Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia

Robertus Dole Guntur; Jonathan Kingsley; Fakir M. Amirul Islam

doi:10.1371/journal.pone.0259950

Peer Review History

Original SubmissionOctober 30, 2020
17 Mar 2021 Decision Letter - Ramesh Kumar, Editor PONE-D-20-34159 Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia PLOS ONE Dear Author, 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 Apr 30 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-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: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ****** 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: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: In the introduction section, the author should mention and analyze several strategies that have been conducted in the ENTP to eliminate malaria. This explanation would give a more substantial argument why study regarding malaria knowledge related to the symptom, transmission mode, prevention method, and the perception of malaria treatment-seeking behavior in the population-level study, thus important. Reviewer #2: abstract Materials and methods study population, sample size and sampling method were not indicated. strong model like logistic regression is preferable to chi square Results The proportion of malaria awareness index should be specified along with CI. Main body Introduction Research gap was not indicated Materials and methods Sample size was not determined. data collection method was specified malaria awareness assessment was not clear. confidentiality issue and privacy was stated. Results The proportion of malaria awareness index should be specified along with CI. The findings were not written in logical order Discussions The findings were not well written. The findings have not been contrasted. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
1 May 2021 Author Response REBUTTAL LETTER PONE-D-20-34159 Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia Journal 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 Response: Thank you for this feedback. We have updated the manuscript to meet the PLOS ONE style requirements including file naming. 2. Please include a copy of the questionnaire in the original language as Supporting Information or include a citation if it has been published previously. Response: The original language of the questionnaire is a part of published protocol paper. We have cited this protocol paper in our manuscript as reference number 33. 3. In the Methods, please discuss whether and how the questionnaire was validated and/or pre-tested. If these did not occur, please provide the rationale for not doing so. Response: Thank you for this recommendation. The questionnaire used for this study has been adapted from a validated questionnaire which was published previously (reference numbers 35 and 36). The questionnaire was translated into local language and we also conducted a pre-test upon 30 participants before finalising the questionnaire. This is now explained in the data collection section under material and methods (page 8 line 2 – 13). 4. In your statistical analyses, please state whether you accounted for clustering by region. For example, did you consider using multilevel models? Response: In this study, we want to develop malaria awareness of rural ENTP and evaluate the association between malaria awareness and three malaria endemic settings (MES). Since the main question for this study is whether any a significant association between malaria awareness having binary response and different types of MES, we believe the logistic regression method is suitable for this research question. Furthermore, we do not want to predict malaria awareness amongst three different MES based on their characteristics, therefore we did not use multilevel models for this study. Reporting the malaria awareness as a whole was not our objective. 5. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables should remain uploaded as separate "supporting information" files. Response: We have now included Table 1 and Table 2 in this manuscript. However, the size of Table 3 was big. Following the guideline of PLOS One Journal, if the size of table was not fitted in the manuscript due to the its size, it can be transformed to figure and uploaded as separate file. Therefore, we uploaded Table 3 as a figure in a different file. 6. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. Response: We have attached our database in this manuscript to support our findings as supporting information in this submission as shown in page 23 line 24. 7. We note that Figure 1 in your submission contain map images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission: Response: Thank you the academic editor for this recommendation. We have updated the figure 1 for the location of the study. The map was developed by the author of this article. We developed map using ggplot2 and map package in R software version 3.5.3 8. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Response: We have added in-text citations for this supporting information as indicated in page 6 line 23, page 16 line 9, and page 17 line 10. The caption for the supporting information files has been also added at the end of our manuscript as shown in page 23 line 19 and 24. Reviewer's Responses to Questions 5. Review Comments to the Author Reviewer #1: In the introduction section, the author should mention and analyze several strategies that have been conducted in the ENTP to eliminate malaria. This explanation would give a more substantial argument why study regarding malaria knowledge related to the symptom, transmission mode, prevention method, and the perception of malaria treatment-seeking behavior in the population-level study, thus important. Response: We have updated the introduction section of the manuscript. We have presented some intervention methods that have been implemented in the ENTP as a part of the effort of the local government to eliminate malaria by 2030. However, their intervention might be ineffective since the number of malaria cases is still high and their intervention might be dependent on the knowledge and behaviour of the local community which is limited investigated in the study area as indicated in page 4 from line 11 to 25 and page 5 from line 1 to 4. We have also shown the gap between previous malaria studies on malaria knowledge in the ENTP and the current study that we have conducted in order to provide the best solution for malaria elimination program in the ENTP as shown in page 5 from line 18 to 25 and page 6 from line 1 to 11. Reviewer #2: abstract Materials and methods study population, sample size and sampling method were not indicated. Response: We have updated the material and methods section in the abstract. The information on the study population, sample size and sampling method has been added in the abstract as indicated page 2 from line 8 to 11. Strong model like logistic regression is preferable to chi square Response: Thank you to the reviewer #2 for this suggestion. The purpose of this article is to develop malaria awareness index and to evaluate the association of the malaria awareness index amongst community in three different malaria endemic settings of rural adults in ENTP Indonesia. The outcome variables is proportion of rural adults having malaria awareness in each different types of malaria endemic settings. Firstly, we show the association between malaria endemic settings and basic malaria understanding, basic malaria knowledge, as well as malaria awareness applying chi-square test. Furthermore using odds ratio in logistic regression model, we have shown that there is a significant association between malaria endemic settings and basic malaria understanding, basic malaria knowledge, as well as malaria awareness. This information has been updated in the article as shown in page 2 line 12 and 13, page 10 line 19 to 25 and page 11 from line 1 to 3. Results The proportion of malaria awareness index should be specified along with CI. Response: Thank you to the review #2 for this recommendation. We have updated the result section of the abstract. The proportion of malaria awareness index has been specified along with 95% confidence interval as indicated in page 2 from line 16 to 25 and page 3 line 1. Main body Introduction Research gap was not indicated Response: Thank you to the reviewer #2 to this recommendation. We have updated the manuscript. We have updated 2 paragraphs in the manuscript to indicate the research gap in our paper. For the first paragraph, as indicated in page 4 from line 11 to 25 and page 5 from line 1 to 4 of the manuscript, we have presented some evidence of interventions conducted by local authority and independent researchers as a part of their effort to eliminate malaria in line with the national commitment of the country. Most of their intervention might be ineffective since the number of malaria cases still high in the province and the implementation of their intervention might depend on the community behaviour which is limited investigated in the study area. So this is the main reason for conducting this study. For the second paragraph of the research gap, as indicated in page 5 from line 18 to 25 and page 6 from line 1 to 11 of the manuscript, we have updated the article with the new evidence on malaria awareness research in the ENTP indicating low awareness of community in malaria prevention method using the long-lasting insecticide- treated nets (LLINs), however their study evaluated only awareness of pregnant women on malaria prevention method living in high malaria endemic settings (MES). Therefore, their study cannot compare the malaria awareness amongst other types of MES in the ENTP. In our study, we develop malaria awareness of rural adults in ENTP and investigate the difference of malaria awareness amongst different types of MES. These findings allow us to provide new evidence which MES should be prioritized and which aspect should be focus in providing key intervention for rural community in the effort to progress to malaria elimination by 2030. Therefore, our study will provide the novelty of malaria awareness of rural ENTP and the comparison of malaria awareness amongst MES in the ENTP. Materials and methods Sample size was not determined. Response: Thank you to the reviewer #2 for this suggestion. We have updated the article. Overall procedure on how to calculate the sample size has been added in the article. We determined our sample size taking into account of malaria prevalence study previously, design effect, cluster size, and participation rate of the participants in East Nusa Tenggara Province Indonesia. The comprehensive information on the calculation of sample size has been published in our prior publication as indicated in the reference number 33 of this manuscript. All this information were presented in page 7 from line 3 to 11. Data collection method was specified Response: We have updated the article and data collection method has been added in this manuscript. For this study we applied face-to-face interview guided by the validated questionnaire as indicated in page 8 from line 3 to 13. Malaria awareness assessment was not clear. Response: Thank you to the reviewer #2 for this recommendation. We have updated the article. We have presented ten questions used to evaluate malaria awareness of participants. The first three questions categorized as basic understanding of malaria including whether participants have heard malaria term, whether malaria was dangerous for their health, whether malaria can be prevented. The next seven questions categorized as basic malaria knowledge comprising whether participants could identify the main symptom and the main cause of malaria, whether participants could identify some protective measure to prevent malaria, whether participants seeking treatment for their malaria within 24 hours after the onset of the symptoms. Participants who could identify fever as the main symptom of malaria and mosquito bites as the main cause of malaria obtained score one respectively. Participants who could mention sleeping under non-LLINs, sleeping under LLINs, using mosquito coils, keeping house clean as the method to prevent malaria got score one respectively. Finally, participants who mention seeking malaria treatment within 24 hours for their malaria obtained score one. Overall, each participants get a total score of ten if they could answer correctly all these questions. Total marks of ten questions were evaluated following the previous malaria awareness studies as indicated in the reference number 37 and 38. Participants answering correctly at least 60% for these ten questions were categorized as having malaria awareness. The classification of participants to be categorized as aware or unaware of basic malaria understanding and basic malaria knowledge was also following the guidance of previous study (reference number 37 and 38). All this explanation have been updated in the article as shown in page 8 from line 16 to 24 and page 9 from line 1 to 22. . Confidentiality issue and privacy was stated. Response: In the ethic approval section of this article, we have presented that this study has been approved by ethics committee of Swinburne University of Technology and Health Ministry of Indonesia government where we extensively addressed how we would address issues around confidentiality. The confidential issue and privacy of participants has also followed the procedure in the tenet of The Declaration of Helsinki as indicated in page 11 from line 6 to 16 in the manuscript. The evidence of ethics approval from Swinburne University of Technology and Health Ministry of Indonesia government has been uploaded to the system. Results The proportion of malaria awareness index should be specified along with CI. Response: Thank you to the reviewer #2 for this recommendation. We have updated the article and 95% of confidence interval of the proportion of malaria awareness index has been calculated and added in this manuscript as indicated in page 13 from line 10 to 19 and from page 14 to 17. The proportion of malaria awareness index in Table 2 has been also supported with 95% confidence interval as indicated in page 15. The findings were not written in logical order Response: Thank you to the reviewer #2 for this recommendation. We have updated the article. We arranged to present our findings into four themes including demographic characteristic of respondents, malaria knowledge of participants, malaria awareness of participants, the strength of the association between malaria awareness and malaria endemic settings (MES). In each theme, we compared the interest point amongst MES. The demographic characteristic of participant was presented in page 11 from line 20 to 24 and page 12 from line 1 to 3. Malaria knowledge of participants was divided into basic malaria understanding as indicated in page 13 from line 7 to line 13, and the basic malaria knowledge as shown in page 15 from line 19 to line 16 and page 14 from line 1 to 2. Knowledge on malaria prevention methods was presented in page 14 from line 4 to 15, and the understanding of treatment seeking behaviour was shown in page 14 from line 17 to 22. In each section, we made comparison of understanding amongst three different malaria endemic settings. The main result, malaria awareness index of participants was presented at page 16. In this part, we started with the awareness of basic malaria understanding and basic malaria knowledge as indicated in page 16 from line 14 to 22. Next, we presented malaria awareness index of participants as shown in page 16 from line 24 to 25 and page 17 from line 1 to 4. In each part, the comparison of malaria awareness amongst three different types of malaria endemic settings has been provided. Finally, at the last part of the result section, we presented the strength of association between malaria awareness index and MES as shown in page 17 from line 10 to 18. Discussions The findings were not well written. Response: Thank you to the reviewer #2 for this recommendation. We have improved the manuscript. Firstly, we present our main findings which are the low level of malaria awareness amongst rural community in the ENTP and the high MES has the lowest malaria awareness as indicated in page 17 from line 21 to 24 and page 18 from line 1 to 2. Then we compare our main findings with other countries and we provided explanation on why there is a significant discrepancy in malaria awareness in ENTP Indonesia and other countries that had implemented malaria intervention to improve malaria knowledge of the rural community as indicated in page18 from line 2 to 18. The next part is presenting the discussion on malaria awareness in more detail started from basic malaria knowledge on main symptom and main causes as indicated in page 18 from line 20 to 25 and page 19 from line 1 to 9. The discussion on the awareness on sleeping under LLINs to prevent malaria and the comparison with other countries as well as the reason for the difference in ENTP and other countries has been presented in page 19 from line 1 to 25 and page 20 from line 1 to 7. The discussion on awareness on malaria prevention method and the possibility reason why there is a discrepancy in this awareness between MES in ENTP was provided in the page 20 from line 9 to 19. Regarding to malaria treatment seeking behaviour and the discussion of why the level of this awareness was low, it is presented in page 20 from line 21 to 25 and page 21 from line 1 to 6. The next part we provided some recommendations to support malaria elimination program in the ENTP as indicated in page 21 from line 8 to 25 and page 22 from line 1 to 4. Finally the strength and limitation of the research has been presented at the end of the discussion as indicated in page 22 from line 6 to 17. The findings have not been contrasted. Response: Thank you to the reviewer #2 for this recommendation. We have improved the manuscript. We have compared our findings with malaria studies in other countries. The main findings of the study was the low level of malaria awareness of rural population and the lowest malaria awareness was in high Malaria endemic setting (MES) in ENTP Indonesia. This finding has been compared with 6 studies in different countries and we provided an argument to explain the possibility reason for the discrepancy of malaria awareness between ENTP Indonesia and other countries as shown in page 18 from line 4 to 18. The awareness of various aspects of malaria has been also compared with another countries. The awareness of basic malaria knowledge on main malaria symptom has been compared with 2 studies in different countries as indicated in page 18 from line 20 to 25. The awareness on the main causes of malaria has been compared with similar study in 5 countries as shown in page 19 from 1 to 9. The awareness of sleeping under LLINs to prevent malaria has been also compared with similar studies in 6 countries. The possibility reason for the disparity of this awareness in ENTP Indonesia and other countries has been also provided as indicated in page 19 from line 20 to 25 and page 20 from line 1 to 7. Meanwhile, for the difference in the awareness of sleeping under LLINs amongst MES in ENTP has been compared with similar studies in 2 countries. The possibility reason for the trend has also been supported as indicated in page 20 from line 9 to 19. Finally, the awareness of treatment seeking behaviour of rural population ENTP Indonesia has been compared with similar studies in 2 other provinces of Indonesia and in 4 countries in Asia. The discussion on this low awareness has been also provided as indicated in page 20 from line 21 to 25 and page 21 from line 1 to 6. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0259950.r002
25 May 2021 Decision Letter - Ramesh Kumar, Editor PONE-D-20-34159R1 Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia PLOS ONE Dear Author, 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 Jul 09 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, Ramesh Kumar, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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 #2: 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: Yes Reviewer #2: No ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear Author, I appreciate your hard work improving this paper and appreciate your responsiveness. Your response to my comments and your revision according to the comments are acceptable. You did a good job. Good luck. Reviewer #2: Major assumptions of logistics regression analysis like Multi collinearity not stated. Model fitness test was not indicated. What was outcome measure? What is the type of test? The results of logistics regression analyses were not presented. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. 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Revision 2
10 Jun 2021 Author Response REBUTTAL LETTER PONE-D-20-34159R1 “Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia” 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. Response: Thank you for this feedback. We have updated the reference list. Since the Indonesian government has released the current number of malaria cases in Indonesia, we have changed the reference [8] to the year 2020. We have updated all this information as indicated on page 4 in the manuscript. All other references have been prepared following the guidance of the journal. 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: All comments have been addressed Reviewer #2: (No Response) Response: Thank you for your comments ________________________________________ 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Response: Thank you for your comments ________________________________________ 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Response: Thank you for your comments ________________________________________ 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No Response: All data underlying the findings of this manuscript has been made available as a part of supporting information of this manuscript. ________________________________________ 5. Is the manuscript presented in an intelligible fashion and written in Standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No Response: We have sought the assistance of a professional editor to review our paper to address these concerns (a certificate is attached). All authors have spent considerable time editing this paper. ________________________________________ 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear Author, I appreciate your hard work improving this paper and appreciate your responsiveness. Your response to my comments and your revision according to the comments are acceptable. You did a good job. Good luck. Reviewer #2: Major assumptions of logistics regression analysis like Multi collinearity not stated. Model fitness test was not indicated. What was outcome measure? What is the type of test? The results of logistics regression analyses were not presented. Response: Thank you to the reviewer #2 to this recommendation. For the assumption of multi-collinearity, since there is a significant correlation between education level and socio-economic status (SES), we removed the SES variable from the logistic regression model for covariate adjustment. With or without SES also did not change the Wald statistics significantly. Therefore, the final odds ratio was obtained after adjusted for gender, age group and education level. There are three outcome measures of the study. They are basic malaria understanding (the first outcome), basic malaria knowledge (the second outcome), and malaria awareness (the third outcome). All these outcomes were binary variables as indicated on page 8 from line 2 to 25 and page 9 from line 1 to 7. The overall model fit test was evaluated by the omnibus chi-square test and classification tables. The value of the omnibus chi-square test was significant for all outcomes of the study (p-value < 0.001). This indicates an association between outcome variables and malaria-endemic settings. The classification tables also indicate the significant results for three outcomes. The classification accuracy for the first, second and third outcomes was 83.6%, 69.4%, and 66.3%, respectively. For the type of test, the significance of the individual variable was evaluated by Wald statistics. All Wald statistics for three outcomes show a significant result (p-value < 0.001). The results of logistic regression have been presented in figure 3, as indicated on page 16 of the manuscript. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0259950.r004
26 Jul 2021 Decision Letter - Ramesh Kumar, Editor PONE-D-20-34159R2 Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia PLOS ONE Dear Author, 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 revise your paper as per the comments provided with this email. Please submit your revised manuscript by Sep 09 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, Ramesh Kumar, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: No ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: 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 ****** 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: No ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: Abstract The authors did not write their manuscript rigorously. The following concerns should be addressed. types of study, data collection technique, and types of logistic regression analysis were not specified Main body Material and methods There was major methodological defect: types of study, Source population, study population, inclusion criteria and exclusion criteria were not stated Sample size determination was not succinctly computed. Design effect was not considered. Sampling technique was not clearly stated Data collection technique, Descriptive statistics, and types of logistic regression analysis were not specified, model assumptions (multicollinearity) was not checked and its value was not indicated. Was there interaction? How did you estimate strength of association b/n explanatory variables and endpoint? What are the strategies to CONTROL CONFOUNDERS? How did you identify model fitness? ****** 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 [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0259950.r005
Revision 3
17 Aug 2021 Author Response REBUTTAL LETTER PONE-D-20-34159R2 Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia 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. Response: Thank you for this feedback. We have updated the reference list. We added reference [31] to support the sample size calculation, reference [43] for controlling confounding factors, and reference [53], [54], [55], [56] to support the argument for the association between malaria awareness and education level in the discussion section. All references have been prepared following the guidance of the journal. Reviewers' comments: Reviewer #2: Abstract The authors did not write their manuscript rigorously. The following concerns should be addressed: 1. Types of study, data collection technique, and types of logistic regression analysis were not specified. Response: We have updated methods section in the abstract as: “A community-based cross-sectional study was conducted between October and December 2019 in high, moderate, and low malaria-endemic settings (MESs) in the ENTP. After obtaining informed consent, data were collected using an interviewer-administered structure questionnaire among 1503 participants recruited by a multi-stage cluster sampling method. A malaria awareness index was developed based on ten questions. A binary logistic regression method was applied to investigate the significance of any association between malaria awareness and the different MESs” (page 2, lines 8 -14). Main body Material and methods There was major methodological defect: 1. types of study, Source population, study population, inclusion criteria and exclusion criteria were not stated Response: We have updated the material and method section. The study site is updated by including “This community-based cross-sectional study was conducted from October to December 2019 in three districts out of 21 districts and one municipality in the province. They were East Sumba, Belu, and East Manggarai districts representing high, moderate, and low MESs, respectively” (page 6, lines 17-20). The sampling technique section is updated by including “All adults in ENTP were the source population, and all adults in the selected three districts were the study population” (page 7, lines 14 -15). “In each selected household, one head of the family of any gender who provided consent to participate voluntarily was included in the study. If the household head, either husband or wife, was absent, residents over 18 years of age could serve as study participants [33]. We excluded anyone under the age of 18 years old from the study” (page 7, lines 22 - 25). 2. Sample size determination was not succinctly computed. Design effect was not considered. Response: Thank you for this feedback. We have updated the sample size determination section as below: “The initial sample size (n0) was calculated based on the formula n0 = Z2P(1-P)/d2 for the prevalence study of a cross-sectional study [31]. The parameters Z is the value of standard score of 95% confidence interval (1.96), P is the prevalence of malaria study in the ENTP conducted by the Indonesian government (1.99%) [9] , and d is the relative precision which is 0.01125. Therefore, the initial sample size n0 was equal to 592. The design effect was accounted for due to cluster sampling by the multiplication of a factor of 2.16. By considering the participation rate of 85%, the final sample size was 1503 adults. The sample size calculation was described previously [32]” (page 7, lines 3-10). 3. Sampling technique was not clearly stated Response: Thank you for this feedback. We have updated the sampling technique section as below: “A multi-stage cluster sampling procedure with a systematic random sampling procedure at the final cluster level was applied to recruit adults from the three districts. At cluster level 1, three districts were selected out of 22 in the ENTP based on the annual parasite incidence (API) of malaria, at cluster level 2, three sub-districts were randomly chosen from each selected district. At cluster level 3, the number of villages selected from each sub-district was based on their relative populations. At the final cluster level, a systematic random sampling technique was used to recruit 20–40 participants per village, proportionate to the population size of each village” (page 7, lines 15 – 22). 4. Data collection technique Response: Thank you for this feedback. We have improved data collection technique section by including the following information: “An interviewer-administered questionnaire adapted from a validated questionnaire [34, 35] was used to collect data for this study. The English version of the questionnaire was translated into the local language by the lead author of this article and a local language expert. They then combined the two translated versions. The combined version of the questionnaire was then tested on 30 participants before finalization. The data were collected in collaboration with local nurses who were residents in the study area. Nine local nurses, three nurses from each district conducted face-to-face interviews with participants based on the guidance of the structured questionnaire. The data collection process was monitored strictly by the investigator daily to check the questionnaire's completeness. Data on the socio-demographic variables and general knowledge of malaria was collected during the interview” (page 8, lines 2 – 11). 5. Descriptive statistics, and types of logistic regression analysis were not specified, model assumptions (multicollinearity) was not checked and its value was not indicated. Was there interaction? Response: Thank you for this feedback. The descriptive statistics has been specified in the statistical analysis section as: “The proportion of participants answering each question correctly and its 95% confidence interval (CI) were computed for each MES” (page 10, lines 17-19). Types of logistic regression, adjustment and addressing the issue of multicollinearity have been presented in Statistical analysis section as: “A univariate and multivariate binary logistic regression model was applied to evaluate the association between the dependent and the independent variables. The associations were reported as odds ratio with its 95% CI. Multicollinearity tests amongst the independent variables were done before multivariate analysis was conducted” (page 10, lines 22 – 25 and page 11 line 1). 6. How did you estimate strength of association b/n explanatory variables and endpoint? Response: Thank you for this feedback. The strength of association between explanatory variables and endpoint has been specified in the statistical analysis section as: “The direction and strength of association between explanatory variables and endpoints were estimated by adjusting the odds ratio” (page 11, lines 7 – 8). 7. What are the strategies to CONTROL CONFOUNDERS? Response: Thank you for this feedback. Strategies to control confounders have been specified in the statistical analysis section as: “In the univariate binary logistic regression, all variables having a p-value < 0.10 were included in the multivariate analysis to control confounding factors [43]” (page 11, lines 3 – 5). 8. How did you identify model fitness? Response: Thank you for this feedback. The model fitness test has been specified in the statistical analysis section as: “The Hosman and Lemeshow test evaluated the overall model fitness with a significance level of p < 0.05” (page 11, lines 1-2). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0259950.r006
2 Nov 2021 Decision Letter - Ramesh Kumar, Editor Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia PONE-D-20-34159R3 Dear Author, 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, Ramesh Kumar, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed Reviewer #3: 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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: (No Response) Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: The authors should write their manuscript rigorously, The language editorial problems should be corrected to enrich their work. The sampling technique should be written succinctly Reviewer #3: (No Response) ****** 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 #3: Yes:** Midhat Farzeen https://doi.org/10.1371/journal.pone.0259950.r007
Formally Accepted
4 Nov 2021 Acceptance Letter - Ramesh Kumar, Editor PONE-D-20-34159R3 Malaria awareness of adults in high, moderate and low transmission settings: A cross-sectional study in rural East Nusa Tenggara Province, Indonesia Dear Dr. Guntur: 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. Ramesh Kumar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0259950.r008

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