PONE-D-21-28199Primary Care Physicians’ Knowledge of Travel Vaccine and Malaria Chemoprophylaxis and Associated Predictors in QatarPLOS ONE

Dear Dr. Al Dahshan,

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This work was supported by the Medical Research Center (MRC) at Hamad Medical Corporation [grant numbers: MRC-01-19-324]. The publication of this article was funded by the Qatar National Library.‎

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Initials of the authors who received each award: Ayman Al-Dahshan (AAD)

Grant numbers awarded to each author:MRC-01-19-324. ‎

The full name of each funder: Medical Research Center (MRC) at Hamad Medical Corporation, Doha, Qatar

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Reviewers' comments:

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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

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

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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: No

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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: This study is a cross-sectional survey of travel medicine knowledge among primary care providers in Qatar. The paper is clearly written, and results are nicely contextualized within the broader literature.

Introduction:

1. Authors describe that “travel health services are insufficient and not well-established” in Qatar but what does this mean practically? Are there established travel health clinics? Are visits and malaria chemoprophylaxis covered under public or private health insurance?

2. I think it would be helpful context for readers for the authors to describe the epidemiology of malaria + other travel-related illnesses in Qatar – namely, is this a problem? What is the incidence rate and how does it rank in comparison to other travel-related illnesses? Is it legislatively reportable to public health? Who are the risk groups and what are the main countries of travel?

3. The statement “they are positioned to be the most suitable healthcare practitioners to practice TM [11, 12]” needs some qualifiers. This statement may be true in Qatar if there is no infrastructure to support specialized travel medicine clinics that would be staffed by physicians with expertise in TM. Perhaps either “in Qatar” should be added to the end of this sentence or alternatively, authors could modify the sentence to remove judgement re: who is most suitable and rather state that PCPs are an important provider of TM.

4. Change “purposes” to “objectives” in the final sentence of the introduces.

Methods:

5. Recruitment – What constituted “eligible” PCPs? It sounded like all were eligible. Also, were the eligible PCPs approached in person? Could more details be provided on recruitment? In Canada, most primary care physicians were providing primarily virtual care early in the pandemic. What was the situation in Qatar? The response rate was high. Were incentives or compensation provided?

6. Survey - How was the survey formulated and was there a conceptual model that guided your survey development? Were any of the questions taken from validated surveys? How were the destinations selected - informed by frequent travel destinations of reportable travel-related infections? travel patterns from Qatar? The details should be provided and if possible, a copy of the questionnaire included as a supplemental file. (Note: I see the destinations are described in the discussion – i.e., frequent holiday destinations of travellers from – this should be moved up to the methods where you explain the survey).

7. How were postgraduate experience in tropical medicine or developing countries, postgraduate training in TM defined?

8. Outcome measurement - The scores computed could range from 0 to 16. What threshold was used to assess adequate or sufficient knowledge? This seems important to the interpretation of your study findings, especially as you describe overall knowledge as inadequate in your abstract.

9. Chronbach’s alpha – Could you please provide a reference for your assessment that your value was acceptable?

Results:

10. “59.1% were males” – should be changed to 59.1% were male physicians or else 59.1% were men.

11. From Figure 1, it looks like there were ~10 physicians with a score of 0. Did these respondents have 0 correct answers or were these a result of missing data/blanks? The authors do not describe how missing data was dealt with in the analysis.

Discussion:

12. There has been a similar study conducted in Qatar and so any references to this paper being the first study on PCP knowledge of TM in Qatar should be removed i.e., first line of the discussion (see - Al‐Hajri M Bener A Balbaid O Eljack E. Knowledge and practice of travel medicine among primary health care physicians in Qatar. Southeast Asian J Trop Med Public Health 2011; 42:1546–1552). This work should be reviewed by authors and referenced in their introduction and discussion. The statement in the intro “However, little is known about their knowledge of TM” should be revised to indicate there is little CURRENT data on this topic in Qatar.

13. Authors do not discuss the implications of their work. This work replicates findings from both Qatar and other regions and in that respect, is not novel. Given that, the findings should be placed in context with the current state of travel medicine training and provision in Qatar. What should ideally be done differently based on the results of your survey? How can your findings be used to effectively improve TM knowledge among PCPs?

Reviewer #2: I notify that it is a good article, and it meets the scientific requirements.

I just have minor comments.

At the level of the section Predictors of travel medicine knowledge We have the impression that the figure exists before the text, but it is the text that must announce the figure. Is this not a mistake? I also suggest documenting evidence of obtaining verbal consent from study participants. At the level of discussion, the beginning of the paragraph I suggest replacing "examine" with "evaluate"

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Reviewer #1: Yes: Rachel Savage

Reviewer #2: Yes: Bakara Dicko

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Primary Care Physicians’ Knowledge of Travel Vaccine and Malaria Chemoprophylaxis and Associated Predictors in Qatar

PONE-D-21-28199R1

Dear Dr. Al Dahshan,

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,

Filipe Prazeres, MD, MSc, 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 #1: 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: (No Response)

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

Reviewer #1: (No Response)

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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: (No Response)

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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: (No Response)

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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)

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Reviewer #1: Yes: Rachel Savage