A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: A health workers’ perspective

Arthur K. S. Ng’etich; Kuku Voyi; Ruth C. Kirinyet; Clifford M. Mutero

doi:10.1371/journal.pone.0248998

Peer Review History

Original SubmissionOctober 3, 2019
26 Jun 2020 Decision Letter - Jianhong Zhou, Editor PONE-D-19-27712 A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: a health workers' perspective PLOS ONE Dear Dr. Ngetich, 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 Aug 09 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, Jianhong Zhou Associate 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 [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: N/A Reviewer #2: N/A ****** 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: Thank you to the authors for producing this detailed and interesting review of recommendations for improving the implementation of disease surveillance in Africa, with a particular focus on system and organisational issues from the perspective of health workers. I am sure this review will be of interest and useful to those working in disease surveillance internationally, identifying common challenges in implementing these systems and recommendations for their improvement, while providing a collated set of evaluation case studies. I found the review relatively straightforward and clear, although I do have some suggestions to improve the clarity of the methods. Please note that my expertise is in systematic review methodology, and not in disease surveillance systems, so some of my comments may arise from my lack of knowledge of common concepts and terminology in this field. Introduction, last para (p4, line 93 onward): • It’s not clear to me what the difference is between the focus of the previous reviews, and the focus of this one. Perhaps this could be more specifically described? If the difference is the healthcare work perspective, perhaps this could be stated more simply. To me, the following descriptions sound the same: o “critically assessing fundamental recommendations arising from assessment studies regarding IDSR system improvement” o “key recommendations resulting from IDSR system core, support and attribute functions assessment studies” Table 1 (p5, line 110): • It might be helpful to write this table using plain language sentences, rather than search terms, to help people understand quickly and easily what you were including. Especially as these terms aren’t necessarily those used in your final search, as included in your supplementary files. Eligibility criteria (p7, line 135) • These criteria could be written more clearly. Make sure it’s clear whether you’re including: o Only assessments of performance of the IDSR or assessments of any aspect of disease surveillance o Health workers’ views on the implementation & operation of the system (i.e. studies that explicitly ask health workers to express their views e.g. through surveys or interviews), descriptive characteristics of the implementation and operation of the system that are relevant to health workers (e.g. that could be observed by researchers or policy staff rather than health workers), or any other outcomes (e.g. stats on the effectiveness of surveillance systems or disease outcomes) • I’m not sure what the difference is between the studies that meet the main eligibility criteria, and the additional studies that " studies involving record reviews or observations to assess disease surveillance and response systems”. How are these studies different from your included studies, and how are their results treated differently in the review? If they’re not treated differently, then they can be included in the main eligibility criteria. I think you explain this more clearly in your description of include studies in the Results section. Search • The search terms included in the text are not the same as those used in the actual search strategy included in the supplementary documents. Could this be corrected? • If I were drafting this search, I might expect to use some terms such as specific country names (as not all abstracts will specifically refer to Africa), as well as terms relating to evaluation or assessment. I might also consider searching the African Index Medicus. However, I know you have developed this search in collaboration with an information specialist, so you might have made an expert judgement that these would not improve the search. Data extraction (p.7 Line 146) • The PRISMA statement checklist is a very brief checklist of the presence or absence of methods in a systematic review, and cannot be used for data collection from primary studies. This text should be removed, and a description added of what kinds of data were collected. For example, in your PROSPERO record, you note that “The data to be extracted will be as follows: author's name, article publication year, adoption year of IDSR revised guidelines, target disease/s, study assessment methodology, surveillance functions assessed, key findings and recommendations.” Ideally, a copy of your data collection form could be included as a supplementary document, if available. • Later in the review, in the discussion (p.52, line 478), you discuss developing a matrix of subthemes based on a previous review. I would love to see this discussed here, in the methods section, to describe how you identified themes in the included studies and categorised them according to themes. You could include your matrix as a table or figure. Also, did you add any new items to the matrix that you found in your included studies? • It would be helpful to be more specific about exactly what kinds of outcomes you were looking for – that is, outcomes relating to the implementation and operation of the IDSR, but not measures of actual disease surveillance or disease outcomes in the population? • It would be very helpful to provide some additional detail on how you’re identifying which are the key problems identified in each study, and which are the key recommendations. Did you collect every identified problem and every recommendation identified that matched your matrix? Did you select those that you thought were the most important? Did you only select those that matched your original matrix? This is very important so your readers can see how you made your choices and helps them trust your findings. • The reason I’m asking for more detail is not because I think the review was not done appropriately, but just to increase transparency and replicability – e.g. if I were a new research assistant, could I follow the instructions in this methods section and successfully replicate the review? Quality appraisal • The Nursing Research Appraisal tool used to appraise the included studies is not a true risk of bias assessment tool, and it includes elements that do not relate to study bias, e.g. clarity of writing. However, in the context of this review, which aims to map diverse recommendations, rather than identify a correct effect estimates, I think a more general tool is probably fine. Results • Could you include a summary of the study designs found (e.g. cross-sectional, qualitative) • Were there any subthemes identified in your matrix for which no data were found? i..e that you thought might be issues of concern, but weren’t? • Excluded studies – it would add to the transparency of the review if you could provide a list of excluded studies, with their reasons for exclusion, in addition to the PRISMA flow diagram. This could be, for example, either a full list of studies screened in full text, or a subset of these that readers might be most likely to think Table 4 (p48) • This table would be easier to read if it were a frequency histogram or bar chart, showing a bar indicating the number of studies with that subtheme, rather than listing all the studies individually. It might even fit on a single page. • Should this table be linked from the last para on p.46 (line 455), instead of Table 3? I would recommend it is linked from the Results section, and not first introduced in the Discussion section. Discussion • Should this reference to Table 4 actually be a reference to Table 3? (p47, line 465) • The summary of the results in the Discussion could be more brief – it’s currently almost as long as the Results section (9 pages compared to 10). If there are details here that are important to interpreting the results, could they be included in the Results section? This would then allow the Discussion to be more of a brief overview of main findings, rather than repeating so much detail that might overwhelm readers. This would also make space to include some more discussion of your findings overall. • The Discussion could also include some mention of the strengths and limitations of the review design (e.g. those mentioned in the Risk of bias across studies section). • Will some recommendations be easier/harder to implement (e.g. some requiring significant additional resources which may not be available, others involving organisational change that’s more achievable?) • Who is this data for? Who can or should act on it? Conclusion • You noted in the Conclusions that you felt there was not much evidence in NTDs – this is not discussed anywhere else in the review – either in the Results or the Discussion. If this is an interesting and important feature of the evidence, could you discuss it earlier? Are there other aspects of the included studies that would be worth discussing as well? Reviewer #2: This manuscript presents an important and timely review of assessments of disease surveillance in Africa. It is well written and very comprehensive. The authors conducted a comprehensive systematic review and conformed to PRISMA guidelines. A large number of initial papers were screened, though only 27 were included. Major revision: As a consequence of the authors' comprehensiveness, the manuscript tends to be wordy and overly narrative, rather than providing a concise analysis of the included studies and themes. I found myself wanting a concise table of themes, countries, etc. Instead, even the tables are overwhelming in content, and more of appendix tables than main text tables. Because of all of this, I think the reader would be aided by adding a "Main Finding" or "Key Themes" or something table/box. In the results section, I struggled with the narrative text. Readers would be much better served by concise reporting of thematic findings with some quantification. There was almost no quantification throughout. Results such as "Ten of the 27 studies indicated challenges with lack of training...". Minor revisions: Please remove all of the uncommon abbreviations (HW, HP, HF,...). ****** 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:** Miranda Cumpston 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: PONE-D-19-27712_reviewer.pdf https://doi.org/10.1371/journal.pone.0248998.r001
Revision 1
5 Aug 2020 Author Response Reviewer #1: Thank you to the authors for producing this detailed and interesting review of recommendations for improving the implementation of disease surveillance in Africa, with a particular focus on system and organisational issues from the perspective of health workers. I am sure this review will be of interest and useful to those working in disease surveillance internationally, identifying common challenges in implementing these systems and recommendations for their improvement, while providing a collated set of evaluation case studies. I found the review relatively straightforward and clear, although I do have some suggestions to improve the clarity of the methods. Please note that my expertise is in systematic review methodology, and not in disease surveillance systems, so some of my comments may arise from my lack of knowledge of common concepts and terminology in this field. Author response: Thank you for the remarks. Introduction, last para (p4, line 93 onward): • It’s not clear to me what the difference is between the focus of the previous reviews, and the focus of this one. Perhaps this could be more specifically described? If the difference is the healthcare work perspective, perhaps this could be stated more simply. To me, the following descriptions sound the same: o “critically assessing fundamental recommendations arising from assessment studies regarding IDSR system improvement” o “key recommendations resulting from IDSR system core, support and attribute functions assessment studies” Author response (p4, line 93-95): This has been revised to state the focus of the study more clearly. Our review focused on assessing the recommendations to improve performance of the IDSR system core, support and attribute functions based on health workers’ perspectives post-adoption of the revised IDSR guidelines by African countries. Table 1 (p5, line 110): • It might be helpful to write this table using plain language sentences, rather than search terms, to help people understand quickly and easily what you were including. Especially as these terms aren’t necessarily those used in your final search, as included in your supplementary files. Author response (p5, line 109-114): This has been rectified to briefly summarise what the review included as suggested. Eligibility criteria (p7, line 135) • These criteria could be written more clearly. Make sure it’s clear whether you’re including: o Only assessments of performance of the IDSR or assessments of any aspect of disease surveillance o Health workers’ views on the implementation & operation of the system (i.e. studies that explicitly ask health workers to express their views e.g. through surveys or interviews), descriptive characteristics of the implementation and operation of the system that are relevant to health workers (e.g. that could be observed by researchers or policy staff rather than health workers), or any other outcomes (e.g. stats on the effectiveness of surveillance systems or disease outcomes) Author response (p7, line 143-145): The eligibility criteria has been revised according to the suggestions provided. • I’m not sure what the difference is between the studies that meet the main eligibility criteria, and the additional studies that " studies involving record reviews or observations to assess disease surveillance and response systems”. How are these studies different from your included studies, and how are their results treated differently in the review? If they’re not treated differently, then they can be included in the main eligibility criteria. I think you explain this more clearly in your description of include studies in the Results section. Author response (p7, line 145): The eligibility criteria has been revised. As rightly suggested the studies involving record reviews or observations were not treated differently during analysis and have been included in the main eligibility criteria. Search • The search terms included in the text are not the same as those used in the actual search strategy included in the supplementary documents. Could this be corrected? Author response (p6, line 132-135): This has been rectified accordingly and the search terms included in the main manuscript have been matched to the sample search strategy included in the supplementary information (refer to Appendix S1. PubMed search strategy). • If I were drafting this search, I might expect to use some terms such as specific country names (as not all abstracts will specifically refer to Africa), as well as terms relating to evaluation or assessment. I might also consider searching the African Index Medicus. However, I know you have developed this search in collaboration with an information specialist, so you might have made an expert judgement that these would not improve the search. Author response: The search strategy was revised as suggested and included the search terms “evaluation” and “assessment” across the databases and the overall result of the search increased by 76 additional studies (refer to Appendix S1. PubMed search strategy & Fig 1. Flow chart summarising the systematic review process). Therefore, after screening the additional studies, the final number of reviewed studies increased by three additional studies. On the other hand, the search terms “Africa” and “Sub-Saharan Africa” were preferred to find abstracts of previous assessment studies conducted in either one of the 47 WHO African region countries currently implementing the IDSR system. We initially included specific country names in the search strategy but this hardly improved the search results. In addition, we further conducted a search using African Index Medicus (a developing country health database of the WHO Regional Office for Africa) as suggested and the results matched the relevant studies already retrieved using WHOLIS (World Health Organization Library & Information Networks For Knowledge Database) and PubMed. Data extraction (p.7 Line 146) • The PRISMA statement checklist is a very brief checklist of the presence or absence of methods in a systematic review, and cannot be used for data collection from primary studies. This text should be removed, and a description added of what kinds of data were collected. For example, in your PROSPERO record, you note that “The data to be extracted will be as follows: author's name, article publication year, adoption year of IDSR revised guidelines, target disease/s, study assessment methodology, surveillance functions assessed, key findings and recommendations.” Ideally, a copy of your data collection form could be included as a supplementary document, if available. Author response (p7, line 150-155): The PRISMA statement checklist has been revised as suggested and a copy of the data extraction form has been included as supplementary information (refer to Appendix S5. Data extraction form). • Later in the review, in the discussion (p.52, line 478), you discuss developing a matrix of subthemes based on a previous review. I would love to see this discussed here, in the methods section, to describe how you identified themes in the included studies and categorised them according to themes. You could include your matrix as a table or figure. Also, did you add any new items to the matrix that you found in your included studies? Author response (p7, line 159-164): The matrix that guided thematic synthesis of recommendations derived from the reviewed studies has been provided (refer to Appendix S3. Surveillance system functions). However, apart from the main themes that were based on surveillance core, support and attribute functions, no further items were added to the matrix. • It would be helpful to be more specific about exactly what kinds of outcomes you were looking for – that is, outcomes relating to the implementation and operation of the IDSR, but not measures of actual disease surveillance or disease outcomes in the population? Author response: The anticipated outcomes of the review were to be derived from assessing study recommendations to improve implementation of the IDSR system functions in African countries based on health workers’ views. However, there were no actual disease surveillance measures or population-based disease outcomes assessed in the review. • It would be very helpful to provide some additional detail on how you’re identifying which are the key problems identified in each study, and which are the key recommendations. Did you collect every identified problem and every recommendation identified that matched your matrix? Did you select those that you thought were the most important? Did you only select those that matched your original matrix? This is very important so your readers can see how you made your choices and helps them trust your findings. Author response (p8, line 165-169): Yes, we objectively assessed every finding in the reviewed studies relating to assessment of a surveillance function (i.e. core, support or attribute) matching the predefined themes provided in the matrix, in addition to deriving the corresponding recommendations for improving the surveillance functions. • The reason I’m asking for more detail is not because I think the review was not done appropriately, but just to increase transparency and replicability – e.g. if I were a new research assistant, could I follow the instructions in this methods section and successfully replicate the review? Author response: We agree with the reviewer that the procedure for identifying key recommendations from the reviewed studies based on the matrix of pre-defined themes was not described sufficiently. Quality appraisal • The Nursing Research Appraisal tool used to appraise the included studies is not a true risk of bias assessment tool, and it includes elements that do not relate to study bias, e.g. clarity of writing. However, in the context of this review, which aims to map diverse recommendations, rather than identify a correct effect estimates, I think a more general tool is probably fine. Author response: The Dearholt and Dang’s John Hopkins Nursing Evidence Appraisal tool, as the reviewer indicated, is a more generalized assessment tool that has been widely used to assess risk of bias in studies included in systematic reviews involving narrative synthesis. This tool was deemed appropriate by the authors in assessing the quality of the reviewed studies with a focus on the assessment methods adopted. However, the authors did not intend to derive quantitative effect estimates from the reviewed studies given it was a qualitative synthesis of diverse study recommendations. Results • Could you include a summary of the study designs found (e.g. cross-sectional, qualitative) Author response (p10, line 217-222): A brief summary has been included in the result section and further details on the study designs are provided in the assessment methodology column (refer to Table1. Literature summary and quality appraisal). • Were there any subthemes identified in your matrix for which no data were found? i.e. that you thought might be issues of concern, but weren’t? Author response (p7, line 164-166): The subthemes were not pre-defined but rather emerged from the recommendations to improve surveillance functions as described in the reviewed studies. • Excluded studies – it would add to the transparency of the review if you could provide a list of excluded studies, with their reasons for exclusion, in addition to the PRISMA flow diagram. This could be, for example, either a full list of studies screened in full text, or a subset of these that readers might be most likely to think Author response: A summary of the excluded studies has been provided and categorised based on the reasons for exclusion (refer to Appendix S2. Excluded studies). Table 4 (p48) • This table would be easier to read if it were a frequency histogram or bar chart, showing a bar indicating the number of studies with that subtheme, rather than listing all the studies individually. It might even fit on a single page. Author response (p10, line 231): A bar chart providing a summary of the subthemes and the corresponding number of studies has been provided (refer to Fig 2. Summary of themes, sub-themes and the number of reviewed studies). • Should this table be linked from the last para on p.46 (line 455), instead of Table 3? I would recommend it is linked from the Results section, and not first introduced in the Discussion section. Author response: This has been revised accordingly. A summary of sub-themes with frequency and effect sizes has been provided as supplementary information (refer to Appendix S4. Summary of sub-themes with frequency and intensity effect sizes). Discussion • Should this reference to Table 4 actually be a reference to Table 3? (p47, line 465) Author response: Thank you for pointing this out. This has been rectified. • The summary of the results in the Discussion could be more brief – it’s currently almost as long as the Results section (9 pages compared to 10). If there are details here that are important to interpreting the results, could they be included in the Results section? This would then allow the Discussion to be more of a brief overview of main findings, rather than repeating so much detail that might overwhelm readers. This would also make space to include some more discussion of your findings overall. Author response (p50-58, line 508-681): The discussion section has been revised accordingly by discussing the key findings to make it brief and concise. • The Discussion could also include some mention of the strengths and limitations of the review design (e.g. those mentioned in the Risk of bias across studies section). Author response (p57-58, line 673-681): A discussion of the study limitations has been provided. • Will some recommendations be easier/harder to implement (e.g. some requiring significant additional resources which may not be available, others involving organisational change that’s more achievable?) Author response (p58-59, line 701-705): Thank you for this suggestion. We have explained this aspect of implementation of the recommendations in the manuscript. • Who is this data for? Who can or should act on it? Author response (p59, line 707-710): This has been described in the conclusion section of the manuscript. Conclusion • You noted in the Conclusions that you felt there was not much evidence in NTDs – this is not discussed anywhere else in the review – either in the Results or the Discussion. If this is an interesting and important feature of the evidence, could you discuss it earlier? Are there other aspects of the included studies that would be worth discussing as well? Author response (p9-10, line 210-213; p56, line 634-641): We observed that diseases classified by WHO as neglected tropical diseases (NTDs) were hardly mentioned as “case diseases” in the reviewed surveillance assessment studies compared to other notifiable conditions. This outcome informed the need for further surveillance assessments considering these conditions as target diseases. Focus was especially on NTDs since they are listed by most African countries as diseases targeted for elimination or of public health importance within the integrated disease surveillance and response systems. Reviewer #2: This manuscript presents an important and timely review of assessments of disease surveillance in Africa. It is well written and very comprehensive. The authors conducted a comprehensive systematic review and conformed to PRISMA guidelines. A large number of initial papers were screened, though only 27 were included. Author response: Thank you for the remarks. Major revision: As a consequence of the authors' comprehensiveness, the manuscript tends to be wordy and overly narrative, rather than providing a concise analysis of the included studies and themes. I found myself wanting a concise table of themes, countries, etc. Instead, even the tables are overwhelming in content, and more of appendix tables than main text tables. Because of all of this, I think the reader would be aided by adding a "Main Finding" or "Key Themes" or something table/box. Author response: In line with the suggestion by the reviewer, a table with the key themes and sub-themes has been included to summarise the findings (refer to Appendix S3. Surveillance system functions & Fig 2. Summary of themes, sub-themes and the number of reviewed studies). Table contents have been revised (refer to Table 1. Literature summary and quality appraisal) and the table summarising sub-themes frequency and intensity effect sizes has been moved from the main manuscript and included as supplementary information (refer to Appendix S4. Summary of sub-themes with frequency and intensity effect sizes). In the results section, I struggled with the narrative text. Readers would be much better served by concise reporting of thematic findings with some quantification. There was almost no quantification throughout. Results such as "Ten of the 27 studies indicated challenges with lack of training...". Author response (p39-50, line 247-508): Thank you for this suggestion. The results section has been revised to quantify the findings as suggested. Minor revisions: Please remove all of the uncommon abbreviations (HW, HP, HF,...). Author response: This has been revised accordingly. https://doi.org/10.1371/journal.pone.0248998.r002
14 Dec 2020 Decision Letter - Hong-Liang Zhang, Editor PONE-D-19-27712R1 A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: a health workers' perspective PLOS ONE Dear Dr. Ngetich, 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 Jan 28 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, Hong-Liang Zhang, M.D., Ph.D. 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 #3: (No Response) ******** 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 Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: N/A ****** 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 #3: 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 #3: 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 #1: All comments have been addressed. My one remaining suggestion is that direct links to the Appendices be included in the relevant sections of the text, to assist readers in finding them. Reviewer #3: This manuscript emphasized the current disease surveillance in Africa based on the revised IDSR and the methodologies to optimize the system and organizational issues for caregivers and health workers. Authors concluded the implementation of revised IDSR including reporting, feedback, training, supervision, timeliness, and completeness in African regions should be strengthened via optimized strategies and may need further policy reinforcement. The manuscript has been critically revised in the previous revision. I only have a few suggestions for this Ms as following. 1.The tables are still lengthy for readers. I would suggest the authors further simplify the study aims and key findings for the included researches in Table 1. Meanwhile, I would suggest deleting the Article title in column Table 2, which is redundant with the citations. 2.Reference format should be carefully checked by authors. The current reference list is not consistent. 3.It’s difficult to read the words in Figures. Authors may want to increase the font and clarity. 4.Authors also need to cite the supplementary tables and figures at the appropriate locations in the manuscript. 5.I would authors concise the discussion and conclusion part, the current version is still too wordy. ****** 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:** Miranda Cumpston Reviewer #3: 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.0248998.r003
Revision 2
19 Dec 2020 Author Response Dear Academic Editor, Thank you for giving us the opportunity to re-submit a revised version of the manuscript titled “A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: a health workers' perspective” for publication consideration in PLOS One journal. We appreciate the time and effort dedicated by the reviewers to provide insightful feedback on the revised manuscript. We have revised the manuscript considering reviewers’ comments and the provided suggestions. Please find below a point-by-point response to the reviewers’ comments. All page and line numbers cited herein refer to the revised manuscript (without track changes). Reviewer #1: All comments have been addressed. My one remaining suggestion is that direct links to the Appendices be included in the relevant sections of the text, to assist readers in finding them. Author response (p6, line 123 & 135; p7, line 148, 152, 155 & 160; p8, line 173; p41, line 514): The manuscript has been revised as suggested by providing relevant links to all supplementary files and tables in the relevant sections within the text. Reviewer #2: This manuscript emphasized the current disease surveillance in Africa based on the revised IDSR and the methodologies to optimize the system and organizational issues for caregivers and health workers. Authors concluded the implementation of revised IDSR including reporting, feedback, training, supervision, timeliness, and completeness in African regions should be strengthened via optimized strategies and may need further policy reinforcement. The manuscript has been critically revised in the previous revision. I only have a few suggestions for this Ms as following. 1. The tables are still lengthy for readers. I would suggest the authors further simplify the study aims and key findings for the included researches in Table 1. Meanwhile, I would suggest deleting the Article title in column Table 2, which is redundant with the citations. Author response (p12, line 241 & p21, line 251): Table 1 has been revised by providing a brief summary of the study aims and key findings retrieved from the reviewed studies. In addition, the column “Article title” in Table 2 has been deleted as suggested. 2. Reference format should be carefully checked by authors. The current reference list is not consistent. Author response (p49, line 685): All references have been updated accordingly to ensure consistency. 3. It’s difficult to read the words in Figures. Authors may want to increase the font and clarity. Author response (p9, line 202 & p10, line 233): The font size for labels and words contained in all figures have been increased to ensure clarity. 4. Authors also need to cite the supplementary tables and figures at the appropriate locations in the manuscript. Author response (p6, line 123 & 135; p7, line 148, 152, 155 & 160; p8, line 173; p41, line 514): The manuscript has been revised as suggested by citing all supplementary files and tables in the appropriate sections within the text. 5. I would authors concise the discussion and conclusion part, the current version is still too wordy. Author response (p41-47, line 515-665): The discussion section has been revised accordingly by only discussing the key findings. Similarly, the manuscript conclusion has been revised as suggested. https://doi.org/10.1371/journal.pone.0248998.r004
23 Feb 2021 Decision Letter - Hong-Liang Zhang, Editor PONE-D-19-27712R2 A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: a health workers' perspective PLOS ONE Dear Dr. Ngetich, 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 Apr 09 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, Hong-Liang Zhang, M.D., Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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 #3: All comments have been addressed Reviewer #4: (No Response) ******** 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 #3: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: Yes Reviewer #4: 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 #3: Yes Reviewer #4: 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 #3: Yes Reviewer #4: 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 #3: (No Response) Reviewer #4: According to previous reviewers' comments and authors' answers, the manuscript has been critically revised. However, authors should further concise the Table 1 and the conclusion part. In the next round of review, authors should submit a clear vision of manuscript without changing traces. ****** 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 #3: No Reviewer #4: 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.0248998.r005
Revision 3
25 Feb 2021 Author Response Response to academic editor and reviewer comments Manuscript PONE-D-19-27712R2 Title: A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: a health workers' perspective” Authors: Arthur Kipkemoi Saitabau Ng'etich (arthursaitabau@yahoo.com) Kuku Voyi (kuku.voyi@up.ac.za) Ruth Kirinyet (kirinyet.ruth@ku.ac.ke) Clifford Maina Mutero (cmutero@icipe.org) Dear Editor, Thank you for giving us the opportunity to re-submit a revised version of our manuscript for publication consideration in PLOS One journal. We appreciate the time and effort dedicated by the academic editor and reviewers to provide insightful feedback on the revised manuscript. We have revised the manuscript considering all the comments provided. Please find below a point-by-point response to the comments. All page and line numbers cited herein refer to the revised manuscript (without track changes). Academic Editor: Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Author response: The reference list has been reviewed to ensure all references are complete and correct. However, two references (refer below) in the previous manuscript were replaced with a relevant and updated reference (References, line 879-881, page 54). We further checked all references and can confirm to the best of our knowledge that none of the articles cited were retracted. -Franco LM, Fields R, Mmbuji PK, Posner S, Mboera LE. Situation analysis of infectious disease surveillance in two districts in Tanzania 2002. Working Paper; 2003. -Pond B, El Sakka H, Wamala J, Lukwago L. Mid-term evaluation of the integrated disease surveillance and response project. Washington, DC: USAID. 2011. Reviewers’ comments: 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 #3: All comments have been addressed Reviewer #4: (No Response) Author: No Response 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 #3: Yes Reviewer #4: Yes Author: No Response 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: Yes Reviewer #4: Yes Author: No Response 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 #3: Yes Reviewer #4: Yes Author: No Response 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 #3: Yes Reviewer #4: No Author response: The manuscript has been be revised accordingly by checking and correcting all typographical and grammatical errors. 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 #3: (No Response) Reviewer #4: According to previous reviewers' comments and authors' answers, the manuscript has been critically revised. However, authors should further concise the Table 1 and the conclusion part. In the next round of review, authors should submit a clear vision of manuscript without changing traces. Author response: Table 1 and the conclusion section have been revised as suggested by the reviewer. The final version of the revised manuscript is without any track changes. All authors reviewed the final version of the revised manuscript and ensured it adheres to all editorial requirements. We hope that our response to the comments provided render the revised manuscript suitable for publication in PLOS One journal. Yours Sincerely, Arthur Kipkemoi Saitabau Ng’etich (Corresponding author) Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0248998.r006
10 Mar 2021 Decision Letter - Hong-Liang Zhang, Editor A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: a health workers' perspective PONE-D-19-27712R3 Dear Dr. Ngetich, 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, Hong-Liang Zhang, M.D., Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0248998.r007
Formally Accepted
11 Mar 2021 Acceptance Letter - Hong-Liang Zhang, Editor PONE-D-19-27712R3 A systematic review on improving implementation of the revitalised integrated disease surveillance and response system in the African region: a health workers' perspective Dear Dr. Ngetich: 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. Hong-Liang Zhang Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0248998.r008

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