PONE-D-21-03079Male partner involvement in postnatal care service utilization and associated factors: A community based cross sectional study in Motta district, Northwest EthiopiaPLOS ONE

Dear Dr. Getu,

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 Nov 1 2021 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Zelalem Nigussie Azene, MPH

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

This is an important study, as it offers a benchmark evidence-base of the male involvement in postnatal care service utilization and its determinants in Motta district, Ethiopia

1. The quality of the English used throughout your manuscript does not currently meet our requirements, as there are several incorrect sentence constructions and grammatical errors throughout obscuring the message the authors want to convey. We recommend that you ask a native English speaking colleague to help you copy-edit the paper. If this is not possible, you may need to use a professional language editing service. Use of an editing service is neither a requirement nor a guarantee of acceptance for publication.
2. Can you please review all statistical reporting in your manuscript? We would encourage you to seek additional advice from a statistician before submitting your revised paper. It is important that the statistical analyses used are suitable for your study and that all statistical reporting is correct. Can you please confirm in your cover letter whether you have addressed this point?       
3. I request the authors do add the implications of this particular study at the end of the discussion section.
4. Please, include the added value of this work at the end of the discussion section.
5. In Abstract section, the authors state “favorable attitude [AOR=2.61, 95%CI= (1.55, 4.39)], short distance [(AOR=2.35, 95%CI=1.30, 4.26)]”, however, favorable attitude?? And short distance?? These phrases are incomplete that can potentially baffle the reader. Please, do them complete by stating the full variable (favorable attitude towards-------) this issue is also happened in operational definition section.
6. Please, see again the operational definition section, there even variables, which actually don’t need operationalization but did.
7. Very amazingly, there are a huge overlapping of words even sentences from the so far works, please, avoid this.
8. “Conclusion and recommendation”: Please, do erase recommendation and rewrite as conclusions. And also “Community-based awareness creation through health education should be provided to raise their involvement, knowledge, and attitude on postnatal care service”, these should only be the ways forwarded to tackle the problem studied.
9. “PNC service, Male involvement, Ethiopia”: Are these only keywords?  

 I, therefore, request the authors to make major revisions before resubmitting their manuscript.

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2. Thank you for stating in the text of your manuscript "The ethical committee of Bahir Dar University College of Medicine and Health sciences approved this study. Further approval was also granted from Motta district and each kebeles administration. Informed consent from all participants was obtained before conducting this study. The obtained information was kept anonymous and recorded in such a way that the respondent could never be known". 

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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: Partly

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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: The authors selected an important topic of time for The study site and related context. In their Introduction an additional information regarding traditional gender roles expected of men and women in Ethiopia would benefit the paper in terms of measurements and hence outcomes /results. Authors may look at this point and discuss the point in the discussion section to aid better recommendations

Ethical considerations paragraph may be improved to include confidentiality and issues of anonymity.

The authors may want to write briefly about limitations and straight of their study approach/methodological considerations at the beginning of the Discussion section to improve rigour.

Few typos may be looked at again

The paper is generally good but I suggest you rectify my few suggests prior publication in PLOS ONE

Reviewer #2: This is an interesting topic, but unfortunately, the paper needs quite some more work. The language shows that the authors are not native speakers nor very experienced in academic write up in English, so an language editor would be good. The sample size seems sufficient, but the analysis is very descriptive for the most. I miss a better cultural and social description on gender issues in pregnancy in Ethiopia. I miss a more thorough explanation of the state of the art in Post partum care in general. The findings are interesting and pretty detailed, but a numeric comparison between countries make not so much sense. The situation in Ethiopia is interesting enough in its own right. So why, or why not, are men there for the women?

Abstract

Do not include too much detail in the abstract such as statistical method, confidence intervals or likewise. Start with a small problem statement; “so what is at stake here”….. An abstract should inspire readers to grasp the idea and to look for more detail in the text. An abstract should capture the essence of the only.

Article. I would start by describing what male participation actually IS. Most over the industrialized world has witnessed an ever increasing presence of partner during birth , in antenatal care visits, as part-takers in maternity and paternity leave from work, etc. These developments have not always come on as projects pr policy, but evolved from increased gender sensitivity and family choice. The article should describe the state of the art in delivery services in Ethiopia (many deliver at home, partners are often not present, neonatal mortality is still high etc:

I do not really see how male participation in general is linked to better mother and child survival, this has to be explained (better access to resources, faster transport? Better negotiating power?) So the whole introductory part needs to be re written, and don’t use statements that are not documented by evidence.

In methods. The statement “reviewing different literatures” needs references, Which studies did you learn from?

Results. No need to repeat table results in text.Shorten the presentation of results a little.

Chose one way to present

Please refrain from using too many decimals in estimations. One decimal is often enough.

I miss a mote thick discussions on ways forward, based on the findings.

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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

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PONE-D-21-03079R1Male partner involvement in postnatal care service utilization and associated factors: A community based cross sectional study in Motta district, Northwest EthiopiaPLOS ONE

Dear Dr. getu,

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.

There has been a change of academic editor from the previous version. The manuscript was sent back to the previous reviewers. Only reviewer 1 was available. The new academic editor, based on a detailed revision of the revised manuscript and the review process is able to make a decision, noting that the readability is much improved but there are important issues in the formulation of the model, the reporting, and the interpretation of results that need to be addressed in order to meet PLOS ONE guidelines.

Sample size determination:

Two objectives (1 and 2) are mentioned on p.5-6, but it is not disclosed what these objectives are. Probably it should have been mentioned at the end of the introduction, that is too succinct regarding the goals of this particular study.

p. 8: “595 male partners were participated” Remove “were”

There is an apparent contradiction in the analysis. It is said that “Male partner involved in PNC service: those who had scored median value and above” (this would imply that, by definition, 50% are involved). Then: “The overall magnitude of male involvement in PNC service utilization was 124 (20.8%)”. Is the same name being used for two different things? Please clarify. You should also provide some description of the scale of involvement. Table 4 provides the item by item, but there is no information on the distribution of the scale of the 10-point index.

A more important caveat is the lack of justification for the inclusion of “knowledge of PNC service”, “Knowledge of danger signs during PNC”, “attitude to the service” as “independent variables”. Note that the data is compiled AFTER the childbirth. Therefore, it is not possible to talk about the effect of knowledge of PNC service prior to pregnancy (which would be the magnitude of interest) with this data. If, after birth, there is lack of knowledge it is a sign of low involvement, but the causality goes the other way round: because of low involvement the opportunity was lost to get to know PNC services during pregnancy. The suggestion is to REMOVE this variables from the analysis. Note also, that the inclusion probably is also making the socioeconomic variables less interpretable, eg: education: It would be involvement of partner with different education level for a given level of knowledge of PNC. You’d expect part of the effect of education is through better knowledge. If you control for this factors, the interpretation of the socioeconomic variables becomes very difficult.

An alternative: It would be defensible to extend the index of involvement and include as extra points in the dependent variable the knowledge of PNC service and danger signs AFTER the childbirth. Distance from PNC service can be used, although the limitation should be commented of being measured after the childbirth.

I am not so sure about the other service variables such as waiting time, privacy, and welcoming. If those variables are only available for those who attended some ANC service, they should not be used. If the are reported by everyone, how do they no? Instead of actual characteristics of the service it may refer to their preconceptions. My inclination is also to drop them from the analysis keeping only the clearly exogeneous variables

On a related topic: there is no talk about missing values and the “don’t know” responses. How were they treated?

Please also provide in the appendix the details regarding the PC analysis for constructing the wealth index and the final index used.

A section on limitations needs to be added. The major limitation is that the attitudes are observed AFTER and not before the childbirth.

Please submit your revised manuscript by Jun 04 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,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS ONE

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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

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

Reviewer #1: Yes

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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 #1: 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

**********

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: The authors have fairly addressed the editors' comments prior given to them. However, I have one more comment for authors to address. The Authors need to write the limitations/methodological considerations of this study given that one of the main factors for male participation in maternal health services with their partners /wives is the underlining social cultural gender norms where a cross sectional study may be considered to have some limitations in exploration of group norms.

I should also suggest that in for future further qualitative studies may benefit the topic in Ethiopia and for now I do offer one reference if authors would wish strengthen their discussion section. Maendeleo B, Matovelo D, Laisser R, Swai H, Yohani V, Tinka S, et al (2021) Men's perspectives on attending antenatal care visits with their pregnant partners in Misungwi district Rural Tanzania; A qualitative study. BMC Pregnancy and Childbirth 21 (1),1-8.

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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

[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-21-03079R2Male partner involvement in postnatal care service utilization and associated factors: A community based cross sectional study in Motta district, Northwest EthiopiaPLOS ONE

Dear Dr. getu,

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.

The manuscript has improved but some of the previous comments have not been properly addressed.

Regarding a possible conflict in the use of the term “median”: Median is a technical term referring to the location of the 50% percentile of a variable. As I state, there is always by definition 50% above and 50% below for a given variable. You say that “Male partner involved in PNC service: those who had scored median value and above” and that they are only 20.8%. That is not a median. Do you mean those that scored at least half of the total score? Then say so.

You again refer to “median score (50%)” Replace all such instances accordingly. It is wrong. All the instances of the word “median” in your reply are wrong!

• “A more important comment is the lack of justification for the inclusion of knowledge of PNC service, Knowledge of danger signs during PNC, attitude to the service as independent variables. Note that the data is compiled AFTER the childbirth….. because of low involvement the opportunity was lost to get to know PNC services during pregnancy”.

- Dear editor if we understand your question, we know that knowledge and attitude towards PNC service are the possible factors that affect male partner involvement in maternal health service as showed by different studies. Since those male partners with good knowledge may understand well the possible birth complications; so that they encourage their spouses to attend PNC service. As well as husbands’ positive perception on benefit of maternity care might lead to higher level of male partners’ participation. Generally this finding point to the important roles of male partner’s knowledge and attitude in influencing their involvement in postnatal care. Regarding to their opportunity to get knowledge and develop attitude towards PNC service, it could be through mass media, books, magazines or health education by Health extension workers, health care providers or another bodies. In the other way, this could be also the limitation of cross sectional study design to show cause and effect relationship.

I am not saying that those factors are not important. I am saying that your measurement is weak because it takes place post-partum, and it might be the case that the knowledge of PNC happened during or after because, for instance, a difficult delivery. Or the attitude to the service might have changed due to the use (or problems using) ANC. You have to state as one of the limitations that this variables are measured at the interview time, not prior to childbirth, and as a result can be affected by issues of reverse causality. You should raised these concerns in the section on the limitations of the study.

“On a related topic: there is no talk about missing values and the “don’t know” responses. How were they treated?”

- The ‘don’t know’ responses were recoded with ‘No’ responses for analysis and missing values were dropped

- But we have already removed those variables (like waiting time, privacy, welcoming, etc) with missing value and don’t know responses

It would be important to state what proportion of the observations had missing data and have been dropped.

Please submit your revised manuscript by Jul 30 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,

José Antonio Ortega, Ph.D.

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.

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Reviewers' comments:

[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-21-03079R3Male partner involvement in postnatal care service utilization and associated factors: A community based cross sectional study in Motta district, Northwest EthiopiaPLOS ONE

Dear Dr. getu,

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.

==============================Thank you for responding to all the reviewers' requests in the previous rounds of review. There are no further reviewer comments to address. However, please note that there are still many language errors in your submission. PLOS ONE does not copy edit accepted manuscripts (https://journals.plos.org/plosone/s/criteria-for-publication#loc-5). To that effect, please ensure that your submission is free of typos and grammatical errors.

 ==============================

Please submit your revised manuscript by Oct 02 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,

Steve Zimmerman, PhD

Associate 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.

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Male partner involvement in postnatal care service utilization and associated factors: a community based cross sectional study in Motta district, Northwest Ethiopia

PONE-D-21-03079R4

Dear Dr. Alemwork Abie Getu,

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,

Yann Benetreau

Staff Editor

PLOS ONE

Additional Editor Comments (optional):

In your final version, please address the following issues:

* line 71: evidences -> evidence

* line 91: does not focused -> does not focus

* Please do not include funding sources in the Acknowledgments or anywhere else in the manuscript file. Funding information should only be entered in the financial disclosure section of the submission system. https://journals.plos.org/plosone/s/submission-guidelines#loc-acknowledgments

Reviewers' comments: