https://orcid.org/0000-0002-8951-3245
Peer Review History
| Original SubmissionDecember 7, 2020 |
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PONE-D-20-38462 Analysis of maternal and newborn health training content and approaches to inform future training programs for routine care, basic and comprehensive emergency obstetric and newborn care: Lessons from Ethiopia and Nepal PLOS ONE Dear Dr. Sharma, 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 19 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:
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 We look forward to receiving your revised manuscript. Kind regards, Hannah Tappis, DrPH, MPH Academic Editor PLOS ONE Additional Editor Comments: This is an interesting article with potential to make a unique contribution to maternal and newborn health policy, programming and research. Please carefully consider feedback from both reviewers, with particular attention to clarification of research questions/objectives and contextualization of findings within the current global evidence base on the topic of focus. Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1.) 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 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. 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To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ 5. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. [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: N/A ********** 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: General comments: The manuscript analyzes the maternal and newborn health training curricula in Ethiopia and Nepal. The authors conducted mixed qualitative and quantitative methods to assess the maternal and newborn health training content and approaches. The authors concluded that the technical content of training curricula had several gaps that should be addressed and the alignment between different MNH training packages should be improved by using innovative methods. The manuscript needs improvement in grammar, the writing style and the sentence structure. Copy editing is required. Below are the specific comments and questions: Abstract: In findings, it is strange to separate active management of the third stage of labor from CmONC as it is one of the signal functions. It would be better to include specific gaps in CmONC. It seems that qualitative findings are missing. The recommendations need to be adjusted based on the aims and findings of the study. The second and third recommendations seem vague. It would be better to come up with a clear and concise conclusion in the abstract. Introduction The introduction section needs a fundamental revision. It is a challenge for a reader to follow the sentences and paragraphs. The logical flow between the sentences and paragraphs needs to be considered. Also, the definition of the authors for this study should be aligned with evidence and literature. Many statements are not supported by references. The rationale for this study is not well described. Page 3: It would better to move the table as an annex and briefly describe the table in the introduction. Page 3, line 6-10: It is hard to understand what the authors are trying to describe here. It does not have a logical flow with the previous sentences. Page 3, table 1: According to proposed new signal functions by Gabrysch et. al BEmONC should be changed to Basic emergency care and CEmONC to Comprehensive emergency care. Otherwise, it creates confusion among readers. Page 4, first paragraph: A reference is needed. Page 4, line 6-7: It could be a perception, may not be supported by evidence. Page 4: 13-19: Again, it is a challenge to follow. And the references are missing. Page 5, Second paragraph: The logical flow should be considered. Page 5: The aims of this study should be clear and easy to understand. It is difficult to grasp the aims of the study. Page 5: Line 18-21: This sentence needs to be moved to the acknowledgments. Page 5: The last paragraph should be integrated with the aims of the study followed by possible implications. Methods: Again, the logical flow of the ideas should seriously be considered. It’s a challenge for a reader to follow the jumping ideas in these sentences. It would be better to follow a smooth transition from one sentence to another and clarify the linkages. Page 7: The last two paragraphs are relevant to the introduction section. The authors need to describe Figure 1. the essential data in the text and clearly explain the inclusion and exclusion criteria. “Priority was given to in-service training and interventions at health facility setting only.” It is a standalone sentence without any justification or profound description. The tools development process and justification should further be explained. It would be better to describe the type of software used for qualitative data analysis and the quality assurance data analysis- intercoder reliability assessment. Result: The authors need to consider reorganizing the results section and retain the consistency of presenting the findings. It would be better to include numbers beside the proportion for each clinical practice as number (%). Page 11: Why did authors present the findings of different packages such as PMTCT, NICU, and IMNCI under the subheading of Newborn care interventions in BEmONC and CEmOC. These are confusing! If the authors are following Sabine Gabrysch et.al proposed framework, then the terms need to be clarified as basic or comprehensive emergency care to avoid confusion. Presenting the data is not consistent throughout the results section e.g. page 12. Page 12: Again, “In Ethiopia, for CEmONC, fluid management in a newborn, safe oxygen therapy and b-CPAP therapy were covered comprehensively in the NICU training materials,”. It is confusing to see the CEmONC is mixed up with different training packages. It seems that BEmONC and EmONC packages and signal functions are miss-interpreted in the results section. Page 13: “the national BEmONC manual was found to be comprehensive”. It seems subjective without presenting the data. The authors don’t need to present all the details of the findings in the qualitative section. They can focus more on the main and key findings. They also need to include some quotes from the participants of the study to support the findings and make the results more interesting. It would be interesting to see subheadings based on the themes. Discussion: The findings which are presented in the results section need to be interpreted in the discussion section but not the other new findings. For example: ”Specifically, newborn infection prevention guidelines were found to be deficient for topics such as hand washing before and after handling babies, the importance of rooming-in with the mother, benefits of co-bedding, encouragement for early breastfeeding...". It would be strange to see these results for the first time. It would be better to discuss the qualitative results, not only the recommendations from the participants. Conclusion: The first paragraph seems unnecessary. The first sentence of the second paragraph is general. It would be better to make it more specific. Thank you. Best wishes to the authors. Reviewer #2: This is an important study with the potential to help us understand gaps in the delivery of maternal and newborn health training content and approaches in Ethiopia, Nepal and more broadly. The paper is well written with only some minor grammatical edits required. The study sought to audit existing training packages in the two contexts of interest, and the authors have effectively defined essential maternal and newborn care interventions for routine care, basic, and comprehensive emergency obstetric and newborn care, and mapped current offerings against these very effectively. There is, however, a lack of clarity as to whether this auditing is the full extent of the authors’ purpose in preparing this manuscript. The abstract and the introductory passages focus on the ‘integration of technical content in training on maternal and newborn health’ (abstract), establishing the expectation that this will be a significant component of the paper. Reading the document, it was unclear if the study was designed as an audit only (with findings confirmed through the qualitative method), or whether there was an initial intent to compare stand-alone and integrated packages and any evidence for their comparative effectiveness. The abstract suggests that ‘it seems logical and cost-effective to integrate maternal and newborn health trainings’ and this seems to be an important issue for exploration. If this is the focus of the study, this needs to be made clearer throughout the remainder of the document, including highlighting findings on integration of training in the results, and situating these results in broader literature on integrated training and its benefits/ limitations in the discussion. This would help to provide solid, evidence-informed recommendations on what an effective integrated MNH training would look like in Ethiopia and Nepal. The audit of existing training packages provided by this study would also indicate what is in place and what is needed to reach the desired goal of effective integrated training. If the focus of the paper is on the audit component, and not on the potential of integration of training content and approaches, this should be made clear and the abstract and introductory section re-written to reflect the purpose of the study. The following comments are divided by manuscript section and include both major and minor issues, and examples of what may need to be addressed. Many of the comments that follow spring from this confusion around the core purpose of the paper. Title and abstract: • The title and the abstract do not seem to align. The abstract highlights a focus on integration of training content but this is not mentioned in the title. Introduction: • Table 1 is very useful but should be described more fully in the body of the manuscript. It is noted that references are provided at the end of the table, but more is needed in the text about where these essential maternal and newborn care interventions were extracted from, why they were chosen, whether they are the globally accepted standard etc. This is explained on page 6 but needs some explanation here to accompany the table. Explain the key guidelines that informed the construction of this table. • Page 4: paragraph 1: suggest authors begin paragraph with a broader statement about MNH trainings in general- what is most commonly done- are stand-alone or integrated trainings the norm in LMIC? Are integrated trainings less common? Link this statement back to the opening statement that health workers are often responsible for care across the continuum and so an integrated training- a training that integrates maternal and newborn care would be a logical approach. Maybe also reference the different possible timings of trainings and make clear that this paper is focusing on in-service training, not pre-service etc. • Page 4 paragraph 2: suggest removing first sentence to page 3 where there is reference to the same individual providing different services- both refer to the work, not the training and it is confusing to put this sentence in the middle of a passage about training. • Page 4 paragraph 2- more references/evidence are needed throughout the second half of this paragraph. Examples: statements such as ‘…therefore, acquisition of skills may often fall short and quality may be compromised’; ‘There can be a tendency to omit certain topics…’ and others. • Page 5 paragraph 2: the Kirkpatrick model of training evaluation is mentioned here but not referred to again. Suggest it is unnecessary. It is unclear how the reaction and learning components relate to the results and discussion. • Pages 5-6 paragraph 2: states that ‘This rapid assessment aims to contribute to the evidence base on differences in training content and implementation approaches for integrated and stand-alone trainings…’ As explained above, this does not clearly come out in the results and discussion. This seems to be an important focus but it is not explored adequately in the sections to follow. Materials and methods: • A clear statement of research aims/ objectives/ question(s) would help guide the reader through the remainder of the paper. Again, the abstract highlights a focus on integrated training but this is absent from the title and does not flow through the results and discussion to support recommendations of ways forward for future MNH training packages in these contexts. Study design • Suggest changing the order of this section for clarity. Paragraph 1 under study design begins by discussing the identification of relevant training packages- suggest continuing this focus by moving the following passage (abbreviated here) “Available training materials were identified by the senior in-country study coordinator…Essential MNH interventions were based on validated WHO guidelines presented under Table 1” so that it comes directly after “The next step was to identify the national focal person for MNH trainings, and through them, we identified all the relevant national packages that fulfilled our selection criteria”. This allows the reader to better understand the first process of identifying national training packages. Now that the selection process is more fully described, it is suggested that authors next move on to the review of these selected training packages. This would begin with the passage (abbreviated here) “Training packages were reviewed by two independent…and technical content for routine, basic and comprehensive emergency and obstetric newborn care”. This could then be followed by The extraction tool gave equal weight to all interventions…and not deliberate omissions due to contextual factors” (on page 7). Adopting this structure means that authors are first describing how training packages were selected, and then describing how they were analysed. Changing the order of text in this way may also require deleting repetition or other editing. • The inclusion of the data extraction template is excellent. It would be beneficial to provide some information on where this was derived from. If it was from the same documents that informed Table 1, please make this clear. • Figure 1: provide some example reasons for exclusion. • Make clear in the body of the manuscript that training packages included for analysis were both stand-alone and integrated. • The sentence ‘Priority was given to in-service trainings…’ is unclear. Were only in-service trainings included? What was the criteria for this? Were some pre-service trainings included? If so, with what justification? Data collection • First paragraph is repeated from previous section. • Need to be clearer on why the key informants were interviewed. What was the purpose of including this qualitative component? When the research aims/ questions are more clearly defined (as recommended above), the reason for using interviews should be clearly linked and explained. The provided interview guide is very broad so it would be helpful to have a clearer indication of the purpose of these interviews, how this method helped answer the research question, and how it fits with the quantitative analysis/ audit. Data analysis • A description of how the 2 components of the research work together to answer the research question is not provided. Ethics • Provide an explanation as to why in-country ethics approval was not needed. Results • Table 2: It was hard to read with the heavy load of acronyms. Could this be re-formatted to include the names of the training packages within the table? • The results are well structured as they follow the key components outlined in Table 1. • The reader can assume the meaning behind the %s given in this section (from p10), but it would be good to explain, at least in the first instance, how percentages were arrived at. • Page 14- summary of qualitative findings: it would be good to reiterate the rational for conducting these interviews and their focus to guide the reader through the findings. • From page 15: make clearer that statements included in the text encapsulate what the interviewees stated and are not a reference to other literature or the authors’ own interpretations. Examples of this: Pages 14- 15: ‘Implementing such a strategy where specific modules (or trainings) are implemented to address identified gaps in existing quality of care will help to improve knowledge and skills of health workers’. Is this reporting what was said by those interviewed or is this a conclusion drawn by the authors? If it is the former, this should be made clear through reporting verbs such as ‘the respondent explained/ respondents stated…’ etc. If the latter, it should be in the discussion and supported by other evidence. Page 16: ‘There is a need to update existing…’. If this is what was said by those interviewed, this needs to be clear by adding something like ‘It was reported that…’ Page 16: ‘Rapidly scaling up trainings to meet…’. As above. Page 17: ‘We need to learn more about effective models for mentorship and supervision…’. As above. And others- make it clear what was told/ reported to the researchers by the interview participants. If it is interpretation by the authors or relating the responses to other literature, it would be best in the discussion section. • Some passages seem to be interpretive/ reference other literature/studies and may be best in the discussion: Examples: Page 17: ‘In Nepal, program reviews have found that skills deteriorate rapidly…’. Page 17: ‘Also, skill retention is likely to vary depending on the work…’. • There is a noted absence of reporting on what participants said in relation to the integration of training packages. This is mentioned in the table e.g., ‘MNH training materials do not cover newborn health…’. As this was a stated focus of the paper, it would be good to have this as a theme if there is sufficient data. This would combine all that was discussed in relation to the overlaps between maternal and newborn health trainings and any comments participants had on this key issue. Discussion • Overall, the discussion needs to be improved by reference to existing literature and evidence from other studies or comparable contexts. The discussion does not adequately situate the findings/ results within existing literature and this is especially true for the qualitative findings. • A deeper discussion section could be provided, followed by recommendations based on the results/ discussion. • Again, the issue of integration of training contents is not clear in the discussion. If this is a focus of the paper, this needs to be described and the results pertinent to integrated trainings placed within the context of relevant literature. Are there relevant findings from different settings that could be referred to? What is the evidence for integrated training and how do the authors’ findings sit with these? Are there insights from the qualitative data that could provide further clarity here and point to recommendations? • The discussion also does not elaborate on what the findings/ results mean for integration. Again- if this is the focus of the paper (as indicated by the abstract and the introduction section), this needs to be a focus of the discussion. Where else have integrated training packages been used? What was found in these contexts? What does the data say for Nepal and Ethiopia in this regard and how does this align/ not align with what is known in the literature about the use of stand-alone and integrated training packages? The abstract mentions evidence of benefits that come from integrating training contents but these are not followed through in the results or discussion. More information on this would be helpful in supporting the recommendations. • If integration is not the focus of the paper, authors should use the discussion to situate the study results (from both the audit and the interviews) more clearly within existing literature on training effectiveness. There is an abundance of resources on training transfer which provide more insight into the nuances of trainees’ capability and willingness to pursue the objectives of their training when they return to work. This literature would be particularly useful to explain and situate the qualitative findings outlined in Table 3 and could be consulted whether integration is the final focus of the manuscript or not. • There is a lack of reference to existing literature/ referencing in general. Examples, the statements: “Further, babies born to HIV positive mothers tend to be preterm and will need additional feeding and thermal care support…” (p20); and “Similarly, all MNH trainings should cover management of the HIV exposed infant” (p20). These (and others) are without references and do not refer to what is known on these issues from comparable contexts. If these are recommendations arising from this study, they should be stated as such. • Reference to literature on the recommended alternative approaches to training is also needed (on p21). ********** 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. 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. |
| Revision 1 |
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PONE-D-20-38462R1 Analysis of maternal and newborn health training content and approaches to inform future training programs for maternal and newborn care in the low- and middle-income countries: lessons from Ethiopia and Nepal PLOS ONE Dear Dr. Sharma, 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 Sep 17 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:
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. We look forward to receiving your revised manuscript. Kind regards, Hannah Tappis, DrPH, MPH 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. Additional Editor Comments (if provided): Please carefully consider feedback from both reviewers, with particular attention to outstanding questions regarding methodology and risk of biases or subjectivity in presentation of results. A comprehesnive copyedit is also recommeded. [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 #3: (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 #3: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 #1: Yes Reviewer #3: No ********** 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: No 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 #1: The authors have brought considerable changes to the manuscript and incorporated previous comments and suggestions. Below suggestions will help to improve the manuscript further. There are some grammatical and typographical errors in the manuscript, and the authors need to correct them. Abstract: The aim of the study seems complex. Therefore, the authors need to make the aim of the study simple, concise, and focused. Meanwhile, the integration of training packages and services stated in the first paragraph does not match the study's aim. Keywords: It would be better to match the selected keywords with MeSH. Introduction: The introduction section is unnecessarily lengthy. It would be better to keep this section brief, clear, and aligned with the objective of the study. Several paragraphs are slipping away from the study's central concern, e.g., page 5, second paragraph. In addition, the aim of the study stated in the introduction should be aligned with the abstract. Methods: The authors need to include relevant references to the selected design/methods of the study. Introduction. The introduction section is unnecessarily lengthy. It would be better to keep this section brief, clear, and aligned with the study's objective. Several paragraphs are slipping away from the study's central concern, e.g., page 5, second paragraph. In addition, the aim of the study stated in the introduction should be aligned with the abstract. Methods: The authors need to include relevant references to the selected design/methods of the study. Results: Figures 2 and 3 captions should be adjusted to the subheadings (page 16-18). Adding some quotes from the study participants will enrich the qualitative results. Discussion: It will be better to compare the findings with other similar studies in LMIC and explain the differences. Reviewer #3: I commend the authors for addressing a topic that has large programmatic relevance. Maternal and newborn health is an integral part of sustainable development targets. Huge amount of money government and aid money is spent on MNH training. Generally speaking, the manuscript is written well and followed a sound technical approach. However, there are a few areas that need explanation and/or improvement. 1. The authors stated that their evaluation targeted levels 1 (reaction) and 2 (learning) of Kirkpatrick Framework but I have not seen the learning component clearly assessed in the paper. The authors should review the introduction section where they describe the Kirkpatrick evaluation framework. Levels 2 and 3 are exchanged. 2. In the methods section, the authors stated that they excluded training packages that are not approved by the MOH in the focus countries. What proportion of MNH trainings followed approved training materials? How might this have affected the selection and results? 3. The data extraction tool has binary responses (Yes or No). I wonder if the data extractors had difficulty in giving a Yes/No answer and what influence that might have had on the findings. 4. The manuscript identified missing technical contents in the reviewed materials. On the other hand, the authors rightly acknowledge the concerns about integration and said that training should respond to specific performance gaps instead of universal coverage of topics. The latter suggests we should not expect every training material to cover every related topic. It is not clear how the authors determined essential from nice to know content. Lack of clarity on this can potentially affect validity of conclusions. There are needs for editorial improvements. Full stop at the end of sentences is missing in many places. ********** 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 #3: Yes: Tegbar Yigzaw Sendekie [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. |
| Revision 2 |
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Analysis of maternal and newborn training curricula and approaches to inform future trainings for routine care, basic and comprehensive emergency obstetric and newborn care in the low- and middle-income countries: lessons from Ethiopia and Nepal PONE-D-20-38462R2 Dear Dr. Sharma, 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, Hannah Tappis, DrPH, MPH Academic Editor PLOS ONE Additional Editor Comments (optional): Please ensure a careful copyedit at the proof stage. There are a few minor language/style issues remaining (e.g. 'mix methods' used instead of 'mixed methods'). Reviewers' comments: |
| Formally Accepted |
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PONE-D-20-38462R2 Analysis of maternal and newborn training curricula and approaches to inform future trainings for routine care, basic and comprehensive emergency obstetric and newborn care in the low- and middle-income countries: lessons from Ethiopia and Nepal Dear Dr. Sharma: 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. Hannah Tappis Academic Editor PLOS ONE |
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