PONE-D-20-16369

Spatial distribution and geographical heterogeneity factors associated with poor consumption of foods rich in vitamin A among children age 6 -23 months in Ethiopia: Geographical weighted regression analysis

PLOS ONE

Dear Dr. Tiruneh,

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.

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Miquel Vall-llosera Camps

Senior Editor

PLOS ONE

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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: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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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

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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: No

Reviewer #2: No

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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: It is an interesting article whose findings can help policymakers and health planners to select appropriate interventions. The methodology used can be also used to identify hot spot areas of low consumption of vitamin A and its determinants not only in Ethiopia but also in other Sub-Sahara Africa countries. However, there are some caveats and extensive editing of English language and style will be needed to facilitate the reading of the whole document.

Background

It is difficult to follow the different paragraph, although the background section provides sufficient information and include relevant references.

The background section needs to be reorganized. It will be helpful to combine some paragraphs. For example, the first three paragraphs can be reduced to one.

Results

Table 1: Since the study is related to children, it will be better to present children characteristics before the mothers’ results.

Discussion

It will be important not to repeat most of results in the discussion section.

The consumption status of Foods rich in Vitamin A among children age 6-23 months was determined using a 24-hour recall. The results need to be analyzed with precaution, as it does not reflect any dietary habits. Thus, it needs to be highlighted in Discussion.

It will be helpful to give some examples of regional variation dietary preference, low practice to complementary feeding, or socioeconomic status.

References for this confirmation: The possible justification might be living in rural area had no access to get foods rich in vitamin A, poor knowledge about foods rich in vitamin A, and other socioeconomic factors.

Reviewer #2: This study aimed to assess the spatial distribution and its determinants of dietary consumption of foods rich in vitamin A among children aged 6-23 months in Ethiopia. It could provide valuable information to identify areas with high vitamin A deficiency. However, there are a number of issues to be addressed.

Abstract

- Methods: please specify how poor vitamin A consumption was defined

Background

- Need references for the sentence ‘So far, different studies conducted in Ethiopia to assess dietary diversity among children including foods rich in vitamin A consumption’.

- The authors presented the importance of vitamin A in the background. However, the background regarding geospatial analysis is relatively weak. The authors should provide more details to strengthen the justification of this study. For instance, the authors indicated that there was no evidence on geospatial distribution of dietary consumption in Ethiopia. However, relevant studies were done from other countries so it would be informative to add- what is the current knowledge on geospatial distribution of dietary intake, specifically in Africa, what is the gap and how this study could contribute to the existing body of evidence. Also, if there is no study on spatial distribution of dietary consumption of foods rich in vitamin A, it would be still useful to add studies in Ethiopia targeting other nutrients or other nutrition outcomes such as stunting and wasting.

- ‘The magnitude of vitamin A deficiency (VAD) was highest in Sub-Saharan Africa (48%; 25–75) and South Asia (44%; 13–79)’: if 25-75, 13-59 mean CI or other, please specify

Methods and materials

- I suggest the authors revise ‘Source and study populations’ and ‘Data collection tools and procedures’ as some parts were overlapped and it is not easy to understand

- Some important information is missing regarding the data source- for instance, how did this study handle missing data and what was the survey response rate?

- Outcome variable: as it is critical part in the manuscript, the authors need to provide enough details such as who responded to the question, what were the seven food items and what was the justification to define poor consumption of vitamin A

- Predictor variables: It is not clear how the authors considered possible multicollinearity

- It is not clear how the authors considered complex survey design

- Data management and analysis: didn’t the author also use Kuldorff’s SaTScan version 9.6 software, Arc GIS 10.7 software and MGWR (Multi-scale Geographically Weighted Regression)? If then, please indicate in addition to STATA and Excel

- It is not clear what was done for model validity and uncertainty assessment. Please provide details.

- Ethical consideration: better to clearly say that ethical approval was not required for what reason.

Results

- Be consistent with presenting numbers- up to two decimals, one or? i.e. 18.45%, 61%

- Table 1: the authors need to explain how variables were classified in the ‘Methods’ section. For instance, how household wealth was classified into poor, middle and rich? Is it solely based on household income or with other assets? Please explain what Dega means. Also, how ‘media exposure’ was defined?

- How about the associations with other variables such as - education, religion, occupation, child age, etc. and outcome? Please also specify if the association were not significant

Discussion

- It is not clear what the first paragraph is trying to say

- The last sentence on page 19 needs more elaboration- how dietary preference, low practice to complementary feeding or socioeconomic status differ by regions and how it could explain geographical variation of vitamin A consumption. Same goes for the last sentence on page 20.

- It is not clear what ‘The possible reason might be household with poor wealth did not get minimum meal frequency to their child and poor wealth will affect adherent to the consumption of foods rich in vitamin A and dietary diversity to their child.’ means, please specify.

- The authors could have provided comprehensive comparison with other studies to strengthen the discussion part. For instance, what were the results of other similar studies examining spatial distribution of food consumption or nutrition/health status? How similar or different were the results and what would be the possible reasons for that?

- The authors listed one limitation but there might be more – for instance, how food consumption was defined as poor or good? Was amount of food considered? Was there any possibility of recall bias?

References

- Need revision. For instance, #3 ref: (World Health Orgnaisation) is repeated

- #10 ref: year is repeated twice like ‘J Nutr Metab. 2013;2013’

There are some grammar and flow issues so I recommend copyediting. Below are some examples

- Venerable: do you mean vulnerable? (appeared several times in abstract, result)

- The following sentence on p9 is not clear- On the other hand, only 12 to 24% of children age 6-23 months consumed animal source foods rich in vitamin A in Ethiopia (6,12), however, eggs (11.0%) and meat (2.6%) were less frequently consumed (8).

- p20 …male frequency and Nepal which is Children from the poorest… did you mean ‘meal’?

- p21 .. The expectation of the finding of hos spot maps in line.. did you mean ‘hot’?

- p21 …This study focuses on typical consumption of foods rich in vitamin A.Tthe association between….

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Reviewer #1: No

Reviewer #2: No

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PONE-D-20-16369R1

Spatial distribution and geographical heterogeneity factors associated with poor consumption of foods rich in vitamin A among children age 6 -23 months in Ethiopia: Geographical weighted regression analysis

PLOS ONE

Dear Dr. Tiruneh,

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 manuscript has been greatly improved from the preceeding submission, as can be seen from the reviewer comments. However there are still some outstanding issues that need to be addressed before a final decision can be made. These are:

• There are still major issues with the English language at various points in the manuscript - please make sure that there is a further round of proof-reading before resubmission
• The reviewer comments need to be addressed in full
• The first introductory paragraph (p3) highlights what Vitamin A is. The information about its uses is not referred back to in the rest of the document, so it is strongly suggested to remove this information, or not to put about rhodopsin etc in the first paragraph. The paper is about the spatial distribution and determinants of low Vitamin A, and not about the biology behind it so the introduction (and whole paper) should reflect this.

Please submit your revised manuscript by May 23 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Andrew Amos Channon, PhD

Academic Editor

PLOS ONE

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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.

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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 #2: (No Response)

Reviewer #3: All comments have been addressed

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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 #2: (No Response)

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: (No Response)

Reviewer #3: Yes

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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 #2: (No Response)

Reviewer #3: Yes

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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 #2: (No Response)

Reviewer #3: Yes

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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 #2: Congratulations on this work. It looks great and please see minor comments below.

• In Introduction, the newly cited article by Pardede et al seems irrelevant (ref 15).

• Lines 356-360: the authors mentioned that ‘This finding is not similar to a study done in Ethiopia, which found that the wealth status of the household is not statistically significant for the consumption of foods rich in vitamin A’. It would be valuable if authors elaborate more regarding the inconsistencies.

• Don’t need to cite figures again in discussion. No need to repeat the results – you can highlight the key findings and provide some insights.

• Review again the list of figures and numbering (fig 3 appeared twice in the list and some figures were numbered as figure 1).

• It seems that the editing wasn’t done for final version of the manuscript because there are still some errors in edited parts.

Reviewer #3: (No Response)

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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 #2: No

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.

Spatial distribution and geographical heterogeneity factors associated with poor consumption of foods rich in vitamin A among children age 6 - 23 months in Ethiopia: Geographical weighted regression analysis

PONE-D-20-16369R2

Dear Dr. Tiruneh,

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,

Andrew Amos Channon, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: