Prevalence of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia

Melashu Balew Shiferaw; Mulusew Alemneh Sinishaw; Desalegne Amare; Genetu Alem; Dawit Asefa; Eveline Klinkenberg

doi:10.1371/journal.pone.0253177

Peer Review History

Original SubmissionFebruary 3, 2021
25 Feb 2021 Decision Letter - Frederick Quinn, Editor PONE-D-21-03747 The magnitude of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia PLOS ONE Dear Dr. Shiferaw, 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. If you will need significantly more time 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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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, Frederick Quinn Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: 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: No Reviewer #2: Yes Reviewer #3: 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 Reviewer #3: 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 is of interest and well written. The discussion should be implemeented . Limits of the study should be better discussed. Minor spelling check are required. I suggest to accept after minor revision Reviewer #2: Thank you for the opportunity to review this paper. TB among health care workers is an important issue and often under reported with huge implications for occupational safety and infection prevention and control. This is especially true now with COVID-19 as well. I just have a few comments and suggestions for clarification. 1. May want to check grammar throughout especially plurals. 2. Page 8 lines 143-144 – The authors may want to clarify how ventilation was assessed? Was this simply whether windows were open or closed? Was there a window? Was ACH calculated? What is meant by “ventilation in the room”? Which room? Did you assess infection control in all areas of all facilities? Or only in TB clinics/wards/rooms? Please clarify. 3. Page 10 line 195 – The authors mention that 78.7% did not have nor use N95 respirators. Can you specify what percentage did not have access to N95s versus percentage that did not use them? 4. Page 11 lines 216 – 218 – The authors state that the TB prevalence for HCWs is higher than the TB prevalence for Ethiopia (140 per 100,000) but do not state what the prevalence in HCWs is. Did the authors calculate a prevalence of TB among HCWs in this study for comparison? If so, may want to consider adding to the results section. 5. Table 2. What is meant by “room cleanness” and what impact does that have on airborne transmission and TB? 6. Table 4. Compare “had direct contact with known TB patients” in the table – but it is well known that contact with undiagnosed cases of TB is a greater risk than known TB patients on treatment. Did you assess the risk of contact with undiagnosed cases – perhaps in general medical wards or OPDs? 7. A general comment which may fit under limitations. In Ethiopia nursing staff rotates through different facilities and areas/wards within facilities at regular 3-6 month intervals. Did you consider this rotation of staff through the facility in terms of risk factors? Reviewer #3: Comments. The Title did not reflect the comparative nature of the work.in addition, I think prevalence should be used instead of magnitude of active tuberculosis. Line 31: Please remove the 290 HCWs 290 Support staff as it has been captured in the result section to avoid repetition in the abstract section. Line 39: The title of this manuscript did not reflect the comparative nature of the work between HCWs and Support Staff. Line 40: TB infection prevention and control is the terminology to be used not TB infection prevention Line 36: Repetition of study participants Line 43-44: What is the magnitude of active TB in the general population? Line 69: PPE abbreviation should be from line 69 at first mention Line 101: Can the authors explain better how 2009 fiscal year will be captured in 2016/2017. This is rather confusing. Methodology Line 127: What inform the selection of 38 HFs? What is the average number of HFs in each of the selected zones? Line 128: What inform the selection of 9 HCWs and 9suppor staff from facilities selected from the study? What is the staff strength of the HCWs and the Support Staff in each of the facility selected? Proportionate sampling should have been done to ensure adequate representation of each facility selected. Line 143: How was the ventilation status of the rooms assessed? Which room was assessed for example, for the support staff? Were clinics assessed for the HCWS? Line 145: Were trained professional nurses/ health officers’ part of the data collectors? Lines 146-148: What happened to those who did not have any symptoms? All the participants should have been screened. Line 205: What stage of the treatment were those five participants who were currently on treatment because for them to still be positive Line 222: TBIC should be written in full at the first mention References: Line 307: date the reference cited should be included Line 312: Page numbers should be provided Results: There is no need to put study date on the title Table 1: some of the variables in some cell is more than 100% It is better to list all the support staff before HCWs. What is the difference between case managers and treatment supporters? The statistical test employed and the p-value that informed the comparison made in the text that showed that HCWs and Support staff did not differ significantly was not presented in the tables. Grid lines should be removed from the tables. In addition, there were lots of grammatical errors and syntax in the manuscript, hence the work should be edited for example but not limited to the following: Line 26…” can be utilized” Line 30: “to recruit” would have been better than “to target” Line 73: ………….knowing the prevalence of active TB among HCWs Line 81: besides ‘the’ use of PPE Line 112: “Cashiers” not “Cashers”. Line 162: “lab” should read “laboratory personnel” Line 177: male/female “ratio” not “ration” Line 197: “of whom” should read “of which” ****** 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 Reviewer #3: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0253177.r001
Revision 1
2 Mar 2021 Author Response Dear Editor, Thank you for giving us the opportunity to revise our manuscript. We also thank the reviewers for their critical review of our manuscript and providing us important comments that help us to significantly improve our paper in advance. The following is our point by point response. Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: thank you we checked the references and revised as seen in the updated version of the manuscript. 5. Review Comments to the Author Reviewer #1: The paper is of interest and well written. The discussion should be implemented . Limits of the study should be better discussed. Minor spelling check are required. I suggest to accept after minor revision Response: Thank you for the comments. Now, the comments are accepted and have been addressed in the updated manuscript Reviewer #2: Thank you for the opportunity to review this paper. TB among health care workers is an important issue and often under reported with huge implications for occupational safety and infection prevention and control. This is especially true now with COVID-19 as well. I just have a few comments and suggestions for clarification. 1. May want to check grammar throughout especially plurals. Response: thank you for the comment, and it has been addressed in the new version manuscript 2. Page 8 lines 143-144 – The authors may want to clarify how ventilation was assessed? Was this simply whether windows were open or closed? Was there a window? Was ACH calculated? Response: thank you, the ventilation of the room was evaluated and considered ventilated if a room had open window and cross ventilation was present with the door. ACH was not calculated. We added a better definition of our measurements in the new version manuscript What is meant by “ventilation in the room”? Which room? Did you assess infection control in all areas of all facilities? Or only in TB clinics/wards/rooms? Please clarify. Response: thank you, how we measured room ventilation is outline above. As presented in table two, 381 of the participants (91 support staff and 290 HCWs) worked in different rooms such as TB clinic, card room, x-ray, laboratory, etc. Of which, 174 participants worked in well ventilated rooms in the health facilities of the Amhara region, Ethiopia (Table 2). Others who had no room to work in like security guards did not have rooms to be evaluated. We made this now more clear in the method section of the manuscript. We did assess infection control in all areas of facilities included in the study this is outlined in in the updated manuscript. 3. Page 10 line 195 – The authors mention that 78.7% did not have nor use N95 respirators. Can you specify what percentage did not have access to N95s versus percentage that did not use them? Response: thank you for the comments. Of the total 124 participants who had N95 respirator access, 82 (66.1%) did not use the respirator to prevent TB infection. This has now been made more explicit in the results section of the revised paper. 4. Page 11 lines 216 – 218 – The authors state that the TB prevalence for HCWs is higher than the TB prevalence for Ethiopia (140 per 100,000) but do not state what the prevalence in HCWs is. Did the authors calculate a prevalence of TB among HCWs in this study for comparison? If so, may want to consider adding to the results section. Response: The prevalence of TB disease found in this study was (1.6% ~ 1600 per 100000 populations). Now, it has been included as per the reviewer’s recommendation 5. Table 2. What is meant by “room cleanness” and what impact does that have on airborne transmission and TB? Response: thank you for the comment. Room cleanness was evaluated by interview and observation of the room using a standardize checklist. It was included to check the implementation of general infection prevention practices like cleaning of the floor, benches, chairs, etc with appropriate detergent such as bleach solution. 6. Table 4. Compare “had direct contact with known TB patients” in the table – but it is well known that contact with undiagnosed cases of TB is a greater risk than known TB patients on treatment. Did you assess the risk of contact with undiagnosed cases – perhaps in general medical wards or OPDs? Response: thank you for this constructive comment. Honestly, we did not assess the risk of contact with undiagnosed cases assuming all of the HCWs and support staff would have had a risk of contact then. 7. A general comment which may fit under limitations. In Ethiopia nursing staff rotates through different facilities and areas/wards within facilities at regular 3-6 month intervals. Did you consider this rotation of staff through the facility in terms of risk factors? Response: thank you for the comment. We did not consider rotation of staff through different facilities and areas/wards within facilities in terms of risk factors. We have now included this issue under the limitations in the updated version manuscript. Reviewer #3: Comments. The Title did not reflect the comparative nature of the work. In addition, I think prevalence should be used instead of magnitude of active tuberculosis. Response: thank you, now the title has been modified in the new version manuscript. Line 31: Please remove the 290 HCWs 290 Support staff as it has been captured in the result section to avoid repetition in the abstract section. Response: thank you for this comment. Now, it has been removed from the abstract section Line 39: The title of this manuscript did not reflect the comparative nature of the work between HCWs and Support Staff. Response: thank you for the comments, our objective is to show the burden of active tuberculosis equally affected support staff as healthcare workers. The prevalence found in HCWs is 1.4 and in support staff 1.7% but the difference was not significant indicating both of them equally suffered from TB diseases Line 40: TB infection prevention and control is the terminology to be used not TB infection prevention Response: thank you, now it has been corrected Line 36: Repetition of study participants Response: thank you, now it has been corrected Line 43-44: What is the magnitude of active TB in the general population? Response: thank you, in the general population, it is 140 per 100000 populations. And now it has been included in the new version manuscript. Line 69: PPE abbreviation should be from line 69 at first mention Response: thank you, now it has been abbreviated as the reviewer’s advice Line 101: Can the authors explain better how 2009 fiscal year will be captured in 2016/2017. This is rather confusing. Response: thank you, the 2009 Ethiopian fiscal year is 08 July 2016 to 07 July 2017 Methodology Line 127: What inform the selection of 38 HFs? What is the average number of HFs in each of the selected zones? The average number of health facilities (HFs) in each selected zone was 52 in Awi, 12 in Bahir Dar, 102 in South Gondar, 109 in East Gojjam, and 70 in North Wollo. Then, proportionally we allocated 6 HFs from Awi, 2 HFs from Bahir Dar, 11 HFs from South Gondar, 12 HFs from East Gojjam, and 7 HFs from North Wollo zones making a total of 38 sampled HFs. More details on the selection process has been added in the updated version manuscript. Line 128: What inform the selection of 9 HCWs and 9suppor staff from facilities selected from the study? What is the staff strength of the HCWs and the Support Staff in each of the facility selected? Proportionate sampling should have been done to ensure adequate representation of each facility selected. Response: thank you for this comment really help to improve our manuscript. This was planned to represent 580 samples equally distributed to the 38 health facilities making 16 participants per site (580/38=15.3~16). That is 8 HCWs and 8 support staff interviewed per facility. The 9 HCWs and 9 support staff described was clerical error and now it has been corrected. Line 143: How was the ventilation status of the rooms assessed? Which room was assessed for example, for the support staff? Were clinics assessed for the HCWS? Response: The ventilation of the room was evaluated as well ventilated if a room had open window and cross ventilated with the door. As presented in table two, 381 of the participants (91 support staff and 290 HCWs) worked in different rooms such as TB clinic, card room, x-ray, laboratory, etc. Of which, 174 participants worked in well ventilated rooms in the health facilities of the Amhara region, Ethiopia (Table 2). Others who had no room to work in like security guards did not have rooms so that not evaluated. Line 145: Were trained professional nurses/ health officers’ part of the data collectors? Response: thank you for the comments. Yes, first we trained professional nurses/health officers on how to fill the questionnaire and the way on how to collect during observation. Then, those trained data collectors evaluated TB symptoms from the study participants. Lines 146-148: What happened to those who did not have any symptoms? All the participants should have been screened. Response: thank you for the constructive comments. Based on the Ethiopian national TB screening algorithm, those who had no any active TB symptoms were considered as TB screening negative. This has been made more explicit in the revised manuscript Line 205: What stage of the treatment were those five participants who were currently on treatment because for them to still be positive Response: thank you, those five patients were on the intensive phase of TB treatment, and now we describe in the updated manuscript Line 222: TBIC should be written in full at the first mention Response: thank you, TBIC refers to TB infection control, and now it has been written in full at the first mention in the new version manuscript References: Line 307: date the reference cited should be included Response: thank you, now date the reference cited has been included Line 312: Page numbers should be provided Response: Thank you, now it has been provided in the new version manuscript Results: There is no need to put study date on the title Response: thank you, study date has been removed on the title of result tables Table 1: some of the variables in some cell is more than 100% It is better to list all the support staff before HCWs. Response: thank you, the variables having more than 100% has been revised, and support staff has been listed before HCWs. See updated version manuscript What is the difference between case managers and treatment supporters? Response: Thank you, Case manager: support staff assigned to help patients in guiding and facilitating the diagnosis and treatment in health facilities; Treatment supporter: support staff assigned to follow treatment adherence of patients using different communication mechanisms such as phone call. We have now described this better in the revised version of the manuscript The statistical test employed and the p-value that informed the comparison made in the text that showed that HCWs and Support staff did not differ significantly was not presented in the tables. Response: thank you, p value has been presented in the table 2 of the updated manuscript. Grid lines should be removed from the tables. Response: thank you, the grid lines has been removed from the tables in the updated manuscript In addition, there were lots of grammatical errors and syntax in the manuscript, hence the work should be edited for example but not limited to the following: Line 26…” can be utilized” Response: thank you, now it has been revised Line 30: “to recruit” would have been better than “to target” Response: thank you, now it has been revised Line 73: ………….knowing the prevalence of active TB among HCWs Response: thank you, now it has been revised Line 81: besides ‘the’ use of PPE Response: thank you, now ‘the’ has been included Line 112: “Cashiers” not “Cashers”. Response: thank you, now it has been corrected Line 162: “lab” should read “laboratory personnel” Response: thank you, now it has been corrected Line 177: male/female “ratio” not “ration” Response: thank you, now it has been corrected Line 197: “of whom” should read “of which” Response: thank you, now it has been revised Attachments Attachment Submitted filename: Rebuttal letter.docx https://doi.org/10.1371/journal.pone.0253177.r002
26 Mar 2021 Decision Letter - Frederick Quinn, Editor PONE-D-21-03747R1 Prevalence of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia PLOS ONE Dear Dr. Shiferaw, 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. If you will need significantly 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, Frederick Quinn Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed Reviewer #3: 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 Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: 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: The manuscript was substantially implemented. All comments have been addressed. The paper can be accepted for publication. Reviewer #2: (No Response) Reviewer #3: The authors had done the corrections but there are still some grammatical errors. Other comments have been attached ****** 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 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. Attachments Attachment Submitted filename: Plos one 2021 March Comments.docx https://doi.org/10.1371/journal.pone.0253177.r003
Revision 2
10 May 2021 Author Response Dear editor, thank you for giving us the opportunity to revise our manuscript and we also thank the reviewers for comments and critics helping us to improve our paper. The following are point by point responses. The authors had done the corrections but the manuscript still need to be edited for grammatical errors. Response: thank you, grammatical errors have been corrected throughout the whole manuscript. In addition, I suggest that the variables in table one should be listed in descending other; Support staff: Cleaner 58(20.0) Data clerk 51(17.6) Cashier 42(14.5) HCWs: Nurse 122 (42.1) Laboratory staff 50(17.2) Pharmacy staff 34(11.7) Response: thank you for the valuable comment. Now, table one has been updated according to the reviewer’s advice Attachments Attachment Submitted filename: point by point.docx https://doi.org/10.1371/journal.pone.0253177.r004
31 May 2021 Decision Letter - Frederick Quinn, Editor Prevalence of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia PONE-D-21-03747R2 Dear Dr. Shiferaw, 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, Frederick Quinn Academic Editor PLOS ONE Additional Editor Comments (optional): 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: All comments have been addressed Reviewer #3: 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 #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: No Reviewer #3: 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 #2: Please correct the grammar and language issues as noted in the original review. It still appears that these have not been corrected. Reviewer #3: Thanks for asking me to review the manuscript titled: “The Prevalence of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia.” (PONE-D-21-03747R2) for the third time. The authors had done the corrections and the manuscript has been edited for grammatical errors. ****** 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 Attachments Attachment Submitted filename: Plos one 2021 May Comments.docx https://doi.org/10.1371/journal.pone.0253177.r005
Formally Accepted
3 Jun 2021 Acceptance Letter - Frederick Quinn, Editor PONE-D-21-03747R2 Prevalence of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia Dear Dr. Shiferaw: 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. Frederick Quinn Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0253177.r006

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