PONE-D-20-31282

Chronic diseases and vulnerability to COVID-19: the case of adult people with Chronic diseases in Gamo, Gofa, and South Omo zones in Southern Ethiopia

PLOS ONE

Dear Dr. Mekuria,

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 11 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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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,

Tauqeer Hussain Mallhi, 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

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.  If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible.

Additional Editor Comments:

Dear Authors, thank you for submitting in Plos One. Your manuscript has been assessed by relevant experts from the field. They found manuscript interesting but raised substantial concerns in methodology (selection of participants, operational definitions) and interpretation of results. Moreover, reviewers raised issues on bias and generalizability of the findings. It is requested to please consider the comments of reviewers.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

Reviewer #4: Yes

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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

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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: No

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: Yes

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5. Review Comments to the Author

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

Reviewer #1: Identifying the sociodemographic factors influencing the preventive behavior is important for defeating the pandemic of COVID-19. In this manuscript, Fikre Bojola et al assessed the association between sociodemographic factors and the knowledge or behavior on COVID-19 prevention. The study collected data from patients with chronic diseases in southern Ethiopia, using a structured questionnaire and a community based cross-sectional study design. The authors found that many sociodemographic factors have influences and more striking is the knowledge and behavior showed big discrepancy. The study done here has a good starting point, however further analyses and in depth discussions are still needed.

Major concerns:

(1) The title of this manuscript is not reflecting the actual purpose and research type of this study.

(2) Since the knowledge and behavior showed huge discrepancy, find out the key rescrictions on preventive practice and find ways to change the behavior would be of great value. The key restriction factors need to be deeply analyzed and summarized.

(3) It would be helpful to compare the key restriction factors of preventive practice identified in this study with key restrictions identified from previous sociodemographic studies conducted in other region or coundries around the wrold.

Minor concerns:

(1) Most of the results are presented in the form of tables, which will greatly enhance the readability if represented by graphs, especially for the significantly associated factors.

(2) The abbreviations and meaning of the numbers in the Supplemental dataset should be described.

(3) The text needs reviewing by a professional English editor as many sentences are still ambiguous.

Reviewer #2: GENERAL COMMENTS

This report shows the gap between knowledge about COVID-19 and preventive practices among patients with hypertension or diabetes in three regions of Ethiopia. Despite the months that have passed since the outbreak of the pandemic, the frequency of preventive practices among subjects who are high-risk patients was low. This may be explained by the regional characteristics and low income. There are several similar studies, but this regionalism is what makes this paper unique. This study suggests that NCDs patients are the target population for health education programs on COVID-19 prevention.

SPECIFIC COMMENTS

Major

i)Line129: The reasons for choosing hypertension and diabetes as representatives of NCDs are not presented.

It is recommended to indicate the percentage of patients receiving medication.

ii)Line162,166: Why did you set the cutoff point for each score at 60%? Showing a histogram of the scores is a good way to interpret the results.

iii)Table-1: What is your rationale for dividing income into two groups at 2500ETB?

Do you have data on body mass index or obesity rate? Obesity is an important risk factor for the severity of COVID-19, which is also associated with lifestyle and NCDs.

iv)The limitations of the study are not mentioned in this report.

Selection bias exists because only hypertension or diabetes were selected as NCDs. And it is also desirable to describe the bias inherent in the questionnaire method.

Minor

i)Line36:It is suitable to describe “patients with hypertension or diabetes mellitus" than "chronic patients".

ii)Line192: Please add some more information about the bivariate analysis method.

iii)Table-1: It is recommended that continuous variables (Age and Income) show mean or median values. Or could you provide histograms of them?

Reviewer #3: Overall the authors have attempted to survey a cohort of patients with NCDs to assess knowledge and perceptions of COVID-19 in the southern regions of Ethiopia. I acknowledge all the hard the work that went into the construction and implementation of the study but much is needed to improve the manuscript (in my opinion) if acceptable for publication in PLOS ONE.

I have some suggestions moving forward:

- Many grammatical and sentence structure errors exist in the manuscript and should be edited accordingly; manuscript in my opinion is not acceptable at current stage of standard English being presented.

- Title is misleading. It appears the participants were selected from those who only had hypertension and diabetes mellitus. Were those with other NCDs (if present) included? Will need a major revision to focus on those with hypertension and diabetes.

- Fatality rates vary on region of the world and other factors, so I have a hard time accepting "overall fatality of COVID-19 is low" which is described multiple times in the manuscript, including the abstract. Please rephrase this and add some statistics relevant to Ethiopia known fatality rate

- Line 29 needs rewording. I think you are trying to say that those with NCDs are more likely to be non-adherent to medications and other life style related recommendations during COVID-19

- throughout the manuscript you use the term "chronic patients" and this needs to be replaced something else that is more clear, such as "among those with NCDs".

- In the abstract please redesign and leave out what software was used to conduct the analysis. How were these patients selected and in what setting?

- Methods: please include a map of the three zones which will help the readers understand the geography of Ethiopia and the where the study took place

- Results: 96.3% response rate? that seems too high to be reliable. How did they come to that conclusion. Need describe engagement protocol for introducing the research project to a potential participant.

- Why the split in age above and below 30 years? I recommend dividing into 18-30, 31-50, 51-64, 65-80, 81+

- line 264: "bad practices" please explain differently

Adherence to drug and control measures NCDs: Does this only pertain to hypertension and diabetes medications? Insulin therapy?

- Discussion: needs total revamping; will need to focus on diabetes and hypertension among COVID-19 and cannot say "chronic patients" and NCDs, as it is unclear if others with NCDs were included.

- Does not have limitations to the study and there are several

- Line 414: why is "almost" used here and also found in the abstract

Reviewer #4: The presented descriptive study by Bojola et al. has aimed to address the multi-dimensional knowledge about the COVID-19 spread and the preventive practices followed by the chronic disease subjects, who are vulnerable to COVID-19 infection, in the three selected zones of Ethiopia. Such community-based studies are crucial to create awareness and to identify the factors that require special attention to prevent and/or control the spread of COVID-19 infection. Interestingly the data presented in this study reflect the importance of knowledge, in addition to monthly income, in practicing preventive behaviors among these study participants. Establishing again knowledge is the key to good practice. Although the data has been presented in a suitable format, the background information provided in the Introduction is hard to verify from the given references. It would be better to give an appropriate reference at the end of every claim, but not at the end of the paragraph. Particularly, the previous study results mentioned for ref # 8 through #13 have become difficult to cross-check. Further, multiple references are not in the right format and many of them with missing information (volume and page numbers).

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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

Reviewer #4: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-20-31282R1

Non-communicable diseases (NCDs) and Vulnerability to COVID-19: the case of adult patients with Hypertension or Diabetes Mellitus in Gamo, Gofa and South Omo zones in Southern Ethiopia

PLOS ONE

Dear Dr. Mekuria,

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 Sep 10 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

Thank you for revising the draft and addressing the comments of the reviewers. However, referees found few minor errors in the draft which should be considered before taking any decision for the manuscript. Please consider the comments of the reviewers and send us revised version at your convinience.

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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: (No Response)

Reviewer #2: (No Response)

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

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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

Reviewer #3: Yes

Reviewer #4: Yes

**********

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

Reviewer #1: No

Reviewer #2: I Don't Know

Reviewer #3: Yes

Reviewer #4: 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: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: The authors declared, Knowledge of COVID-19 was found to be an independent 433 predictor of preventive practices towards COVID-19. Health education programs aimed at mobilizing 434 and improving COVID-19- related knowledge and practices are highly recommended for these patients 435 with hypertension or diabetes mellitus.

No independent data is sue to replicate this finding, I suggest to use data from other countries to verify the finding.

The potential biological mechanisms should be deeply discussed.

Reviewer #2: COMMENTS

This paper has been corrected for format and grammatical errors.

But there are still a few things that need to be fixed.

Line87-91:When you are going to address the relationship between COVID-19 and body mass index(BMI), it is appropriate to mention BMI in the discussion. If you were unable to obtain data on BMI, it is better to specify it.

Line225:It is preferable to include in the text the reason for setting the cutoff to 2500 ETB.

I recommend to format each tables properly;The number of the table, alignments, and typographical errors.

Reviewer #3: Authors have taken into consideration all comments given by the reviewers. They have addressed these recommendations and have provided a much improved manuscript.

Reviewer #4: The revised manuscript submitted by Bojola et al shows the improvements in data presentation and has also addressed the reviewer's comments appropriately. This study addresses an important issue of the community to prevent the spread of COVID-19 infection. Overall, with the survey conducted among non-communicable disease subjects from Ethiopia, who are vulnerable to COVID-19 infection, this study clearly shows the importance of knowledge and preventive practices to control/prevent COVID-19 spread. However, there are minor typos in the manuscript that can be corrected during the publication process.

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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: Yes: Yuuki Bamba

Reviewer #3: Yes: Norman Beatty, MD, University of Florida College of Medicine, Gainesville, Florida, USA

Reviewer #4: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-20-31282R2Non-communicable diseases (NCDs) and Vulnerability to COVID-19: the case of adult patients with Hypertension or Diabetes Mellitus in Gamo, Gofa, and South Omo zones in Southern EthiopiaPLOS ONE

Dear Dr. Mekuria,

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 Oct 28 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Tauqeer Hussain Mallhi, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Dear Authors, thank you for submitting in Plos One. Your manuscript has been re-assessed by relevant experts from the field. They found manuscript interesting but raised some more concerns while discussing the findings. It is requested to please consider the comments of reviewer. It must be noted that reviewer has referred few citations in the comments. You are free to select whether these references fit to your discussion or not. We don't encourage any coercive citations.

[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: (No Response)

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: 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

Reviewer #3: (No Response)

Reviewer #4: Yes

**********

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

Reviewer #1: No

Reviewer #2: I Don't Know

Reviewer #3: (No Response)

Reviewer #4: 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: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: I am not sure the identified predictors for COVID-19 can be precisely predict the Vulnerability to COVID-19. The authors may explore or discuss using machine learning/deep learning to see their prediction performance. For this reason, the following machine-learning based prediction model can be mimicked and the paper can be cited:

Ref 1: Liu, M. et al. A multi-model deep convolutional neural network for automatic hippocampus segmentation and classification in Alzheimer's disease. NeuroImage 208, 116459, doi:10.1016/j.neuroimage.2019.116459 (2020).

Ref 2:Yu, H. et al. LEPR hypomethylation is significantly associated with gastric cancer in males. Experimental and molecular pathology 116, 104493, doi:10.1016/j.yexmp.2020.104493 (2020).

The causal effects of Non-communicable diseases (NCDs) on Vulnerability to COVID-19 should be explored or discussed with mendelian randomization analysis. For this reason,the following papers can be cited or mimicked for the analysis or discussion:

Ref 1:Zhang, F. et al. Causal influences of neuroticism on mental health and cardiovascular disease. Human genetics, doi:10.1007/s00439-021-02288-x (2021).

Ref 2:Zhang, F. et al. Genetic evidence suggests posttraumatic stress disorder as a subtype of major depressive disorder. The Journal of clinical investigation, doi:10.1172/jci145942 (2021).

Ref 3:Wang, X. et al. Genetic support of a causal relationship between iron status and type 2 diabetes: a Mendelian randomization study. The Journal of clinical endocrinology and metabolism, doi:10.1210/clinem/dgab454 (2021).

Ref 4:Hou L, Xu M, Yu Y, Sun X, Liu X, Liu L, Li Y, Yuan T, Li W, Li H, Xue F. Exploring the causal pathway from ischemic stroke to atrial fibrillation: a network Mendelian randomization study.Mol Med. 2020 Jan 15;26(1):7. doi: 10.1186/s10020-019-0133-y.

Reviewer #2: (No Response)

Reviewer #3: Authors have addressed some previous concerns with the manuscript. Overall, much improved submission with a focused attention to hypertension and diabetes mellitus as it relates to vulnerable populations in these regions of Ethiopia during the pandemic.

Reviewer #4: This revised version submitted by Bojola et al has included the reviewer recommended correction in the methods sections, that is defining the poverty line, and in the discussion section, to discuss the biological mechanisms associated with diseases severity of COVID-19 among diabetes and hypertension conditions. It shows much improvement since the original submission. From the public health point of view, it is important to know, how knowledge and preventive practice are important to living a disease-free life.

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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: Yes: Yuuki bamba

Reviewer #3: Yes: Norman Beatty, MD, University of Florida College of Medicine, Gainesville, FL, USA

Reviewer #4: 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.

Non-communicable diseases (NCDs) and Vulnerability to COVID-19: the case of adult patients with Hypertension or Diabetes Mellitus in Gamo, Gofa, and South Omo zones in Southern Ethiopia

PONE-D-20-31282R3

Dear Dr. Mekuria,

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

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

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Kind regards,

Tauqeer Hussain Mallhi, Ph.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 #2: All comments have been addressed

Reviewer #3: All comments have been addressed

Reviewer #4: All comments have been addressed

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

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

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #2: I Don't Know

Reviewer #3: I Don't Know

Reviewer #4: Yes

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

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

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

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

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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6. Review Comments to the Author

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

Reviewer #2: Authors have adequately addressed my recommendations.

This study suggests that patients with hypertension or diabetes may be a vulnerable group to COVID-19 that should be intensively intervened by the government.

It is great that you have actually made policy recommendations based on the results of this study.

Reviewer #3: Author's have addressed previous recommendations from the reviewers. Data collected reflects the study aims and objective. Thank you for you work and attempt to break barriers for those in southern Ethiopia impacted by COVID-19.

Reviewer #4: Submitted re-revised manuscript by Bojola et al, to address the importance of knowledge about COVID-19 and preventive practices among subjects with hypertension and diabetes in regions of Southern Ethiopia, has included the reviewer recommended suggestions and modified the manuscript appropriately. Overall, this manuscript clearly shows the relationship between COVID-19 related knowledge and preventive practices, as well as the factors associated to adopt preventive practices among subjects with non-communicable diseases. Such studies are essential to prevent the disease from spreading among vulnerable subject groups. This revised manuscript shows better improvement over the earlier submission and can be accepted for publication. However, there are a few minor recommendations, such as:

1. In Line 306-307, the numbers are redundant.

2. In Line 338, the AOR mentioned in the text is not matching with table

3. In Table 2 and Table 3, observed numbers and percentages are to be distinguished.

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Reviewer #2: Yes: Yuuki Bamba, MD, PhD

Reviewer #3: No

Reviewer #4: No