Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia

Hana Mamo; Abinet Dagnaw; Nigussie Tadesse Sharew; Kalayu Brhane; Kehabtimer Shiferaw Kotiso

doi:10.1371/journal.pone.0255613

Peer Review History

Original SubmissionMarch 15, 2021
13 Apr 2021 Decision Letter - Claudia Marotta, Editor PONE-D-21-08455 Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia PLOS ONE Dear Dr. Kotiso, 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 by30 April. 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, Claudia Marotta Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 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 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. Moreover, please include more details on how the questionnaire was pre-tested, and whether it was validated. Please upload a copy of Supporting Information File 1 which you refer to in your text on page 15. Additional Editor Comments : dear authors follow reviewer suggestions to improve your paper [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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 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: No ****** 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: PLOS One Review: Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan Town, Ethiopia Dear PLOS One Editorial Board and authors of this manuscript, I would first like to acknowledge and commend the work preformed by this group. The questions they asked are of particular importance, not only in Debre Berhan Town but globally as well, and paramount to the understanding of maternal health and development of children. Without first an understanding of the frequency of and factors that lead to a short interpregnancy interval it is impossible to then work on making changes, improve health and awareness for the society and future research projects. Additionally, I find it personally impressive that they were able to enroll and receive responses from nearly 500 people in a short, one month time frame – an indication in my mind that they are committed and focused on applying the data and making true change in their community not merely publishing another paper. Further, a 500 individual sample size is of course quite robust. The goal of this paper was, as is clearly stated in their title, to determine how common a short interpregnancy interval is and what variables are correlated and associated to it specifically in Debre Berhan Town, Ethiopia. They preformed a cross sectional study using 5 midwives to sample pregnant mothers in 5 of 14 randomly selected kebeles (which my understanding act as areas/neighborhoods within Debre Berhan Town) and then pregnant mothers were sampled proportionately among those 5 kebeles at random. These mothers were then given a questionnaire administered by the midwives, each of whom sampled one kebele. For the purpose of pregnancy, abortions and miscarriages were not counted which I will discuss further in a moment. This study found that 40.9% of sampled women were pregnant again within this World Health Organization suggested period. Per their clearly written conclusion, “Age at the first birth, parity, non-use of modern contraceptive, duration of breast feeding, and unintended pregnancy were independently associated with short inter-pregnancy interval in the study. Therefore, it implies that increasing contraceptive use and encouraging optimal breast feeding might help in the efforts made to avert the problem.” This manuscript is written clearly and such that non-specialists in the field can certainly understand, but some clarification with regard to customs and structure within Debre Berhan Town, Ethiopia would be beneficial as is discussed further bellow. Before moving forward and addressing the areas left for improvement and questions that should be asked or considered in this paper, I would first like to make two points which may explain some of the points I am about to make: 1) I acknowledge that the patient data was collected from February 9th to March 9th of 2020, ending just a few days prior to the WHO declaration that there was a global pandemic caused by sars-cov-2 (COVID-19). It is conceivable that a larger study was originally planned. 2) I am not entirely familiar with what life is like in Debre Berhan Town, Ethiopia – as I imagine is the case for most people who will read this publication. As such, I may be missing some information that is needed to fully understand the authors position or the nature of pregnancy care and labor. While I was able to find some of this information online, such as population size and what definition of a Kebele, more of this information should be stated clearly in the manuscript. Here are my points for improvement and/or clarification: 1) Why only Debre Berhan Town, Ethiopia? a. I can make the assumption that this is because this is where the authors work and where their funding is from, however, it should be stated clearly. b. Is this town particularly at risk for having a low interpregnancy duration? 2) With regard to Kebeles and addressing sample representation of Debre Berhan Town, Ethiopia: a. Define a Kebele better early in the paper b. Determine whether or not the 5 kebeles – while randomly selected – are indicative of the general population. i. Ie. Were they the wealthiest or poorest kebeles? Do all kebeles have similar structural make up? Do all kebeles have access to the same healthcare? There are some socioeconomic techniques that can be used to preform these statistics if not readily available. 3) Describe access to healthcare in Debre Berhan Town and how women normally give birth, particularly in relation to the fact that in this study only midwives were used to gather all of the data (important for generalization ability and potential sources of bias): a. What percentage of women give birth with a midwife as opposed to physician, family alone, c-section etc? b. Do midwives take care of all pregnancies? i. Ie if a mother is particularly ill or there is a complication with the pregnancy, does a midwife provide the care? If not, then there is selection bias against this group. c. Paper should either be rewritten to reflect it is looking at this subset of pregnancies/births if this is the case or address other forms of birth as well. 4) Perhaps some co-variables could be looked at together, not simply alone. 5) “Family Planning” and interventions are mentioned in introduction. This raises the following points for this manuscript: a. It is mentioned that the interpregnancy period is short, despite these interventions. Was there data from before that the new data presented in this paper can be presented against? b. Family planning does not seem to be discussed further in the manuscript but should be considered as a variable, unless everyone has this training – in which case that needs to be stated. 6) Abortions and miscarriages were not counted as pregnancies, but equally was also not considered as a variable which seems short sighted as it can be incredibly impactful on a mother and family. a. Excluding these cases can lead to under reporting the data and leading to the data, and thus study, being less generalizable. b. Why were they excluded? i. Would the following situation be considered as a pregnancy interval: Birth 1, miscarriage, birth 2? Would the mother be excluded from the study? Or would the miscarriage merely not be considered? c. What is the abortion rate and miscarriage rate in Debre Berhan Town, Ethiopia? d. I do acknowledge that infant mortality rates and maternal infertility history are considered and may reflect some of these concerns. If so, please discuss and address this fact more specifically. To reiterate it is my belief that the authors conducted important research with an impressive work ethic and sample size, while focusing on what I ascertain to be important and actionable variables for their situation, which can likely be generalized to other areas of a similar nature. There are no ethical concerns or statistical interpretation concerns. It is my formal recommendation that the Editors accept this paper after minor revisions are completed to clarify the aforementioned points and I encourage the authors to continue this line of inquiry for the betterment of the community they are serving but also the global research community that is also focusing on the effects and associated factors of short interpregnancy time. There is potential for further, more in-depth research into the well-being of the mother and children from this study, as the impact of a short interpregnancy period is not studied beyond the introduction. Additionally, a sociological and psychological approach to understanding the influences behind a short interpregnancy interval would certainly be interesting and add another level of depth to this paper. However, this would change the nature of this manuscript significantly and is not needed to finalize a publishable product. I wish the authors the best in their efforts to help their community and contribute meaningfully to the international research community. It has been a privilege to review their work, and I am appreciative of this opportunity. Kindly, The Reviewer Reviewer #2: ABSTRACT: Under background, the definition of interpregnancy interval (1st sentence) should be recasted for better understanding. Grammatical errors that need to be corrected. INTRODUCTION: Lines 5-7,page 3,paragraph 2 should be referenced. Page 3, paragraph 3,lines 14-18 should be recasted. METHODS: Why was Debre Berham chosen as the study location? The authors should explain what kebeles are for international readers. There should be a more detailed explanation as to how the pregnant women were selected, where this was done, by whom and when? When were the questionnaires administered and where was this done? DISCUSSION: Lines 8,page 11,US should be written in full 1st. Also RHC (lines 11,page 8.) In page 12,lines 8 and line 10 when referencing statements, the authors mix cities and countries in different references.eg Port-Harcourt (reference 13) is a town in Nigeria but reference 7 is Nigeria. Also US (reference 9) then Michigan reference 12. The referencing of statements should be uniform for better understanding. Page 12,line 13-14 should be recasted. The literature review should be more robust. CONCLUSION: The statement in the last line in the conclusion in page 13, including the non-use of contraceptive as part of the recommendations reduce the incidence of short interpregnancy intervals seems to be at variance with the information in the last paragraph of the discussion before the limitations. REFERENCES>NO 6- BMJ should be written in full ****** 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 [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. 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Revision 1
7 May 2021 Author Response Dear reviewers and editor, Thanks for your review and important issues you raised in the paper. Hereunder, kindly get the responses to the points raised. Response to editor 1. I have uploaded the questionnaire (both English version and Amharic version) as Supporting Information. 2. A copy of supporting information file 1 (the dataset of the study) was also uploaded in the system. Responses to Reviewer #1 1. We selected Debre Berhan town because it was the largest town in North Shewa zone where we can find the larger proportion of women compared to other towns of the zone and considering the available budget to conduct the study. (stated in the manuscript) b) Generally, the culture of Amhara region where Debre Berhan town is located, encourages giving birth of too many children 2. Kebele was defined as “Kebele is the smallest administrative region in Ethiopia approximately comprising 1,000 households.” in the manuscript. The characteristics of the population in all the 9 kebeles is more or less similar. (stated in the manuscript) 3. Relevant information in the study area including access to health care are included in the revised manuscript such as “In the town, there are 29 health institutions: two hospitals (one private and one referral governmental hospital), 3 health centers, 17 drug stores, and 7 private specialty clinics.” And in Ethiopia, the midwives give basic care to all pregnancies and refer those women with serious complications needing urgent referral to hospitals. To eliminate selection bias, the participants were selected randomly from the family folder, and the printed hardcopies were given to the data collectors to access the women and make interview. Besides, being a community-based study, the sampling will not depend on the level of care that the midwives will give. 4. We tried to check for possible interaction of variables; however, we haven’t found significant and/or plausible result. 5. The issue of family planning and interventions were also addressed in the revised manuscript. Actually, it was mentioned not in the background section but in the abstract subsection conclusion and now it’s fixed. 6. Women who had miscarriage/abortion immediately before the current pregnancy were excluded from the study because they are more likely to get pregnant earlier as a result of the pregnancy loss, and they are recommended to have an interval of only six months. Because of the difference in the recommended interval between the pregnancies for those who experienced abortion immediately before the current pregnancy and who didn’t, we excluded them not to overestimate the short interpregnancy interval in a biased manner. However, those women who were recorded as pregnant in the family folder but had abortion at the study period were not excluded. Despite these, the possibility of bias associated with the exclusion was discussed in the limitation of the manuscript. Besides, we could not find a true figure of abortion rate and miscarriage rate in Debre Berhan Town as per our search. Responses to Reviewer #2 ABSTRACT: Under background, the definition of interpregnancy interval (1st sentence) was recast and corrected in the revised manuscript. INTRODUCTION: Lines 5-7,page 3,paragraph 2 was referenced. Page 3, paragraph 3, lines 14-18 was recast. METHODS: Concerning “Why was Debre Berham chosen as the study location?” And definition of kebeles, kindly see the responses to reviewer 1 under #1 and #2, respectively. A more detailed explanation as to how the pregnant women were selected was added in the revised manuscript. DISCUSSION: Lines 8,page 11,US was written in full 1st. Also RHC (lines 11,page 8.) In page 12, line 8 and line 10 the referencing issue, the authors mix cities and countries in different references was fixed, and the cities were replaced by the respective countries to make it consistent and for better understanding. Page 12, line 13-14 was recast. CONCLUSION: “The statement in the last line in the conclusion in page 13, including the non-use of contraceptive as part of the recommendations reduce the incidence of short interpregnancy intervals seems to be at variance with the information in the last paragraph of the discussion before the limitations.” Was addressed in the revised manuscript. REFERENCES>NO 6- BMJ should be written in full. It is the journal’s actual name, and it’s how they suggest to cite their journal With kind regards, The authors Attachments Attachment Submitted filename: Rebuttal Letter 2 revised.docx https://doi.org/10.1371/journal.pone.0255613.r002
22 Jun 2021 Decision Letter - Clive J Petry, Editor PONE-D-21-08455R1 Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia PLOS ONE Dear Dr. Kotiso, 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. ============================== This manuscript has been improved by the various revisions made. Both reviewers have suggested further (minor) revisions. I think that they would improve the manuscript once again, so please attend to each one of the suggestions to make the manuscript as good as it can possibly be. I will not add to the various suggested revisions, which should not be too onerous for the authors to deal with. I look forward to seeing the next version of the manuscript. ============================== Please submit your revised manuscript by Aug 06 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, Clive J Petry, PhD 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: (No Response) Reviewer #2: (No Response) ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 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 Reviewer #2: 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: 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 #1: Dear Authors, Thank you for addressing my comments thoroughly and making appropriate adjustments to the manuscript. Please see the last few areas of improvement after which, I believe this manuscript will be ready for publication. Introduction: In the sentence "Therefore, the result of this study could present a true picture of the problem and aid in the efforts being tried to reduce the short inter-pregnancy interval." I suggest replacing the word "true" with "more accurate" Study setting/Background: Mention the culture often leads to women having too many children Mention midwives are primary point of care for all pregnancies Response 3: sampling may not change but it is important for the generalizability and validity of the paper. Response 5 - thank you, I apologize for missing it. Response 6 -thank you for the thorough further explanation. I look forward to reading the final draft. Again, I note the importance of the research the authors have undertaken. Kindly, The Reviewer Reviewer #2: GENERAL: Few grammatical errors and wrong tenses METHODS: Under population (page 4), the 1st sentence should better read- Pregnant women who give birth a least once----. DICUSSION: In page 13,line 3-4; This study is in line with a study done in Nigeria (13, 16) and Bangladesh (16). Reference number 16 is quoted for a study done in both Nigeria and Bangladesh. REFERENCES: Number 6-bmj should be in capital letters. The paging in reference number 7 is not complete ****** 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 [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.0255613.r003
Revision 2
16 Jul 2021 Author Response Dear reviewers and editor, Thank you for your review and important issues you raised in the manuscript entitled “Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia.” We have read the reviewer's comments carefully and hope that the revised version now submitted will be regarded as having enhanced the previous version. The authors very welcome the reviewer's comments and suggestions. These contributions have appreciably improved the final paper quality. Hereunder, kindly get the responses to the points raised under each point. Response to reviewers 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: (No Response) Reviewer #2: (No Response) ________________________________________ 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 ________________________________________ 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ________________________________________ 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 Reviewer #2: 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: 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 #1: Introduction: In the sentence "Therefore, the result of this study could present a true picture of the problem and aid in the efforts being tried to reduce the short inter-pregnancy interval." I suggest replacing the word "true" with "more accurate" Comment: true was replaced by more accurate based on the reviewer’s comment Study setting/Background: Mention the culture often leads to women having too many children Mention midwives are primary point of care for all pregnancies Comment: amendments were made based on the reviewer’s comment. Response 3: sampling may not change but it is important for the generalizability and validity of the paper. Comment: thank you for the important notice. Response 5 - thank you, I apologize for missing it. Response 6 -thank you for the thorough further explanation. Reviewer #2: GENERAL: Few grammatical errors and wrong tenses Comment: Some grammatical errors were fixed based on the reviewer’s comment. METHODS: Under population (page 4), the 1st sentence should better read- Pregnant women who give birth a least once----. Comment: Corrections were made based on the reviewer’s comment. DICUSSION: In page 13,line 3-4; This study is in line with a study done in Nigeria (13, 16) and Bangladesh (16). Reference number 16 is quoted for a study done in both Nigeria and Bangladesh. Comment: reference number 16 is removed from a study done in Nigeria. REFERENCES: Number 6-bmj should be in capital letters. The paging in reference number 7 is not complete Comment: bmj was capitalized, and the paging in reference 7 was made complete. Thank you for your consideration. We look forward to hearing from you. Sincerely, The authors https://doi.org/10.1371/journal.pone.0255613.r004
21 Jul 2021 Decision Letter - Clive J Petry, Editor Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia PONE-D-21-08455R2 Dear Dr. Kotiso, 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, Clive J Petry, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0255613.r005
Formally Accepted
23 Jul 2021 Acceptance Letter - Clive J Petry, Editor PONE-D-21-08455R2 Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia Dear Dr. Kotiso: 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. Clive J Petry Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0255613.r006

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