PONE-D-21-04196

High attribution of non-consented care for high prevalence of mistreatment among postpartum mothers who give birth at public health facilities in Gondar City, northwest Ethiopia

PLOS ONE

Dear Dr. Boke,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Orvalho Augusto, MD, MPH

Academic Editor

PLOS ONE

Additional Editor Comments:

Improving maternal child care access requires the quality of care and respectful care. The authors document the levels of women mistreatment during delivery in the Gondar City. Their data and account will contribute to the relatively scarce literature for the vast sub-Saharan Africa region.

However, there are some important issues that need to be addressed before this report is acepted.

1. Please correct the many English typos. Here are few examples:

line 63 - Experian's

line 67 - Review the sentence around the "Ethiopian government"

lines 69 to 71 it is unclear. May be it is better to write the number using numeric symbols

lines 72 to 74 please mention the name of the study area. By this moment the reader does not know what study are is.

line 75 put a period after "gap". Remove the "and indicate". Put "It aims to estimate".

Line 89 after “Gondar city” there should be a verb

Line 129 after “questionnaire” it should be “was developed”

lines 245 and 246 put the confidence interval in the brackets

line 321 what the word “ever” means here. This is repeated in the whole conclusion as well as in the abstract. Please review.

It would be highly beneficial to find some English review support.

2. Careful with the interpretation of the reference. In the first paragraph of the introduction you have reference 1 (The 2014 UNICEF report on maternal mortal between 1990 and 2013). Please find that report to correct your numbers. There is no, in that report, an African MMR. There is a sub-Saharan Africa estimate. And it is 510 per 100,000 live-births; also the fraction of deaths is not 64%, is 61%. [Check that report on table 2 and on page 21].

3. In the description of the study area please do mention the private clinics as well. Also, do add basic description of coverage of institutional deliveries and antenatal care. This information is useful to understand the group included.

4. On sampling procedures please use words to explain what is that k-interval for the systematic sampling. See further comments of the reviewer below.

5. The operational definition section needs a table with the list of things to make these definitions. It would be beneficial if the English instrument were added in the supplements.

6. Data processing and analysis

This section needs to be expanded.

- We do not analyze a logistic regression. We use a logistic regression to analyze something. Please correct.

- There is use of confidence intervals for a proportion in the results. How such thing interval was estimated. This is something to put in the methods.

- Line 219 is for the “data processing and analysis” section not in the “results”. Please correct.

7. Results see the reviewer comment.

- See the comment about the line 219

- When report the mean as in the line 163 we usually write the SD as, for example, “(SD = 5.76)”. Notice the equals sign.

- Remove the “The” on “The proportion of mistreatment during facility-based childbirth”

- Please report the confidence intervals for all mistreatment types in text

8. table 1

- Add the mean and SD of the age

- Make all percentages 1 decimal place

- Add more categories for the “family estimated monthly income” variable. And please provide quartiles.

- On “HCP conducting ANC follow up” variable please correct the “Privet clinic”. That should be “Private clinic”.

- Please check the alignment for “complication during delivery”.

9. Table 3

- for the ORs please make all 2 decimal places

- Make sure that references have 1 (for example it is missing on Educational status)

- Why age and “religion” are not included? Regardless of the p-value. This is an key variable.

10. Figure 1

- This pie is taking a lot of space to inform exactly the same in text. And it does not provide any confidence interval as in the text you did. Drop it. I suggest to add this information on figure 2.

11. Figure 2

- Add the proportion of mistreatment you have on pie. Add this to the bar plot.

- Add to all of these bar error bars to capture the confidence interval

- Fix the decimal places to 1

- Remove the percentage symbol in the plot

- Remove the so called main title this can be placed in the x-axis and in caption of the plot

12. Discussion

- Lines 253 to 257. The reason for the differences did you check that these studies define the same way as you do here? Are the populations comparable besides the health facility? Be very careful. We do not want to label medical schools as the center of mistreatment.

- What the authors thing of the tool they used to assess the mistreatment ? Did you check for validity to use in this setting? Please discuss this. And most likely this must be considered for the limitation subsection.

- The strengths and limitations need more elaboration. This is a health facility based study therefore a potential for selection bias may doom the generalization of this study. There is always possibility of confounding this must be discussed.

13. Please fill the STROBE statement and add to the supplements (https://www.strobe-statement.org/index.php?id=strobe-home)

14. Add a specific and clear section of ethics

15. Abstract

- OR please make sure they have 2 decimal places

- For all mistreatment proportion make sure they have confidence intervals

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7. Thank you for submitting the above manuscript to PLOS ONE. During our internal evaluation of the manuscript, we found significant text overlap between your submission and the following previously published works:

- https://www.biorxiv.org/content/10.1101/430199v1 (Introduction, paragraph 1, sentences 3-5) (Introduction, paragraph 4, sentences 1-2) (Discussion, paragraph 13, sentence 3)

- https://www.tandfonline.com/doi/full/10.1080/09688080.2018.1502020 (Introduction, paragraph 2, sentence 1)

- https://www.researchsquare.com/article/rs-107805/v1 (Introduction, paragraph 2, sentence 2)

- https://preview-reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-015-0024-9 (Types of mistreatment during facility-based childbirth, sentences 1-2) (Discussion, paragraph 5, sentence 4)

- https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0205545 (Discussion, paragraph 2, sentence 4) (Discussion, paragraph 12, sentence 4)

- https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2014.08.015 (Discussion, paragraph 6, sentence 4)

- https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-018-1970-3 (Discussion, paragraph 11, sentence 4)

We would like to make you aware that copying extracts from previous publications, especially outside the methods section, word-for-word is unacceptable. In addition, the reproduction of text from published reports has implications for the copyright that may apply to the publications.

Please revise the manuscript to rephrase the duplicated text, cite your sources, and provide details as to how the current manuscript advances on previous work. Please note that further consideration is dependent on the submission of a manuscript that addresses these concerns about the overlap in text with published work.

We will carefully review your manuscript upon resubmission, so please ensure that your revision is thorough.

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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

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

Reviewer #1: 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

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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

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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: Thank you for the opportunity to review this paper.

It is an important topic on an issue that is prevalent in LMICs including Africa

General comments:

1. Grammar and spelling: The paper is written in poor English, has multiple grammatical and spelling errors throughout the entire document. I have highlighted most of them in the manuscript. Recommendation: the authors need to rewrite the paper in standard English to enable the readers to understand.

2. Justification(line 72-74): the two statements contradict each other. Which is the correct position?

3. Study site: it is not clear whether the study was conducted in one or multiple study sites. What is the name of the facility? How was it chosen from among the other 14 facilities in the city? What are the numbers of deliveries handled by this facility per annum? What made this site the most ideal for your study?

4. Sample size: the explanation after sample size calculation is not clear. recommendation: edit for clarity

5. Data collection procedures: Review the whole of this section for consistency in grammar eg the use of "is" instead of "was". Clarify the role of the degree nurses vis a vis the principal investigator. What research experience did the six research assistants have? Were the research assistants employees of the same hospitals or were they independently employed for the study only? how did you address the issue of bias if these nurses worked in the same facilities where they conducted the interviews? Lots of redundancies and repetitions eg questionnaire was pretested (written more than twice)

6. Results: clarify if n=574 or 584(all tables). Table 2: In some of the cells eg previous ANC attendance, the "n" is not 574 as some of the women were carrying a first pregnancy

7. Discussion: some of the explanations are not coherent eg why pregnant women who delivered in a hospital before were likely to be mistreated. Review the explanations

8. Strengths and limitations: too brief and not clear

9. Conclusions: Edit for clarity

10. Ethics and consent: did the study pose any risks to the study participants? what care was offered to the abused women? were they linked to any care? Did you obtain parental consent for those below 18 years of age. Edit the grammar for clarity

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Reviewer #1: Yes: George Gwako

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PONE-D-21-04196R1

High attribution of non-consented care for high prevalence of mistreatment among postpartum mothers who give birth at public health facilities in Gondar city, northwest Ethiopia

PLOS ONE

Dear Dr. Boke,

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 19 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,

Orvalho Augusto, MD, MPH

Academic Editor

PLOS ONE

Journal Requirements:

Additional Editor Comments (if provided):

This is the second revision of this report on the prevalence of mistreatment among postpartum mothers. The authors did respond to many of the issues raised in the first revision. However, there are still issues and new orthographic mistakes were introduced.

1. Introduction

- Line 46 - maternal mortality ratio of 70,000 per 100,000 live births?

- Line 47 - Why this “please check the number 70,000”.

- Line 58 - ”A laboring mother is subjected toa diverse”. Please correct the “toa”

- Line 61 - put a space before “Mistreatment”

- Lines 70 to 74 there are a lot of strange interval mistakes. I cannot understand why the percentages are repeated.

2. Methods

- Line 89 - the “KM” should be “Km”

- Line 94 - what is this “2011 EFY”? Why not a more recent reference?

- Line 104 - remove this “Finally, the largest sample size was used”

- Line 109 - put space after “.” In the whole document, there is a lot of these.

- One thing I cannot get from this report is where the women were recruited from within the public health facilities. This is an important detail.

3. Results

- Line 172 - put space after 17.2%.

- Page 17 - when reporting the prevalence, as for example the one in line 201, please write, for example, 171 (29.8%, 95% CI: 25.4 to 32.8%). Revise all proportions on this page including the one in line 197.

- Please report the odds ratio and their confidence intervals with 2 decimal places. This applies to the abstract, page 18 and table 4.

- Line 222 remove the “at P-value of loss than 0.05”. Do not resume associations to a matter of p-values.

4. Discussion

- Please revise spaces like line 158 after “.”

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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: All comments have been addressed

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

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

Reviewer #1: Yes

Reviewer #2: No

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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

Reviewer #2: No

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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

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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: I have gone through my previous comments to the authors of the paper, the author response and both the manuscript with track changes and the final copy, and, I am satisfied with the author's response to my comments.

Reviewer #2: Title:

I would like to suggest a change in title. What do you think about “prevalence and risk factor for mistreatment in childbirth: a survey in a Gondar City, Ethiopia.

I think easier to the reader.

Intruduction

Line 43 - Define the initials: Maternal Mortality Ratio (MMR)

Line 48 – it’s not 70,000; it is 70.

Line 55 – this - small letter

Line 57 and line 72 – disrespect and abuse have different definition from mistreatment. (Bohren et al., 2015; Bowser & Hill, 2010)

Line 55 – 61 – define mistreatment in childbirth or disrespect and abuse. (Bohren et al., 2015; Bowser & Hill, 2010)

Line 69 - three out of four/ three in four

Line 70 - four hundred twenty mothers out of / in one hundred thousand live 71 birth

Coments:

The first paragraph - I think the first paragraph is important to explain Africa and Ethiopia's context. However, this paragraph is not about the major issue (mistreatment). I suggest starting the manuscripts by talking about mistreatment and put information about maternal mortality throughout the introduction.

The introduction talking about mistreatment as a strategy to prevent maternal mortality. However, mistreatment should cause death in a small part of victims. It’s mean that to prevent maternal mortality other issues should be addressed before as antenatal care and health assistance in labor/childbirth, for example.

Mitigate mistreatment is important to improve women's human rights and decrease the risk of consequences as postpartum depression and evasion of health services (Leite et al., 2021; Leite, Pereira, Leal, & Silva, 2020; Silveira; et al., 2019). Another possibility is explaining better that women have afraid to go to the hospital due to mistreatment and this behavior puts women at risk to die.

What are the risk factors to suffer mistreatment in Ethiopia or Africa? Nothing about this was informed.

Methods

In “population” is not clear the hospital (s) participants. The research was conducted in one hospital because there is only one hospital in the city? Or there were other Hospitals/health services? I think this situation could be clearest in the text.

Manuscript: In “Population” – “All postpartum mothers who gave birth at public health facilities of Gondar city during a period 93 of data collection were considered as the study population.”

Manuscript: In “Sample size determination and Sampling Procedure” – “Finally, to get the study 100 participants systematic sampling method with k-interval of two were employed at each facility”

I cannot understand the sampling. It was the census of all women in postpartum between March and April 2019 or it was a sampling of all eligible women.

The definition of mistreatment is not according to the mistreatment definition used by WHO. The definition used is about “disrespect and abuse”.

Line 102 – 127 - The authors could to presents the original question which was asked for women

The topic “Operational definition” should be before “Data Collection Tool and procedures”

The line “That is, a total 136 of 24 verification criteria of mistreatment were included.” Should be in topic “Operational definition”

The topic “Operational definition” should describe all variables included in the analysis.

There no information about Ethics committee approval

Results

Table 1 – income: inform the currency

Line 218 – 220 – I suggest change this sentence to “statistical Analysis”

Comments: Commonly, the choices about variables that compose the multivariate logistic regression have been done based on statistical criteria. But, in my point of view, this choice should be based on in theoretical model using the DAG definition about causality and confounders.

Based on my own country, type of birth and parity are important predictors of mistreatment in labor. I suggest adding this information to the model.

history of previous institutional delivery is a complicated variable. This should be used only if a woman is multiparous. To primiparous women, this question is not applicable. Therefore, this variable just could be used in a sensitivity analysis with multiparous women.

Suggests: I suggest conducted some multivariate logistic regression stratifying by parity and type of birth.

Discussion:

In my opinion, the discussion about prevalence should offer more than a simple comparison between the current study and the other studies. The context of the hospitals should be considering and why health care providers use to mistreat women in Ethiopia. The prevalence was very high.

Considering the discussion about risk factors, the authors could explain why (the causal mechanism) some variables present as a risk factor. Comparison with other studies is important to observe some consistency of the findings. However, the interpretation of the finding should be the major topic.

Strength and limitation

I have some doubts if collect information immediately following delivery and inside the hospital/health center is a good option to measure mistreatment. Some women could have been afraid to address this issue and suffer consequences (more mistreatment) due to these acts. A second point is some women could present the “gratitude bias” to be alive and with their baby in arms. Thereby, only a few days after the delivery they get realize all violence and mistreatment that she has suffered.

Do not address fundal pressure and episiotomy could be a limitation

Conclusion

Knowing the mistreatment prevalence is high, what action it is possible to take aiming to mitigate mistreatment in Ethiopia?

References:

Bohren, M. A., Vogel, J. P., Hunter, E. C., Lutsiv, O., Makh, S. K., Souza, J. P., … Gülmezoglu, A. M. (2015). The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Medicine, 12(6), 1–32. https://doi.org/10.1371/journal.pmed.1001847

Bowser, D., & Hill, K. (2010). Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth Report of a Landscape Analysis. Harvard School of Public Health University Research Co., LLC. https://doi.org/10.1624/105812410X514413

Leite, T. H., Gomes, T., Marques, E. S., Pereira, A. P. E., Silva, A. A. M. da, Nakamura-Pereira, M., & Do Carmo Leal, M. (2021). Association Between Mistreatment of Women during Childbirth and Postnatal Maternal and Child Health Care: Findings from “Birth in Brazil.” Women and Birth.

Leite, T. H., Pereira, A. P. E., Leal, M. do C., & Silva, A. A. M. da. (2020). Disrespect and abuse towards women during childbirth and postpartum depression: findings from Birth in Brazil Study. Journal of Affective Disorders, 273, 391–401.

Silveira;, M. F., Mesenburg;, M. A., Bertoldi;, A. D., Mola;, C. L. De, Bassani;, D. G., Domingueses;, M. R., … Coll, C. V. N. (2019). The association between disrespect and abuse of women during childbirth and postpartum depression: Findings from the 2015 Pelotas birth cohort study. Journal of Affective Disorders, 256(April), 441–447. https://doi.org/10.1016/j.jad.2019.06.016

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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.

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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: Tatiana Henriques Leite

[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-21-04196R2Prevalence and risk factor for mistreatment in childbirth: in Gondar city health facilities, EthiopiaPLOS ONE

Dear Dr. Boke,

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 Apr 01 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'.
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Academic Editor

PLOS ONE

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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 #3: (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 #3: Yes

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

Reviewer #3: I Don't Know

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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 #3: (No Response)

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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 #3: No

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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 #3: Thank you for the opportunity to review your paper. I appreciate all of the effort that the authors put into submitting and then revising your manuscript.

I have a few comments and edits for your consideration:

1.) Suggest editing title to “Prevalence and risk factors for mistreatment in childbirth: in health facilities in Gondar City, Health facilities, Ethiopia

2.) Abstract-Background section:

a. Is compassionate RMC ensuring women’s survival? I’m unsure of this statement although I do understand that more positive experiences of care could lead to better health outcomes for women and newborns (based on improving the coverage of facility deliveries).

b. You say that compassionate and respectful maternity care has received less attention both in practice and research in Ethiopia I think there is quite a bit of literature about RMC in Ethiopia. Perhaps there is less data from Gondar City specifically and if so, I might state that.

3.) Abstract—Methods

a. How many facilities was this study conducted in?

b. These are postpartum women—how long postpartum?

c. You say: A binary logistic regression analysis was done to see the association between mistreatment and the independent variables. Suggestion: A binary logistic regression analysis was done to see whether there was an association between mistreatment and independent variables such as XXXXXX

d. You say: Finally, the logistic regression analysis was done by stratifying type of party and mode of delivery. I think you mean parity?

4.) Abstract—Results

a. Suggest changing the word “Result” to “Results” on line 27

b. Line 31—change “complication” to “complications” on line 31

c. Did you adjust for facility-based clustering?

5.) Abstract—Conclusions

a. Suggest capitalizing the word “the” in line 34

b. The conclusion that the proportion of women who were mistreated was higher here than in other developing countries—it seems like it would be useful to compare what you found with other studies in Ethiopia since there have been quite a few published

c. You mention some possible ways to address mistreatment based on your findings. How would you address the issue that mistreatment was more prevalent in hospitals?

d. In your conclusion you state that the proportion of mistreatment was higher in this study but the in the introduction of the paper, you do show ranges of up to 98.9%

Introduction

• Line 43: Maternal mistreatment at childbirth is more than just what you’ve mentioned here. I suggest using a more accepted definition of RMC

Methods

• Line 152: Data were collected through face-to-face interviews. Were these interviews conducted in the health facilities? A chart review was also done but which data/indicators were extracted from the charts?

Results

• Line 203—The majority of participants had ANC visit—I assume this is at least one ANC visit?

• Line 245—You state that mothers who had less than 4 ANC visits were 3.58 times more likely to mistreat—but should be changed to experience mistreatment rather than mistreat; this is the same for the next few sentences—the women themselves are not mistreating but are rather being mistreated

• Line 251—"The analysis was stratified by party…”; this should be parity

Conclusions:

• Line 277—You say here that the findings in this paper show a lower proportion of mistreatment than other studies in Ethiopia so this should be mentioned in the abstract rather than what you’ve mentioned about it being higher

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Reviewer #3: No

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Prevalence and risk factor for mistreatment in childbirth:  in health facilities of Gondar city, Ethiopia

PONE-D-21-04196R3

Dear Dr. Boke,

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.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

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,

Orvalho Augusto, MD, MPH

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 #3: (No Response)

**********

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 #3: Yes

**********

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

Reviewer #3: I Don't Know

**********

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 #3: (No Response)

**********

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 #3: 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 #3: Thank you for making the revisions on the paper. I just have two additional comments in response to your revisions:

Comment 1: Suggest a minor edit to the current title (“Prevalence and risk factor for mistreatment in childbirth: health facilities of Gondar city, Ethiopia”) to “Prevalence and risk factors for mistreatment in childbirth in health facilities in Gondar City, Ethiopia

Abstract 4c: About sampling the facilities—it’s unclear how you selected these facilities then. Was it purposive? Or did you randomly select from a list?

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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 #3: No