Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: An observational cohort study

Susannah L. Woodd; Abdunoor M. Kabanywanyi; Andrea M. Rehman; Oona M. R. Campbell; Asila Kagambo; Warda Martiasi; Louise M. TinaDay; Alexander M. Aiken; Wendy J. Graham

doi:10.1371/journal.pone.0254131

Peer Review History

Original SubmissionJanuary 19, 2021
15 Apr 2021 Decision Letter - Calistus Wilunda, Editor PONE-D-21-01978 Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: an observational cohort study PLOS ONE Dear Dr. Woodd, 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 May 30 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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If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This study estimates rates of postnatal infection among women and infants in Dar es Salaam, Tanzania, using telephone surveillance. It demonstrates the feasibility of telephone surveillance for this purpose in Tanzania, and provides the first post-discharge estimates of maternal and newborn infection rates in this setting, as well as associated risk factors. It is clear, well-written, the methods and conclusions are sound, and it is a valuable addition to the literature on maternal and newborn health in sub-Saharan Africa. Minor comments: Line 72: Can any more information about the selected hospitals be provided? Are they public/private? What is their catchment area? How many hospitals of this size are there in Dar es Salaam? Line 92: Given that one of the major limitations of the study is around the ability of the questionnaire to accurately identify infections, could you provide more details here on how the standard definitions were adapted? Are there any existing questionnaires for measuring postnatal infection that were considered but not used? If so, it would be helpful to discuss this here too. Line 128: What was the frequency of discordant data, stillbirths and twins/triplets? Reviewer #2: Line 203 - 28 early stillbirths occurred, did you include these in your final analysis? Line 204 - between day 8-28 additional 6 babies died, did you include these numbers in you final analysis? Line 217 - What do you mean by "weak evidence" of higher infection rates in women 25-29 years ( you make reference to table 5: [2.14 (1.12- 4.09): p=0.06]. How do you explain these p-value versus CI above 1.0? Line 235: Maternal postnatal infection was associated with increased odds of possible newborn infection (crude Odds Ratio 2.74, 95%CI 1.16–6.48, p=0.02). Author should rephrase this statement or provide some explanation as well as discuss this in the section for discussion of results Line 238-239: Please rephrase to provide easy readability ****** 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: Yes:** Richard Mangwi Ayiasi [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.0254131.r001
Revision 1
8 Jun 2021 Author Response Response to Editor's comments The competing interests statement is updated as follows: "I have read the journal's policy and the authors of this manuscript have the following competing interests: SLW, AMK, AK, WM and WJG received personal salary funded by The Soapbox Collaborative for their work on the study. SLW received a Research Degree Travel Grant from LSHTM. AMR received salary from the UK Medical Research Council and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement. Other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials." In tables 5 and 6 we have now combined the information into a single footnote: Values imputed for variables with missing data, except for Preterm birth where the amount of missing data was considered too large to impute We hope it is now clear that imputation was carried out for all variables except Preterm birth We have updated table 2 to use a letter instead of a symbol for the footnote. As suggested, we have changed the reporting to hazard ratios We have now explicitly stated the comparison group for each association, in both the abstract, and the results section Response to reviewers' comments Reviewer 1: The hospitals are two of the three public regional referral hospitals in Dar es Salaam, covering the districts of Ilala and Temeke. This has been reflected in the text. For information, there are 28 hospitals at this level in Tanzania. We adapted the infection definitions by removing all laboratory investigations and any clinical signs that could not be easily reported by the women, for example, temperature readings, abdominal tenderness, perineal wound redness. We were less rigid with some definitions e.g. superficial wound infection, to allow for these necessary omissions. A more detailed account is being written up elsewhere. A short sentence has been added to the manuscript. "These definitions were adapted by the first author to include only symptoms and signs easily reported by the women." We did not search extensively for other questionnaires, but from our work in this field, including a systematic review of maternal peripartum infection, we are not aware of any published, (validated) telephone questionnaires for this purpose. Regarding twins and stillbirths: Among the 12 interviews with mothers of liveborn twins, only six record data on the second twin, partially due to a fault in the ODK programming. Among mothers with hospital and telephone data, 28 have a baby who dies in the first 7 days. Of these, maternal cause-of-death reports are consistent with 7/8 of the hospital-recorded stillbirths. However, the hospital records miss 4 more stillbirths reported by mothers and at Temeke hospital no stillbirths are recorded, which we consider highly unlikely. Reviewer 2: Women giving birth in hospital and recorded in the delivery register were eligible for recruitment, including those with stillbirths. All recruited women who were reached for interview were included in the analysis of maternal postnatal infection. Stillbirths contribute to the 28 deaths occurring up to day 7. Stillbirths were not included in the analysis of newborn infection. As described in the methods, line 104, babies who died after day 7 contributed to the analysis (infection rate and analysis of associations) up to day 7 only. Line 217 p=0.06: The p-value refers to the overall association between the three categories of age-group and infection rate rather than the 25-29 year group alone. We have rephrased the text to better reflect the result. "There was also weak evidence of an association between women’s age-group and infection (p=0.06) with the highest infection rates occurring in women aged 25–29." Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0254131.r002
21 Jun 2021 Decision Letter - Calistus Wilunda, Editor Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: an observational cohort study PONE-D-21-01978R1 Dear Dr. Woodd, 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, Calistus Wilunda, DrPH Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0254131.r003
Formally Accepted
23 Jun 2021 Acceptance Letter - Calistus Wilunda, Editor PONE-D-21-01978R1 Postnatal infection surveillance by telephone in Dar es Salaam, Tanzania: an observational cohort study Dear Dr. Woodd: 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. Calistus Wilunda Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0254131.r004

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