Menstrual hygiene practice among adolescent girls in Ethiopia: A systematic review and meta-analysis

Biniyam Sahiledengle; Daniel Atlaw; Abera Kumie; Yohannes Tekalegn; Demelash Woldeyohannes; Kingsley Emwinyore Agho

doi:10.1371/journal.pone.0262295

Peer Review History

Original SubmissionJuly 12, 2021
24 Nov 2021 Decision Letter - Balasubramani Ravindran, Editor PONE-D-21-22639Menstrual Hygiene Practice among Adolescent Girls in Ethiopia: a systematic review and meta-analysisPLOS ONE Dear Dr. Sahiledengle, 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 Jan 06 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Balasubramani Ravindran, Ph.D Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1.Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: 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: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 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: This study is not a primary scientific research, it is a systematic review and meta-analysis. Therefore, it does not satisfy the first publishing criteria of PLOS ONE. However, it should be noted that the manuscript is technically sound and well written. The manuscript substantially met remaining requirements for publication in PLOS ONE. Reviewer #2: Thank you. The article is well written and relevant as menstrual hygiene is vital to the empowerment and well-being of women and girls worldwide. Safe menstrual hygiene practice is especially important for adolescent girls as it affects girls’ participation and psychological well-being while in classes. Below are some minor comments: Abstract: Line 35: please write out “MHM” before using abbreviation Introduction: Line 95-99: wordy and the meaning is not clear. Suggest rephrasing of this sentence “Despite, a school WASH initiative includes MHM as a major focus, as part of its overall objective of improving the school enrolment and attendance of girls was implemented by the Federal Ministry of Health (FMoH) of Ethiopia, still, poor access to dignified, clean, and functional WASH facilities in schools in Ethiopia remains a major setback for proper MHM by adolescent girls.” Method: Line 136-138: These 2 sentences discussing exclusion criteria should be moved to Exclusion criteria. Line 145: as mentioned in point above, the exclusion criteria should include “Systematic reviews, commentaries, letters to editors, short communications, qualitative studies were excluded. Also, articles that were not fully accessible after two-email contact with the primary/corresponding author were excluded.” Result: Detailed, clear and well-written. Line 274-276: Please rephrase the sentence and clarify if the 41.67% of schoolgirls had access to water only OR water and soap OR either, “However, 50.69% (95%CI: 41.53, 59.84, I2 98.9%) of schoolgirls reported they used both soap and water for genital cleaning, and 41.67% (95%CI: 27.12-56.23, I2 98.8%) reported wash their genitalia daily or two-time a day during menstruation” Discussion: Line 422: The message is not clear, please rephrase the sentence “However, the problem does not give due attention as more adolescent girls turn to commercial pads (65%), with the potential generation of non-biodegradable wastes.” Conclusion: Well written with summary of the research question and recommendation. General: Few typographical errors were identified throughout the manuscript. Please address typo/grammatical errors highlighted in the pdf file. Reviewer #3: This study is important and would be very useful for policy makers and other stakeholders to develop interventions that will be appropriate for improving safe menstrual hygiene management especially in developing countries. These are my reviews 1. Introduction The introduction is clear. The objectives are well spelt out 2. Methods line 145: Exclusion criteria should also include population that are not within the adolescent age bracket line 164 should be a continuous statement under primary outcome, it need not to be on a fresh paragraph Line 165 should be on a new paragraph stating the secondary outcome clearly 3. Results The secondary outcome stated under methods which is the safe menstrual practice and association between sociodemgraphic and behavioural factors is not clearly evaluated. Table 5, line 319. This makes the study needing a major revision 4. Discussion The inclusion of unpublished studies may be a limitation to this study as some of the unpublished manuscript might not eventually meet up with quality peer reviewed article. ****** 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: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-21-22639-RV.pdf https://doi.org/10.1371/journal.pone.0262295.r001
Revision 1
13 Dec 2021 Author Response Response to Reviewers Dear Editor, Receiving such valuable comments and suggestions to improve the current manuscript is a prestigious opportunity for us. The comments and suggestions taught us a lot. We improved our manuscript based on the reviewers' suggestions, and we used "Green Text Highlight Color" for all affected revisions and corrections. In the attached word document, we also included a point-by-point response to the editor's and reviewers' comments. Thank you. Response to Reviewer #1: Reviewer #1: This study is not a primary scientific research, it is a systematic review and meta-analysis. Therefore, it does not satisfy the first publishing criteria of PLOS ONE. However, it should be noted that the manuscript is technically sound and well written. The manuscript substantially met remaining requirements for publication in PLOS ONE. Response: Receiving such valuable comments and suggestions is a prestigious opportunity for us. Thank you for your valuable time and constructive feedback. Response to Reviewer #2: Thank you for this wonderful opportunity, respected reviewer #3. The comments and suggestions taught us a lot. We have improved our manuscript in response to your wise advice. For all affected revisions and corrections, we used "Green Text Highlight Color." Please refer to the updated manuscript. Thank you very much. Reviewer #2: Thank you. The article is well written and relevant as menstrual hygiene is vital to the empowerment and well-being of women and girls worldwide. Safe menstrual hygiene practice is especially important for adolescent girls as it affects girls’ participation and psychological well-being while in classes. Below are some minor comments: Abstract: Line 35: please write out “MHM” before using abbreviation Response: Thank you, our respected reviewer #2. As per your wise advice we write out MHM accordingly. Please see the revised manuscript abstract section. Thank you. Introduction: Line 95-99: wordy and the meaning is not clear. Suggest rephrasing of this sentence “Despite, a school WASH initiative includes MHM as a major focus, as part of its overall objective of improving the school enrolment and attendance of girls was implemented by the Federal Ministry of Health (FMoH) of Ethiopia, still, poor access to dignified, clean, and functional WASH facilities in schools in Ethiopia remains a major setback for proper MHM by adolescent girls.” Response: Thank you, our respected reviewer #2. We apologize for this confusing statement. As per your wise advice we rephrased the stated introduction section accordingly. Please refer to the updated manuscript. Thank you. Method: Line 136-138: These 2 sentences discussing exclusion criteria should be moved to Exclusion criteria. Response: Thank you, our respected reviewer. As per your wise advice we removed the two sentences in the exclusion criteria. Thank you. Line 145: as mentioned in point above, the exclusion criteria should include “Systematic reviews, commentaries, letters to editors, short communications, qualitative studies were excluded. Also, articles that were not fully accessible after two-email contact with the primary/corresponding author were excluded.” Response: Thank you, our respected reviewer. As per your wise advice corrected accordingly. Thank you with all respect. Result: Detailed, clear and well-written. Line 274-276: Please rephrase the sentence and clarify if the 41.67% of schoolgirls had access to water only OR water and soap OR either, “However, 50.69% (95%CI: 41.53, 59.84, I2 98.9%) of schoolgirls reported they used both soap and water for genital cleaning, and 41.67% (95%CI: 27.12-56.23, I2 98.8%) reported wash their genitalia daily or two-time a day during menstruation” Response: Thank you, our respected reviewer. We apologize for the confusing statement. As per your wise suggestion we clarify and rewire accordingly. Please refer to the updated manuscript. Thank you with all respect. Discussion: Line 422: The message is not clear, please rephrase the sentence “However, the problem does not give due attention as more adolescent girls turn to commercial pads (65%), with the potential generation of non-biodegradable wastes.” Response: Thank you, our respected reviewer. We apologize for the confusing rephrase. As per your wise suggestion we clarify and rewire accordingly. Please refer to the updated manuscript. Thank you with all respect. Conclusion: Well written with summary of the research question and recommendation. Response: Thank you, our esteemed reviewer. General: Few typographical errors were identified throughout the manuscript. Please address typo/grammatical errors highlighted in the pdf file. Response: Thank you for your time, our respected Reviewer #2. We apologize for the typographical and grammatical errors. In the revised manuscript we correct and rewired in accordance with your wise advice. Please refer to the updated manuscript. Thank you. Response to Reviewer #3: Thank you for this wonderful opportunity, respected reviewer #3. The comments and suggestions taught us a lot. We have improved our manuscript in response to your wise advice. For all affected revisions and corrections, we used "Green Text Highlight Color." Please refer to the updated manuscript. Thank you very much. Reviewer #3: This study is important and would be very useful for policy makers and other stakeholders to develop interventions that will be appropriate for improving safe menstrual hygiene management especially in developing countries. These are my reviews 1. Introduction The introduction is clear. The objectives are well spelt out Response Thank you our respected reviewer. 2. Methods line 145: Exclusion criteria should also include population that are not within the adolescent age bracket Response Thank you our respected reviewer. As per your wise advice we include population that are not within the adolescent age in the exclusion criteria. Please refer to the updated manuscript. Thank you very much. line 164 should be a continuous statement under primary outcome, it need not to be on a fresh paragraph Line 165 should be on a new paragraph stating the secondary outcome clearly Response Thank you our respected reviewer. As per your wise advice we include revised this section accordingly. Please refer to the updated manuscript. Thank you very much. 3. Results The secondary outcome stated under methods which is the safe menstrual practice and association between sociodemgraphic and behavioural factors is not clearly evaluated. Table 5, line 319. This makes the study needing a major revision Response Thank you for your time, Mr. Reviewer #3. We sincerely apologize for the error we made while writing our draft manuscript. As stated in the introduction, we did not have a secondary objective in this study. “This systematic review and meta-analysis aim to estimate: (1), the pooled proportion of safe MHM, and (2) the pooled estimate for the type of absorbent used by adolescent girls, disposal practice of absorbents, hygiene during menstruation, bathing during menstruation, and school absenteeism were measured using available studies.” We removed line 319 “The second outcome of the study was to determine the association between safe menstrual hygiene practice and socio-demographic and behavioral factors.”. Regarding Table 5, we used a univariate meta-regression to identify potential sources of heterogeneity across primary studies. Please refer to the updated manuscript. Thank you very 4. Discussion The inclusion of unpublished studies may be a limitation to this study as some of the unpublished manuscript might not eventually meet up with quality peer reviewed article. Response Thank you for your time, our respected Reviewer #3. According to your wise advice, we describe the inclusion of unpublished studies as one of the study's limitations. Please see the revised manuscript. Thank you kindly. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0262295.r002
21 Dec 2021 Decision Letter - Balasubramani Ravindran, Editor Menstrual Hygiene Practice among Adolescent Girls in Ethiopia: a systematic review and meta-analysis PONE-D-21-22639R1 Dear Dr. Biniyam Sahiledengle, 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, Balasubramani Ravindran, Ph.D Academic Editor PLOS ONE 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 ******** 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: 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 #2: 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: Besides making the suggested corrections by the reviewers, the author has responded satisfactorily to the reviewers' comments. This has significantly improved the overall quality of the manuscript. Therefore, I will recommend that the manuscript be accepted for publication. Reviewer #2: Thank you for revising the manuscript and responding to all comments. There is one sentence that is still unclear even after rephrasing. Discussion: Line 420; “However, the issue does not pay enough attention to raising awareness about proper disposal of such pads”, unclear/redundant statement. ****** 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 https://doi.org/10.1371/journal.pone.0262295.r003
Formally Accepted
26 Dec 2021 Acceptance Letter - Balasubramani Ravindran, Editor PONE-D-21-22639R1 Menstrual Hygiene Practice among Adolescent Girls in Ethiopia: a systematic review and meta-analysis Dear Dr. Sahiledengle: 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. Balasubramani Ravindran Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0262295.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .