PONE-D-21-32281Quality of life and associated factors among patients with epilepsy at specialized hospitals, Northwest Ethiopia; 2019PLOS ONE

Dear Asmare Getie

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Reviewers' comments:

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Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Overall interesting study and results presented

English editing required for changes for grammatical coherence throughout the text in addition to correcting typographical errors.

Introduction

Overall a few changes need to be made for grammar and for it to read well. Examples are:

Line 52 kindly replace ITS' with ITS without the apostrophe

Lines 54, 55 I believe that sentence would read better if IS and HAD are replaced with "HAS"

Line 57 replacing increased with increases

Lines 59-62 Restructuring the sentence and possibly dividing into two sentences. If it does not change the thought the authors want to convey, a suggestion is as follows: "Therefore, it is important that health care providers routinely measure the impact of the complex pharmaco–psycho-social therapy given. Assessing the success of such a holistic method of care by determining the extent of seizure control with medication and monitoring for reduction of seizure frequency is important"

Line 76 consider adding "is" after the 80%

Lines 77-81, 82-88, 89-92 Kindly review grammar and structure of sentences Consider breaking into multiple sentences for each if possible.

Kindly state aims and objectives of the study as in abstract.

Methods

Line 120 DMRH has not been defined. This seems to be Debre Markos Referral Hospital. Kindly define this abbreviation before use here. Same for SMDH in line 128

Line 145 Duplication. It is already stated earlier that the study was conducted at two hospitals from line 107-117

Line 182 Data Processing and anlysis.

How was the regression carried out? for example Stepwise forward?

Results

Would have been interesting to see a breakdown of the results based on institutions since the study was institution based. Kindly do so if possible to identify specific patterns for the individual hospitals if any. Nevertheless, the Results are still interesting and well done .

Discussion

English editing needed once again for better coherence and grammar.

Lines 279-282. Sentence not clear. Kindly review. I believe the authors are communicating that in those other studies, respondents had higher quality of life than in their study. This could be more clearly stated.

Lines 295-303 This paragraph may benefit from restructuring again mainly for coherence with grammar.

lines 317-322 Sentences not clear. This is an important finding and the interpretation must be very clear to any reader with no ambiguity.

Lines 329-333 also need more clarity.

Line 346 typo. "physico-social"

Conclusion

Also important to highlight that middle age was associated with higher quality of life. It is also an important positive finding.

List of abbreviations

No CRO in the text. Rather COR in the results section. Kindly amend.

Reviewer #2: Comments

This is a valuable piece of work that examine quality of life for epilepsy patients using WHO HRQoL-BERF. To determine associated factors of HRQoL authors also considered some clinical factors (adherence, anxiety, and depression) and psychological factor like perceived stigma that also measured using some well-known established scales. It is a very good combination for data base research using different scale for epilepsy patient.

However, substantial improvement is required especially in introduction and methodology section. Some suggestions to improve the manuscript are as follows:

Overall comments

1. What is the relevance of this study as of few similar studies published in recent year on the same patients in the same region? More recently (in 2021) published two papers and one of them in PLOSONE as well (DOI: https://doi.org/10.1371/journal.pone.0247336).

2. No clear literature gap stated in the introduction section. Major revision is required to update on literature review specially to find the current status of Ethiopia to find out the existing literature gap.

3. What is the relevance to use of HRQOL-BERF to measure QOL for epilepsy patients, although there existing another tool (Quality of Life in Epilepsy Inventory (QOLIE-31)) to measure QOL especially for epilepsy patients.

4. It is required to take permission from developer to use developed tools for research purpose. No statement found about to take permission to use different tools (like: MMAS-8, KESS-15, DAS-14, WHOQOL-BERF-26) for the current study.

5. IRB statement should be stated with the IRB number for more transparency.

Specific comments:

Introduction:

1. Required to update with recent publication

2. Significance of the study and literature/knowledge gap should be stated clearly and decent way as huge lacking found here.

Methodology:

1. According to the statement (The total number of epilepsy patients from the two referral hospitals was 1,395, in Debre Markos referral hospital 864 and Shegaw Motta district hospital 531) population size of this study was known. So it is possible to calculate sample size from this known population. Although the current procedure is fine but better to go for strait forward method.

2. Procedure of systematic random sampling should be explain in details

3. Please give the reference to use P-value ≤ 0.2 to select covariates for multiple model. Page 10 L-187-188, In bivariable logistic regression analysis variables having P-value ≤ 0.2 was a potential candidate for multivariable logistic regression analysis.

4. Required to explain properly about the Outcome variable. How classified QOL good vs poor? What is the cutoff value? Have any reference?

5. Similarly explanation also required about SCALING, SCORING and CLASSIFICATION with cutoff point and reference/logic for independent variables ADHERENCE, STIGMA, ANXIETY and DEPRESSION.

Results:

1. In table 5 better to report p-value for odds to avoid confliction as higher p-value was used to select variables for multiple regression

2. Very high odds observed for ADHERENCE categories from table 5. Required to crosscheck it.

3. Better to report the result about model fitness under the respective tables

Discussion:

1. ‘Results with statistics’ were repeated in the several parts of the discussion section with the results section. Repetition should be prohibited due to redundancy

2. Major revision is required on the writing style as the writing of the manuscript failed to follow scientific merit due to unnecessarily describe some points with repetition of results that increased the volume

Reference:

1. Reference is required to update. Reference number 3, 9, 29 updated reference is available.

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Reviewer #1: No

Reviewer #2: No

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Submitted filename: Review Comments for QoL Ethiopia Manuscript.docx

Quality of life and associated factors among patients with epilepsy at specialized hospitals, Northwest Ethiopia; 2019

PONE-D-21-32281R1

Dear Dr. Asmare Getie,

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.

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Kind regards,

Muhammad Junaid Farrukh

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

we are pleased to inform you that your revised manuscript is suitable for publication

Reviewers' comments: