Determinants of pregnancy-induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case-control study

Getachew Ossabo Babore; Tsegaye Gebre Aregago; Tadesse Lelago Ermolo; Mangistu Handiso Nunemo; Teshome Tesfaye Habebo

doi:10.1371/journal.pone.0250548

Peer Review History

Original SubmissionMay 1, 2020
26 May 2020 Decision Letter - Frank T. Spradley, Editor PONE-D-20-09595 Determinants of pregnancy induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case-control study. PLOS ONE Dear Dr. Babore, 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. SPECIFIC ACADEMIC EDITOR COMMENTS: An expert reviewer in the field handled your manuscript. Although interest was found in your study, several major comments arose during review that require your attention. These comments include, but are not limited to, the necessity to improve the readability of your manuscript and the conclusions need to be better supported by the major results of this study. Please submit your revised manuscript by Jul 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, Frank T. Spradley 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. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ 3. Please amend either the abstract on the online submission form (via Edit Submission) or the abstract in the manuscript so that they are identical. 4. Please upload a copy of Figures 1 and 2, to which you refer in your text. If the figures are no longer to be included as part of the submission please remove all reference to them within the text. 5. Please include a copy of Tables 1 to 5 which you refer to in your text. 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ****** 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 ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The paper entitled “Determinants of pregnancy induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case controlstudy,” is reporting on a case control study undertaken in Hossana town administration, Hadiya zone, Southern Ethiopia, to determine maternal and fetal outcomes of pregnancy induced hypertension. It is commendable that the authors are researching how to improve care for women and their babies during pregnancy in a low-income country with limited resources. I congratulate them on conducting a case control study under these circumstances. The finding that women with ≥3 pregnancies, previous history of pregnancy-induced hypertension, and informal educational status were associated with pregnancy-induced hypertension adds to knowledge in this area and may support early diagnosis and improve management and pregnancy outcomes. These findings offer local evidence on which to base future public health interventions in this population and may have important implications for future research and practice. However, the paper requires modifications before it is ready for publication. Major: 1. The abstract conclusion and the paper conclusion are not consistent with the reported results. The results report that having a previous history of pregnancy-induced hypertension is associated with increased odds of pregnancy-induced hypertension in the pregnant women in this study, and having ≥3 previous pregnancies, and no formal education, is associated with reduced odds of pregnancy-induced hypertension. However, the abstract conclusion and paper conclusion report that ‘women with multigravida, previous history of PIH and with informal educational status were prone to develop pregnancy-induced hypertension.’ Please modify the abstract conclusion and paper conclusion so that they accurately reflect the results. 2. The background and discussion contain considerable detail about other studies, which is most interesting. However, the readability of the paper would be improved if the background and discussion were restructured, so that the focus is on information that is directly related to the objectives and findings of this study. In addition, some comparisons made with other studies would benefit from rechecking to ensure that the comparisons reported in this paper are accurate. Minor: 3. The authors may wish to consider having the paper professionally edited for English language to assist understanding. 4. The background reports ‘Pregnancy induced hypertension also known as Preeclampsia…’ Please revise this definition, so that the reader understands that while pregnancy-induced hypertension may lead to preeclampsia, they are not the same condition. 5. When reporting the results of the multivariable analysis (which are odds ratios) in the text, please consider describing the association of the assessed factors as ‘increased odds of pregnancy-induced hypertension’ or ‘decreased odds,’ rather than ‘likelihood’ or ‘prone to.’ 6. Where percentages have been provided in the text, please also report the numbers to support the readers understanding. 7. Please provide abbreviations in full the first time they are reported. 8. The authors may wish to consider combining some of the result tables and adding a column for the univariable odds ratios for all factors in Table 2 to support understanding. The addition of text below the tables to explain abbreviations in the tables would also be helpful. 9. Please consider providing a copy of the data collection tool (the structured and pretested questionnaire) as an attachment, as this would assist understanding of the work that has been undertaken for this study and would be of considerable interest to readers. Thank you for the opportunity to review this most interesting and important case control study that is researching the determinants of pregnancy-induced hypertension in order to improve care for women and their babies in Ethiopia. I believe that after some modifications, this paper will provide valuable local evidence on which to base future public health interventions in this population. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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.0250548.r001
Revision 1
22 Sep 2020 Author Response All authors of this manuscript read and took any effort to revise the whole manuscript based on the comment given by peer review. For all forwarded minor and major comments authors gave response as follows. 1. We assure you that all components (manuscript, tables, figures, abstract and abbreviations) of this article was prepared based on the PLOS ONE guide line. 2. My ORCID is 0000-0002-7214-4025 3. Abstract in the manuscript and online submission in-terms of character and contents were revised and identical. 4. For all listed figure (figure_1 & Figure_2) in the main part of the manuscript their copies uploaded separately. 5. Copy of tables (table 1-5), which referred in the text were uploaded immediately next to the each paragraph in the manuscript. Reviewer #1: The finding of this study revealed that women with previous history of pregnancy induced hypertension more likely to develop pregnancy induced hypertension on current conception whereas women with > 3 number of pregnancies and informal education status were decreased odds of pregnancy induced hypertension. Thus, research team/authors recommend that concern bodies should have facilitate basic setups to make conducive environment (women waiting village, in-service training, and tax free transportation) for better management of the cases where as health care providers should have increased early diagnosis and on time intervention rather than managing complication. Therefore, our paper conclusion part is modified as like aforementioned. Major comment 1. Conclusion in abstract and paper regarding factors revised based on the finding of the multivariate logistic regression. Variables description: women with previous history of pregnancy induced hypertension increased odds of developing PIH in current conception whereas number of pregnancies > 3 and women having informal education status are 67.7%, 68.4% less likely to develop pregnancy induced hypertension/PIH respectively, this implies they associated with reduced odds of developing PIH. From the point of epidemiology, if the odd ratio/OR < 1 a factor has protective effect of likelihood occurrence of event. Therefore, both number of pregnancies > 3 and women having informal education status reduced odds of developing pregnancy induced hypertension/PIH. 2. In fact, background of this manuscript contains detail about others studies, but for seek of readers better understanding and readability background of the manuscript was revised based on the stated objectives and its finding. As you have reviewed the back ground of the manuscript contained detail about the previously studied articles, but the revised background contain about Pregnancy induced hypertension of preeclampsia and eclampsia and maternal and foetal outcomes in details. Moreover, discussion part also restructured through focusing on Objectives (predictors of PIH and foeto-maternal outcomes) and for more understanding almost all comparison was made with case control studies. We assure you that all comparison made based on the reference which in-line with our study. For further accuracy and consistent you can crosscheck according to the cited reference. Minor comment 3. The manuscript for better readability and understanding edited by English language professionals who is PhD candidate in Addis Ababa University, Ethiopia. If you have further enquires you can communicate through this address. Email negatuhabitamu@gmail.com cell phone +251912191000. 4. Pregnancy induced hypertension and preeclampsia differ according to the ‘operational definition given in this manuscript. In-addition, Pregnancy induced hypertension is a broad definition and according to the latest American college of obstetrics and gynaecologist preeclampsia is one category of Pregnancy Induced hypertension/PIH. In-fact, Preeclampsia may lead to ecalmpsia but not Pregnancy induced hypertension lead to preeclampsia. A woman diagnosed with preeclampsia who experienced with convulsion with or without coma can be diagnosed as eclampsia. 5. Words ‘likelihood’, ‘prone’ used to describe finding of the multivariate analysis are revised according the given comment. In main manuscript multivariable analysis finding (Odds ratio) revised as previous history of pregnancy induced hypertension is increases odds of developing PIH in current conception whereas informal educational status decrease odds of PIH or less likely develop pregnancy induced hypertension. 6. For all reported percentages in the text cross-ponding ‘numbers’ also added. For further confirmation you can check highlighted text under revised manuscript. 7. Standard Abbreviation appears first in text fully described and appears in text less than three times were excluded. 8. As our understanding if we combine any one of the table; readers may be confused because their descriptions and contents are different. For those abbreviations in the table which are not described under abbreviation explanations in text are given the tables. 9. All structured and pretested questionnaires are uploaded as supporting document. Attachments Attachment Submitted filename: Response to reviewer .docx https://doi.org/10.1371/journal.pone.0250548.r002
14 Oct 2020 Decision Letter - Frank T. Spradley, Editor PONE-D-20-09595R1 Determinants of pregnancy induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case-control study. PLOS ONE Dear Dr. Babore, 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. There are still revisions that need to be addressed by the authors. You must respond all of the reviewer's comments in your revised manuscript. Please submit your revised manuscript by Nov 28 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, Frank T. Spradley Academic Editor PLOS ONE 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) ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 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: 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: The revised paper entitled “Determinants of pregnancy induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case control study,” is reporting on a case control study undertaken in Hossana town administration, Hadiya zone, Southern Ethiopia, to determine maternal and fetal outcomes of pregnancy induced hypertension. Thank you for the opportunity to review this interesting and important case control study that is researching the determinants of pregnancy-induced hypertension in order to improve care for women and their babies in Hadiya zone, Southern Ethiopia. The work by the authors to revise the manuscript based on previous feedback is appreciated, however, further changes are required before the paper is ready for publication. Following changes, this paper will provide valuable local evidence on which to base future public health interventions in this population. Major: 1. The authors have had the manuscript edited for readability and understanding for English language from a professional who is PhD candidate in Addis Ababa University, Ethiopia. However, it is essential that the authors have the paper edited again for English language by a person who is skilled in this area. English spelling and language improvements are necessary throughout every section of the paper, so that the information is clear and understandable and the data is not misinterpreted by the reader. Minor: To assist with the recommended changes to the paper, the authors may find previously published papers in their reference list, on the same topic of hypertension in Ethiopia, are a helpful guide. Introduction: • This section would benefit from being shorter and clearer. English spelling and language improvements may assist with this. • The information provided on hypertension, pre-eclampsia and eclampsia is important as background to the paper, however, the way it is currently written is confusing to the reader. Please revise so that the reader is clear about the definition of pregnancy induced hypertension and how it relates to pre-eclampsia and eclampsia, and maternal and fetal outcomes. Some papers in your reference list may be helpful with this, e.g. Berhe, A.K., Kassa, G.M., Fekadu, G.A. et al. Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC Pregnancy Childbirth 18, 34 (2018). https://doi.org/10.1186/s12884-018-1667-7. Results: • Please note that this reviewer is not an expert on statistical analysis, therefore is unable to comment on the sample size and process of analysis. • Table 4 and Table 5, please change the ORs, CIs, and p=values in the tables from 3 decimal places to 2 decimal places (e.g. Table 4, Maternal complication, please change to OR 2.83, 95% C 1.30, 6.15, P 0.01). • Table 5, “Number of pregnancy/gravid” requires “>3 times” to be changed to ≥ 3 times. • While Table 5 shows that having ≥3 previous pregnancies is associated with reduced odds of pregnancy-induced hypertension, the text reports that ‘Number of pregnancy women with three and above pregnancies increased odds of pregnancy induced hypertension with AOR=0.32 [95% CI (0.121, 0.864)] than two and below.” Please change the text so that it matches the data in the table. Discussion: • It is recommended that the first paragraph of the discussion describes if the objectives of the paper have been met. • Comparisons made with findings from other studies are useful, but not always understandable, and would benefit from English language improvements to improve reader understanding. Conclusion: This conclusion is unclear. English language improvements would help to ensure that the study findings are not misinterpreted by the reader. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0250548.r003
Revision 2
27 Nov 2020 Author Response All authors of this manuscript read and took any effort to revise the whole manuscript based on the comment given by the reviewer. All authors try to incorporate the given comment in the entire manuscript. For all forwarded minor and major comments authors gave response as follows. All authors rigorously tried to address all points answered by reviewer, which stated from 1-7. Then major improvements were made from abstract to recommendation. Reviewer #1: Major In addition to previous edition made by English language professional who is PhD candidate in Addis Ababa University, Ethiopia, in this round additional edition to improve readability and understanding made by Dr. Feleke Doyore (PhD, health promotion and communication) Who is lecturer in Wachemo University) and English language professional Mr Yirga H. (BA, MA) currently, who is teaching in Bobicho preparatory school, Hossan, Ethiopia. Minor Regarding Pregnancy Induced Hypertension, Pre-eclampis and eclampsia; to improve readability and understanding for the reader, detail definition written in the background part (from line number 85-94). In addition to this, for further understanding detail definition is also described in the operational definition part (line number 324-332). The relation between pregnancy induced hypertension with preeclampsia and eclampsia is one is the inclusive the other; when a women diagnosed for eclampsia also fulfil diagnosis criteria of preeclampsia as well women diagnosed for preeclampsia fulfil diagnosis criteria of pregnancy induced hypertension. Therefore, eclampsis = definition of Preeclampsia + occurrence of convulsion or coma + >+2 proteinuria whereas preeclampsia = definition of pregnancy Induced hypertension + presence of proteinuria in dipstick test with or without oedema. The effect of the pre-eclampsia and eclampsia on the maternal and foetal health explained in detail in the background part (from line number 132-153), which reflect the related outcomes of preeclampsia and eclampsia. Sample size calculation was performed by using statistical software EPI-Info V 7 for window considering all statistical assumptions and others those needed to estimate sample size. Thus, software sample size estimation is more recommendable and it gives large sample size than manual calculation. All figures of the ORs, CIs and P values in the tables 4 and 5 are changed to the 2 decimal places from 3 decimal places. Table 5 finding and text report regarding having >3 previous pregnancies and its odds ratio edited as ‘’ decrease odds of pregnancy induced hypertension.’’ Discussion Discussion based on the objective of the study revised rigorously. It is the fact that, the first objective of this study is to measure the outcomes of the pregnancy induced hypertension among cases and controls group. Hence, the outcomes of pregnancy induced hypertension on maternal and foetal health explained in detail and based on the multivariate analysis predictors of pregnancy induced hypertension discussed one by one. Conclusion To improve understanding and readability for the readers, major amendment undertaken in conclusion part based on the objective of the study and finding of multivariate analysis. Attachments Attachment Submitted filename: Response to reviewres.doc https://doi.org/10.1371/journal.pone.0250548.r004
6 Jan 2021 Decision Letter - Frank T. Spradley, Editor PONE-D-20-09595R2 Determinants of pregnancy induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case-control study. PLOS ONE Dear Dr. Babore, 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. ACADEMIC EDITOR: The reviewer and I still have major issues with the readability of this manuscript. The reviewer has kindly offered suggestions to improve this issue. However, it is requested that the authors contact a copyeditor to help with improvement and proof of English grammar and syntax. Failure to do so will prohibit acceptance of this manuscript. Please provide a markup of changes within your revised manuscript. Please submit your revised manuscript by Feb 20 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, Frank T. Spradley Academic Editor PLOS ONE 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) ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 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: 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: The third draft of the revised paper entitled “Determinants of pregnancy-induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case control study,” is reporting on a case control study undertaken in Hossana town administration, Hadiya zone, Southern Ethiopia, to determine maternal and foetal outcomes of pregnancy-induced hypertension. The work by the authors to revise the manuscript based on previous feedback is appreciated. However, despite the authors’ revisions, the paper is still not presented in an intelligible fashion. To be clear, there are English language corrections required in every section (abstract, introduction, methods and material, result, discussion and conclusion), every sub-section, every paragraph, and every sentence in this paper. In addition, the paper is still too long, with unnecessary repetition, and many sentences still do not make sense. The definition of pregnancy-induced hypertension and how it is related to pre-eclampsia and eclampsia must be revised and clarified. Spelling corrections required throughout the paper include, but are not limited to: - Please correct the spelling of the word ‘sever’ to ‘severe’ (note that several corrections are required). - Please correct the spelling of the word ‘per-eclampsia’ and ‘preeclampsia’ to ‘pre-eclampsia’ (note that several corrections are required). - Please correct the spelling of the abbreviation ‘HEELP’ to ‘HELLP’ (note that several corrections are required). - Please correct the spelling of the word ‘pregnancy induced hypertension’ and ‘pregnancy-induced hypertension (note that several corrections are required). - Please correct the spelling of the word ‘case-control’ to ‘case control’ (note that several corrections are required). - Please correct the spelling of ‘dipstic’ to ‘dipstick’. - Please correct the spelling of ‘Intra uterine growth retardation’ to ‘Intra uterine growth restriction’ (note that several corrections are required, although following the first use of IUGR abbreviation in the introduction, they can be abbreviated to IUGR). - Please remove unnecessary capital letters in the middle of sentences (note that several corrections are required). Abbreviation corrections required include, but are not limited to: - Introduction, paragraph three, first sentence: This is the first time the words ‘pregnancy-induced hypertension’ appear in the main body of the paper. Please add the abbreviation PIH here. That is, the sentence should say, ‘Studies suggested that either pre-existing pregnancy-induced hypertension (PIH) or pregnancy changes could be responsible for preeclampsia occurrence.’ - Introduction, paragraph seven, second sentence: This is the first time the abbreviation ‘HDP’ appears in the main body of the paper. It should appear the first time the words ‘hypertensive disorders of pregnancy’ appear in the main body of the paper (which is in the first paragraph of the introduction). - Introduction, paragraph eleven, second sentence: This is the first time the abbreviation ‘HEELP’ (which must be corrected to HELLP) appears in the main body of the paper. Please add the definition here. That is, the sentence should include that HELLP syndrome includes Haemolysis, Elevated Liver enzymes, and Low Platelets. In summary, there are English language corrections required in every section (abstract, introduction, methods and material, result, discussion and conclusion), every sub-section, every paragraph, and every sentence in this paper. Until these English language corrections are made, the paper is shorter, and the sentences make sense, I cannot recommend this paper for publication. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0250548.r005
Revision 3
2 Apr 2021 Author Response Response to reviewers Under the guidance of corresponding authors, all authors read for long period and they brought the revised manuscript to the table and revision was made together. The whole manuscript revised based on the comment given by the reviewer though using copyedit and others language academicians. For all forwarded major and minor comments authors gave response as follows. All authors rigorously tried to address all points answered by reviewer, which stated from 1-6. Then major improvements were made from abstract to recommendation according the points raised by reviewers. Reviewer #1: In addition to previous edition made by English language professional who is instructor at Bobicho high school, Hossana, Ethiopia, Mr Yirga H. (BA, MA) in this round additional edition in every section (abstract to Conclusion) to improve readability and understanding made by Amanuel Tirkaso (MA, PhD candidate) Who is lecturer at English department, college of social science, Wachemo University, Hossan In order to avoid unnecessary repetition, exhaustive reading and formatting few lines were undertaken. To minimize paper length, total words in main body of the manuscript (introduction to conclusion) reduced from 5674 to 5,222 words. Regarding Pregnancy Induced Hypertension, Pre-eclampis and eclampsia definition and relation; to improve readability and understanding for the reader, detail definition written in the background part (from line number 83-89). In addition to this, for further understanding detail definition is also described in the operational definition part (line number 289--298). The relation between pregnancy induced hypertension with preeclampsia and eclampsia is one is the inclusive the other; a woman diagnosed for pre-eclampsia characterised with elevated blood pressure (SBP > 140 & DBP > 90mmHg) without presence of proteinuria which developed after 20 weeks of gestation. Preeclampsia: two reading of SBP > 140 mmHg & DBP > 90mmHg 4-6 hours apart after twenty weeks of gestation with proteinuria 2+ or more whereas eclampsia is women with signs and symptoms of preeclampsia plus convulsion with or without coma. Oligohdrouia or anuria is present. Therefore, eclampsis = definition of preeclampsia + occurrence of convulsion or coma + >+2 proteinuria whereas preeclampsia = definition of pregnancy-induced hypertension + presence of proteinuria in dipstick test with or without oedema. All miss spelt words edited appropriately. Abbreviation correction in case of first appearance revised through out of the main body of the manuscript. Regarding Intra uterine growth retardation/IUGR the right word is retardation but not restriction. Discussion Discussion based on the stated objective of the study revised rigorously. More focuses of the discussion done considering studies done using case control design. Hence, the outcomes of pregnancy induced hypertension on maternal and foetal health explained in detail and based on the multivariate analysis predictors of pregnancy induced hypertension discussed one by one. Conclusion Based on the objective of the study, conclusion focus adverse outcomes of PIH on maternal and foetal health and multivariate analysis findings. Attachments Attachment Submitted filename: Response to reviewres.doc https://doi.org/10.1371/journal.pone.0250548.r006
12 Apr 2021 Decision Letter - Frank T. Spradley, Editor Determinants of pregnancy induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case-control study. PONE-D-20-09595R3 Dear Dr. Babore, 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, Frank T. Spradley Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0250548.r007
Formally Accepted
20 Apr 2021 Acceptance Letter - Frank T. Spradley, Editor PONE-D-20-09595R3 Determinants of pregnancy induced hypertension on maternal and foetal outcomes in Hossana town administration, Hadiya zone, Southern Ethiopia: Unmatched case-control study. Dear Dr. Babore: 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. Frank T. Spradley Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0250548.r008

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