PONE-D-20-31194

FACTORS ASSOCIATED WITH HEALTH FACILITY DELIVERY AMONG UNMARRIED AND MARRIED YOUTH IN UGANDA

PLOS ONE

Dear Dr. Agaba,

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.

The manuscript has been evaluated by two reviewers, and their comments are available below. You will see the reviewers have commented on the importance of your manuscript to policy makers. However, the reviewers have also raised critical concerns and the manuscript will need significant revision before it can be considered for publication – you should anticipate that the reviewers will be re-invited to assess the revised manuscript, so please ensure that your revision is thorough. I have outlined some of the key concerns noted by the reviewers below, but you should respond to all concerns mentioned by the reviewers in your response-to-reviewers document. 

The key concerns noted by the reviewers relate to the reporting of the methods and the results. Specifically, the reviewers have requested the addition of n values in the results section. Reviewer 2 has requested clarity regarding multivariate model as well as the analysis of the individual- and community-level factors. 

Please submit your revised manuscript by Apr 27 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

We look forward to receiving your revised manuscript.

Kind regards,

Danielle Poole

Academic Editor

PLOS ONE

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When submitting your revision, we need you to address these additional requirements.

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2. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 1 in your text; if accepted, production will need this reference to link the reader to the Table.

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: No

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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: The paper is well written and highlights the utilization of health facilities by youth, However, the authors seem to have laid a background on women, not youth specifically. The problem among this group need to be more pronounced. The methods have been well described. Were there limitations since this was secondary data? How was this overcome? The title could be changed to predictors instead of factors since that is what is entirely referred to in the whole paper. The results need to have n values. Line 260, correct ANV to ANC. Line 280, add full stop. The discussion is well done, it compares the findings well with other studies and also there is the author's attribution of the findings. The section on conclusion includes recommendations and it should be titled so.

Reviewer #2: I recommend the authors to use "multilevel logistic regression" analysis since there are community and individual factors rather than using "logistic regression". See the attached files for the detail.

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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: Yes: Joyce Jebet Cheptum

Reviewer #2: Yes: Maru Mekie

[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: Reviewer feedback_MM.docx

PONE-D-20-31194R1PREDICTORS OF HEALTH FACILITY DELIVERY AMONG UNMARRIED AND MARRIED YOUTH IN UGANDAPLOS ONE

Dear Dr. Agaba,

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.

 Reviewer 2 is not yet satisfied with the improvements and has detailed suggestions mostly for missing elements. In this respect, PLOS ONE endorses the use of the STROBE checklist (http://www.strobe-statement.org) to ensure completeness of reporting. Check also PLOS ONE guidelines for statistical reporting. Note that in your case you are making use of secondary data from standard sources (DHS). You do not need to delve in detail on the aspects connected the design, that you did not implement. You can point to the relevant sources, however.

Please submit your revised manuscript by Apr 17 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,

José Antonio Ortega, 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.

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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)

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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

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

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: No

**********

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 paper has been well revised and it captures the earlier suggested corrections. The paper can be accepted for publication, however the authors need to check grammatical and editorial errors prior.

Reviewer #2: REVIEW PLOS ONE

TITLE: FACTORS ASSOCIATED WITH HEALTH FACILITY DELIVERY AMONG UNMARRIED AND MARRIED YOUTH IN UGANDA

ARTICLE ID: PONE-D-20-31194R1

General comment

The authors tried to address all the issues raised. Hence, I would like to thank the authors for taking comments to improve the manuscript.

Issues to be cleared

Abstract

1. It would be good if the authors consider revising the result presentation to make it sound (It is good to compare findings among married and unmarried youths. But the presentation is not attractive and there is redundancy (“Versus” repeatedly mentioned).

Please try to present the result in abstract in reader friendly manner.

Main document

Methods

2. The authors tried to address the previous comments raised in the method section. However, the are other issues that shall be cleared. What study design have you used? The authors reported nothing regarding the study design used in the manuscript except describing the sampling technique used as well as the type of survey in the DHS data.

3. You have tried to compare the level of facility delivery among married and unmarried youths and the associated factors. Is it a comparative study? If so, is the analysis method appropriate?

4. If it is not comparative study there may not be a need to put the title as “Married and Unmarried youth”. Please clearly address these issues.

Results

5. Pages 9-10 in narration of the result as well as pages 10-12 in Table 2; please correct P = 0.000 to “P< 0.001”,

6. You are comparing facility delivery among married and unmarried youth but nothing has been stated about the proportion of married and unmarried youth in each of the variables in table to aside from putting “p” from cross tabulation. Please put the cross-tabulation findings by inserting additional columns in Table 2 “Married youth N(%) “ and Unmarried youth N(%) for each variable”

7. On pages 16, line 329, Table 3: “Multivariate analysis of factors….” Shall be corrected as “Multivariable analysis of factors…since the two terms.

8. Please consider to put the proportion of married and unmarried youth in each of the variables entered in the multivariable model in Table 3 (using cross-tabulation) so that it will be simple for readers to observe consistency as well as to compare variation in the proportion among married and unmarried youths (Example parity one among unmarried & Married, Parity two among married & unmarried …secondary education among married and unmarried etc.) It is a must to have an additional two columns in Table 3 for proportions of unmarried and married youth in each of the variable.

9. On pages 16-17, Table 3, you have put keys for

� RC: Reference Category

� CI: Confidence Interval

However, both are not listed as acronyms in Table 3 . Better to remove

Put 1: as reference category below Table 3.

Discussion

10. Page 19, lines 378-380 you explained “Unmarried youth were observed to use health facilities more than the married youth in Uganda between 2006 and 2016. This could be due to the confounding effect of higher parity as most married youth were pregnant for the second time or more.

However, nothing has been stated regarding the proportion of “parity among married and unmarried youth” either in the descriptive part of the result section or another area which makes difficult to confirm whether proportion of parity was higher among unmarried youth compared to the married one.

Conclusion and recommendation

Well written and all the comments are addressed.

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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: Yes: Joyce Jebet

Reviewer #2: Yes: Maru Mekie

[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: Review comments - PLOS ONE.doc

Attachment

Submitted filename: REVIEW PLOS ONE_MM2.docx

PREDICTORS OF HEALTH FACILITY CHILDBIRTH AMONG UNMARRIED AND MARRIED YOUTH IN UGANDA

PONE-D-20-31194R2

Dear Dr. Agaba,

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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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,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

It is felt that the issues raised were addressed and there is no need to send back to the reviewers. Congratulations!

Reviewers' comments: