PONE-D-21-25497Health hazards related to using masks and, or personal protective equipment among the physicians working in different public hospitals in Dhaka: A cross-sectional studyPLOS ONE

Dear Dr. Reaz Mahmud ,

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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ACADEMIC EDITOR Comments:

• Why you used the heading “Methods and Materials”? Is there a material that used for this study? if not, please omit the “materials”.
• The methods will be better if structered in this way; Study Area and Period, Study Design, source population, study population, Eligibility criteria, Sample Size Determination, Sampling Technique and Procedures, Study Variables, Operational Definitions, Data Collection Instrument, Data Collection Procedures, Data Quality Control, and Data Processing and Analysis. Specially, this section should be critically addressed!
• The authors should clearly explain their Eligibility criteria as; inclusion and exclusion criteria.
• The authors must operationalize their outcome variables. How did they measure their outcome variables?
• Concerning to the sample size calculation for this study, the authors explained as …. So the estimated sample size was 384. We included a total of 506 respondents in this study” why you didn’t used the calculated sample size? This needs a justification.
• How did they get the study subjects? They have to clearly address their sampling technique?
•  Since you conducted the data collection with online means, how did you keep the data quality for this study?
• Study instrument: have you developed, adapted or adopted the questionnaires? You have to clearly explain about the questionnaires you used because this is crucial. You have to report the reliability analysis finding for your questionnaires.
• Add the response rate.
• Discussion: discuss by using the scientific reasoning.
• Conclusion: avoid numbering. Make it a paragraph. Focus on your main findings, clinical implications, recommendations etc.

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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• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.​
  Please include the following items when submitting your revised manuscript:

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Please submit your revised manuscript by April 20, 2022. 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.

We look forward to receiving your revised manuscript.

Kind regards,

Addisu Dabi Wake

Academic Editor

PLOS ONE

Journal requirements:

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

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf.

2. Thank you for stating the following in the Funding Section of your manuscript:

“Directorate General of Health services, Government of the People’s Republic of Bangladesh”

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

“The research project received a grant of 2000 $ from Directorate General of Health Services, Government of People's Republic of Bangladesh.

None of the author received any honorarium.

he funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

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: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: 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: Manuscript Title: Health hazards related to using masks and, or personal protective equipment among the physicians working in different public hospitals in Dhaka: A cross-sectional survey

1. Title: it is researchable, interesting and targeted. The manuscript had presented Health hazards related to using masks and, or personal protective equipment among the physicians working in public hospitals. It can be a valuable scientific literature if published after incorporation of the comments raised.

2. Abstract:

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3. Introduction

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4. Methods

� Better to state about the brief background of your study area, from how many hospitals the physicians recruited.

� Why you conduct only on physicians, what about other health care workers like Nurses, pharmacists, midwiferies, Anesthesia…?

� If you conceptual framework it is better to show the relationship of predictor and outcome variables in the form of conceptual framework.

� Better to clarify about your sample size determination, I think you used census method, so what is the advantage of using single population proportion formula?

� What types of technique you used to keep/control your data quality? Since data quality is the corner stone for mixed research approach.

� I haven’t seen about your tool/questionnaire or checklist you used to collect your data; therefore, please try to state about the checklist you used and where you adopt or adapt the checklist or questionnaire. .

5. Result

� No need to state repeat similar concepts in different data presentation form. Therefore, it is better to state either in table or graph with brief description, or in text form….

� Your logistic regression model is not clear?

o You only conducted bivariable logistic regression which is not enough and didn’t consider the confounders, and your odds ratio is not clear whether it is AOR or COR.

� If your odds ratio (OR) is Adjusted Odds Ratio (AOR), where is your COR and what was the criteria to pass your variables from bivariable to multi variable logistic regression?

� If your odds ratio (OR) is COR you need to conduct multivariable regression model for better decision since COR is didn’t consider other confounding variables.

� If you refine the above things, your study would be valuable. Therefore, try to focus on your logistic regression model.

Reviewer #2: Reviewer comments

Manuscript Number: PONE-D-21-25497

Title "Health hazards related to using masks and, or personal protective equipment among the physicians working in different public hospitals in Dhaka: A cross-sectional study".

Generally speaking:

Thank you for providing me the opportunity to review this manuscript that raises important issues about health hazards related to using masks and/or personal protective equipment in one of the developing countries.

Comment 1:

1. ABSTRACT:

a) Results:

• The number of samples should be mentioned in the methodology of the abstract.

• (35.4[7.7]) these numbers should be clarified.

• Furthermore, the feminine female gender and reusing masks for an extended period were the risk factors for facial disfigurement.

Comment 2:

2. INTRODUCTION:

a) The text of the introduction does not seem to have coherence and integrity. It should be concise and targeted to the aim.

b) Global/ Regional/ Bangladesh prevalence of health hazards related to using of personal protective equipment among health workers should be mentioned. The current situation of other developing and developed countries should also be added.

c) Risk factors associated with health hazards related to using of personal protective equipment should be clearly stated.

d) Explaining why this topic was chosen for analysis in this article is not well written. The benefits of conducting the study to the community should be explained.

Comment 3:

3. METHODS:

Generally, the information mentioned under the methods are too long with redundancy and diffusion and should be divided into several sub-sections as follow:

a) Type of the study

b) Study setting

c) Study Participants: The characteristics of the study participants should be mentioned as inclusion criteria and exclusion criteria (if any)

d) Sample size

e) Study tools:

• There was no clear mention of the questionnaire used. Was it newly developed by the authors (if so, include the reference)? Was it piloted to assess its internal consistencies? Was it validated?

• It is advisable to include the questions as per each domain in the methodology, how to score the questionnaire, specify the cut points in the questionnaire, as well as how long did it take to complete each questionnaire?

f) Data management analysis

g) Ethical considerations

Comment 4:

4. RESULTS:

1) In line 237, I don't agree with the term ''mostly'' when describing those worked in COVID-19 dedicated units, they were about two thirds and not the most of study population. Again, in line 238, the term ''most'' for describing the respondents worked on the roster is not true, they were three quarters and not the most of study population. In line 280, the term ''most'' was repeated twice while the percentages were 52% and 39%. It is advisable to revise the rest of the result comments.

2) How does increasing personal stress level increased the chance of dyspnea with any severity, while OR is 0.7.

3) In line 284, it is table 2 not table 3.

4) Assessment of Relative Risk in table 1 should be explained.

Comment 5:

5. DISCUSSION:

a) Should give reasons for the risk factors. The manuscript could be greatly strengthened if the authors could provide highlight on the risk factors in other developing and developed countries with similar context.

b) Compare the findings of the study with other findings and state the reasons for the strengths and weaknesses in each section.

a) Line 356: “Headache prevalence is similar to other studies”. It is advisable to give the prevalence of headache and other health hazards which was not mentioned, as well as the prevalence of the risk factors.

b) Line 364: regular psychological assessment and counseling for managing the stress

c) The sentence “It was a cross-sectional study” was repeated many times. e.g, it was repeated two times in the last paragraph of the discussion.

Comment 6:

6. CONCLUSION:

It is unclear. It should be specific and based on the findings of the study.

Comment 7:

7. STRENGTHS AND LIMITATIONS:

a) Please analyze the strengths of the study.

b) Last paragraph of discussion is the limitations of the study

Comment 8:

8. REFERENCES:

a) Please revise the Harvard Vancouver method.

b) All references should be written in the same way.

Comment 9:

English needs to be revised.

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If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[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.]

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Attachments

Attachment

Submitted filename: comments.docx

Attachment

Submitted filename: Reviewer comments PONE-D-21-25497.docx

PONE-D-21-25497R1Health hazards related to using masks and/or personal protective equipment among physicians working in public hospitals in Dhaka: a cross-sectional studyPLOS ONE

Dear Dr. Mahmud,

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. While Reviewer #2 sees all points addressed, Reviewer #3 still has some minor comments. Please submit your revised manuscript by Aug 28 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,

Christoph Strumann

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.

[Note: HTML markup is below. Please do not edit.]

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

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 #2: Yes

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: Reviewer comments

Manuscript Number: PONE-D-22-03316R1

Title "Health hazards related to using masks and, or personal protective equipment among the physicians working in different public hospitals in Dhaka: A cross-sectional study".

Thank you for providing me the opportunity to review this manuscript that raises important issues about health hazards related to using masks and/or personal protective equipment in one of the developing countries.

It seems that all corrections were done.

Reviewer #3: The authors of this manuscript have improved upon its quality substantially based on the comments from the first review. However, the authors should address the comments raised below:

Line 121: Change these words "As frontliners of this pandemic," to read "As frontliners in the control of this pandemic,"

Line 124: Are there updated/more recent figures on the mortality of HCWs due to COVID-19? Since this study focused on physicians only, are there specific records for physicians only?

Line 154: What are the reasons for selecting these public hospitals? How many public hospitals are in Bangladesh? Are these hospitals representative enough? A map of Bangladesh showing the sampled hospitals would be a good fit.

Lines 172-177: As part of the eligibility criteria, the authors should indicate within the manuscript the reason why other HCWs were excluded from the study.

Lines 178-181: Authors should include a reference for using the stated formula in calculating the sample size. Furthermore, the authors must include a justification within the manuscript as to the reason why respondents well-above the calculated sample size were recruited into the study.

Line 182: I believe the authors have used a non-probability sampling technique "Purposive" since physicians were targeted. It won't be out of place to indicate that a Purposive sampling technique was used.

Line 284: Why have the authors considered the use of Relative risk and not odds ratio in this cross-sectional study?

Table 1: Authors should include among the keys below the table the full terms of all abbreviations used.

Table 3: Authors should include among the keys below the table the full terms of all abbreviations used.

The authors should include a paragraph just before the conclusion stating clearly the limitations associated with this study and how these limitations affect the generalizability of their findings.

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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 #2: No

Reviewer #3: Yes: Ismail Ayoade Odetokun (Ph.D.)

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[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 comments PONE-D-21-25497_R1.docx

Health hazards related to using masks and/or personal protective equipment among physicians working in public hospitals in Dhaka: a cross-sectional study

PONE-D-21-25497R2

Dear Dr. Mahmud,

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,

Christoph Strumann

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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