PONE-D-21-06886

Prevalence of Noncommunicable Diseases Risk Factors and their Determinants: Results from STEPS survey 2019, Nepal

PLOS ONE

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PLOS ONE

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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

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

Reviewer #1: Yes

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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

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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: Yes

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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: Introduction

The rationale for reporting this study could be reframed better.

For ex. There is no link between the multi sectoral plan and current STEPS survey; linking these two might give better clarity to understand the need for present STEPS survey

Methods

Sampling methods adapted in previous STEPS surveys are different from the current survey. The change in context should get mentioned for the readers to compare and interpret these two surveys

As per methods details provided in the reference, the sample size was estimated to cover each province with equal number of participants (around 900 each). If it is so, why there are 20% participants from some province and 8% from some province. Please clarify.

As province and ecological belts were considered as independent variables across all NCD risk factors give a brief write up regarding the characteristics of these provinces and ecological belts which are relevant to understand the burden of NCD risk factors.

Though sample size and sampling methods were published elsewhere it is better to give a brief description on the sample size and selection of PSUs.

Under Ethical concern, for minors it require assent from the adolescents and consent from parents. Hence it needs to be clarified accordingly. Avoid the tern assent consent.

Results:

In this survey 15-29 years age group is predominant which is entirely different from the previous STEPS survey or Nepal population distribution based on age.

Please clarify how this over representation from this age group has happened.

Two decimals in results make the tables too crowded. It does not become reader friendly.

There is no display of gender disaggregated results within the province. But the discussion section presented in those lines.

Tobacco use and smokers are used inter changeably. Please use the term consistently

For fruits & vegetables intake, when everything is more than 97% sub group disaggregation does not help much (line no 221 to 223) could be avoided.

Table 2: As majority of the times the number in the sub group is going to remain same across all NCD risk factors it seems there is redundancy the way the n is represented. Instead of total number in the sub group it is preferred to give number with the particular risk factor present under the column n.

Discussion

Comparison of smoking with previous STEPS survey is incomplete.

The speculation for higher prevalence of smoking in Nepal is not justified well. (line No 268-274). Actually the prevalence in Nepal is more that should be explained by extent of lacunae in implementation of current tobacco legislative measures.

Adjusted prevalence ratio or adjusted relative risk has been calculated but it has been interpreted as if they were odds ratios. (line No 322-324, 334-335, 337,350, 353)

Introduction

The rationale for reporting this study could be reframed better.

For ex. There is no link between the multi sectoral plan and current STEPS survey; linking these two might give better clarity to understand the need for present STEPS survey

Methods

Sampling methods adapted in previous STEPS surveys are different from the current survey. The change in context should get mentioned for the readers to compare and interpret these two surveys

As per methods details provided in the reference, the sample size was estimated to cover each province with equal number of participants (around 900 each). If it is so, why there are 20% participants from some province and 8% from some province. Please clarify.

As province and ecological belts were considered as independent variables across all NCD risk factors give a brief write up regarding the characteristics of these provinces and ecological belts which are relevant to understand the burden of NCD risk factors.

Though sample size and sampling methods were published elsewhere it is better to give a brief description on the sample size and selection of PSUs.

Under Ethical concern, for minors it require assent from the adolescents and consent from parents. Hence it needs to be clarified accordingly. Avoid the tern assent consent.

Results:

In this survey 15-29 years age group is predominant which is entirely different from the previous STEPS survey or Nepal population distribution based on age.

Please clarify how this over representation from this age group has happened.

Two decimals in results make the tables too crowded. It does not become reader friendly.

There is no display of gender disaggregated results within the province. But the discussion section presented in those lines.

Tobacco use and smokers are used inter changeably. Please use the term consistently

For fruits & vegetables intake, when everything is more than 97% sub group disaggregation does not help much (line no 221 to 223) could be avoided.

Table 2: As majority of the times the number in the sub group is going to remain same across all NCD risk factors it seems there is redundancy the way the n is represented. Instead of total number in the sub group it is preferred to give number with the particular risk factor present under the column n.

Discussion

Comparison of smoking with previous STEPS survey is incomplete.

The speculation for higher prevalence of smoking in Nepal is not justified well. (line No 268-274). Actually the prevalence in Nepal is more that should be explained by extent of lacunae in implementation of current tobacco legislative measures.

Adjusted prevalence ratio or adjusted relative risk has been calculated but it has been interpreted as if they were odds ratios. (line No 322-324, 334-335, 337,350, 353)

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Reviewer #1: No

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Prevalence of noncommunicable diseases risk factors and their determinants: Results from STEPS survey 2019, Nepal

PONE-D-21-06886R1

Dear Dr. Dhimal,

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.

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Kind regards,

Brecht Devleesschauwer

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 #1: 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 #1: Yes

**********

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

Reviewer #1: 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: 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: The manuscript has been substantially revised in terms of language and Reviewers comments.

The survey methods and rationale section has been revised according to previous comments. Similarly, the findings are appropriately interpreted as adjusted Prevalence ratio

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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 #1: No