PONE-D-22-26162Knowledge of behavioural risk factors for types 2 diabetes mellitus and its associated factors among reproductive-age women in Arba Minch town, Gamo zone, 2022PLOS ONE

Dear Dr. seyoum,

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 with by Mar 07 2024 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,

Liknaw Bewket Bewket Zeleke, Masters

Academic Editor

PLOS ONE

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4. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files

Additional Editor Comments:

Reviewer 1

This is an important article on knowledge of behavioral risk factors of Diabetes among reproductive age group women in Ethiopia. However, the manuscript needs editing throughout in terms of English language, typos, abbreviations and the result section needs to be articulated in a proper fashion. Thanks

Reviewer 2

I was kindly asked to review the manuscript of Seyoum T et al. I thank the authors for their work, as the result is interesting and achieved through a very well described and reproducible methodological rigor. I believe the article may also be of interest to readers of the journal, but before publication, it should, in my opinion, be fixed in form, following the suggestions given below.

General considerations:

Editing for English language is recommended.

Line numbers in the manuscript file are missing.

Title:

I suggest deleting “2022” at the end of the title and using “…in Arba Minch, Gamo zone, Southern Ethiopia” here and everywhere into the main text, abstract included.

Corresponding author:

Please, report on the same line the corresponding author and the email address

Authorship:

Please, verify with the Editor that, beside a first joint authorship, another equal contribution is admitted.

Please, delete the #aArba Minch, South Nation Nationality Region, Ethiopia, as affiliations report this information.

Abstract, page 2:

Define abbreviations upon first appearance in the text. For example, the abbreviations AOR, BRF and DM are cited, but not defined.

Please, verify the order of words at the end of the Objective sentence and as suggested previously.

Introduction:

Line 2, please add a space between diabetes and (T2DM)

Line 28, please remove the space at the beginning of the sentence

Line 32, please define the abbreviation “RA” before using it

Line 35-38, please evaluate to move this paragraph before the sentence “As a result, …” at line 31 or in the discussions section

Materials and methods:

Please, define the study design: qualitative, quantitative or mix-method?

Please, correct the study period: from February 20, 2022 to March 22, 2022, not February20/2022.

Please, correct “women of reproductive age”. In my personal opinion, a woman of reproductive age is 46 years old, at maximum. I strongly recommend to define the fertile age among inclusion criteria, exclude from the study women of more than 46 years old and revise the manuscript accordingly.

What about parity? It should be of interest to analyse wherever parity >0 may be associated with higher or lower consciousness

Results:

I suggest renaming sub-headings or numbering the entire section as “5.RESULTS” and the others of the manuscript accordingly.

Discussion and Conclusion:

Section are numbered. Either all sections are numbered, or no section is numbered, your choice!

References:

Please, use proper formatting and the same font.

What does it mean “uncategorized references”?

Reviewer 3

Introduction

The manuscript didn’t give a clear idea of the central question that the research is intended to answer and its justification.

•Make sure you provided a sufficient detail on the magnitude of T2DM among reproductive-age women and the consequences for those affected

•The outcome of interest “Knowledge of BRF for T2DM” should have been the central idea in a discussion of why certain factors need more investigation if the problem is to be fully understood. Rather it was "BRF-T2DM" " "behavioral changes -Knowledge" BRF Knowledge - T2DM prevention"…

•The argument on non-existence of studies on this topic in Ethiopia was inconsistent with the fact that numerous studies were used to compare and contrast findings later on the discussion section.

•The statement on significance of the study doesn’t identify the beneficiaries and the benefits of this specific study clearly.

Materials and Methods

The manuscript contain errors in the design and conduct of research.

For example, the statement on

•Sample size determination was incorrect given their statistical implications. “q = proportion of people”

•A multi-stage sampling strategy doesn’t provide sufficient details on the sampling units and sample allocation and selection procedure.

•Variable of the study doesn't identify all the variables used in the analysis including Awareness on DM, Knowledge of Type-2DM, Knowledge of symptoms of Type 2-DM, Knowledge relate to prevention of DM and its complication, Behavioral risk Perception for Type 2DM, Adopting healthy life style for Type 2 DM.

•Data collection was incorrect given their statistical implications “a pre-test of 5 % of the sample population out of the study area” and also described repeatedly. “after sampling technique” and “under a section titled data collection”

•Data processing and analysis was incorrect with regard to description of

•Statistical program used and their purpose. “Epi Data 4.6”

•Statistical procedures used to modify raw data before analysis. “Combining wrong or uncertain responses in determining level of knowledge of the behavioral risk of T2DM”

•Variables used in the analysis “demographic factors” and “the level of knowledge of the behavioral risk of T2DM”

•Summary statistics and graphical techniques used in descriptive statistics for each variables.

•Methods used for analysis coherently. “Binary logistic regression analysis” “multivariable logistic regression” “Descriptive statistic”

•Purpose and reporting format to be followed for the analysis made “Binary logistic regression analysis to identify determinants of behavioural risk factors for T2DM… crude odds ratio (COR) and adjusted odds ratio (AOR) with its respective 95% confidence interval (CI) was used to interpret the result. Then, multivariable logistic…”

Results

The manuscript contain errors in the application, analysis, interpretation, and reporting of statistics. For example

•Age was with different measures that requires difference in properties of distribution. “minimum age of respondents is 15-year-old and maximum age is 49 years” and “mean age of respondents was 27.3 (SD+8.2 years).”

•Continuous variable was also reported without measures of variance. “Average family income was 3910.00 Eth birr(--- SD)”

•Inconsistent format was used in reporting distribution of variables. 235 (37.7%) were collage and above, “married (57.6%)”, “Half of the participants (312, 50.1%) knew T2DM”

•The interpretation of results disregard group sizes for each analysis in many instances in the manuscript. “Source of information (Health workers -116)”, “Have got DM health education (Yes- 159)”

•The text report of the regression analysis states a measure of precision (a confidence interval and P values) for each explanatory variable which is unnecessary.

•Erroneous interpretation of result was made in some instances. “A household with an average income of more than 5,001 Eth. Birr was also 1.93 times...”

•There is no report of whether the variables were assessed for interaction.

Discussion

•The discussion was unjustified, inappropriate, and erroneous in many instances in the manuscript. “The knowledge gap in the WRA may worsen the burden of the illness.”

•The discussion was also made for each explanatory variable which fails to show association with outcome variable unnecessarily.

Conclusions

•Conclusions are presented in inappropriate way. “Nearly 60% of the respondents had no idea about others T2DM risk factors”

•The conclusions was also overstated and erroneously discussed possible implications of the results out of the context of data presented in the manuscript. “This might indicate that women are ignoring their health.”

•The conclusions didn’t provide sufficient details on the association of interest that is “BRF Knowledge” and “Friend /relatives” “Family” “Health worker”

General comment

The language in this manuscript was difficult to understand in many instances and includes.

•Grammatical error: for instance ".. is rises.."

•Typographical error such as "from he study period"

•Unconventional and inappropriate use of abbreviations "RA"

•Issues with substantial clinical implications for example " T2DM is evolving"

In conclusion

•These errors are serious enough to question the conclusions.

•I recommend authors to read PLOS ONE manuscript submission guidelines and seek editorial help in research report write-up.

[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

Reviewer #3: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

**********

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

Reviewer #3: 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: No

Reviewer #2: Yes

Reviewer #3: No

**********

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: This is an important article on knowledge of behavioral risk factors of Diabetes among reproductive age group women in Ethiopia. However, the manuscript needs editing throughout in terms of English language, typos, abbreviations and the result section needs to be articulated in a proper fashion. Thanks

Reviewer #2: I was kindly asked to review the manuscript of Seyoum T et al. I thank the authors for their work, as the result is interesting and achieved through a very well described and reproducible methodological rigor. I believe the article may also be of interest to readers of the journal, but before publication, it should, in my opinion, be fixed in form, following the suggestions given below.

General considerations:

Editing for English language is recommended.

Line numbers in the manuscript file are missing.

Title:

I suggest deleting “2022” at the end of the title and using “…in Arba Minch, Gamo zone, Southern Ethiopia” here and everywhere into the main text, abstract included.

Corresponding author:

Please, report on the same line the corresponding author and the email address

Authorship:

Please, verify with the Editor that, beside a first joint authorship, another equal contribution is admitted.

Please, delete the #aArba Minch, South Nation Nationality Region, Ethiopia, as affiliations report this information.

Abstract, page 2:

Define abbreviations upon first appearance in the text. For example, the abbreviations AOR, BRF and DM are cited, but not defined.

Please, verify the order of words at the end of the Objective sentence and as suggested previously.

Introduction:

Line 2, please add a space between diabetes and (T2DM)

Line 28, please remove the space at the beginning of the sentence

Line 32, please define the abbreviation “RA” before using it

Line 35-38, please evaluate to move this paragraph before the sentence “As a result, …” at line 31 or in the discussions section

Materials and methods:

Please, define the study design: qualitative, quantitative or mix-method?

Please, correct the study period: from February 20, 2022 to March 22, 2022, not February20/2022.

Please, correct “women of reproductive age”. In my personal opinion, a woman of reproductive age is 46 years old, at maximum. I strongly recommend to define the fertile age among inclusion criteria, exclude from the study women of more than 46 years old and revise the manuscript accordingly.

What about parity? It should be of interest to analyse wherever parity >0 may be associated with higher or lower consciousness

Results:

I suggest renaming sub-headings or numbering the entire section as “5.RESULTS” and the others of the manuscript accordingly.

Discussion and Conclusion:

Section are numbered. Either all sections are numbered, or no section is numbered, your choice!

References:

Please, use proper formatting and the same font.

What does it mean “uncategorized references”?

Reviewer #3: Introduction

The manuscript didn’t give a clear idea of the central question that the research is intended to answer and its justification.

•Make sure you provided a sufficient detail on the magnitude of T2DM among reproductive-age women and the consequences for those affected

•The outcome of interest “Knowledge of BRF for T2DM” should have been the central idea in a discussion of why certain factors need more investigation if the problem is to be fully understood. Rather it was "BRF-T2DM" " "behavioral changes -Knowledge" BRF Knowledge - T2DM prevention"…

•The argument on non-existence of studies on this topic in Ethiopia was inconsistent with the fact that numerous studies were used to compare and contrast findings later on the discussion section.

•The statement on significance of the study doesn’t identify the beneficiaries and the benefits of this specific study clearly.

Materials and Methods

The manuscript contain errors in the design and conduct of research.

For example, the statement on

•Sample size determination was incorrect given their statistical implications. “q = proportion of people”

•A multi-stage sampling strategy doesn’t provide sufficient details on the sampling units and sample allocation and selection procedure.

•Variable of the study doesn't identify all the variables used in the analysis including Awareness on DM, Knowledge of Type-2DM, Knowledge of symptoms of Type 2-DM, Knowledge relate to prevention of DM and its complication, Behavioral risk Perception for Type 2DM, Adopting healthy life style for Type 2 DM.

•Data collection was incorrect given their statistical implications “a pre-test of 5 % of the sample population out of the study area” and also described repeatedly. “after sampling technique” and “under a section titled data collection”

•Data processing and analysis was incorrect with regard to description of

•Statistical program used and their purpose. “Epi Data 4.6”

•Statistical procedures used to modify raw data before analysis. “Combining wrong or uncertain responses in determining level of knowledge of the behavioral risk of T2DM”

•Variables used in the analysis “demographic factors” and “the level of knowledge of the behavioral risk of T2DM”

•Summary statistics and graphical techniques used in descriptive statistics for each variables.

•Methods used for analysis coherently. “Binary logistic regression analysis” “multivariable logistic regression” “Descriptive statistic”

•Purpose and reporting format to be followed for the analysis made “Binary logistic regression analysis to identify determinants of behavioural risk factors for T2DM… crude odds ratio (COR) and adjusted odds ratio (AOR) with its respective 95% confidence interval (CI) was used to interpret the result. Then, multivariable logistic…”

Results

The manuscript contain errors in the application, analysis, interpretation, and reporting of statistics. For example

•Age was with different measures that requires difference in properties of distribution. “minimum age of respondents is 15-year-old and maximum age is 49 years” and “mean age of respondents was 27.3 (SD+8.2 years).”

•Continuous variable was also reported without measures of variance. “Average family income was 3910.00 Eth birr(--- SD)”

•Inconsistent format was used in reporting distribution of variables. 235 (37.7%) were collage and above, “married (57.6%)”, “Half of the participants (312, 50.1%) knew T2DM”

•The interpretation of results disregard group sizes for each analysis in many instances in the manuscript. “Source of information (Health workers -116)”, “Have got DM health education (Yes- 159)”

•The text report of the regression analysis states a measure of precision (a confidence interval and P values) for each explanatory variable which is unnecessary.

•Erroneous interpretation of result was made in some instances. “A household with an average income of more than 5,001 Eth. Birr was also 1.93 times...”

•There is no report of whether the variables were assessed for interaction.

Discussion

•The discussion was unjustified, inappropriate, and erroneous in many instances in the manuscript. “The knowledge gap in the WRA may worsen the burden of the illness.”

•The discussion was also made for each explanatory variable which fails to show association with outcome variable unnecessarily.

Conclusions

•Conclusions are presented in inappropriate way. “Nearly 60% of the respondents had no idea about others T2DM risk factors”

•The conclusions was also overstated and erroneously discussed possible implications of the results out of the context of data presented in the manuscript. “This might indicate that women are ignoring their health.”

•The conclusions didn’t provide sufficient details on the association of interest that is “BRF Knowledge” and “Friend /relatives” “Family” “Health worker”

General comment

The language in this manuscript was difficult to understand in many instances and includes.

•Grammatical error: for instance ".. is rises.."

•Typographical error such as "from he study period"

•Unconventional and inappropriate use of abbreviations "RA"

•Issues with substantial clinical implications for example " T2DM is evolving"

In conclusion

•These errors are serious enough to question the conclusions.

•I recommend authors to read PLOS ONE manuscript submission guidelines and seek editorial help in research report write-up.

**********

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: No

Reviewer #2: No

Reviewer #3: 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.]

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-22-26162R1Knowledge of behavioral risk factors for type 2 diabetes mellitus and its associated factors among women of reproductive agePLOS ONE

Dear Dr. seyoum,

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 Oct 21 2024 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,

Tomislav Bulum

Academic Editor

PLOS ONE

[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 #1: All comments have been addressed

Reviewer #4: (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 #1: Yes

Reviewer #4: Partly

**********

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

Reviewer #1: Yes

Reviewer #4: No

**********

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 #4: 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

Reviewer #4: No

**********

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: (No Response)

Reviewer #4: Thank you for the opportunity to review this interesting manuscript on women's knowledge about DM type 2 risk factors.

The information is important from the public health point of view, both regional and perhaps world-wide. However, There are some points to be addressed:

1. An English proofing tool should be used, as there are some sentences throughout the text which are not properly constructed.

2. Authors should provide some information regarding the representativity of the sample for the Ethiopian female population.

3. The results are a tad difficult to follow and the list of variables is quite long. The logistic regression model is not quite clearly presented.

4. The Discussion section should be improved - the comparison with other studies should be a tad more detailed, especially with the Ethiopian ones. Also, the results are partly repeated, but not discussed.

5. The conclusions are not quite conclusions - there is a mixture of discussions and general statements.

**********

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 #4: 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.]

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-22-26162R2Knowledge of behavioral risk factors for type 2 diabetes mellitus and its associated factors among women of reproductive agePLOS ONE

Dear Dr. seyoum,

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 Jan 16 2025 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,

Tomislav Bulum

Academic Editor

PLOS ONE

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 #4: (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 #4: Partly

**********

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

Reviewer #4: 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 #4: 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 #4: 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 #4: Thank you for submitting a revised version of the manuscript. The information is quite important. However, there are some relevant issues still pending:

- English proofing is still much needed; some of the phrases are poorly constructed; active and passive voice alternates, etc.

- the methods section should be improved - the variables should be clearly defined; the choice for the cut-off for "good knowledge" should be mentioned;

- the discussion part is lacking consistency; it merely mentions other studies/countries with similar studies; should focus more on previous knowledge in Ethiopia, mention the other studies, perhaps comparing the methods used and then the results.

- the conclusion part is rephrased, but restates the results.

I would suggest a major revision of the whole manuscript with the help of an English proofing system and other manuscripts on the subject.

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Reviewer #4: No

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Knowledge of behavioral risk factors for type 2 diabetes mellitus and its associated factors among women of reproductive age

PONE-D-22-26162R3

Dear Dr. Seyoum

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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Kind regards,

Tomislav Bulum

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for adressing all comments.