Impact of Covid-19 pandemic on obstetric fistula repair program in Zimbabwe

Chipo Chimamise; Stephen Peter Munjanja; Mazvita Machinga; Iris Shiripinda

doi:10.1371/journal.pone.0249398

Peer Review History

Original SubmissionFebruary 27, 2021
11 Mar 2021 Decision Letter - Godfrey Nyangadzayi Musuka, Editor PONE-D-21-05832 Impact of Covid-19 pandemic on obstetric fistula repair programming and characteristics of Obstetric fistula repair camp attendees at Mashoko Christian Hospital in Zimbabwe PLOS ONE Dear Chipo 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 25 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. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a very good manuscript that attempts to describe the impact of the COVID-19 pandemic on obstetric fistula repair in Zimbabwe. Obstetric fistulae remain a significant challenge in Zimbabwe and attempts to repair them are commendable. This is a technically sound, original manuscript, which has a significant contribution to the literature regarding the impacts of the COVID-19 pandemic on public health services delivery in a resource-limited setting. This study is worthy publishing; however, the author must correct the many grammatical errors noted in the manuscript, which are highlighted on the attachment. Reviewer #2: The manuscript is a relevant piece of academic writing, however the statistical analysis is too simplistic as the authors chose to limit themselves to univariate analysis. Beyond the reasons provided by the clients one might want to know whether there were any factors associated with a no show for fistulae repair(only 1/3 came)? Is it possible that clients with certain characteristics were more likely not to show up for repair than others? These questions would give insights into issues of equity which are relevant for such a program undertaking. Such questions would have been answered through multivariate analysis and a sample size of 90 must be powered enough to give insight. Given that a complete dataset is available I suggest that the authors consider adding a more detailed statistical analysis beyond the descriptives they shared ****** 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: Grant Murewanhema Reviewer #2: Yes:** Brian Kumbirai Moyo [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-21-05832_reviewer(1).pdf https://doi.org/10.1371/journal.pone.0249398.r001
Revision 1
16 Mar 2021 Author Response • 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. Reference list reviewed, the reference which was not complete was corrected ie ref 13. Abokaiagana A. Experiences of women with Obstetric fistula in the Bawku East District of the Upper East Region, Ghana [Internet]. University of Ghana; 2010 [cited 2021 Jan 18]. Available from: http://ugspace.ug.edu.gh. It was originally cited as: 8. Abokaiagana A. Experiences of women with Obstetric fistula in the Bawku East District of the Upper East Region. :155. • Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Figure file naming was corrected. Fig 1was renamed Fig 1.tif, Fig 2 was renamed Fig 2.tif, Fig 3 was renamed Fig 3.tf and Figure 4 was renamed Fig 4.tif • Please address all comments from reviewers This was done • Please beef up the section on weaknesses of the study This was attended to: Study limitations Data collection was mainly records review and telephone conversations, this approach poses restrictions on collecting the finer details on information obtained as compared to face-to-face interviews. Also, a larger sample size would have provided more confidence in obtained results. • Please include a section on recommendations to programmers and policymakers This was addressed: Recommendations to programmers and policy makers Basing on the findings of this study, it is recommended to the Ministry of Health and Child Care to scale up and intensify fistula case finding in communities and link them to treatment services so as to end or minimize suffering of women and girls. There is need to increase treatment centers so that patients will not need to travel long distances to access services, this need has been highlighted by the Covid-19 lockdown. It is also recommended to scale up the community obstetric fistula surveillance system making use of community based workers and other personnel to actively search for fistula cases in the community. The use of mobile communications through phone calls or social network platforms is recommended to sustain screening and identification of women living with fistula so as to have them repaired as soon as possible after the Covid-19 pandemic or when the situation allows. The program needs to be expanded to establish fistula repair centers in other provinces for equity and accessibility even in times like the Covid-19 pandemic lockdown. • Reviewer #1: This is a very good manuscript that attempts to describe the impact of the COVID-19 pandemic on obstetric fistula repair in Zimbabwe. Obstetric fistulae remain a significant challenge in Zimbabwe and attempts to repair them are commendable. This is a technically sound, original manuscript, which has a significant contribution to the literature regarding the impacts of the COVID-19 pandemic on public health services delivery in a resource-limited setting. This study is worthy publishing; however, the author must correct the many grammatical errors noted in the manuscript, which are highlighted on the attachment. This was attended to as highlighted in the copy with track changes • Reviewer #2: The manuscript is a relevant piece of academic writing, however the statistical analysis is too simplistic as the authors chose to limit themselves to univariate analysis. Beyond the reasons provided by the clients one might want to know whether there were any factors associated with a no show for fistulae repair(only 1/3 came)? Is it possible that clients with certain characteristics were more likely not to show up for repair than others? These questions would give insights into issues of equity which are relevant for such a program undertaking. Such questions would have been answered through multivariate analysis and a sample size of 90 must be powered enough to give insight. Given that a complete dataset is available I suggest that the authors consider adding a more detailed statistical analysis beyond the descriptives they shared Attended to. Authors went further to perform bivariate analysis (only one factor was statistically significant) and discussed the findings in the discussion section and cascaded it to recommendations. In results: Likelihood of attending the camp by province of origin At 95% confidence level, participants from Manicaland and Masvingo provinces were about 11 times more likely to reach the repair center than those coming from other provinces (OR 11.5; CI 3.7-35.3) and this difference was statistically significant (p<0.001), (Masvingo and Manicaland were put together because although Mashoko Hospital is in Masvingo, it is at the far border separating the two provinces). Likelihood of attending the camp by age group Adolescent and young participants (below age 25 years) were 0.3 times more likely to attend the camp than those 25years and older (OR1.3; CI 0.53-3.32) but this was not statistically significant (p=0.54). Similar results were observed for period living with fistula and the likelihood of attending the camp where the OR was 1.06, CI 0.48-4.7, p = 0.8. In discussion: Proximity to the fistula repair center was the main determinant for whether the participants would reach the center or not. This may be so due to the number of law enforcement agents checkpoints participants had to pass on their way to hospital. Distance to health facilities which offer services was also noted by the World Health Organization to affect uptake of services [15]. This was made more evident by the Covid-19 pandemic lockdown restrictions. In recommendations: The program needs to be expanded to establish fistula repair centers in other provinces for equity and accessibility even in times like the Covid-19 pandemic lockdown. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0249398.r002
18 Mar 2021 Decision Letter - Godfrey Nyangadzayi Musuka, Editor Impact of Covid-19 pandemic on obstetric fistula repair program in Zimbabwe PONE-D-21-05832R1 Dear Dr. CHIMAMISE, 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, Godfrey Nyangadzayi Musuka Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0249398.r003
Formally Accepted
23 Mar 2021 Acceptance Letter - Godfrey Nyangadzayi Musuka, Editor PONE-D-21-05832R1 Impact of Covid-19 pandemic on obstetric fistula repair program in Zimbabwe Dear Dr. Chimamise: 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. Godfrey Nyangadzayi Musuka Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0249398.r004

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