PONE-D-20-23821

Institutional delivery practice in southern Ethiopia.

PLOS ONE

Dear Dr. Kassa,

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.

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 main limitation of the current study is that it can be seen as a replication study of the numerous similar studies carried out in different regions of the country. Many of them are reported, some of the more recent ones are missing. PLOS ONE policy regarding replication studies is that if a submitted study replicates or is very similar to previous work, authors must provide a sound scientific rationale for the submitted work and clearly reference and discuss the existing literature. Submissions that replicate or are derivative of existing work will likely be rejected if authors do not provide adequate justification. The authors should streghthen the rationale for the submitted work and ensure they clearly reference the existing literature.

Regarding some of the key missing references: https://doi.org/10.1186/s12889-019-7854-2 is interesting since it works with the DHS survey mentioned in the introduction, DOI: 10.1186/s12884-017-1409-2 looks also at the relationship with seeking antenatal care..., DOI: 10.1186/s12889-020-08919-8 ... I believe there are more references missing.

Another limitation of this study is sample size and low power. This means that large differences in relative risk such as those of antenatal care, seem not be significant. I say seem, because there are problems in reporting. It is said that a screening based on p-values of 0.2 is carried out in a first stage, but those p-values are missing from table 3 (or elsewhere), they should be included.

There is also no treatment of multicolllinearity. Several of the variables are probably closely related, such as urban/rural and distance to health facility. This might explain changes of signs. Some evaluation of multicollinearity is needed. I suggest one of two strategies: the first one, you could use a backward/forward model selection procedure similar to the Debremarkos study mentioned above. Otherwise, you could report the R2 of the covariiates with respect to the rest of covariates (VIF, equal to 1/1-R2aux is better avoided since it does not provide a variance inflation factor in the context of logistic regression).

Due to the large number of categorical variables and small sample size, there could be problems of complete or quasi-complete separation. Please report on the convergence of estimates (at least in the review report) since lack of convergence is often due to problems of separation.

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Look also at the additional points made by the reviewers.

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We look forward to receiving your revised manuscript.

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José Antonio Ortega, Ph.D.

Academic Editor

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

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

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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

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: 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: How could you see the significance of the study as many studies published in Ethiopia including DHS?. (may be as requirements for KMC project)As a report made by authors the study sampling procedure is multistage and design effect of 2 was used to calculate sample size but only three districts selected to represent the whole 36districts in Sidaama region mentioned in the title. 

How do you see generalization to the whole region?

and also why you are interested in urban and rural division in spite of the fact that statistical difference and separate factors for both was not appreciated(32 versus 3.2 Percent)

Need further discussion for maternal merchant occupation as risk factors for home delivery since women economic empowerment pave the way for institutional delivery?

the issues of wide confidence interval for prominent factors called planned place of delivery and chi square assumption which is not fulfilled(1)

The limitations didn't go with study objectives? Since the trend is not many objectives of current study?

Reviewer #2: Very useful manuscript. Major revisions are required as the discussion is repetition of results. Discussion needs to be more of explanation for findings and comparison with other studies. Need to be rewritten.

Authors do not compare data across districts. No description of graph of district wise deliveries in the results but mentioned in the discussion but no elaboration.

Discrepancy of merchant women having more home births needs to be discussed in a detail.

Reviewer #3: 1. Title says "Institutional delivery practice in southern Ethiopia" but the aim is to assess prevalence and determinants of of home delvery. Better to change it " Home delivery practice and its predictors in South Ethiopia"

2. Discussion part: first paragraph should only summarize the main findings, the interpretation and comparisons should come in the subsquent paragrpahs.

3. In the limitation part: it is stated " “Being cross sectional, this study may not give picture on the trends of delivery” but the aim of your study is to determine prevalence of home delivery and factors associated, and you answered that, I don’t think the cross-sectional design is a limitation here.

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Reviewer #1: No

Reviewer #2: Yes: Kranti Suresh Vora

Reviewer #3: No

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Home Delivery Practice and its Predictors in South Ethiopia

PONE-D-20-23821R1

Dear Dr. Kassa,

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,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

There are some editing suggestions by reviewer 3 that should be incorporated.

Also I have noticed that in the main text you refer to merchant women when the category includes all employed women (including self-employed). I would suggest changing merchant to employed women throughout, making sure the first time to mention that employed women include those working for wage and self-employed.

Regarding the backwards-selection GLM regression, it is important to specify in the methods section the procedure employed (alpha level chosen for removing, or AIC maximization, ...).. Also note that PLOS ONE criteria for statistical reporting ask you to Include the full results of any regression analysis performed as a supplementary file. Include all estimated regression coefficients, their standard error, p-values, and confidence intervals, as well as the measures of goodness of fit. I'd suggest including the first full model estimated and the final model selected by the backward selection algorithm.

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: (No Response)

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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

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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

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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: 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 #2: (No Response)

Reviewer #3: 1. Title is corrected as suggested in the previous review report; which is good.

2. There are few editorial correction which need to be corrected to show some of them

-Introduction last paragraph, last sentence, better be corrected to read " to assess the prevalence of homebirth and determinants, omit "rate"

-Results: sociodemograph characterstics: last sentence "377 (76.2%) of the women were housewives and 45% of had at least'' either remove "of" or add "them" after it.

- Under the heading Antenatal care follow up and plan for place of deliverey: first paragraph , last sentence "preferred their women,relatives" I think you need to omit the coma betwen women and relative.

- Conclusion and recommendation: don't you think it is important to recommend further study using qualitative methods, as it allows to get depth information about the issue. There are recent quaitative studies from Ethiopia on similar topics.

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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: Kranti Suresh Vora

Reviewer #3: No