Managing incontinence in low-and middle income-countries: A qualitative case study from Pakistan

Zara Ansari; Sian White

doi:10.1371/journal.pone.0271617

Peer Review History

Original SubmissionFebruary 11, 2022
2 Mar 2022 Decision Letter - Alison Parker, Editor PONE-D-22-04296Managing incontinence in low-and middle income-countries: A qualitative case study from PakistanPLOS ONE Dear Dr. White, 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. You'll see both reviewers have some minor, specific comments which it should be straightforward to address, so we look forward to seeing the revised manuscript soon. Please submit your revised manuscript by Apr 16 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. 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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 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: Yes ****** 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 ****** 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: A valuable study and contribution to the emerging field of incontinence in LMICs and an enjoyable read. The Photovoice aspect was very powerful and of great interest to me. I have a few minor recommendations. In the introduction to the paper, I would add a brief line about the fact that incontinence can affect anyone at any life stage. A good reference would be the Frontiers of Sanitation on incontinence produced by the Sanitation Learning Hub. This would give context to that fact that whilst this is a study on older people, anyone can be affected. The section about the study site appears to read as though it is about Pakistan as a whole rather than Sindh province. It would be good to see a little more detail about the locality in general and its WASH context to paint a better picture of the conditions the people with incontinence are living in. The methodology could be strengthened with a little more detail. Were there any challenges faced in the data collection process? Incontinence is a taboo issue and there can be ambiguity over definitions. How was incontinence defined in Urdu, and were there any issues in getting people to talk about it? A few words about the 6 step analysis method would help the reader to easily follow through. Was there any particular apparent reason why the older people without impairment refused to participate in the study? On page 8, line one 163, it may be clearer to replace the word ‘predicted’ with ‘planned around’ The section on not being clean for God is really powerful. Interesting to see the religious diversity in this context. How were the minority Hindu families accessed and were there any more details on why they felt they needed to keep clean in the context of their religion? Are there geographical factors which made it easier to access them? The section on use of local products for incontinence management jumps straight into findings from rural areas. Were there any patterns or distinct differences between urban and rural which can be outlined at the start as an overall pattern? The five domains of interventions may read easier in the form of a simple and small table with one column for the type of intervention and a second column for description. This is very important information that should stand out. The recommendations would also be strengthened further by adding a little clarity on which actors should be responsible for implementing these. Reviewer #2: This is a well-written and concise account of a very interesting study. I saw the results presented at a conference several years ago and have been looking forward to its publication! I have no overarching comments, I think it's great. I have a few small comments on the manuscript, mostly grammatical, but of relevance to the authors a couple of places where I think the citation might be incorrect/a couple of other citations could be added to assist the reader to learn more. ****** 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: Amita Bhakta Reviewer #2: Yes:** Dani Barrington [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- Managing incontinence in LMICs.docx Attachment Submitted filename: PONE-D-22-04296_reviewer.pdf https://doi.org/10.1371/journal.pone.0271617.r001
Revision 1
13 Jun 2022 Author Response Responses to Reviewer #1: 4. A valuable study and contribution to the emerging field of incontinence in LMICs and an enjoyable read. The Photovoice aspect was very powerful and of great interest to me. I have a few minor recommendations. In the introduction to the paper, I would add a brief line about the fact that incontinence can affect anyone at any life stage. A good reference would be the Frontiers of Sanitation on incontinence produced by the Sanitation Learning Hub. This would give context to that fact that whilst this is a study on older people, anyone can be affected. Response: Thank you for your kind comments. In the first paragraph we have added that incontinence can affect people across the life cycle. We have also included the reference you suggest. 5. The section about the study site appears to read as though it is about Pakistan as a whole rather than Sindh province. It would be good to see a little more detail about the locality in general and its WASH context to paint a better picture of the conditions the people with incontinence are living in. Response: We have edited this section to include more information on the local conditions in Sindh province. 6. The methodology could be strengthened with a little more detail. Were there any challenges faced in the data collection process? Incontinence is a taboo issue and there can be ambiguity over definitions. How was incontinence defined in Urdu, and were there any issues in getting people to talk about it? A few words about the 6 step analysis method would help the reader to easily follow through. Response: We have described how there is no word in Urdu for incontinence and how we went about developing a definition that was used in the study. We have added extra detail to the analysis process. 7. Was there any particular apparent reason why the older people without impairment refused to participate in the study? Response: The older people that were approached stated that they did not have incontinence, even though their caregivers confirmed it. We have not added anything to the text here as this was already stated. 8. On page 8, line one 163, it may be clearer to replace the word ‘predicted’ with ‘planned around’ Response: This has been changed in the text. 9. The section on not being clean for God is really powerful. Interesting to see the religious diversity in this context. How were the minority Hindu families accessed and were there any more details on why they felt they needed to keep clean in the context of their religion? Are there geographical factors which made it easier to access them? Response: There are certain districts in Sindh that have a higher number of Hindus living in them and those districts were part of the study. We did not purposively sample on the basis of religion so we did not know they were Hindu when we approached them to be part of the study. This detail came out through the interviews. As described in the text through their attitudes towards incontinence because of their religion seemed consistent with Muslim participants. 10. The section on use of local products for incontinence management jumps straight into findings from rural areas. Were there any patterns or distinct differences between urban and rural which can be outlined at the start as an overall pattern? Response: Urban participants did not bring up using any unique alternatives (such as the use of straw or sand) for incontinence management. They relied more on water and soap. This has been clarified in the text of the manuscript. 11. The five domains of interventions may read easier in the form of a simple and small table with one column for the type of intervention and a second column for description. This is very important information that should stand out. The recommendations would also be strengthened further by adding a little clarity on which actors should be responsible for implementing these. Response: We have taken the reviewers advice and transformed this into a table (Table 4) Responses to Reviewer #2: 12. This is a well-written and concise account of a very interesting study. I saw the results presented at a conference several years ago and have been looking forward to its publication! I have no overarching comments, I think it's great. I have a few small comments on the manuscript, mostly grammatical, but of relevance to the authors a couple of places where I think the citation might be incorrect/a couple of other citations could be added to assist the reader to learn more. Response: These comments have been incorporated throughout the paper. Attachments Attachment Submitted filename: Responses to reviewers.docx https://doi.org/10.1371/journal.pone.0271617.r002
5 Jul 2022 Decision Letter - Alison Parker, Editor Managing incontinence in low-and middle income-countries: A qualitative case study from Pakistan PONE-D-22-04296R1 Dear Dr. White, 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, Alison Parker 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 #2: All comments have been addressed ******** 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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: N/A ****** 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 #2: Yes ****** 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 #2: 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 #2: (No Response) ****** 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 #2: Yes: Dani Barrington ******** https://doi.org/10.1371/journal.pone.0271617.r003
Formally Accepted
7 Jul 2022 Acceptance Letter - Alison Parker, Editor PONE-D-22-04296R1 Managing incontinence in low-and middle income-countries: A qualitative case study from Pakistan Dear Dr. White: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Alison Parker Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0271617.r004

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