PONE-D-21-34551

Determinants of incomplete childhood immunization among children aged 12-23 months in dabat district, Northwest Ethiopia: Unmatched Case- control Study

PLOS ONE

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5. 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, some of which you are an author.

- https://www.tandfonline.com/doi/full/10.1080/21645515.2018.1502528

- https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246018

- https://pubmed.ncbi.nlm.nih.gov/33243208/

- https://media.neliti.com/media/publications/7191-EN-predictors-of-immunization-defaulting-among-children-age-12-23-months-in-hawassa.pdf

- https://www.tandfonline.com/doi/abs/10.1080/21645515.2019.1670124?journalCode=khvi20

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

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: Yes

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: Most of the reasons for the incomplete immunization are same as in most of the studies. No doubt it confirms that the district in study of Ethiopia is also having similar reasons. As I understand poverty and illiteracy are the two main reasons in all the third world countries.

Reviewer #2: MAJOR REVISION

The authors present a study into factors explaining incomplete vaccination in the Dabat region of Ethiopia. This is an important topic. I have several questions regarding some metholological choices made by the authors, and suggestions to improve grammar and spelling. Overall, however, it is a good study that should be part of the global evidence base regarding demand-side issues of incomplete vaccination.

Major points

- There are grammatical errors throughout the manuscript. I've tried to flag them but it may be smart to enlist the help of a text editor or native english speaker.

- What about missed opportunities of vaccination, i.e. children who did not get their vaccination at the exact right time for example due to a missed appointment, but a little while later?

- The authors state that "All eligible Cases and controls were identified by using health post EPI registration books of the selected rural kebeles and health center EPI registration books of the selected urban kebeles". This means children that are not EPI registration books cannot be part of the study as cases or controls. Can this have led to selection bias? What percentage of children born in the region are in the EPI books? If many are not, then the authors may be missing factor for incomplete immunization that are relevant for those children.

- This study focused mainly on factors relating to the mother. In earlier reports (from Nigeria), the husbands role as well as their 'permission' to give vaccination was also important: https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/j.1440-1754.2010.01956.x. Why did the authors focus mainly on the mothers? Does caregiver, for example also imply fathers, or is the impact of fathers likely to be different in Ethiopia compared to Nigeria?

- Why was the Dabat region chosen specifically for this study?

- in tables 1-4 add p values for statistical tests checking if groups differed significantly on characteristics. For example caregiver age and wealth index seems to differ, would be good to know if these are significant differences. I think standard practice is to use t tests for continuous variables and chi-square tests for categorical ones.

- at various points the age of child is mentioned. When was this measured? I assume it is the child's age at middlepoint of your study time (april/may 2021), so 1 may 2021?

- Many continous independent variables were dichotomized, what was the reasoning behind this and how are the results if this is not done?

- were there any missing data, or cases were respondents did not recall particular things? it is mentioned as a limitation but the extent to which it occured cannot be seen in the results.

Minor points

- ll 26: revise grammar of sentence

- ll 29: change to "a community-based (...)"

- ll 32 "one dose routine" -> "one dose of the routine"

- abstract results: I prefer the notation (AOR: 2.3, 95% CI 1.3 to 5.5) for clarity but refer to journal guidelines to see what they prefer

- abstract results: perhaps present these in order of largest effect to smallest effect?

- ll 41 "children's whose place of delivery at home" -> "children who were delivered at home"

- ll 49: an->the

- ll 49: "proposed to provoke" -> "which provokes"

- ll 54: "cost effective" -> cost-effective

- ll 55 please provide a reference

- ll 58 children->child

- ll 59 please specify the abbreviations

- ll 61 "vaccine preventable" -> vaccine-preventable

- ll 61 "according to national" -> "according to the national"

- ll 61: Why does EPI reduce mortality and morbidity of the 'mother' from vaccinate preventable diseases? Later section the authors show TT (tetanus injection). Maybe the can explain that here

- ll 62 remove "as"

- ll 68-80 I would suggest to move a large part of this to the start of the introduction.

- ll 70: please provide a reference for "due in large portion to immunization"

- ll 81 please specify abbreviation

- ll 86 please specify that you are talking about Ethiopia

- ll 93 "reasons of not to" -> "reasons to not"

- ll 102 perhaps it is more insightful to mention total number of births in this time period?

- ll 100-102 can you explain the different between "kebels" and "kebeles" for those unaware (like myself) what they mean?

- ll 105: consider splitting this sentence up as it is very long and therefore hard to read. For example "E.g. All children aged between 12-23 months with mothers/ caretakers who had at least one dose of routine vaccination residing in Dabat district, were considered as a source population for both cases and controls. Those children aged between 12-23 months who did not complete the recommended vaccination before her/his 1ste birthday in selected kebels during the data collection were considered cases. Whereas those children aged between 12-23 months who completed the recommended vaccination before her/his 1ste birthday in selected kebeld during data collection period were considered as controls"

- ll 108 "her/his" -> "their"

- ll 110 "her/his" -> "their"

- ll 113 "from EPI" -> "from the EPI"

- ll 118 "for unmatched" -> "for an unmatched"

- ll 121 "a lot of" -> "many"

- ll 121 specify abbreviation

- ll 121 "follows up" -> "follow-ups"

- ll 122 remove "so,"

- ll 127 "by lottery" -> "by a lottery"

- ll 134 "Socio" -> "socio" (remove capital)

- ll 134: I take it these are independent variables as well? This is not immediately clear from the text.

- ll 138-139 please specify abbreviations

- ll 133-169 this may be converted to tables for clarity

- ll 149 "his/her" -> "their"

- ll 151: what about delayed vaccination i.e. missed opportunities?

- ll 171-172 remove "which were published in credential journals"

- ll 173 "in to" -> "into"

- ll 189 remove "were"

- ll 212 level->levels

- table 1: at occupation for controls, the 98.6% at gov't seems like an error as the percentages add up to more than 100%

- ll 283 remove "were"

- ll 240 Sorry I do not understand, round of what?

- ll 241 remove "to"

- table 3 please specify abbreviations.

- ll 248 "had good knowledge" -> "had a good knowledge"

- ll 253 I think this belongs in the caption of table 4?

- table 5 please specify abbreviations seperately in the caption

- table 5 first two columns (cases and controls) can be removed here as they already reported in earlier tables.

- ll 273 "but" -> "but a"

- ll 274 remove "was"

- ll 275 "increase them to die" -> "increases their risk of dying"

- ll 284 "also help by remembers" -> "can also help by remembering"

- ll 286 "was significant" -> "was a significant"

- ll 294 "was significant" -> "was a significant"

- ll 301 which->this

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Reviewer #1: Yes: Dr Raju Shah

Reviewer #2: Yes: Henk Broekhuizen

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Determinants of incomplete childhood immunization among children aged 12-23 months in Dabat district, Northwest Ethiopia: Unmatched case- control Study

PONE-D-21-34551R1

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.

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Ricardo Q. Gurgel, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I have revised the response to reviewers and we had the decision for acceptance from one reviewer. The second reviewer could not revise the authors responses, but I have done it and I aggree to accept the manuscript for publication.

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

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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

**********

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

Reviewer #1: 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

**********

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

**********

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: Thanks for correcting the manuscript. There are still few grammatical mistakes which needs to be corrected in final manuscript

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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

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