PONE-D-21-12395

COVID-19 Infection Prevention and Control Practices among Food Handlers in Food and Drinking Establishments of Dessie City and Kombolcha Towns in Northeastern Ethiopia

PLOS ONE

Dear Dr. Metadel Adane

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 findings of the study are important for program managers at the local municipal councils that regulate and control the food service establishments during COVID 19 pandemic. However, fundamental issues are indicated to be provided mainly for the methodology section (sample size calculation) and the statistical analysis.  The manuscript could be greatly strengthened by aggressive editing for the majority of the study sections.

Please note that your manuscript was reviewed by 11 experts in the field due to the sensitivity of the topic. There is consensus agreement that the idea of the article is interesting but also consensus agreement that the article required additional work. The reviewers identified many important problems and provided copious comments (enclosed).

The manuscript could be greatly strengthened by considering editing according to the specific Reviewers’ comments.

The reviewers had several comments. To allow you to easily understand and address them, the Academic Editor has summarized here the main concerns and suggestions that need to be addressed at revision (only the concerns summarized below need to be answered in your Response to Reviewers): 

Overall General comment:

Please note that further language improvements is indicated. Consider revising the spelling, grammar, diction, and syntax throughout the manuscript for increased clarity. The paragraphs should be made brief as there is a lot of repetition of words/phrases (refer to reviewer specific comments for some sentences as example). Consider replacing some words as described by the reviewers to be more specific and precise e.g : in the Abstract consider replacing "prevent" with "reduce" - "Thus, ensuring infection prevention and control practices for this high-risk group is urgently required to prevent COVID-19 transmission."

Main points to be addressed:

Abstract:

• Consider adding one paragraph as background discussing the hypothesis of the study.
• Formulate the objective with 2 to 3 aims
• Delete the non-related conclusion¨ Thus, ensuring infection prevention and control practices for this high-risk group is urgently required to prevent COVID-19 transmission}.
• Consider adding the study design and too to the methodology and remove the statistical tests description.
• Consider re-arranging the results Report proportions for knowledge, attitude and then finally practice. Then report the results for the multivariable logistic regression on factors associated with good practice. Although attitude was lower, it may not be related to poor practices. I think the authors might be better off suggesting how the uptake of good practices can be increased?
  Consider removing from the result of the abstract sentences that out of context. Delete ".... whereas the poor practice of infection prevention and control was 56.1% (95% CI: 51.4%-60.8%)" since the first part of the sentence already captures the main result.
• restrict to provide conclusions out of the study ¨Our findings showed that three-fourths of food handlers had good knowledge and more than half had a favorable attitude about infection prevention and control. Thus, integrated work is urgently needed to prevent COVID-19 transmission by further improving food handlers’ good practice of infection prevention and control}.
• Consider writing the keywords in an alphabetical order.
   

Introduction:

• the first 2- paragraphs should be merged with the following text added at the end of first paragraph while the rest of the text should be deleted as it is only a repetition: {According to a World Health Organization (WHO) report on 20 September 2020, 30.6 million positive cases with 950,000 deaths worldwide have been recorded. On that date, Africa accounted for 1,145,397 COVID-19 positives with a total death of 24,757; and in Ethiopia the number of COVID-19 cases reached 68,131 and confirmed deaths reached 1,089 [9].
• In the last paragraph the following sentence should be either deleted or re-written as it does not clearly interpret what is author trying to convey: {Implementation of IPC practices based on WHO and Ethiopian Ministry of Health (EMoH) guidelines is rapid, decisive, and collective action which saves millions of lives [13, 16, 17].}

Objectives

• Consider formulating the objectives of the study to be more focused  as the given objective is too genialized.
   

Methodology

Study Area:

• It is not clear why only Dessie and Kombolcha town were included in the study.
• Add some description about the socioeconomic status of the area to generate some idea about the general people perceptions and attitudes in the study area.

Approach

•  A flowchart would add useful information to the reader of the paper. Particularly because not the entire food establishments were included.

Study design, period, and population:

• consider mor clarification for the terminology : “The source population” and “The study population”
• consider including the categories based on nature of food and drinking facilities in the study.
• Consider including the systematic random sampling design and not simple random which is reflected on using by using logistic regressions rather than ordinal logistic regressions.
  Sample size determination and sampling techniques:
  How the sample size from each study area has been selected should be written more clearly as currently it is very ambiguous and unclear. Similar is true for sampling techniques and should be re-written.
  Statistical methods and Measurement of the outcome variable:
• More elaboration is required for discussing the questionnaire design” and  the“checklist” and to be included as supportive documents.
• The authors should state the score of each question to prevent ambiguity.
• Please classify the questions that were used as the basis for classification of the participants into the ones with good/poor knowledge or favorable/unfavorable attitude. Authors should consider refining how they describe the analysis - it is about the factors associated with good practices (and not both good practices and poor practices).
• Consider using the proportional odds model during the statistical analysis
• Consider writing which variables were used for the univariate or multivariate models as interest variables or for the model adjustment.
• Additionally, for the bivariate analysis, authors could have included variables with p-value up to 0.10 with backward or forward elimination or Other? Why P-value up to 0.1? add  reference

Data collection and quality control:

• Consider adding what the observations were to be, and anticipate what the observed findings were in the results section
• Consider adding how the validity and realibility of the questionnaires were checked
• Please attach your survey tool (questionnaire using original and local language)
• Please also attach the raw data set
   

Results:

• While there are 3 tables related to infection prevention and control practices
• consider including table for the information related to knowledge/attitude questionnaire and results.
• Rephrase statements of the results as recommended by the reviewers
• "Hosmer-Lemeshow test was used to test model fitness, Multicollinearity was tested using the Variance Inflation Factor (VIF) and tolerance test." Please put their results under bracket for Hosmer-Lemeshow test, VIF and tolerance test.

Discussion

• Please consider discussing studies in segregated way from global to local and put justification accordingly taking into consideration the used tools.
• Critically discuss reasons based on the findings. Author had highlighted methodological differences between their study vs others, but maybe need to elaborate more on the socio-cultural practices context that distinguishes the respondents from this study as compare to others, or maybe to highlight more on the local health policy and strategies to prevent COVID-19 in the study localities.
• The information would be more beneficial to readers to learn and improve COVID-19 prevention and control in their food service establishments.
   

References:

• majority of the citations in the bibliography do not have page numbers please address that
  Specifically, look at citation number 14 and 15 and address the error accordingly.
   

Minor and optional points:

1. The manuscript should have line number since it makes difficult for comment
2. The font type should be standardized as well
3. Improve the quality of graphs
4. Do you think food and drinking establishments (FDE) are facilities? If it was so, does your study uses a single facility? I think the appropriate terminology was institutions-based. Please update the throughout.
5.  You should mention the statistic numbers regarding the food handlers infected by covid?
6. mention gold standard for food handlers from food hygiene discipline.<br />2 all studies globally or in Africa related Covid vs food handlers in background section.
7.  what kind of Food and drinking establishments that had no food handlers?
8. Is one sampling participant represent where there were many (20-100) food handlers in the selected food and drinking establishments?
9. Moving the operational definitions to the Annex
10. Figures 1, 2 and 3 seem unnecessary since they are already reported in the main text.

Please submit your revised manuscript by July 15 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,

Lucinda Shen 

Staff Editor 

on behalf of

Ammal Mokhtar Metwally, Ph.D (MD)

Academic Editor

PLOS ONE

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

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

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

3. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified:

a) whether the ethics committee approved the verbal/oral consent procedure,

b) why written consent could not be obtained, and

c) how verbal/oral consent was recorded.

If your study included minors, please state whether you obtained consent from parents or guardians in these cases. If the need for consent was waived by the ethics committee, please include this information.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Partly

Reviewer #5: Yes

Reviewer #6: Partly

Reviewer #7: Partly

Reviewer #8: Partly

Reviewer #9: Partly

Reviewer #10: Yes

Reviewer #11: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: No

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: I Don't Know

Reviewer #9: Yes

Reviewer #10: Yes

Reviewer #11: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: No

Reviewer #7: No

Reviewer #8: Yes

Reviewer #9: No

Reviewer #10: Yes

Reviewer #11: 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

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

Reviewer #6: Yes

Reviewer #7: Yes

Reviewer #8: No

Reviewer #9: No

Reviewer #10: Yes

Reviewer #11: 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: Hello, here are my comments that might improve the write-up:

Page 9, you mentioned about the questionnaire and checklist used during the survey. could you please elaborate more on the domains that you measured in your instrument? When I read the results section then only I realised there were domains in knowledge, attitude and practice (KAP). How each of these domains were measured? Do each domain produced score? max score? and at the end how you measure positive attitude? I noticed you had defined favourable attitude which I need to scroll up at the operational definition but it would be better if you could explain in detail about your instrument and put all the relevant definitions in the 'instrument used' section.

In page 10, you mentioned data were analysed with binary logistic regression method, maybe you can add information about the dependance binary outcome used in the analysis? and what are the independence variables that you included in the model for crude and adjusted. The statistical method was explained sophisticatedly but reader will be enlighten with additional information about variables included in the model. I'm confused whether the dependence measured in this study was knowledge or practices? How many models were tabulated?

In general for the Discussions section, instead of comparing with other studies, I would suggest if the author could critically discuss reasons based on the findings. Author had highlighted methodological differences between their study vs others, but maybe need to elaborate more on the socio-cultural practices context that distinguishes the respondents from this study as compare to others, or maybe to highlight more on the local health policy and strategies to prevent COVID-19 in the study localities. The information would be more beneficial to readers to learn and improve COVID-19 prevention and control in their food service establishments.

The rest looks good. All the best.

Reviewer #2: Abstract

I suggest that the authors consider replacing "prevent" with "reduce" - "Thus, ensuring infection prevention and control practices for this high-risk group is urgently required to prevent COVID-19 transmission."

I suggest deleting this which is not quite necessary for an Abstract - "Variables that had a p-value < 0.25 from the bivariate analysis were retained in multivariable logistic regression analysis for controlling confounders. From the multivariable analysis, variables that had a p-value < 0.05 were taken as factors significantly associated with good infection prevention and control practices to prevent COVID-19"

Delete ".... whereas the poor practice of infection prevention and control was 56.1% (95% CI: 51.4%-60.8%)" since the first part of the sentence already captures the main result.

I suggest re-arranging the results. Report proportions for knowledge, attitude and then finally practice. Then report the results for the multivariable logistic regression on factors associated with good practice.

Although attitude was lower, it may not be related to poor practices. I think the authors might be better off suggesting how the uptake of good practices can be increased?

Methods

Could the authors clarify why the selection approach focused on "houses". i.e. "To select the house-paired with 8

one eligible study participant, the data collector started with a bench mark of the known location and then walked straight forward to identify each house." Did the authors mean "premises"?

I think there were three outcomes of interest: (i) Knowledge, (ii) Attitudes and (iii) Practices, not just one. It is just that the multivariable regression analysis was conducted on (iii) Practices? I think the authors should consider refining how they describe the analysis - it is about the factors associated with good practices (and not both good practices and poor practices).

Could the authors provide justifications to support why the cut-off for KAP scores was set at the mean of the total scores? That just simply divides participants into two almost equal groups (assuming the distribution is normal). Would it be better to the authors considered a higher cut-off, say 75% of the possible score to be considered as "good"?

I am wondering whether the authors might be open to assessing whether there is a relationship between knowledge and attitude scores, and whether high knowledge and attitude scores were associated with high practice scores?

Results

Table 3 - Can the authors fill in all the missing p-values for the stratum specific estimates?

Figures 1, 2 and 3 seem unnecessary since they are already reported in the main text.

Reviewer #3: There are some typographical errors that need to be addressed.

There are statements do not have clarity in understanding and needs to be revised.

Also, majority of the citations in the bibliography do not have page numbers please address that

Specifically, look at citation number 14 and 15 and address the error accordingly.

Some technical language errors have been raised in the attached document

Reviewer #4: Thank you for analysing this interesting dataset during the COVID-19 pandemic. However, in my point of view, some fundamental issues are missing, which will improve the statistical analysis and the result of the study and as a consequence the study conclusion.

• It is not clear why only Dessie and Kombolcha town were included in the study.

• A flowchart would add useful information to the reader of the paper. Particularly because not the entire food establishments were included.

• Dichotomising the fifteen-infection scale at an arbitrary cut-off (suing the sample mean) reduces the statistical power by the same amount as would discarding a third of the data (1, 2). In general, there is no good reason to believe that there is an underlying dichotomy, and if one exists there is no reason why it should be at the mean especially as the fifteen-infection scale is not normally distributed. The fifteen-infection scale looks like an ideal candidate for one of the ordinal cumulative probability models. Therefore, I suggest using the proportional odds model.

• The authors have ignored the systematic random sampling design by using ordinal logistic regressions. I recommend considering use survey data analysis software when performing logistic regressions. This is because it is important to take into account the differences between the study design that you have used to collect the data and simple random sampling.

• The authors have used a cut-off value of 0.25 for variable selection in the multivariate model, because they believe that it is not legitimate to include a predictor with a p-value>0.25. If the authors insist on basing the inclusion rule on a p-value<0.25, then a reasonable cut-off that does allow for deletion of some variables is 0.5 (3).

• I don’t believe that the sample size calculation is relevant as the underlying primary aim is the multivariate regression modeling.

1- On the practice of dichotomization of quantitative variables. MacCallum RC, Zhang S, Preacher KJ, Rucker DD Psychol Methods. 2002 Mar; 7(1):19-40.

2- Cohen J. The cost of dichotomization. Appl Psychol Meas 1983;7: 249-53.

3- E. W. Steyerberg, M. J. C. Eijkemans, F. E. Harrell, and J. D. F. Habbema. Prognostic modelling with logistic regression analysis: A comparison of selection and estimation methods in small data sets. Stat Med, 19:1059–1079, 2000. 69, 100, 286

Reviewer #5: Comments and questions

Manuscript number = PONE-D-21-12395

Title = COVID-19 Infection Prevention and Control Practices among Food Handlers in Food and Drinking Establishments of Dessie City and Kombolcha Towns in Northeastern Ethiopia

General comments

1. The manuscript should have line number since it makes difficult for comment

2. Do you think food and drinking establishments (FDE) are facilities? If it was so, does your study uses a single facility? I think the appropriate terminology was institutions-based. Please update the throughout.

3. The study setting should be better if it explains more about existed Food and drinking establishments and food handlers. So please write this way. “Food and drinking establishments that had no food handlers during the data collection period were excluded”. This sentence explains that your sampling unit is Food and drinking establishments but from your finding the study unit is food handlers. How you do it? Please rewrite the exclusion criteria. “When one eligible study participant was not available from the selected food and drinking establishments, another visit was made the same day. If they were again not available, another visit was performed the next day in order to minimize the non-response rate. If not available after the three visits, it was taken as non-respondent”. And “Food and drinking establishments that had no food handlers during the data collection period were excluded”. These two sentences were not compatible with each other. So better to correct the exclusion criteria

4. “Then, based on the source population (food handlers) for each kebele, sample size was proportionally allocated for all ten kebeles based on their number of size of the food and drinking establishments. Using the sampling frame, a systematic random sampling with a fixed interval of every house was used to select sampling unit within each kebeles”. Better to correct as Using the sampling frame, a systematic random sampling with a fixed interval of (K) to get the next Food and drinking establishments. One food handler was included from one Food and drinking establishments.

5. “The principal investigator and supervisors made daily spot-checks for completeness of the questionnaire”. AND “Each questionnaire and observational checklist was checked daily for completeness and any incomplete questionnaires or checklists were corrected in the same day by visiting the food and drinking establishments” Were repeated sentences and please avoid one of them to reduce redundancy which found line 196 and 200.

6. “Data were analyzed using a binary logistic regression model at 95% confidence interval and variables with p-value < 0.25 during the bivariate analysis were entered into a multivariable logistic regression analysis to see the relative effect of confounding variables and interaction of variables”.

Here how do you see the confounding variables? and how you report confounding variables? better to say control confounding variables

Regarding interaction of variables how you compute interaction? if it was an interaction what order of interaction? I think you didn’t do this so please delete it or write the result of the interaction report

interaction were also done for continuous outcomes, so please delete this section

7. The sentence on page 14 says “From the bivariate analysis age, educational status, years of experience, availability of COVID- 19 prevention guidelines, availability of COVID-19 infection prevention and control focal person, availability of specific budget for COVID-19 infection prevention and control, availability of PPE in food and drinking establishments, ever having taken COVID-19 infection prevention and control training and attitude on COVID-19 infection prevention and control were p-value <0.25 and retained into the multivariable analysis”. This variables should be listed as foot note of the multivariable analysis result table 3.

8. On page 13 line 251, Almost all 378 (94.3%) of food handlers knew that washing hands with soap, sanitizer and water would inhibit or kill corona virus. Please rewrite and edit your questionnaire also (Almost all 378 (94.3%) of food handlers knew that washing hands with soap, sanitizer and water would physically remove from hands, inhibit or kill corona virus.)

9. On line 251, washing of hands at what time of the day or at what frequency? Please correct it as washing hands frequently with soap

10. On table 2, Order servants and customers to practice social distancing and to avoid touch each other. Please correct as “ availability of visibly posted Order servants and customers to practice social distancing and to avoid touch each other”

11. Please attach your survey tool (questionnaire using original and local language)

12. Please also attach the raw data set

13. Please get support for language editor to make the paper very easy for readers.

Questions

1. Infection prevention and control: the two terms are quite different. Do you justify why you use the term control? Do you mean that infected persons are working there in the establishments?

2. The tittle was about practice but the finding section has also knowledge and attitude. Better to correct title. Also how many question items were used to measure PRACTICE, KNOWLEDGE and ATTITUDE? please put the results of each of them using table with their frequency and percentage

3. On page 6 line 121, the sentence said “the study population was food handlers among the selected food and drinking establishments”. Do you include all food handlers from the selected food and drinking establishments?

4. How you reach the study participants? The sampling procedure is not clear.

5. Regarding to the exclusion criteria it said “Food and drinking establishments that had no food handlers during the data collection period were excluded”. How is an establishment open without food handlers? Who is food handler? Do owners themselves serve as food handler? Does owners that give service does not consider as food handlers? I think there is some body acting as food handler how you exclude this guy?

6. Does any Food and drinking establishments were included into the study? or those only who are licensed ?

7. Does your proportional allocation based on the number of Food and drinking establishments or the number of food handlers?

8. How many food handlers were taken from each Food and drinking establishments and how?

9. In ethical part of the document data collectors wore mask what you did if you get food handlers who do not wear mask. Don’t you give advice and supply mask.

10. On page 18 line 373 -374, what is proxy data on Page 18. What variables make respondents to made social desirability bias. does it mean you didn’t kept confidentiality/privacy and anonymity and don’t have information sheet on the questionnaire.

11. In the table1, Job position in the food and drinking establishments (Others____) please specify others job categories

Reviewer #6: Dear authors,

Thank you allowing me to review your study. I think this a good study. However, many things need to improve for the publication. Please don't be discourage, I know this paper can be improved.

1) There a lot of grammatical error through the manuscript, so my suggestion this manuscript should be send to English editing.

2) The font type should be standardized as well.

3) You should mention the statistic numbers regarding the food handlers infected by covid maybe?

4) I already read the results. I think you should compare "N" between food handlers who had experience with Covid and also without Covid. Thus, you can get the result either their practice " good" or " poor". Furthermore, that more accurate if you want to suggest any prevention and control measure for food handlers. Yes, it's major modification. but surely you can do better.

5)The figures are nice, but it's just the descriptive. Which is the readers can get it from the table.

Reviewer #7: Present study was planned to determine the level of food handlers' knowledge, attitudes, and practices in relation to COVID-19 in northeastern Ethiopia. Food handlers can be highly exposed to the virus due to their daily contacts with customers who visit their food and drinking establishments. Therefore, the information provided in this study can guide relevant training and policy making organisations in prioritizing the protection and avoiding occupational exposure. Although this study is interesting for the reader, the method and result look ambiguous. While there are 3 tables related to infection prevention and control practices, there is little information related to knowledge/attitude questionnaire and results. It is unclear which questions are used as the basis for classification of the participants into the ones with good/poor knowledge or favorable/unfavorable attitude. Therefore, major revision is required to clarify more details in these sections.

Reviewer #8: please include

1 mention gold standard for food handlers from food hygiene discipline.

2 all studies globally or in Africa related Covid vs food handlers in background section.

3. what kind of Food and drinking establishments that had no food handlers?

4. Is one sampling participant represent where there were many (20-100) food handlers in the selected food and drinking establishments?

5. How and where you adopted this standard "Good infection prevention and control practiceswas determined for study participants who responded above or equal to the mean value amongfifteen infection prevention and control practices questions, whereas poor infection preventionand control practices refers to those study participants who responded to fifteen infection prevention and control practices questions below the mean value."

6. Was validity and realibility of the questionnaires checked?

7. how did you distinguish data collectors and supervisors during recruition? Because they have the same status.

8. how did you pre-tested and assured the data quality the 10 % of selected food handlers?

9. if one study participant answer 8 question and missed answer about wearing mask and hand washing how did you accomodate? Did he/she have good knowledge?

10 you did "Hosmer-Lemeshow test was used to test model fitness. Multicollinearitywas tested using the Variance Inflation Factor (VIF) and tolerance test." Please put thier resul under bracket for Hosmer-Lemeshow test, VIF and tolerance test.

11 please format randendency one-fifth 96 (23.9%). Put only figure and percent through out result section.

12 From 11 questions how did you manage " I do not know" response?

13 in Attitude section, did you use likert scale(strongly disagreed,agreed

14. Please polish your english and your write up through out your document it needs critical improvements. look your statements e.g. "Most respondents 389 (97%) reported that when they sneezed, they coveredtheir nose and mouth with an elbow.

& Of 36 food handlers who did notwear PPE, 10 of them thought that wearing PPE is not always necessary to prevent COVID-19."

15 In your discussion part you merged studies and the reason of dicrepancy but you have to discuss in segregated way from global to local and put reason of dicrepancy accordingly.

16 when you reason out the reason of dicrepancy you are not sure about your conclusion. For example "This may be due to the differences in the tool used for assessment of..." "may be"

Reviewer #9: Andualem et al., Review: COVID-19 Infection Prevention and Control Practices among Food Handlers of Food and Drinking Establishments of Dessie City and Kombolcha Towns in Northeastern Ethiopia

Dear Editor

The manuscript titled “COVID-19 Infection Prevention and Control Practices among Food Handlers of Food and Drinking Establishments of Dessie City and Kombolcha Towns in Northeastern Ethiopia” presented by Atsedemariam Andualem and co-authors is aimed to highlight the COVID-19 prevention and control practices adopted by food handlers in two cities of Ethiopia. The authors have contributed well by selecting the important sector of society which can play a significant role towards the transmission and spread of C COVID-19 pandemic. But while reviewing the article there are some ambiguities and questions which needs to be addressed before the article will be assessed for its publication in PLOS ONE. The details of comments and queries are given below. I hope it will prove to be helpful for the authors.

Section wise Comments:

Abstract: The first paragraph of Abstract couldn’t successfully generate the hypothesis of the study. The author should clearly write atleast 2 to 3 aims and objectives to justify that why the study has been conducted? The following line is too early to be stated in the beginning therefore should be deleted from here: {Thus, ensuring infection prevention and control practices for this high-risk group is urgently required to prevent COVID-19 transmission}.

In the second paragraph of Abstract it is important a brief description should be added about the design of the questionnaire and checklist with its strength and important parameters while the description about statistical tests should be given in one line only.

In the last paragraph of Abstract the first line {Just more than one-third of food handlers had good infection prevention and control practices} should be deleted as it seems out of context. The paragraph should be made brief as there is a lot of repetition of words/phrases “infection prevention and control”. It is suggested that only the following text should be given in the last part: {Our findings showed that three-fourths of food handlers had good knowledge and more than half had a favorable attitude about infection prevention and control. Thus, integrated work is urgently needed to prevent COVID-19 transmission by further improving food handlers’ good practice of infection prevention and control}.

Keywords: should be written in an alphabetical order.

Introduction: the first 2- paragraphs should be merged with the following text added at the end of first paragraph while the rest of the text should be deleted as it is only a repetition: {According to a World Health Organization (WHO) report on 20 September 2020, 30.6 million positive cases with 950,000 deaths worldwide have been recorded. On that date, Africa accounted for 1,145,397 COVID-19 positives with a total death of 24,757; and in Ethiopia the number of COVID-19 cases reached 68,131 and confirmed deaths reached 1,089 [9].}

In the last paragraph the following sentence should be either deleted or re-written as it does not clearly interpret what is author trying to convey: {Implementation of IPC practices based on WHO and Ethiopian Ministry of Health (EMoH) guidelines is rapid, decisive, and collective action which saves millions of lives [13, 16, 17].}

The objectives of the study should be elaborated more by focusing on what the authors are trying to achieve by conducting this study and how it will be helpful for the society as the given objective: {Therefore, this study was designed to assess the practice of infection prevention and control strategies against the novel coronavirus pandemic among food handlers in Dessie City and Kombolcha Town food and drinking establishments} is too generalized.

Methods and Materials:

Study Area: Add some description about the socioeconomic status of the area to generate some idea about the general people perceptions and attitudes in the study area.

Study design, period, and population:

The terms “The source population” and “The study population” leads to confusion as they both refer to study subjects therefore it would be better to use “The study population” to avoid confusion. The following lines should be re-written as seems a repetition {The source population was all food handlers working in Dessie City and Kombolcha Town food and drinking establishments. The study population was food handlers among the selected food and drinking establishments}.

It is also important that detail data in the form of table/graph (could be added in Annexure) should be given about the categories based on nature of food and drinking facilities included in the study.

Sample size determination and sampling techniques:

How the sample size from each study area has been selected should be written more clearly as currently it is very ambiguous and unclear. Similar is true for sampling techniques and should be re-written.

Measurement of the outcome variable:

It is important to discuss questionnaire and important aspects included in its structure and how the mean value has been calculated. As currently the most important tool of the study “Questionnaire design” and “checklist” has been lacking from the study which is a serious discrepancy.

Operational definitions:

These definitions should be given in the Annexure.

Data collection and quality control:

This part could also be given in the Annexure.

Results:

Overall, the results have been interpreted in detail but there is a need to improve the quality of graphs and tables.

Discussion:

At large Discussion is well written and has thoroughly justified the results.

Overall, some grammatical mistakes have been found in the write up along with repetition of words and phrases therefore it is highly recommended that authors should proof read the draft from an expert with strong English language background to improve the overall quality of the manuscript.

Reviewer #10: The article of Metadel et al. is a completed study and is of interest to scientists for studying the problems of COVID-19 iinfection prevention and control practices among food handlers. The manuscript describes the the knowledge, practice and attitudes of handlers of food and drinking establishments’ in cities and towns of Ethiopia The paper is well structured but it needs some modification prior to publication. I think this manuscript should be accepted for publication after some revision:

1.It is not clearly written in methods, which variables were used for the univariate or multivariate models as interest variables or for the model adjustment.

2.Additionally, for the bivariate analysis, authors could have included variables with p-value up to 0.10 with backward or forward elimination or Other? Why P-value up to 0.1? Do you have reference?

3.Authors must provide more details on methods: which factors and explanatory variables were addressed by the questionnaire and in the analyses (e.g., as continuous or dichotomous).

4. The manuscript has used inappropriate English word “illiterate” which is erroneous that must be removed.

5. It was a kind of cross sectional study, why you used prolonged time (two months) for data collections?

6.Why the experiences were defined as <1, >1-5 and >5 years? It should be clearly stated in methods.

Reviewer #11: There are some observations made in the process of this review.

1. Methods

The authors mentioned in the section of measures of measures that the mean value from fifteen questions was considered good infection prevention and control practice. The authors should state the score of each question to prevent ambiguity. Readers will be well informed of the for instance, the authors says either each question contains 1,3,3 or so score, from which the mean value I'd calculated.

In the data collection and quality control section, authors stated that, protested questions and on the spot observations checklist were used. However, they failed readers of what was entailed on the observations checklist. Readers will appreciate it much, if they are informed what the observations were to be, and anticipate what the observed findings were in the results section

2. The results

The authors did not indicate the observations made by way of the observations checklist that was employed. instead the results were focused on only the structure question. It is important for readers to know whether answers provide by the study subjects were in concordance with the observations made by the researchers. This will probably prevent some bias introduced by the subjects because of the researchers' presence.

In reporting the the results, the third sentence should be checked and rephrase...." most of the respondents were under 30 years 273 (68.1%)."

"The odds of having good COVID-19 infection prevention and control practice among food handlers who had work experience of greater than 5 years were 3 times (AOR=2.55; CI:1.43-5.77) greater compared to those who had 5 or fewer years of work experience. " this statement should be written to reflect the results. It is emphatic, however, that is not the case. Trying saying "almost 3 times....."

3. Discussion

In the second paragraph, the researchers identified some difference in results and attributed same to differences in tools

"This may be due to the differences in the tool used for assessment of COVID-19 infection prevention and control practice, differences in study participants where our study focused on food handlers, or a methodological difference such as the difference in the accessibility of COVID-19 infection prevention and control guidelines and types of PPE in the food and drinking establishments. "

It is therefore important to mention the tool used in your study and that used in the other studies which could be the plausible reason.

**********

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: Yes: Mohd Hatta Bin Abdul Mutalip

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

Reviewer #5: No

Reviewer #6: No

Reviewer #7: No

Reviewer #8: Yes: Thomas Ayalew Abebe

Reviewer #9: Yes: Dr. Zaira Ahmad

Reviewer #10: Yes: Tariku Neme Afata, Jimma University, department of environmental health science and technology

Reviewer #11: 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.

Attachments

Attachment

Submitted filename: Manuscript_Review.docx

PONE-D-21-12395R1COVID-19 Infection Prevention Practices among Food Handlers in Food and Drink Establishments of Dessie City and Kombolcha Town, Northeastern EthiopiaPLOS ONE

Dear Dr. Adane,

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.

Great effort was made by the authors to utilize the feedback that was provided for them to correct for resubmission. There are still major things to adjust. Although this topic is an important one, yet the authors did not adopt appropriate methodology to achieve the aim. Accordingly, fundamental issues are indicated to be revised mainly for the methodology section mainly the statistical analysis (enclosed). 

The manuscript could be greatly strengthened by considering editing according to the specific Reviewers’ comments.

Please submit your revised manuscript by Nov 01 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: https://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,

Ammal Mokhtar Metwally, Ph.D (MD)

Academic Editor

PLOS ONE

Journal Requirements:

Additional Editor Comments (if provided):

[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 #2: (No Response)

Reviewer #4: (No Response)

Reviewer #6: All comments have been addressed

Reviewer #7: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Partly

Reviewer #4: Partly

Reviewer #6: Yes

Reviewer #7: Yes

**********

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

Reviewer #2: No

Reviewer #4: No

Reviewer #6: Yes

Reviewer #7: 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 #2: Yes

Reviewer #4: No

Reviewer #6: Yes

Reviewer #7: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #4: Yes

Reviewer #6: Yes

Reviewer #7: 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: The authors responded to my suggestion on considering a higher cut-off score to define "good", that the mean is typically the best measure of central tendency because it takes all values into account (the distribution of the data is normal). I believe the authors may have misunderstood what I meant.

If the maximum possible score was 100, and the average mean score was just 20, it is not reasonable to assume that those who scored above 20 are all considered to be "good". However, if the mean score was 90 out of 100, potentially those who scored below 90 but say above 70 would also be considered to have done well. So the mean is not a good way to define "good".

The definition of good should be based on a proportion of the maximum possible score. I think 70 out of 100 is considered "good". Possibly 60 out of 100 could also be "good". I acknowledge that there may be no studies out there which can be referenced to set the threshold definition for good. But surely, 50% cannot be considered "good".

I urge the authors to consider setting the threshold for the definition of "good" at 70% (which would be a score of 18.75) or at 60% (which would be a score of 15). Otherwise, the authors would have to amend their manuscript throughout to state that they "analyzed factors associated with participants who scored above the mean.", which in no way suggests whether these are considered "good" or otherwise.

Reviewer #4: 1- This manuscript has not been prepared from the right perspective of the research methodology.

2- I don’t believe that the sample size calculation is relevant as the underlying primary aim is the multivariate regression modeling

3- Dichotomising the fifteen-infection scale at an arbitrary cut-off (suing the sample mean) reduces the statistical power by the same amount as would discarding a third of the data (1, 2). In general, there is no good reason to believe that there is an underlying dichotomy, and if one exists there is no reason why it should be at the mean especially as the fifteen-infection scale is not normally distributed. The fifteen-infection scale looks like an ideal candidate for one of the ordinal cumulative probability models. Therefore, I suggest using the proportional odds model.

Reviewer #6: Dear authors,

Thank you for allowing me to review this manuscript. I think this is a good study and worth for publication. Generally, I am satisfied with all the corrected version from the manuscript. Keep up the good work. Thanks

Reviewer #7: The article seems clearer with the changes you have made. Thank you for taking my suggestions into consideration.

**********

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: No

Reviewer #4: No

Reviewer #6: No

Reviewer #7: 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.

PONE-D-21-12395R2

COVID-19 Infection Prevention Practices among Food Handlers in Food and Drink Establishments of Dessie City and Kombolcha Town, Northeastern Ethiopia

PLOS ONE

Dear Dr. Adane,

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 Dec 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: https://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,

Lucinda Shen, MSc

Staff Editor

on behalf of 

Ammal Mokhtar Metwally, Ph.D (MD)

Academic Editor

PLOS ONE<o:p></o:p>

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):

Great effort was made by the authors to utilize the feedback that was provided for them to correct for resubmission after revision. Meanwhile, minor modifications are required according to PLOS one guidelines:

1. Please consider restricting the Abstract to no more than 300 words
2. The authors declared that oral consent was sought from participants before the study started, please justify why authors did not take written consent and please clarify whether the institutional review board approved the use of verbal consent.
3. Please also state in the ethics approval the approval number

 

in addition refer to the journal’s other publication criteria (https://journals.plos.org/plosone/s/criteria-for-publication)

[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 #2: All comments have been addressed

Reviewer #6: All comments have been addressed

********** 

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #6: Yes

********** 

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

Reviewer #2: Yes

Reviewer #6: 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 #6: Yes

********** 

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

Reviewer #6: 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 #6: Thank you for allowing me to review this manuscript. I think this is a good study and worth for publication. Generally, I am satisfied with all the corrected version from the manuscript. Everything already improvised.

Keep up the good work.

********** 

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: No

Reviewer #6: 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.

COVID-19 Infection Prevention Practices among Food Handlers in Food and Drink Establishments of Dessie City and Kombolcha Town, Northeastern Ethiopia

PONE-D-21-12395R3

Dear Dr. Adane,

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,

Ammal Mokhtar Metwally, Ph.D (MD)

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have done a good work by addressing all the comments raised in the previous review.

Reviewers' comments: