PONE-D-21-27952Prevalence and Determinants of Wasting of Under-5 Children in Bangladesh: Quantile Regression ApproachPLOS ONE

Dear Dr. Hossain,

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 see the comments from two reviewers below. The reviewers have provided detailed queries that may be useful to clarify the motivations behind some of the choices made, and should enhance the overall clarity of the manuscript. Please note that there is no requirement to cite any of the specific references suggested by the reviewers.

Please submit your revised manuscript by Jul 24 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,

Hanna Landenmark

Staff Editor

PLOS ONE

Journal Requirements:

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

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

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

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

2. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

[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: Partly

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

**********

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

**********

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: Hossain and colleagues examined the prevalence and determinants of wasting among children aged below 5 years in Bangladesh using quantile regression approach based on the 2017/2018 Bangladesh DHS data. This study is critical to understanding the factors associated with the indicator of wasting in the population of this children to inform sound policy decision making. I commend the authors for the application of the quantile regression in their analysis and we look forward to more of this in the literature in relation to modelling nutritional status of under-five children. However, I have some reservations of the use of wasting as the only indicator of nutritional status in this study, the arbitrary use of the tau (i.e., quantiles) values, and why the authors ignored the hierarchical structure of the DHS data in their analysis. See further comments below:

Though the authors attempt to solve an important public health problem, especially in the developing countries like Bangladesh, they failed to justify the use of only wasting as a measure of nutritional status in their study, ignoring other important indicators of nutritional status of children such as stunting (indicator of long-term malnutrition) which is the highest prevalent globally and in developing nations, and underweight among others. Notably, the three commonly used indicators of nutritional status of children below 5 years are stunting, underweight and wasting. Each of this captures different dimension of under-five malnutrition so the authors must provide a scientific reason for choosing only wasting (indicator for short term malnutrition) as the only nutritional status in their study.

Also, like any other DHS data, the Bangladesh DHS data is hierarchical in nature where we have children nested within households, and household nested within clusters (i.e., communities) but the authors did not explain how they account for the hierarchical structure of the data used in this study. Assuming this was not explored during their modelling stage using multilevel quantile regression analysis, it could lead to spurious statistical significance with its associated misleading interpretations. Fortunately, we currently have statistical software packages that allow easy implementation of the multilevel quantile regression analysis. Authors are encouraged to explore this and compare the results for the single level quantile regression to improve the quality of their results in the manuscript.

Furthermore, the arbitrary use of the quantile values is not very informative in this study. Analysing nutritional status indicators using quantile regression should be guided by the thresholds for the quantiles and what they are measuring. For example, a quantile threshold between [0.01, 0.2] measures severe form of stunting, wasting and underweight. Thus, the authors should make conscious efforts to include these thresholds among the selected quantiles analysed and interpret same in relation to the severity of the nutritional status alongside other thresholds outside these to inform sound nutrition policies for these children. They considered 0.1 through 0.9 without any attention to the interpretation in relation to the severity of the wasting based on the quantile regression model. The authors will benefit from the paper by Aheto (2020) below that addressed this issue.

Also, it will be helpful for the readers if the authors provide the plot of the quantile regression coefficients together with the coefficient plot from the ordinary least square regression to allow the comparison between the two approaches as done by Aheto (2020) presented in the reference below.

The discussion and the conclusion look good, but the authors should consider the comments raised above to improve the quality of their manuscript.

Reference

1. Aheto JMK: Simultaneous quantile regression and determinants of under-five severe chronic malnutrition in Ghana. BMC Public Health 2020, 20(1):644. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08782-7

Reviewer #2: Abstract: Strength of associations needs to be reported

Methods:

Lines. Statistical Jargons on quantile regression could be put as a supplementary file.

Lines 162-164 should be placed in method section.

Line 172. Mean, not average.

Line 177. How did you define the outliers? Please mention it clearly somewhere.

Line 179. HAZ is stunting, not wasting. Is it just a typo or the authors coded data incorrectly?

Line 180. Same as above.

Line 185 to 200: Please always use the term that you studied. Malnutrition is a very wide term and the authors explored the factors of wasting only.

Lines 202 to 207. Should be placed in Method section under statistical analysis.

Lines 236-238: Why HAZ again? Please re-write the section carefully and focus on the relationship between the outcome variable and the predictors only.

Discussion:

Lines 17-18: How are the authors so confirm about the confounding effect of infections? Did they test that? If not, it must be properly referred. Biologically, the linear growth spurt slows down with time. As a result wight-for-height becomes more stable with increasing age.

Lines 26-27: It was tough to get the meaning. I don’t know why the authors brought the long-term malnutrition issues here?

Line 35. “Therefore, the government's efforts to…….”- totally redundant.

Line 43: “cross-protective immunity……..an enhanced innate immune response……trained immunity against”- again, totally confusing. The message is not at all clear.

**********

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: Yes: Justice Moses Aheto

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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-21-27952R1Prevalence and Determinants of Wasting of Under-5 Children in Bangladesh: Quantile Regression ApproachPLOS ONE

Dear Dr. Hossain,

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 Dec 09 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,

Saqlain Raza

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.

Additional Editor Comments (if provided):

1. In the abstract, details about the data collection is not mandatory. In the manuscript, it is unnecessarily lengthy. Authors can reduce methods and materials in the abstract.

2. The 'Conclusion' in the abstract needs to be more specific with the results. Authors need to point which government or pubic-private organizations can make the situation better.

3. In Table 2, authors have tested the quantiles. It is understood that if the two closer quantiles are statistically significant, their successors will be surely significant, too. In the table, two quintiles Q10 and Q20 are significant. It means the quintiles with bigger difference will be surely significant. What is the reason to include so many quintiles in the table? If authors believe that these are redundant, they may remove the additional quintile results from the table. The results are sufficiently communicated in the interpretation.

4. The authors are suggested to replace the old references with the new one. For example, a wide literature is available in recent years:

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0263470

https://www.frontiersin.org/articles/10.3389/fpubh.2022.792164/full

It provides the healthy discussion comparing different methods of measurements.

[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: (No Response)

Reviewer #2: All comments have been addressed

**********

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 #2: Yes

**********

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

**********

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

**********

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: I thank the authors for the revision, good job.

The revision made by the authors are satisfactory. However, there are few things to correct. For example, in Table 3 column 4, the authors stated Q25 instead of Q20, leading to duplication of Q25 in the table.

In addition, the Figure 2 provided as response to my earlier query improved the understanding of the effect of covariates on the various quantiles of weight for height z-score. However, the authors forgot to add the ordinary least squares regression coefficient line to the plot which I recommended in my earlier review to put the quantile regression in perspective. This will show why the quantile regression approach is preferred to the ordinary least squares regression approach. I provided an example based on a published paper in my first review (see below here again) to guide the authors. In that paper, the authors will find a solid red lines in Figure 2 which represent the ordinary least squares regression line. Same was stated beneath the Figure 2 in the published paper.

Reference

Aheto JMK: Simultaneous quantile regression and determinants of under-five severe chronic malnutrition in Ghana. BMC Public Health 2020, 20(1):644. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08782-7

The authors made me spent much time to review their revision because they did not do their rebuttal letter well. They are expected to respond to each item point-by-point, but in their case, they only provided responses without referring to the queries. They should remember to do this in their next revision.

Please, once the above are addressed, the paper should be sound for publication.

Reviewer #2: (No Response)

**********

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: Yes: Justice Moses Aheto

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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.

Prevalence and Determinants of Wasting of Under-5 Children in Bangladesh: Quantile Regression Approach

PONE-D-21-27952R2

Dear Dr. Hossain,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Saqlain Raza

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Remark: The authors added some suggested studies in their manuscript. But it seems that they only relied on the results of these studies and mentioned in their manuscript. I would urge the authors to read the methodology for more clarity on the topic and for the future research.

Reviewers' comments: