PONE-D-20-34446

Cultural malpractice during perinatal period and associated factors among women of child bearing age in Southern Ethiopia: Community based cross-sectional study

PLOS ONE

Dear Dr. Abebe,

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 by Mar 04 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Nülüfer Erbil, Ph.D, Prof.

Academic Editor

PLOS ONE

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2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information.

3.Thank you for stating the following financial disclosure:

 "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."

At this time, please address the following queries:

1. Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.
2. State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”
3. If any authors received a salary from any of your funders, please state which authors and which funders.
4. If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. We note that you use the term "cultural malpractice" throughout your manuscript and title. As the term "malpractice" is tied to specific legal meanings, we request that you change this term throughout the manuscript to something that does not contain the word "malpractice".

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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

Reviewer #2: Yes

Reviewer #3: Yes

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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: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #2: Yes

Reviewer #3: 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: Dear author,

The necessary corrections for the article are shown on the text. Please review the abstract section. There is an inconsistency in your sample size. I can only write in one language and admire anyone who attempts to write in a language other than their native one. unfortunately the English used here sometimes obscures your meaning. There is incorrect use of the definite and indefinite article, tenses, spelling and plural/singular to name a few problems. The manuscript should have been reviewed by a native English speaker

Reviewer #2: Review Comments for Author

Title: Cultural malpractice during perinatal period and associated factors among women of child bearing age in Southern Ethiopia: Community based cross-sectional study.

Investigating this research has many merits for multicultural and multi ethnic country Ethiopia and has a contribution for policy makers and other stakeholders who work up on community health.

Here below are the comments and questions for author;

Keywords should be no more than 5 and no less than 3.

“Perinatal period is considered as time period including the pregnancy, childbirth and postnatal period” what is implication of stating term definition in abstract?

Your method in abstract lacks overview of sampling technique, data presentation and analysis.

As far as this study has two objectives, it should have to consider sample size calculation for second objective too.

“Perinatal period: Time period including the pregnancy, childbirth and postnatal period” is term definition or operational definition? Clarify?

“The data collected were entered into Epi Info version ™ 7 and exported to Statistical Package for Social Science (SPSS) version 25 for cleaning and analysis” why? Cleaning and analysis was also possible for Epi info.

You stated multivariate and multivariable analysis interchangeably. Do you think it is similar? Which one you used? Justify?

“The mean age of study participants were 27.6 (SD ± 5.4 years)”. Did you check normality test? If yes how? Why you select mean to describe age? Why didn’t other descriptive statistics?

Are these ethnic groups only dwell in the study area?

“Koso”, “telba”… is local language and it should have to be elaborated and italic while you write.

In table 2, Frequency of food taboo is beyond total sample size? Do you have a justification? Why pre-lacteal feeding percentage left blank? Justify?

“Regarding ANC follow up, participants who had ANC follow up during the last pregnancy were almost three [AOR 2.62, 95%CI, 1.54-4.48] times more likely execute cultural malpractice during perinatal period.” How do you justify this? It contradicts the logic and the science? Is there possible explanation for your study?

Food taboo is a vague word. How you assessed it?

“This level of cultural malpractices is higher than what is reported from a study done elsewhere in Ethiopia” and “This finding was lower than the study conducted in Northwest Ethiopia” these two sentences are contradicting? Justify?

Your study was community based cross-sectional study and asks retrospectively about perinatal period. This is prone your study to recall bias. How did you reduce recall bias for this study?

Is your study had no limitation? if yes add limitations of the study

Reference no.14 and no.18 are similar. Consider revision

Reviewer #3: 1-It was good to see researchers are trying to address an important issue of developing country

2- It would be appreciated, if author can explain the reasons of repeating the similar study in different zone of Ethiopia, when it was already conducted in north west Ethiopia (mentioned in sample size reference)

3- It would be nice, if STROBE guidelines can be followed so that methodology can be fully evaluated.

4- The whole document needs a substantial language revision to improve grammar and style.

5- The whole document should be revised considering the within text citation as it has been noticed at multiple places where references within text references are missing like page 3, paragraph 1, line 2 and 6 and paragraph 5 line 2, 4 etc.

6- Study setting needs further description in terms of population being catered like their ethnicity, socio economic status so one can understand the homogeneity or heterogeneity among the settings

7- Kindly justify why are you calling the the sampling technique as simple random sampling and not proportionate or multi level sampling

8 - How did you maintain the consistency between different data collectors? as there were 6 separate data collectors

9- who did training for data collectors and what was covered in training?

10- Authors have mentioned that corrections and modification was made after pretesting, please specify

11- Why the results considered confounding variable? as this study does not have any main exposure so please share the reasons of considering confounders as it is not meeting the criteria of assessing confounders.

12- did the author assessed the normality of each variable?

13- data results were based on 413 whereas in abstract it was mentioned 422. please correct this and explain the reasons of dropout?

14- did researcher did the stratified analysis on different perinatal time i.e pregnancy, childbirth & post natal? this would be a great addition to see at which phase culture malpractices affects the most.

15- On Page 9 in table 2, percentages are missing for pre lacteal feeding.

16- Does researcher assess multi collinearity between independent variables?

17- Can these finding be generalized, justify and write yes or no with proper justification

18- Author should highlight the strengths and limitation of this study? Any bias ( selection or reporting) observed & how it was managed?

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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.

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Reviewer #1: No

Reviewer #2: Yes: Alex Yeshaneh

Reviewer #3: Yes: Shireen Shehzad Bhamani

[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.]

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Attachments

Attachment

Submitted filename: PONE-D-20-34446_reviewer.08.12.2020.pdf

PONE-D-20-34446R1

Cultural harmful practices during perinatal period and associated factors among women of childbearing age in Southern Ethiopia: Community based cross-sectional study.

PLOS ONE

Dear Dr. Abebe,

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 by Jun 25 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,

Nülüfer Erbil, Ph.D, Prof.

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.

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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: All comments have been addressed

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: 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: 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 #2: Yes

Reviewer #3: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: All my questions and concerns are responded to well, conclusions are supported by data and now the manuscript scientifically sounds. Besides, the amendment of the title instead of cultural malpractice to harmful traditional practice also sounds more.

Reviewer #3: 1-I strongly feel that, study flow chart will be a great addition to this manuscript and it will clarify the sample enrolled or drop out at each phase.

2- Some of the comments were appropriately answered by author but I could not see these were incorporated in manuscript like normality assessment, training details and steps taken by researchers to improve consistency between data collectors. Plus considering multicollinearity ( do share which variables were found correlated) etc.

These points are their efforts to improve the rigor of the study so it should be added.

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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: Yes: Alex Yeshaneh

Reviewer #3: Yes: Shireen Shehzad Bhamani

[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.

Harmful cultural practices during perinatal period and associated factors among women of childbearing age in Southern Ethiopia: Community based cross-sectional study.

PONE-D-20-34446R2

Dear Dr. Abebe,

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,

Nülüfer Erbil, Ph.D, Prof.

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 #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 #3: Yes

**********

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

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 #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 #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 #3: Authors have responded well to every query raised at second review. Technically it is now a well written piece.

**********

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 #3: Yes: Shireen Shehzad Bhamani