PONE-D-21-19307Trend and Burden of Neural Tube Defects among cohort of pregnant women: Where are we in the prevention and what is the way forward?PLOS ONE

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“The authors acknowledge all study participants, data collectors, and supervisors who took part in the study, as well as the kind and cooperative staff of the health facilities in eastern Ethiopia. Jimma and Dire Dawa University s deserve a special appreciation for the financial support.”

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Additional Editor Comments (if provided):

General comments

Dear authors on your scholarly work; you have brought an important study problem with good findings that have public health importance in the area of practice. However, the manuscript has multiple language usage flaws including punctuations, wordings, spelling and mainly grammar errors. These problems are found throughout the manuscript. Moreover, there are several methodological gaps. Therefore, please make repeated proof-reading and thorough copyediting before considering the manuscript for publication. This would help increase the readability of the manuscript if published.

Specific comments

1.Title: the study area should be included in the title

Abstract

2.Background of the abstract doesn’t clearly show the existing burden of NTD in Ethiopia, and even elsewhere in the globe. Generally, burden of NTD should be numerically stated followed by the objectives showing the research gap the authors would like to address.

3.Methods of abstract should include sampling technique, measurement of NTD, type of data collection tool (adapted or adopted) and software for data entry and analysis.

Background

4.In the last paragraph, it is better to include national incidence of NTD during the launch of different interventions in 2005 in Ethiopia

Methods

5.Add a separate subsection of study area. Then, important details including nutrition culture and ANC follow up of the study population should be clearly stated so that any reader new to the Eastern society can get some understanding of the study area.

6.Why the authors considered only 2017-2019 time period which is actually not sufficient to show the time trend of NTD.

7.Variables and operational definitions: Kindly include a separate subsection detailing measurement of the variables considered for the study.

8.Sampling technique: It would be more self explanatory and easily understandable if the authors showed pictorial presentation (flow chart) of the sampling procedure including how many regions �districts � hospitals � sample size (A cohort of 48,567 pregnant women delivered in three selected hospitals from 2017 to 2019)

9.Please upload your data collection tools (for both quantitative and qualitative) as additional file.

10.Ethical clearance: What beneficent actions will the authors provide the community in return for this study?

Results

11.Please include a separate section that addresses incidence of NTD than mixing it with socio-demographic characteristics section.

Discussion

17.The authors present severity of iron folate deficiency for the high burden of NTD in the study area than other regions. Why folate deficiency in Eastern Ethiopia is severe than other regions? Kindly give strong evidence, because it is clear that iron folate is uniformly distributed to all regions of the country.

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: 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: No

Reviewer #2: 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: Yes

Reviewer #2: 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: I have some questions for clarification and suggestion for betterment of this article.

1. In your method section, it is not clear that from how many hospitals in eastern Ethiopia, you was selected those three hospitals?

2. I am not sure that your study design clearly retrospective cohort. What makes different from chart/record review?

3. Sample size determination and sampling procedure is not clear.

4. You should clearly describe morbidity/ major illnesses for current pregnancy and previous pregnancy separately.

5. It will be better if you add risk factors for NTDs.

Reviewer #2: Comments to the author

Methods

The study is very relevant and well structured. Just including following few suggestions might be useful.

1.Better to say a facility based instead of” institution based”

2.Why you want to focus from 2017 to 2019? What is new within this period?

3.Are there only 3 hospitals in Eastern Ethiopia?

4.Your study was” among cohort pregnant women who delivered in Dil-Chora, Hiwot Fana specialization teaching Hospital, and Adama Medical College Hospital” but the study population was medical records of cases who delivered or terminated or stillbirth or dead neonate with neural tube defects. Who were your exposed and unexposed groups? Please clarify this statement.

5.“On the other hand, any type of NTDs case which is not clearly recorded and inconsistent data or data with more than 50% of values missing was excluded from the study” did the author excluded inconsistent data within the study period ? If yes how much?

6.Was it closed cohort or open cohort study?

7.The author is required to clarify sample size calculation

8.In your sampling technique” all neural tube defects case those born in selected hospitals were included and selected conveniently” so what is the importance of talking about sample size calculation?

9.Who were your data collectors and supervisors?

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Reviewer #1: No

Reviewer #2: No

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Trend and burden of neural tube defects among cohort of pregnant women in Ethiopia: Where are we in the prevention and what is the way forward?

PONE-D-21-19307R1

Dear Dr. Berhane,

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,

Wubet Alebachew Bayih, M.Sc.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors shall go through their entire revised manuscript for its readiness of publication.

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

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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

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

Reviewer #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: 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 #1: Yes

Reviewer #2: 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 #1: (No Response)

Reviewer #2: (No Response)

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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: No