PONE-D-21-19464Knowledge, attitudes, and practices (KAP) towards COVID-19 pandemic among pregnant women in a tertiary hospital Karachi, PakistanPLOS ONE

Dear Dr. malik,

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: Please look into the reviewer comments and address them in your revision==============================

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We look forward to receiving your revised manuscript.

Kind regards,

Prasenjit Mitra, MD, CBiol, MRSB, MIScT, FLS, FACSc, FAACC

Academic Editor

PLOS ONE

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2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. If the original language is written in non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible.

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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: Partly

Reviewer #2: Yes

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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: No

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: 1. Sample size calculated by WHO calculator is 380 assuming a response rate of 50%, confidence interval (CI) 95%, Z as 1.96, and margin of error d as 5% by assuming 5000 deliveries occurred per annum in obstetrics and gynecology unit as per unit annual statistics – VERIFY AND INCLUDE THE CALCULATION IN THE TEXT

2. Explain the sampling method

3. Individual scoring of 10 and above were categorized as excellent whereas score below 10 were considered as poor knowledge – HOW WAS THE CUT OFF DETERMINED

4. QUESTIONNAIRE – 21 ITEM QUESTIONNAIRE – Explain the validation process

5. The attitude section consisted of three questions, and the response of each item collected on a 3 point Likert scale as follows 0 (“Disagree”), 1 (“Undecided”), and 2 (“Agree”) – UNDECIDED CATEROGRY IN LIKERT SCALE IS NOT UNIVERSALLY FOLLOWED, BETTER TO BE CONVERTED AS NEAUTRAL

6. The total score ranged from 0 to 6 with an overall greater score indicates more positive attitudes towards the COVID-19. A cut off level of ≥ 5 was set for more positive attitudes towards the prevention of COVID infection – HOW WAS CUT OFF ARRIVED?

7. The reliability of the questionnaire checked by conducting a pretest among pregnant women by taking 5% of the sample size. From the pretest, understandability, clarity, and organization of the questionnaire will be checked and reviewed – IF RELIABALITY WAS DONE – WHATS THE CRONBACH’S ALPHA VALUE AND ITEM ANALYSIS TO BE EXPLAINED

8. STUDY TOOL – The 21 item questionnaire – Validation process is not explained in the article.

9. Data was entered and analyzed using SPSS version 21. Data was analyzed by using SPSS 19. – DESCRIBE THE VERSION CLEARLY AND MENTION THE LICENSE AGREEMENT

10. Calculated sample size is 380, but the results were given only for 377 due to 3 missing data which is less than optimum sample size – Author has to view this seriously as sampling and sample size determines the internal and external validity of any quantitative study.

Reviewer #2: Summary:

The study is a well-grounded scientific research to assess the Knowledge, attitude and practice regarding COVID 19 among pregnant mothers. The findings of the study will be useful in identifying and filling the gaps in knowledge regarding COVID 19 among pregnant mothers.

Background:

1. WHO, ARDS and KAP has to be expanded for the first time in the manuscript before using them as abbreviations thereafter.

2. Since study has been completed the phrase “study has been planned” can be avoided. Instead “Study was done” can be used.

3. Grammatical errors are present throughout the background section which needs to be addressed.

4. COVID – 19 has to be represented uniformly in capital letters throughout the manuscript.

5. The Justification for the study could be explained in more detail with detailed statistics regarding COVID 19 related deaths among preganant mothers - Globally, Nationally and in the area of study.

Methods:

1. More explanation is required regarding the sample size calculation. (Eg: Reference for WHO sample size calculator)

2. Since the questionnaire is self-made and not standardised, Cronbach alpha and rationale behind choosing the cut-off has to be mentioned in the manuscript. The author could explain whether they used median/mean or interquartile range of the scores to choose the cut-offs.

3. In page 5, line 115, terms like “will be checked and reviewed” has to be avoided as the study is completed.

4. Sampling method and study duration are not mentioned in the methods section.

5. The author could provide details regarding the language in which questionnaire was used.

6. Details regarding the mode of interview could be provided by the author. They could mention whether the participants filled on their own or an investigator asked questions and filled the form.

Results:

1. In the results section, Table 1 could to be cited in Page 6, Line no:115 to give readers that the details are present in frequency table.

2. In figure 1, the numbers looks pixelated and not visible. The authors could provide an image with good clarity so that, the numbers looks readable.

3. The authors could give details regarding the participants who gave no answer in attitude and practice section and how those responses were used in analysis.

4. The authors could interpret the beta coefficients in details to add value to the interpretation of the findings.

5. In table 5, since 0 is present in many of the cells, the authors could give details on the statistical test in the univariate analysis used to establish association between variables.

Discussion:

1. Repetition of findings mentioned in the results could be avoided in the discussion. Instead a gist can be given and discussed in detail with relevant study comparisons.

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Reviewer #1: No

Reviewer #2: No

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Knowledge, attitudes, and practices (KAP) towards COVID-19 pandemic among pregnant women in a tertiary hospital Karachi, Pakistan

PONE-D-21-19464R1

Dear Dr. malik,

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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Kind regards,

Prasenjit Mitra, MD, CBiol, MRSB, MIScT, FLS, FACSc, FAACC

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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: 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 #1: 1. Check and verify the references - whether its in recommended

2. The reference articles mentioned in the discussion part are not done in the pregnant women population for comparison except one study from africa

Reviewer #2: (No Response)

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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: No

Reviewer #2: No

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