https://orcid.org/0000-0002-1377-8298
Peer Review History
| Original SubmissionDecember 27, 2020 |
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PONE-D-20-40659 Uterine prolapse and associated factors among reproductive age women in Dawro Zone, southwest Ethiopia: a community based cross-sectional study PLOS ONE Dear Dr. Sorsa, 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 28 Febraury. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Claudia Marotta 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 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 amend your manuscript to adhere to our submission guidelines with respect to. Potentially, outmoded terms should be changed to more current, acceptable terminology. Specifically, we recommend that “Vaginal examination” should be changed to more appropriate term(s). 4. You indicated that you had ethical approval for your study. In your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent. 5. PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Manager. To do this, go to ‘Update my Information’ (in the upper left-hand corner of the main menu), and click on the Fetch/Validate link next to the ORCID field. This will take you to the ORCID site and allow you to create a new iD or authenticate a pre-existing iD in Editorial Manager. Please see the following video for instructions on linking an ORCID iD to your Editorial Manager account: https://www.youtube.com/watch?v=_xcclfuvtxQ 6. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary). 7. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 8. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 1 and 2 in your text; if accepted, production will need this reference to link the reader to the Table. 9.We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: -https://doi.org/10.1007/s00192-007-0375-z In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed. Additional Editor Comments: dear Authors follow reviwers suggestion to improve your paper [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly Reviewer #3: No Reviewer #4: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know Reviewer #3: No Reviewer #4: 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 ********** 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: No Reviewer #4: 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: I read with great interest the paper on important topic and from relevant setting The paper is high quality: both statistical analysis and time of study is excellent some suggestion 1. Introduction:UP is the most common gynecological health problem contributing to maternal morbidity and mortality in women of reproductive age in developing countries. It is strongly related with infection pre and post surgery. Infections are the underlying causes in 11% of maternal, and one-fourth of newborn deaths, but the true burden of maternal infections and related complications remains unknown. Add and cite (Maternal caesarean section infection (MACSI) in Sierra Leone: a case-control study. Epidemiol Infect. 2020 Feb 27;148:e40. doi: 10.1017/S0950268820000370. PMID: 32102721; PMCID: PMC7058652.and Epidemiology, Outcomes, and Risk Factors for Mortality in Critically Ill Women Admitted to an Obstetric High-Dependency Unit in Sierra Leone. Am J Trop Med Hyg. 2020 Nov;103(5):2142-2148. doi: 10.4269/ajtmh.20-0623. PMID: 32840199; PMCID: PMC7646769.) 2. Methods and results: no comment are clear 3. Discussion: add and discuss the need for intensive care in Africa especially to address maternal complications and their sustainability as highlighted in previous studies (see Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis. Ann Glob Health. 2020 Jul 20;86(1):82. doi: 10.5334/aogh.2907. PMID: 32742940; PMCID: PMC7380057.) Reviewer #2: The manuscript entitled "Uterine prolapse and associated factors among reproductive age women in Dawro Zone, southwest Ethiopia: a community based cross-sectional study" is interesting, but I have some concerns: 1 - The title of the manuscript must be more objective and other details must be mentioned in the methodology. We think the title "Uterine prolapse and associated factors among reproductive age women in southwest Ethiopia" would be better. 2 - We suggest greater clarity of the Abstract, as it represents a mirror of the manuscript. 3 - In Introduction, the authors write a long introduction with two pages and an unnecessary mention of the geographical situation and population of Ethiopia, it would be important to mention only the importance of the study in Ethiopia as it is an underdeveloped or developing country where in some regions there are lack of obstetric care. 4 - This study lost international interest, as it was written with a view to more regional interest. We suggest that the authors review this situation. 5 - Also in Introduction or Discussion, the authors, despite studying uterine prolapse in reproductive age in an underdeveloped country, should stress that total uterine prolapse is more common in post-reproductive age, however carcinoma of the cervix and a prolapsed uterus are common diseases in underdeveloped countries , but their association is quite rare (da Silva BB. Carcinoma of the Cervix in Association with uterine prolapse. Gynecol Oncol . 2002; 84 (2): 349-50. doi: 10.1006 / gyno.2001.6503). 6 - In Methods, why do the study on genital prolapse only in a community in Ethiopia with a smaller sample, instead of doing a study with a larger sample size and with greater international interest? 7 - In Results, we suggest greater objectivity, long and confusing results, occupying almost five pages. 8 - In discussion, we suggest that the authors discuss the findings of the current study, point by point, with findings in the international literature. 9 - We suggest improving the English edition. Reviewer #3: About the article “Uterine prolapse and associated factors among reproductive age women in Dawro Zone, southwest Ethiopia: a community based cross-sectional study”: First, I would like to congratulate the authors by this interesting paper. The authors’ aim was to evaluate the prevalence and factors associated with uterine prolapse among women of reproductive age throw a cross-sectional study. The end point was to analyze risk factors associated with uterine prolapse. I have some points regard their work: 1- The article needs a native English speaker review; 2- The authors should describe the full words in first passage abbreviations (i.e. AOR, COR); 3- Introduction: The introduction is too long. The authors should shrink it. I suggest that the treatment section can be suppressed; 4- Introduction: last paragraph: I am not sure that they present the prevalence with this cross-sectional study. I understood that they analyzed a few sample of their population. How they make to this sample be representative? They should revise it; 5- Material and methods: “The sample size was calculated by using a single population formula with p=0.5 margin of error and (d) = 0.05 ”. I couldn’t understand how the authors calculated their sample size. What is their populational average used? And the standard deviation? Please, could you explain how it was estimated?; 6- Material and methods: How were the randomization performed?; 7- Material and methods: The authors describe that the patients were selected by an interview done by midwives? If they had symptoms, they were referred to the gynecologist to pelvic examination. The authors should describe as a weakness of the study that only symptomatic uterine prolapses were included in this study; 8- Material and methods: What questionnaire was used? What questions were used in each 3 main sections?; 9- Material and methods: Was the questionnaire validated by a previous study? Please indicate in the text the reference; 10- Material and methods (abstract): I would like to understand why authors included in the multivariate logistic regression the variables from the bivariate logistic regression with P < 0.25 instead of p<0.20. The authors should include this description in the Material and methods area of the main manuscript also; 11- Results: I would like to understand the results presented: “This study identified that the prevalence of symptomatic and anatomical uterine prolapse was 6.6% (28) and 5.9% (25) respectively”. How can be more symptomatic patients that actually anatomical identified uterine prolapse? The authors should explain; 12- Discussion: I suggest that the first paragraph, the authors describe their main objective findings; 13- Abstract Conclusion: The authors may enhance their conclusion. What is the message? What they suggest to their public health as a possible action?; 14- Manuscript Conclusion: The authors should enhance the conclusion to better comprehension. Cordially Reviewer #4: 25/01/2021 To Dr. Claudia Marotta Managing Editor PLoS One Dear Dr. Marotta, Enclosed please find a review of the manuscript entitled “Uterine prolapse and associated factors among reproductive age women in Dawro Zone, southwest Ethiopia: a community based cross-sectional study” which I am recommending for publication in PLos One after a minor revision. I have prepared a summary of the study and a list of issues that the authors may want to address. Best regards, Salvatore Andrea Mastrolia, MD Department of Obstetrics and Gynecology Ospedale dei Bambini "Vittore Buzzi" Via Lodovico Castelvetro, 32 20154, Milano Italy Email mastroliasa@gmail.com International Fellowship in Advanced Obstetric Training 2013-2016 Soroka University Medical Center Beer Sheva, ISrael
Manuscript #: PONE-D-20-40659 Title: "Uterine prolapse and associated factors among reproductive age women in Dawro Zone, southwest Ethiopia: a community based cross-sectional study” Comments for the author General comments: I am happy of the chance to review this manuscript focusing on a subject that is still not adequately assessed, not only in developing countries but also in high income countries. I read the manuscript with interest and here is a list of minor concerns that the authors may want to address: 1) I would suggest a linguistic revision in order to improve the readability of the manuscript 2) In the Methods section the Authors report that variables with P-values less than 0.25 in bivariate logistic regression were further examined using multivariate logistic regression to investigate associations between the dependent variable and independent variables. How was this value of 0.25 chosen? 3) The Discussion section can be slightly extended assessing potential physiopathologic explanations for the associations found by the Authors. ********** 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 Reviewer #3: Yes: Ricardo Pedrini Cruz Reviewer #4: Yes: Salvatore Andrea Mastrolia [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
| Revision 1 |
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PONE-D-20-40659R1 Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia : a community-based cross-sectional study PLOS ONE Dear Dr. badacho, 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 31 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. 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, Richard Kao Lee, M.D. 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 #1: All comments have been addressed 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 #1: Yes Reviewer #2: (No Response) Reviewer #3: No ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No Reviewer #3: No ********** 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) Reviewer #3: No ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No Reviewer #3: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Authors wrote an important paper on important issue. Maternal mortality is a big global health issue Reviewer #2: The manuscript entitled "Uterine prolapse and associated factors among reproductive age women in Dawro Zone, southwest Ethiopia: a community based cross-sectional study" R1, arouses interest, but I have some regards: 1 - Although the authors show a manuscript on "Uterine prolapse and associated factors among reproductive age women in Dawro Zone, southwest Ethiopia", they fail to stress that, globally, genital prolapse preferentially affects multiparous and elderly women (Hendrix et al. Am J Obstet Gynecol.2002;186(6):1160-6. doi: 10.1067/mob.2002.123819). 2 - Although in Methods it is stated that the staging of uterine prolapse was performed by a gynecologist based on the POP-Q classification, in Background, line 67, the authors mention an old staging of uterine prolapse, when they should have mentioned the updated staging, International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunctio. Wein AJ. J Urol . 2011;185(5):1812. doi: 10.1016/S0022-5347(11)60226-7). 3 - In methods, I think the authors exploit a lot of unnecessary geographic information and human resources, such as, location of the city where the study was done and how many kilometers away from the capital of Turkey. Number of beds, Hospital nurses, and so on. There should be a better suitability of the study for publication. 4 - The sample number is small and from this, the prevalence of genital prolapse in only 28 women. 5 - In Results, we look at a lot of numerical information. We suggest greater clarity. 6 - The discussion is short in that the results are not well discussed, with few reference citations. We suggest discussing the results point by point. Reviewer #3: About the revised article “Uterine prolapse and associated factors among reproductive age women in southwest Ethiopia”: The authors’ aim was to evaluate the prevalence and factors associated with uterine prolapse among women of reproductive age throw a cross-sectional study. The end point was to analyze risk factors associated with uterine prolapse. First, I would like to congratulate the authors by their effort in reviewing the reviewers’ statements. Again, I congratulate the authors by the study importance. It is increasing in our population the desire of “humanized childbearing”, with more deliveries done at home, without adequate professional help. Each point with the revision needed (in my humble opinion): 1- The article needs a native English speaker review; - done 2- The authors should describe the full words in first passage abbreviations (i.e. AOR, COR); “Authors' response#2: Thank you so much. We fully desrcibed the full words in first passage abbreviation. Please see line 49.” Done 3- Introduction: The introduction is too long. The authors should shrink it. I suggest that the treatment section can be suppressed; - done partially The introduction remains too long. It would be better that they cut unnecessary parts. 4- Introduction: last paragraph: I am not sure that they present the prevalence with this cross-sectional study. I understood that they analyzed a few sample of their population. How they make to this sample be representative? They should revise it; “Authors' response#4: Thank you so much; we determined sample size based on scientific method size determination which gave us enough sample size. Participants were randomly selected in the study.” Thank you, but the answer is still lacking to me, as you can see the next question. Also, the authors described that the screening was done by trained midwifes, finding 28 subjects that were suspicion of having UP. After doctor examination, only 25 confirmed. Also, the authors didn’t comment, but not even all UP the patients presents with symptoms. So, they can only estimate the incidence of symptomatic UP. The prevalence of UP is still not known, because only a few subjects were examined. 5- Material and methods: “The sample size was calculated by using a single population formula with p=0.5 margin of error and (d) = 0.05 ”. I couldn’t understand how the authors calculated their sample size. What is their populational average used? And the standard deviation? Please, could you explain how it was estimated?; “Authors' response#5: Thank you so much. We calculated sample size by using a confidence interval approach for a single population proportion with 50% since no published study regarding prevalence of UP in the country settled up. Therefore, we used to assume a proportion of 50% to get the maximum sample to be representative.” Thank you for the explanation. I am afraid that their explanation wasn’t enough to understand their sample size calculation. By the best of my limit knowledge, to calculate a sample by confidence interval approach for a single population proportion, you must know your standard deviation, not presented in the method area. Also, if they assume a 50% margin of error, that is a chance of 50% that their null hypothesis is true. I think that the authors tried to use the sample calculation of other publication (Silwal M, Gurung, G., Shrestha, N., Gurung, A. and Ojha, S.: Prevalence and Factors Affecting Women with Uterine Prolapse in Lekhnath, Kaski, Nepal. , 9(2), pp.52-57. Journal of Gandaki Medical College-Nepal 2016, 9(2):6.). I suggest that they revise it with and epidemiologist or a mathematician. 6- Material and methods: How were the randomization performed?; “Authors' response#6: Thank you so much. From the total 28 kebeles in the Loma district, 30% of kebeles, i.e., a total of eight kebeles, were selected by lottery method. The assumption was to divide the total estimated sample size to the households of each kebele according to the proportion they contribute to the total study subjects. We allocated sample proportion for the selected eight kebeles based on sample size. Out of an estimated 422 participants, sample size was adjusted proportionally for the households of the selected eight kebeles. Then, households were selected by systematic random sampling method, i.e., selecting households at a fixed interval throughout a household list from a registration book of health post as provided by Health Extension Workers(HEWs) working at Health Post in each respective kebele.” The explanation of randomization must be described in the “Material and methods” area. 7- Material and methods: The authors describe that the patients were selected by an interview done by midwives? If they had symptoms, they were referred to the gynecologist to pelvic examination. The authors should describe as a weakness of the study that only symptomatic uterine prolapses were included in this study; Authors' response#7: Thank you so much. We described the li mitation of the study in the limitation of the study section. Please see lines 234 to 235. Done. I suggest that the authors present as a new paragraph only. It does not need that spotlight as a new subdivision in the discussion. 8- Material and methods: What questionnaire was used? What questions were used in each 3 main sections?; “Authors' response#8: The interview question was composed of three main sections; the first two were phase 1 and the third was considered as phase two: 1) Socio-demographic variables and Obstetric and gynaecologic history (14 questions), 2) Questions regarding symptoms of uterine prolapsed (6questions), 3) The third section included two items; confirming by vaginal examination whether the women who reported symptomatic prolapse had anatomical prolapse or not, and the staging the prolapse was done then.” Thank you for the intent to answer the question. Unfortunately, the authors copy the explanation that was already in their article. The questions were not revealed in the article, neither in their review. It is not clear to readers what criteria was used to select patients. What questions were used? It is important to describe all the method used in the paper. Maybe their questions can be useful to others in the screening of UP. 9- Material and methods: Was the questionnaire validated by a previous study? Please indicate in the text the reference; “Authors' response#9 : Thanks so much; we are not sure that the questionnaire was not validated in the previous study.” The question 9 is related to question 8. They do not show questions used. Also, they were not previous used in other articles. So, how they are so sure that their questions are adequate to screening of their sample? 10- Material and methods (abstract): I would like to understand why authors included in the multivariate logistic regression the variables from the bivariate logistic regression with P < 0.25 instead of p<0.20. The authors should include this description in the Material and methods area of the main manuscript also; “Authors' response #10: Thank you so much; We included variables with p< 0.25 for candidate variable for the final model to increase the chance of the variable became a significant predictor variable. We included the description in the material and methods section.” Thank you for the explanation. Unfortunately, their desire to make variables more prone to be significant biased their study. I suggest that it be analyze again, with the correct parameters often used in medical literature. 11- Results: I would like to understand the results presented: “This study identified that the prevalence of symptomatic and anatomical uterine prolapse was 6.6% (28) and 5.9% (25) respectively”. How can be more symptomatic patients that actually anatomical identified uterine prolapse? The authors should explain; “Authors' response #11: Dear reviewer, thank you so much, the data collectors were trained midwifes and creafully assessed symptomatic patients and most of the symptomatic patients identified as anatomically identified utrine prolapse by doctors.” Thank you, unfortunately the question remains: how they find more symptoms than they find the pathology? The symptomatology is not a diagnosis. So, in the initial screening with midwifes, there were 28 subjects that were suspicion of having UP. After doctor examination, only 25 confirmed. They should make the corrections pointed. 12- Discussion: I suggest that the first paragraph, the authors describe their main objective findings; “Authors' response #12: Dear reviewer, thank you so much, we included the statement “In this study; age at first marriage, a history of abortion, birth attendant who assisted the delivery, and place of delivery were independent factors associated with uterine prolapse.” Perfect done. 13- Abstract Conclusion: The authors may enhance their conclusion. What is the message? What they suggest to their public health as a possible action?; “Authors' response #13: Dear reviewer, thank you so much. We enhance the conclusion, including the message: We recommend that the health system link primary health care to hospital-set for uterine prolapse treatment programs. Health institution delivery should be encouraged by the local government. Early marriage and unwanted pregnancy need to be prevented through appropriate strategies. Please See line 49 to 52.” Done. 14- Manuscript Conclusion: The authors should enhance the conclusion to better comprehension. “Authors' response #14: Dear reviewer, thank you so much. We enhance the conclusion to better comprehension, including the "We recommend that the health system is linking primary health care to hospital-set for uterine prolapse treatment programs. Health institution delivery should be encouraged by the local government. Early marriage and unwanted pregnancy need to be prevented through appropriate strategies." Please see lines 240- 243.” Done. 15- Introduction: They erased lines 118-119: “According to a projection from the 2007 national census, Ethiopia had nearly 110 million 119 inhabitants in 2019, with 23.4% of women of reproductive age.”. The subsequent phase must be adjusted: “Given this massive potentially…” 16- Discussion, lines 250-251: Symptomatic prolapse in your sample wasn’t 6.6%. If the patients had gynecological examination by doctors and they diagnosticated only 25 of the total sample of 422, your result is 5.9%. There are 3 patients screened to UP that had not the diagnosis of UP made. 17- Figure 2: The same as the previous: the presence of uterine prolapse was only in 25 patients (5.9%). The authors should revise it. A questionary cannot be the gold standard to UP diagnosis. The clinical evaluation is the gold standard. 18- Table 1: marital status: Is missing data of 1 patient. They should revise. 19- Table 1: religion: Is missing data of 1.7% of their sample. They should revise. Cordially ********** 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 Reviewer #3: Yes: Ricardo Pedrini Cruz [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
| Revision 2 |
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PONE-D-20-40659R2Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia : a community-based cross-sectional studyPLOS ONE Dear Dr. badacho, 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 Nov 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:
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, Richard Kao Lee, M.D. Academic Editor PLOS ONE [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 #3: (No Response) ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #3: Partly ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: No ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #3: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #3: 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: In my opinion can be accept, the paper is very good and also the time related to peer review is too much and I think to make a decision in short time no 1 year Reviewer #3: About the revised article “Uterine prolapse and associated factors among reproductive age women in southwest Ethiopia”: The authors’ aim was to evaluate the prevalence and factors associated with uterine prolapse among women of reproductive age throw a cross-sectional study. The end point was to analyze risk factors associated with uterine prolapse. First, I would like to congratulate the authors by their effort in re-reviewing the reviewers’ statements. Each point with the revision needed (in my humble opinion): 1- The article needs a native English speaker review; ---- done 2- The authors should describe the full words in first passage abbreviations (i.e. AOR, COR); “Authors' response#2: Thank you so much. We fully desrcibed the full words in first passage abbreviation. Please see line 49.” ------ Done 3- Introduction: The introduction is too long. The authors should shrink it. I suggest that the treatment section can be suppressed; - done partially. The introduction remains too long. It would be better that they cut unnecessary parts. Authors' response: Dear Reviewer, Thank you so much: we revised the introduction part. ------ Done partially. The introduction remains too long. It would be better that they cut unnecessary parts. 4- Introduction: last paragraph: I am not sure that they present the prevalence with this cross-sectional study. I understood that they analyzed a few sample of their population. How they make to this sample be representative? They should revise it; “Authors' response#4: Thank you so much; we determined sample size based on scientific method size determination which gave us enough sample size. Participants were randomly selected in the study.” Thank you, but the answer is still lacking to me, as you can see the next question. Also, the authors described that the screening was done by trained midwifes, finding 28 subjects that were suspicion of having UP. After doctor examination, only 25 confirmed. Also, the authors didn’t comment, but not even all UP the patients presents with symptoms. So, they can only estimate the incidence of symptomatic UP. The prevalence of UP is still not known, because only a few subjects were examined. Authors' response: Dear Reviewer, Thank you so much: even though we determined sample size using the scientific method of sample size calculation the subjected examined for UP was few that affected the prevalence of UP among the reproductive age group. --- Thank you, but the answer is still lacking to me. The answer has not clarified my previous questions. Also, the authors described that the screening was done by trained midwifes, finding 28 subjects that were suspicion of having UP. After doctor examination, only 25 confirmed. Also, the authors didn’t comment, but not even all UP the patients presents with symptoms. So, they can only estimate the incidence of symptomatic UP. The prevalence of UP is still not known, because only a few subjects were examined. Unfortunately, they do not know how many asymptomatic reproductive women have UP, so it is possible that their population prevalence be higher than they calculated; 5- Material and methods: “The sample size was calculated by using a single population formula with p=0.5 margin of error and (d) = 0.05 ”. I couldn’t understand how the authors calculated their sample size. What is their populational average used? And the standard deviation? Please, could you explain how it was estimated?; “Authors' response#5: Thank you so much. We calculated sample size by using a confidence interval approach for a single population proportion with 50% since no published study regarding prevalence of UP in the country settled up. Therefore, we used to assume a proportion of 50% to get the maximum sample to be representative.” Thank you for the explanation. I am afraid that their explanation wasn’t enough to understand their sample size calculation. By the best of my limit knowledge, to calculate a sample by confidence interval approach for a single population proportion, you must know your standard deviation, not presented in the method area. Also, if they assume a 50% margin of error, that is a chance of 50% that their null hypothesis is true. I think that the authors tried to use the sample calculation of other publication (Silwal M, Gurung, G., Shrestha, N., Gurung, A. and Ojha, S.: Prevalence and Factors Affecting Women with Uterine Prolapse in Lekhnath, Kaski, Nepal. , 9(2), pp.52-57. Journal of Gandaki Medical College-Nepal 2016, 9(2):6.). I suggest that they revise it with and epidemiologist or a mathematician. Authors' response: Dear Reviewer, Thank you so much: to determine the maximum sample size for cross-sectional study; we determined sample size using a single population proportion formula with the assumption of the prevalence of UP among reproductive age 50%; p=0.5 and Z=1.96, Margin of error of 5% (d)= 0.05. we assumed a 5% of margin of error, not a 50%. A single population proportion gives a maximum sample size. --------- Thank you. First I think you will have to correct the information in the material and methods. You answered here “Margin of error of 5% (d)= 0.05”; however, in the article you wrote “The sample size was calculated by using a single population formula with p=0.5 margin of error and (d) = 0.05 ”. Maybe your desire was to write: “The sample size was calculated by using a single population formula with a proportion of 0.5 and a margin of error of (d) = 0.05 ” You assume a prevalence of 50%. You found around 6% of UP in your sample. You have estimated a high prevalence of UP compared with your sample results (6%). By the methodology used, your article was underpower. Also, there was already an evidence in Ethiopia of 22.3% (Silwal M, Gurung, G., Shrestha, N., Gurung, A. and Ojha, S.: Prevalence and Factors Affecting Women with Uterine Prolapse in Lekhnath, Kaski, Nepal. , 9(2), pp.52-57. Journal of Gandaki Medical College-Nepal 2016, 9(2):6.) that you could used to estimate your sample size. If we consider that your sample calculation was adequate (to 6% of prevalence), your result is not a prevalence of 6%, because you have not diagnosticated women with asymptomatic UP. In my interpretation, you can conclude that the incidence of symptomatic UP of your sample was 5.9%. 6- Material and methods: How were the randomization performed?; “Authors' response#6: Thank you so much. From the total 28 kebeles in the Loma district, 30% of kebeles, i.e., a total of eight kebeles, were selected by lottery method. The assumption was to divide the total estimated sample size to the households of each kebele according to the proportion they contribute to the total study subjects. We allocated sample proportion for the selected eight kebeles based on sample size. Out of an estimated 422 participants, sample size was adjusted proportionally for the households of the selected eight kebeles. Then, households were selected by systematic random sampling method, i.e., selecting households at a fixed interval throughout a household list from a registration book of health post as provided by Health Extension Workers(HEWs) working at Health Post in each respective kebele.” The explanation of randomization must be described in the “Material and methods” area. Authors' response: Dear Reviewer, Thank you so much: we revised how was the randomization performed in material and methods sction. Please see lines 125 -133. ---- Thank you. If I understood right, you performed a simple random sampling, that is correct? If so, I suggest that you can say that you raffle 8 areas of Loma district and after that selected the sample by a simple random sampling in these areas. It will be less confusing to readers. I had to study what is a kebele. Thank you for the knowledge. 7- Material and methods: The authors describe that the patients were selected by an interview done by midwives? If they had symptoms, they were referred to the gynecologist to pelvic examination. The authors should describe as a weakness of the study that only symptomatic uterine prolapses were included in this study; Authors' response#7: Thank you so much. We described the limitation of the study in the limitation of the study section. Please see lines 234 to 235. Done. I suggest that the authors present as a new paragraph only. It does not need that spotlight as a new subdivision in the discussion. Authors' response: Dear Reviewer, Thank you so much: we revised it. Please see lines 256-257. ---- Thank you. The authors could present a paragraph with strengths and limitations of their work. They made only a final phrase of 1 limitation. They can cite that the article sample is underpower also, because of their prior prevalence estimation was more than 8 times higher than what they found. 8- Material and methods: What questionnaire were used? What questions were used in each 3 main sections?; “Authors' response#8: The interview question was composed of three main sections; the first two were phase 1 and the third was considered as phase two: 1) Socio-demographic variables and Obstetric and gynaecologic history (14 questions), 2) Questions regarding symptoms of uterine prolapsed (6questions), 3) The third section included two items; confirming by vaginal examination whether the women who reported symptomatic prolapse had anatomical prolapse or not, and the staging the prolapse was done then.” Thank you for the intent to answer the question. Unfortunately, the authors copy the explanation that was already in their article. The questions were not revealed in the article, neither in their review. It is not clear to readers what criteria was used to select patients. What questions were used? It is important to describe all the method used in the paper. Maybe their questions can be useful to others in the screening of UP. Authors' response: Dear Reviewer, Thank you so much: the structured questionnaire used was included in the supplementary document section submitted with the manuscript. -------- Thank you, I could understand the questionary used. Is there any reference of its use as a screening method to UP? Is it the first time used? If it is the first time used, I suggest that they validate it as a tool to population screening. In this case, all the sample must have gynecologic examination to rightly diagnose UP. The use of a non-validated questionary reinforces the question 5 (they could not conclude they population prevalence). 9- Material and methods: Were the questionnaire validated by a previous study? Please indicate in the text the reference; “Authors' response#9 : Thanks so much; we are not sure that the questionnaire was not validated in the previous study.” The question 9 is related to question 8. They do not show questions used. Also, they were not previous used in other articles. So, how they are so sure that their questions are adequate to screening of their sample? Authors' response: Dear Reviewer, Thank you so much: we reviewed different literature of similar studies. We checked the validity of the questionnaire using Cronbach alpha that was greater than 0.7 that indicates the questionnaire measures what it intended to measure. -------- Thank you. The Cronbach alpha is used to as a measure of internal consistency of a questionary, it is not used as a validation tool. That is OK, you already answer that the text was not previously validated in the question 8. Who were the specialists that participate in the Cronbach alpha calculation? Were the authors of this article? 10- Material and methods (abstract): I would like to understand why authors included in the multivariate logistic regression the variables from the bivariate logistic regression with P < 0.25 instead of p<0.20. The authors should include this description in the Material and methods area of the main manuscript also; “Authors' response #10: Thank you so much; We included variables with p< 0.25 for candidate variable for the final model to increase the chance of the variable became a significant predictor variable. We included the description in the material and methods section.” Thank you for the explanation. Unfortunately, their desire to make variables more prone to be significant biased their study. I suggest that it be analyze again, with the correct parameters often used in medical literature. Authors' response: Dear Reviewer, Thank you so much: Biostaticians recommend using P < 0.25 as candidate variables in bivariate analysis for candidate variables for multivariate analysis. --------- Thank you for your response. I am still confuse. You describe on the abstract’s methodology area that you used variables with P-values less than 0.25 in bivariate logistic regression were further examined using multivariate logistic regression to investigate associations between the dependent variable and independent variables. However, on the methology’s area of the complete article, you do not describe it. Also, your tables did not show what variables was calculated with p<0.25 to use in the multivariable analysis. The authors should clarify or rectify the information. 11- Results: I would like to understand the results presented: “This study identified that the prevalence of symptomatic and anatomical uterine prolapse was 6.6% (28) and 5.9% (25) respectively”. How can be more symptomatic patients that actually anatomical identified uterine prolapse? The authors should explain; “Authors' response #11: Dear reviewer, thank you so much, the data collectors were trained midwifes and creafully assessed symptomatic patients and most of the symptomatic patients identified as anatomically identified utrine prolapse by doctors.” Thank you, unfortunately the question remains: how they find more symptoms than they find the pathology? The symptomatology is not a diagnosis. So, in the initial screening with midwifes, there were 28 subjects that were suspicion of having UP. After doctor examination, only 25 confirmed. They should make the corrections pointed. Authors' response: Dear Reviewer, Thank you so much; in the initial screening with midwives, there were 28 subjects that were suspected of having UP. After the doctor examination, only 25 were confirmed. ------- Thank you, I understood exactly that. So you agree that only 25 were confirmed as having UP. In that way, you cannot say that there were 28 patients with symptomatic UP. You must rectify the information in the text. Also, you cannot affirm that the prevalence of UP in your sample was 5.9%, because you do not know that (there are asymptomatic UP that were not included in your article). 12- Discussion: I suggest that the first paragraph, the authors describe their main objective findings; “Authors' response #12: Dear reviewer, thank you so much, we included the statement “In this study; age at first marriage, a history of abortion, birth attendant who assisted the delivery, and place of delivery were independent factors associated with uterine prolapse.” ------- Perfect done. 13- Abstract Conclusion: The authors may enhance their conclusion. What is the message? What they suggest to their public health as a possible action?; “Authors' response #13: Dear reviewer, thank you so much. We enhance the conclusion, including the message: We recommend that the health system link primary health care to hospital-set for uterine prolapse treatment programs. Health institution delivery should be encouraged by the local government. Early marriage and unwanted pregnancy need to be prevented through appropriate strategies. Please See line 49 to 52.” ------ Done. 14- Manuscript Conclusion: The authors should enhance the conclusion to better comprehension. “Authors' response #14: Dear reviewer, thank you so much. We enhance the conclusion to better comprehension, including the "We recommend that the health system is linking primary health care to hospital-set for uterine prolapse treatment programs. Health institution delivery should be encouraged by the local government. Early marriage and unwanted pregnancy need to be prevented through appropriate strategies." Please see lines 240- 243.” ------- Done. 15- Introduction: They erased lines 118-119: “According to a projection from the 2007 national census, Ethiopia had nearly 110 million 119 inhabitants in 2019, with 23.4% of women of reproductive age.”. The subsequent phase must be adjusted: “Given this massive potentially…” Authors' response: Dear Reviewer, Thank you so much; We revised it. Please see line 97. ------- Thank you. You have cutted the passage “According to a projection from the 2007 national census, Ethiopia had nearly 110 million 119 inhabitants in 2019, with 23.4% of women of reproductive age.” However, the subsequent phrase has lost its meaning. The authors should revise it. 16- Discussion, lines 250-251: Symptomatic prolapse in your sample wasn’t 6.6%. If the patients had gynecological examination by doctors and they diagnosticated only 25 of the total sample of 422, your result is 5.9%. There are 3 patients screened to UP that had not the diagnosis of UP made. Authors' response: Dear Reviewer, Thank you so much; we revised it ------- Thank you. I already commented in the previous questions. Unfortunately, you have not reviewed. 17- Figure 2: The same as the previous: the presence of uterine prolapse was only in 25 patients (5.9%). The authors should revise it. A questionary cannot be the gold standard to UP diagnosis. The clinical evaluation is the gold standard. Authors' response: Dear Reviewer, Thank you so much; we revised it ------- Thank you. I already commented in the previous questions. Unfortunately, you have not reviewed. 18- Table 1: marital status: Is missing data of 1 patient. They should revise. Authors' response: Dear Reviewer, Thank you so much; we revised it ------ Done partially. The percentage is missing 0.2% 19- Table 1: religion: Is missing data of 1.7% of their sample. They should revise. Authors' response: Dear Reviewer, Thank you so much; we revised it ------ Done 20 – Abstract, “The objective of this study was to assess the prevalence of and factors associated with uterine prolapse in women of reproductive age in Ethiopia.”: The objective was not accomplished by this study. UP can be asymptomatic. So, without a medical evaluation, it is not possible to determine the prevalence of UP in their population. The inclusion criteria were done by non-medical interview (using a questionary). The authors should revise it. 21 – Abstract, results, “The prevalence of symptomatic and anatomical uterine prolapse was 6.6% (28) and 5.9% (25), respectively”: Sorry, but the authors already said that 3 patients of the 28 symptomatic did not confirm the hypothesis of UP after medical examination. They did not revise the manuscript as previously indicated in question 04. 22 – Introduction, “UP is the most common gynecological health problem contributing to maternal morbidity and mortality in women of reproductive age in developing countries”: The authors should show the reference of their statement. 23 – Introduction: It is still too long. They should shrink it. 24 - The authors should describe the full words in first passage abbreviations (i.e. COR); 25 – The authors indexed the previous and the new revision, it was a little bit confuse to identification of the new one. Cordially ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #3: Yes: Ricardo Pedrini Cruz [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
| Revision 3 |
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PONE-D-20-40659R3 Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia : a community-based cross-sectional study PLOS ONE Dear Dr. badacho, 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 18 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript:
If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: 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, Richard Kao Lee, M.D. Academic Editor PLOS ONE [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 #3: (No Response) Reviewer #5: (No Response) ********** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #3: No Reviewer #5: (No Response) ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: No Reviewer #5: (No Response) ********** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #3: Yes Reviewer #5: 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 #3: Yes Reviewer #5: Yes ********** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Authors improved their paper that now can be accept Also the paper already done revised for 3 time I think now is correct to accept it Reviewer #3: About the revised article “Uterine prolapse and associated factors among reproductive age women in southwest Ethiopia”: The authors’ aim was to evaluate the prevalence and factors associated with uterine prolapse among women of reproductive age throw a cross-sectional study. The end point was to analyze risk factors associated with uterine prolapse. Unfortunately, I already made many suggestions to enhance the article. I and the authors have disagreement about many topics. The last 2 revisions (included the last one) have not evolved. Cordially Reviewer #5: Line 99, if the sample size was estimated using confidence interval, please state the level of % confidence used for your calculation. E.g. The sample size was calculated to ensure that the two-sided 95% confidence interval (CI) for the estimated prevalence will be within +/- 0.05 by using a single population formula with a proportion of 0.5. Line 104, “theseareas” should be “these areas”. Lines 104-108, it’s not clear about the sample allocations among kebeles. Please add one table to list the numbers of households for each of the eight kebeles, and number of selected households and subjects for this study. Lines 109, “households were selected by systematic random sampling method”. If a selected household didn’t have a woman or have multiple women meeting the inclusion criteria, how did you select the subjects? Line 196, “p < 0.005” should be “p < 0.05”. Lines 237-239, “Even though we determined the sample using the proportion of 0.5 to get the maximum sample size, the sample was underpowered because prior prevalence estimation was more than eight times higher than what we found”. This statement should be removed. It was not underpowered because the sample size was planned as the maximum to ensure the width of 95% CI of an estimated prevalence will be within 0.1. ********** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #3: No Reviewer #5: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. |
| Revision 4 |
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Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia : a community-based cross-sectional study PONE-D-20-40659R4 Dear Dr. Badacho: 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, Richard Kao Lee, M.D. 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 #1: All comments have been addressed Reviewer #5: 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 #1: Yes Reviewer #5: (No Response) ********** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #5: (No Response) ********** 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 #5: (No Response) ********** 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 #5: (No Response) ********** 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: (No Response) Reviewer #5: (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 #1: Yes: Francesco Di Gennaro Reviewer #5: No |
| Formally Accepted |
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PONE-D-20-40659R4 Uterine prolapse and associated factors among reproductive-age women in south-west Ethiopia: a community-based cross-sectional study Dear Dr. Badacho: 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. Richard Kao Lee Academic Editor PLOS ONE |
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