement on knowledge scores for pregnant women and their male partners. The paper and intervention are interesting; however, there are some key questions that need to be addressed. MAJOR 1. The authors published a protocol paper with the following citation: "Moshi FV, Kibusi SM, Fabian F. The Effectiveness of Community-Based Continuous Training on Promoting Positive Behaviors towards Birth Preparedness, Male Involvement, and Maternal Services Utilization among Expecting Couples in Rukwa, Tanzania: A Theory of Planned Behavior Quasi-Experimental Study. J Environ Public Health. 2018;2018:1293760. Published 2018 Sep 27. doi:10.1155/2018/1293760" However, the authors do not reference the protocol paper in this manuscript. It is unclear if these are full related studies. If the paper previously published, it would be helpful to reference the methods and then reduce the detail in the introduction and methods sections. For example, the sample size calculation and equations could be removed and referenced. 2. Please clarify how couples were randomized to receive the intervention or not; or were villages randomized to the intervention? It is clear from the description how the districts and villages were selected. 3. Please add details in the Methods about the timing of data collection with respect to the pre-test assessment and post-test assessment. These details are included in the discussion (Lines 403-405). Can the authors discuss potential recall bias or influence of the birth experience and outcomes on the post-test results? 4. Given that the authors interviewed the same couples pre and post intervention, it seems a difference-in-differences analysis would be appropriate. Can the authors discuss why they have not used this approach? Further it would streamline the Tables 3-7. Figures 3 and 4 also present similar information to Tables 3-7; please consider putting one or the other in the supplementary information. MINOR: 1. In the abstract, please consider adding the baseline knowledge score so readers can understand more clearly the impact of the intervention. 2. In line 96, there is a reference "(martin)" that needs a full citation. Please update. 3. In lines 104 to 121, the authors present several programs for improving pregnant women's outcomes. This contrast and comparison presented may be more useful in the Discussion section to set the results from this research in context. 4. In lines 196-197, please provide clarification as how the doubling of the control arm increases comparability. 5. Please provide more clarity to the actual intervention that was applied; lines 198-207 are more about the measurement of the intervention, but not about the intervention for the couple. This information would be helpful to the readers. 6. Table 4: Please clarify if the mean (SD) knowledge is a score or mean number of danger signs assessed. Further, is there a range associated with each assessment? Further, please limit to 2 significant digits for the mean and SD of scores. 7. Figures 3 and 4 presentation as line charts make the reader compare scores across domain as opposed to pre/post scores. Consider a bar chart for pre/post scores next to each other. ****** 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: Yes:** James Orwa 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.0244845.r001
Revision 1
23 Oct 2020 Author Response Response to Reviewers’ and Editor’s comments Editor’s Comments Comment 1 Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style Response 1 The manuscript meets PLOSE ONE style Comment 2 Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. Response 2 The questionnaire was adopted and modified from Jhpiego. Monitoring birth preparedness and complication readiness: tools and indicators for maternal and newborn health. 2004;1–338. Available from: http://pdf.usaid.gov/pdf_docs/PNADA619.pdf . The tool in both language (English and Swahili) is attached as supporting Information Comment 3 [NO - Include this sentence at the end of your statement: The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.]. At this time, please address the following queries: Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” If any authors received a salary from any of your funders, please state which authors and which funders. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. Response This work is part of my PhD project. The University of Dodoma sponsored the tuition fee and field allowance. Publication fee was not covered in the sponsorship. The funders had no role in decision to publish, or preparation of the manuscript The authors received no specific funding for this work Comment 4 Please include a caption for figure 4 (Figure 3 caption included 2x). Response 4 The caption for figure 4 is included; the repeated figure three was a typing error. It was meant to be figure 4 Comment 5 We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 2 in your text; if accepted, production will need this reference to link the reader to the Table. Response 5 Table 2 is referred in the text line 260 Comments from reviewer 1 Comment 1 Line 53 and 54: should be clear and specific where these deaths occurred Response 1 Authors agree with the comment and correction is made Comment 2 Line 168: correct the name from Sumawanga to Sumbawanga Response 2 Authors agree with the correction and it is done Comment 3 Line 171: what was the interval used in the systematic sampling in the selection of the households? Response 3 No specific interval was used but rather pre determine direction of selection of household after random selection of the first household Comment 4 Line 172: state the inclusion criteria for the study population Response 4 The inclusion criteria are mentioned Comment 5 Line 173: who was responsible for the assessment of signs and symptoms of the pregnancy in each household visited? This needs to be clarified and the signs and the symptoms assessed as well. Response 5 Research assistants who were nurses did the interview and confirmed the test Comment 6 Line 185: check the value of the power at 90% is not 0.84, please confirm and correct. Response 6 The sample size calculation is removed as the portion is published Comment 7 Line 203: the couples were only visited for two days irrespective of the gestation age; how will this intervention have impact for a couple visited at early stages of gestation age? Response 7 The study reports a part of the study One of the components of the intervention was followed up. They were followed and assessed for three main behaviors which were birth preparedness, male involvement and use of health facilities for antenatal services, delivery services and postnatal services In addition they were supplied with pictorial reference materials Comment 8 Line 204: you skipped what happened in step four and went to fifth step, please correct Response 8 What happened in step four is included Comment 9 Line 210: was there any consenting process conducted to the participants? This needs to be stated before the start of data collection. Was the data collected using paper questionnaire or electronically? The author should clarify this. Were there also participants below age 18? Before participation into the study couples were counseled and upon their consent, they were included in the study (Line 244-Line 246) Comment 9 Upon consent to participate, there record were taken to the nearby health facility where their behavior were recorded as they acted Response 9 No electronic data collection was used but an interviewer administered questionnaire Comment 10 The results were well described, how were the assumptions of linear regression verified. the authors also needs to explain whether any statistical method was used to select variables for the multivariable analysis Response 10 Variables which showed significant correlation with knowledge about birth preparedness were entered into the regression model Comment 11 Table 1: what was the lower age limit of the participants that were interviewed? Response 11 The lowest age was 16 years. Comment 12 Table 1: Please indicate the exactly P-values whether significant of or not instead of leaving them blank and showing significant one with asterisk. Indicate the number of participants in each of the groups, and the n (%) at the top of each column to show what the values in the table mean Response 12 The column of p value is removed in this table because the aim of the table is to describe the characteristics of the study respondents. Authors agree with the observation and n(%) are added in each column Comment 13 Table 2: add the p-values, show the lower limit of the gestation age Response 13 The p-values and lower gestation age is added to the table Comment 14 Table 3: add the exact p-values to the table Response 14 The exact p-values is added to the table Comment 15 Were there any strength and limitation for this study? This needs to be explained. Response 15 Strength and limitation of the study is added in the last two paragraphs after discussion (Line 236- Line 449) Comments from reviewer 2 Comment 1 The authors published a protocol paper with the following citation: "Moshi FV, Kibusi SM, Fabian F. The Effectiveness of Community-Based Continuous Training on Promoting Positive Behaviors towards Birth Preparedness, Male Involvement, and Maternal Services Utilization among Expecting Couples in Rukwa, Tanzania: A Theory of Planned Behavior Quasi-Experimental Study. J Environ Public Health. 2018;2018:1293760. Published 2018 Sep 27. doi:10.1155/2018/1293760" However, the authors do not reference the protocol paper in this manuscript. It is unclear if these are full related studies. If the paper previously published, it would be helpful to reference the methods and then reduce the detail in the introduction and methods sections. For example, the sample size calculation and equations could be removed and referenced. Response 1 Yes, the protocol of the study is published. This manuscript is a part of the findings from the protocol. Authors agree with the suggestion and the protocol is cited in the sample size calculation Comment 2 Clarify how couples were randomized to receive the intervention or not; or were villages randomized to the intervention? It is clear from the description how the districts and villages were selected. Response 2 Randomization was not possible in this intervention; there were a lot of limitations one of which was contamination of the intervention. Applying random assignment to neighbors was not possible It was a quasi experimental study where only the districts were randomly assigned to either intervention or control Comment 3 Please add details in the Methods about the timing of data collection with respect to the pre-test assessment and post-test assessment. These details are included in the discussion (Lines 403-405). Can the authors discuss potential recall bias or influence of the birth experience and outcomes on the post-test results? Response 3 A sentence is added in the data collection to explain the timing for data collection for both pre test assessments (Line 223 to Line 225) Limitation of the study is added after the discussion where recall bias as one of the limitation is discussed (Line 436 to Line 448) Comment 4 Given that the authors interviewed the same couples pre and post intervention, it seems a difference-in-differences analysis would be appropriate. Can the authors discuss why they have not used this approach? Further it would streamline the Tables 3-7. Figures 3 and 4 also present similar information to Tables 3-7; please consider putting one or the other in the supplementary information. Response 4 Yes the same couple was assessed pre pre-post in both groups. Difference-in-difference analysis was used. The result section is organized into three main parts. The first part is the comparison between groups pre- assessment and post assessment. The second part of the results is the comparison within the group, pre- post assessment differenced between both groups. The third part is the analysis of the predictors of difference in mean score. For every respondent the difference score was computed. This score was treated as a new variable. Predictors of change were established using multiple liner regression. Authors think allowing all tables to be in the study could still hold water but we are looking forward for more opinion Comment 5 In the abstract, please consider adding the baseline knowledge score so readers can understand more clearly the impact of the intervention. Response 5 Authors agree with the suggestion Comment 6 In line 96, there is a reference "(martin)" that needs a full citation. Please update. Response 6 The reference is inserted Comment 7 In lines 104 to 121, the authors present several programs for improving pregnant women's outcomes. This contrast and comparison presented may be more useful in the Discussion section to set the results from this research in context. Response 7 The introduction of several interventions in the background was placed there to introduce the current intervention. If moved can create discontinuity in the background Comment 8 In lines 196-197, please provide clarification as how the doubling of the control arm increases comparability. Response 8 Authors aimed at having groups with similar characteristics; avoiding having one wing with older population and other group with younger population Comment 9 Please provide more clarity to the actual intervention that was applied; lines 198-207 are more about the measurement of the intervention, but not about the intervention for the couple. This information would be helpful to the readers. Response 9 Actual clarification is added line 218-line 223 Comment 10 Table 4: Please clarify if the mean (SD) knowledge is a score or mean number of danger signs assessed. Further, is there a range associated with each assessment? Further, please limit to 2 significant digits for the mean and SD of scores. Response 10 It is a mean knowledge score. One point for each recalled danger sign or what to prepare for birth/emergency Decimal points are restricted to two places Comment 11 Figures 3 and 4 presentation as line charts make the reader compare scores across domain as opposed to pre/post scores Consider a bar chart for pre/post scores next to each other Response 11 Authors agree with the suggestion and the figure is changed to chart for pre/post Attachments Attachment Submitted filename: Response to reviewers Comments.doc https://doi.org/10.1371/journal.pone.0244845.r002
17 Nov 2020 Decision Letter - Florian Fischer, Editor PONE-D-19-30480R1 The Impact of Community Based Continuous Training Project on Improving Couples’ Knowledge on Birth Preparedness and Complication Readiness in Rural Setting Tanzania; A Controlled Quasi-Experimental Study PLOS ONE Dear Dr. Moshi, 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 find below some minor comments raised by Reviewer 1. We ask you to incorporate these suggestions, before we can accept the manuscript. Please submit your revised manuscript by Jan 01 2021 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, Florian Fischer 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 #1: (No Response) 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 #1: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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 #1: Yes 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 #1: Yes 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 #1: Most of the previous comments are addressed, just a few clarity needed The author mentioned that the first household was selected using a random sampling approach,they selected the subsequent households using systematic sampling but no interval stated. this still needs clarity. The author have removed the sample size calculation but cited the published propotocol, it would have been informative if a brief on this is given. verbal consent was done for women below 18 years, was there a justification why there was no assent? in some cases this group have been treated as mature minors and could provide their own consent. is there a justification why this is no the case in this population?? Reviewer #2: Thank you for addressing the comments and revising the manuscript. I also appreciate that the files have been added in supplemental information. Please note that during the proofing process, please conduct a thorough review, there are some errors that won't be caught by spell checker (i.e. line 240, Match for March, etc) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** James Orwa 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.0244845.r003
Revision 2
3 Dec 2020 Author Response Point to point response to reviewers’ comments Reviewer 1 Comment 1 The author mentioned that the first household was selected using a random sampling approach, they selected the subsequent households using systematic sampling but no interval stated. this still needs clarity. Response 1 Yes, the first household was picked randomly followed by systematic sampling. No interval was set but researchers move to already pre-determined direction. Each visited households were assessed for eligibility, if eligible was selected and next household was visited, if not eligible was skipped and next household was visited until the required sample size was reached Comment 2 The authors have removed the sample size calculation but cited the published protocol, it would have been informative if a brief on this is given. Response 2 Authors agree with the recommendation and the sample size calculation is added line 168-189 Comment 3 Verbal consent was done for women below 18 years, was there a justification why there was no assent? in some cases this group have been treated as mature minors and could provide their own consent. is there a justification why this is not the case in this population?? Response 3 Authors agree with the comment, it is true they are also taken as mature even in this population. What was done in the project were to seek consent from pregnant women then from their male partners; It was until both of them agree to participate then they were included in the study. The sentence is removed. Reviewer 2 Comment 1 Thank you for addressing the comments and revising the manuscript. I also appreciate that the files have been added in supplemental information. Please note that during the proofing process, please conduct a thorough review, there are some errors that won't be caught by spell checker (i.e. line 240, Match for March, etc.) Response 1 Line 240 is corrected Attachments Attachment Submitted filename: Response to reviewers comments.docx https://doi.org/10.1371/journal.pone.0244845.r004
18 Dec 2020 Decision Letter - Florian Fischer, Editor The Impact of Community Based Continuous Training Project on Improving Couples’ Knowledge on Birth Preparedness and Complication Readiness in Rural Setting Tanzania; A Controlled Quasi-Experimental Study PONE-D-19-30480R2 Dear Dr. Moshi, 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, Florian Fischer Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0244845.r005
Formally Accepted
23 Dec 2020 Acceptance Letter - Florian Fischer, Editor PONE-D-19-30480R2 The Impact of Community Based Continuous Training Project on Improving Couples’ Knowledge on Birth Preparedness and Complication Readiness in Rural Setting Tanzania; A Controlled Quasi-Experimental Study Dear Dr. Moshi: 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. Florian Fischer Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0244845.r006

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