PONE-D-21-00752

Family Context and Individual Characteristics in Antenatal Care Utilization among adolescent childbearing mothers in Urban Slums in Nigeria.

PLOS ONE

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1. Please also include the questionnaire used in the study.
2. In table 2 you should indicate within the colums that the comparison is not "fair" in the sense that DHS refers to the whole state, as I understand, and not to the urban slums. You can be more explicit in the header, probably include Slums Adolescent Survey vs State-level DHS.
3. I think the bivariate analysis is useful. Do not exclude it.
4. Regarding the inclusion of 8 visits, you can include it in the analysis if you like, otherwise, admitting the change in recommendation from 4 to 8 visits, you can argue why it is still interesting to look at 4 visits.
5. While you have to improve the description of the variables retained for analysis (items 7 and 8 of strobe statement), this is particularly important regarding the wealth variables, as manifested by the reviewers. Are you defining quintiles based on this questionnaire or are you using wealth cuts according to the DHS? That would make results more comparable. In particular, since only slum areas are included. Also social status is not described in enough detail to allow for replication. There could also be a high overlap between wealth and social status, in which case that could explain non-significance in the multivariate analysis and high significance in the bivariate analysis.
6. Regarding the regression, you should include group tests of significance in table 4 and 5, since the tests for categorical variables that you report (individual) are less interesting since they compare to the referece category.
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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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

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Reviewer #1: Yes

Reviewer #2: Yes

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

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Reviewer #1: Yes

Reviewer #2: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study investigates the role of family context and other determinants in adolescent mother access to antenatal care (ANC). Findings show, among other things, that having lost both parents negatively influences ANC access, while parents' education is not a relevant determinant.

The study is novel in its analysis of the family context and sheds a light in an often marginalized area. Findings on other factors are also in line with previous literature. The reviewer believes the paper would be a valid addition to PLOS ONE, although a few revisions are advised.

1) The Introduction section should provide more insights on the situation in Nigeria urban slums, considering the focus of the paper. Information on average ANC participation in these areas, or on adolescent health in general could prove useful for the reader.

2) The Measurement of Variables section should present a cleared explanation of how the social status indicator has been calculated, considering its relevance in the findings.

3) The role of wealth is not discussed in the Results/Discussion sections, although it is marginally significant. Results are also not reflective of previous literature on the role of wealth on ANC (i.e. the authors find that being wealthier is not correlated with a higher probability of attending 4ANC+). The authors should present hypotheses and potential explanations of their findings to explain why the situation in which households leave in the slums would reduce the importance of wealth in influencing access to ANC.

Reviewer #2: Reviewer feedback

BACKGROUND

Line 6-6: “The greatest burden is concentrated in West and Central Africa where 6 per-cent of adolescents reported births before age 15 and 28 per cent of women between the ages of 20 and 24 reported a birth before age 18.” The authors need to cite compared to what is the West and Central Africa have the greatest burden.

Line 26 -27: Research evidence from 26 developing countries consistently underscores the importance of ANC among childbearing 27 adolescents. What are some of the positive impacts of ANC for childbearing adolescents? For instance, what percent of death reduction is attributed to ANC?

Line 11-26: This section may need more argument why they have conducted their study. For instance, is there no study that examined the influence of family context in ANC uptake among childbearing adolescents in urban slums in Nigeria? If any, what are the methodological and knowledge gaps you wanted to fill on the existing evidence? This section may benefit from more professional and scientific critics of existing evidences to call out their paper’s strong side.

METHODS

Line 31-32: Were there any special ethical procedures followed for adolescents? Does Nigeria’s Research Ethics Guideline allow to take direct consent from women less than 18 years of age? Any assent or witness used during consent taking?

How was slum area defined in this paper? Did you take slum residents based on a set of criteria or slum sites/areas in general? Please provide brief explanation about the slum areas you studied.

Line 38-39: Why did you decide to include those having at least a child less than 5 years? Why not less than 1, why not less than 3 years? Brief explanation if you have any reason for your inclusion criteria.

Page 5: The data collection was implemented between July and October 2018. Why did it take this much time for data collection alone or does the period include the wider study period including analysis and report writing?

Ethical approval related information is repeated between pages 4 and 5.

Page 5: Measurement of variables: WHO has recommended at least 8 visits for a positive pregnancy experience? You have cited the World Health Organization (2016) minimum recommendations but the cut off you applied is older. The 2016 recommendation is a minimum of 8 contacts. Did you consider this or it is because Nigeria didn’t start implementing the new recommendation? Why did you decide a minimum of 4 visits rather than 8? Unless you justify this, you may need to re-analyze in the whole of the paper.

RESULT

Page 6, Line 17-25…the comparisons between the current study and DHS is not in the right place. Better move it to the Discussion part.

Line 29-38: I don’t see the importance of presenting this section (the Bivariate analysis). It is repeated under the Binary; logistic regression model except the later shows net effects…Just explain how you used the bivariate analysis to select the variables entered to the multivariate model and focus on the multivariate findings.

Page 7, Line 7-24: The interpretation approach is not inviting for readers. I counted that the word “Those” was repeated 11 times in this section and this indicates that the authors need to be careful in articulating their findings. It need to be re-written.

Page 7, Line 30-33: Authors have associated the influence of polygamous marriage in the North to 4+ANC visits. The possible explanation is not clear. The authors need to describe how ANC visit is associated with polygamous marriage and it has to be supported with evidence. Readers do not want to read the authors’ hypotheses but their evidence-based explanations. Plus, the “RESULT” section is not the right place to include possible explanations. The result section should only cover the findings in a simple language. Possible explanations and further interpretations of findings should be addressed under the Discussion part of the paper.

DISCUSSION

The first paragraph on page 9 (mental health) issue seems out of context. Mental health was never mentioned in the previous sections.

It would be advisable if the authors could come up with an overall comprehensive conclusion at the end of the discussion part. Recommendations are already mixed in the discussion.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Reviewer feedback.docx

Family Context and Individual Characteristics in Antenatal Care Utilization among adolescent childbearing mothers in Urban Slums in Nigeria.

PONE-D-21-00752R1

Dear Dr. Akinyemi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The main issues raised in the discussion have been dealt with and the article fulfills PLOS ONE publication criteria in the opinion of the editor, congratulations. It's not been judged necessary to send back the article to the reviewers.

Reviewers' comments: