Knowledge, attitude, and practice on antibiotic use and antibiotic resistance among the veterinarians and para-veterinarians in Bhutan

Karma Wangmo; Thinley Dorji; Narayan Pokhrel; Tshering Dorji; Jambay Dorji; Tenzin Tenzin

doi:10.1371/journal.pone.0251327

Peer Review History

Original SubmissionDecember 25, 2020
12 Feb 2021 Decision Letter - Iddya Karunasagar, Editor PONE-D-20-40585 Knowledge, attitude, and practice on antibiotic use and antibiotic resistance among the veterinarians and para-veterinarians in Bhutan PLOS ONE Dear Dr. Wangmo, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The reviewers have raised a number of questions that need clarification and better explanation. Please address all reviewer comments point by point. Please submit your revised manuscript by Mar 29 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. 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Thank you for including your ethics statement: "The study was approved by the Research and Extension Division of the Department of Livestock, Ministry of Agriculture and Forest, Bhutan on 21 April 2020.". PRTC request:(either IRB not named or confirm approval) Closing sentence: Once you have amended this/these statement(s) in the Methods section of the manuscript, please add the same text to the “Ethics Statement” field of the submission form (via “Edit Submission”). For additional information about PLOS ONE ethical requirements for human subjects research, please refer to http://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research. 3. Please ensure that you refer to Figure 1 and 2 in your text as, if accepted, production will need this reference to link the reader to the figure. Additional Editor Comments: Reviewers have raised number of points that need clarification and better explanation. These relate to various sections including methodology used. Please respond to reviewer comments point by point. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is a very important paper on a very interesting topic.I applaud the authors for taking up this challenging work. However, there are several areas in the manuscript that need improvement, clarification, and editing.Line 28: AMR… veterinarians/para-veterinarians in Bhutan. It must come as Veterinarians and para-veterinarians Line 49-50: Without proper knowledge how come they can do good practice? According to me, it is merely a speculative statement. The findings partially fail to support the statement. Line 113-114: antibiotic prescribing trends……para-veterinarians – Does Bhutan country allows para-veterinarians to prescribe an antibiotic? Have they qualified adequately in par with Veterinarians to prescribe antibiotics?Line 143: online using google ……. HGA). The link is closed. I recommend the authors to attach a copy of the unfilled google form/questionnaires an attachment/annexure. Line 172-174: Mention the reference number of ethical approval letter. Line 196-197: All the ….. animal species. Have you confirmed/cross verified this finding? If so, how?Table 2, Pg no: 13: Any bacteria ……. Antibiotic. The question is non-practical. What will happen if the bacteria exposed to the antibiotic at the right dose and right duration will become resistant?Table 2, Pg no: 13: A resistant bacterium……… also to humans.May I know the reason why the authors have forgotten the environmental aspect as well as the agricultural aspect in the transmission part? In general, I recommend good copy editing to fix grammatical errors and punctuation. Reviewer #2: Overall, this is a nicely done study that highlights the importance of information, education and communication related to antibiotics amongst the animal health care workers. Some minor comments: Line 114: “an” evidence based. Line 127: you mean “para-veterinarians.” Line 132: data “was” collected. Line 135-136: either write “17” or “Seventeen”; “4” or “four”. Please be consistent. Somewhere it is a spelling and somewhere it is a number. Line 142: Instead of “latter” write “later.” Line 146: mention the “eligibility criteria” of the participants somewhere. Line 186: degree in “veterinary science” you mean ? Line 371-372: Please write 46% instead of “forty-six” and 71 instead of seventy-one. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0251327.r001
Revision 1
12 Mar 2021 Author Response Response to the Editor and reviewers Editorial comments 2. Thank you for including your ethics statement: "The study was approved by the Research and Extension Division of the Department of Livestock, Ministry of Agriculture and Forest, Bhutan on 21 April 2020.". PRTC request:(either IRB not named or confirm approval) Closing sentence: Once you have amended this/these statement(s) in the Methods section of the manuscript, please add the same text to the “Ethics Statement” field of the submission form (via “Edit Submission”). Response: We have added the ethical approval number in the text. (Line No: 179-180). In addition, we have included the information regarding the informed consent of the respondents (line no:180-183) 3. Please ensure that you refer to Figure 1 and 2 in your text as, if accepted, production will need this reference to link the reader to the figure. Response: We have referred the Figure 1 and 2 in the text. (Line No:240 and 249) Reviewer #1: This is a very important paper on a very interesting topic. I applaud the authors for taking up this challenging work. However, there are several areas in the manuscript that need improvement, clarification, and editing. Line 28: AMR… veterinarians/para-veterinarians in Bhutan. It must come as Veterinarians and para-veterinarians Response: Thank you and we have corrected in the revised manuscript. (Line number: 27) Line 49-50: Without proper knowledge how come they can do good practice? According to me, it is merely a speculative statement. The findings partially fail to support the statement. Response: Thank you for pointing this out. The sentence has been corrected as per the findings (Line: 48-49) Line 113-114: antibiotic prescribing trends……para-veterinarians – Does Bhutan country allows para-veterinarians to prescribe an antibiotic? Have they qualified adequately in par with Veterinarians to prescribe antibiotics? Response: Yes, the para-veterinarians in Bhutan are allowed to prescribe antibiotics. The para-veterinarians in Bhutan have a formal two-year diploma in animal husbandry (after completion of grade 10 and 12) where they are taught veterinary medicines and pharmacology in their curriculum. They are also provided refresher course in veterinary medicine and veterinary drugs time to time. They also seek technical support from the veterinarians and would refer the Drug Formulary developed by the Department wherever necessary. In addition, the Drug Regulatory Authority of Bhutan conduct constant monitoring of the antibiotic prescription in the field. We have included this information in the revised manuscript. (Line: 126-133) Line 143: online using google ……. HGA). The link is closed. I recommend the authors to attach a copy of the unfilled google form/questionnaires an attachment/annexure. Response: The questionnaire form has been attached as supplementary file (Line No: 646) Line 172-174: Mention the reference number of ethical approval letter. Response: We have added the ethical approval number in the revised manuscript. Line number: 179-180) Line 196-197: All the ….. animal species. Have you confirmed/cross verified this finding? If so, how? Response: Yes, we have cross verified this finding with another question on their practice on antibiotic with a question “I give large dose of antibiotics to large animal and small dose to small animal (e.g., Poultry birds) by looking at the size of the animals than the recommended dose” (Table 3). Although, all the respondents (100%) have answered (have knowledge) that antibiotics should be administered with correct dose and dosage for any animal species but in practice, 18.8% (n=41) of the respondents have mentioned that they give large dose of antibiotics to large animal and small dose to small animals (see Table 3). We have discussed these points in the discussion. (Line No 464-467) Table 2, Pg no: 13: Any bacteria ……. Antibiotic. The question is non-practical. What will happen if the bacteria exposed to the antibiotic at the right dose and right duration will become resistant? Response: Yes, you are correct. However, we have kept this question/answer (finding) as it is. Table 2, Pg no: 13: A resistant bacterium……… also to humans. May I know the reason why the authors have forgotten the environmental aspect as well as the agricultural aspect in the transmission part?In general, I recommend good copy editing to fix grammatical errors and punctuation. Response: Thank you for your comments and suggestions. Unfortunately, we have forgotten to include the environmental and the agricultural aspect in the transmission part in this study. We will look into this aspect in future studies. Reviewer #2: Overall, this is a nicely done study that highlights the importance of information, education and communication related to antibiotics amongst the animal health care workers. Some minor comments: Response: Thank you for providing critical comments/suggestions to improve our manuscript. We have addressed all your suggestions in the revised manuscripts. Line 114: “an” evidence based. Response: We have corrected this in the revised manuscript. (Line number: 111) Line 127: you mean “para-veterinarians.” Response: We have corrected this in the revised manuscript (Line number:124) Line 132: data “was” collected. Response: We have corrected this in the revised manuscript (Line number: 136) Line 135-136: either write “17” or “Seventeen”; “4” or “four”. Please be consistent. Somewhere it is a spelling and somewhere it is a number. Response: Thank you for your suggestion. We have changed it as suggested in the revised manuscript (Line number: 139) Line 142: Instead of “latter” write “later.” Response: Thank you for correction and we have revised it (Line number 146) Line 146: mention the “eligibility criteria” of the participants somewhere. Response: Thank you for the suggestion. We have added the eligibility criteria in the revised manuscript as the government veterinarians and para-vets working in the field, and were handling/prescribing antibiotics for the treatment of animal cases. (Line number: 147-149) Line 186: degree in “veterinary science” you mean? Response: The qualification for degree is veterinary science for veterinarians (5 years degree course) and diploma (2-year course) in animal science for para-veterinarians. Some of the para-veterinarians have upgraded their qualification to degree (3 years degree) in animal sciences. We have added this in the revised manuscript (line number:195-196) Line 371-372: Please write 46% instead of “forty-six” and 71 instead of seventy-one. Response: We have corrected this in the revised manuscript. (line number: 382-383) Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0251327.r002
26 Apr 2021 Decision Letter - Iddya Karunasagar, Editor Knowledge, attitude, and practice on antibiotic use and antibiotic resistance among the veterinarians and para-veterinarians in Bhutan PONE-D-20-40585R1 Dear Dr. Wangmo, 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, Iddya Karunasagar Academic Editor PLOS ONE Additional Editor Comments (optional): All reviewer comments have been addressed satisfactorily. 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: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 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 ****** 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: (No Response) ****** 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:** Thulasiraman Parkunan https://doi.org/10.1371/journal.pone.0251327.r003
Formally Accepted
28 Apr 2021 Acceptance Letter - Iddya Karunasagar, Editor PONE-D-20-40585R1 Knowledge, attitude, and practice on antibiotic use and antibiotic resistance among the veterinarians and para-veterinarians in Bhutan Dear Dr. Wangmo: 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. Iddya Karunasagar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0251327.r004

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