Medical cost of acute diarrhea in children in ambulatory care

Xavier Sánchez; Gerardine Leal; Angel Padilla; Ruth Jimbo

doi:10.1371/journal.pone.0279239

Peer Review History

Original SubmissionJuly 7, 2022
27 Jul 2022 Decision Letter - Nasser Hadal Alotaibi, Editor PONE-D-22-19266Medical Cost of Acute Diarrhea in Children in Ambulatory CarePLOS ONE Dear Dr. Jimbo, 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 Sep 08 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, Nasser Hadal Alotaibi Academic 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. Please update your submission to use the PLOS LaTeX template. The template and more information on our requirements for LaTeX submissions can be found at http://journals.plos.org/plosone/s/latex. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. [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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 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: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: 1. The whole manuscript should be revised for improved English and grammatical mistakes. 2. Line 38, %% should be corrected to %, similarly E.coli should be written as E.Coli. All bacterial pathogens name should be written in italic form. 3. Line 79, ‘The district is distributed in 21 ambulatory medical care centres, These health centres are distributed in rural and urban areas of the city and offer health services to 85% of the population’. According to WHO criteria, 30 prescription per facility should be analysed. So the sample size should be at least 630. 4. Line 123, Estimation of annual cost is not clear. How total number of AD episodes per year of the same patient was calculated? 5. Name of health facilities should be mentioned in a tabular form, mentioning the number of samples taken per facility. 6. I could not find the standard treatment of AD given by WHO. Please correlate your study with STGs of AD with WHO guidelines. You can add another variable of Adherence to STGs in your study. For your ease please read and cite the following article. https://dx.doi.org/10.21608/bfsa.2020.93568 7. et al should be italic. 8. Conclusion should be rewritten. As lab test is necessary so I don’t think that treatment cost is increased due to unnecessary testing. So revise conclusion according to prescribed medicines and its cost based on local or multinational brands. 9. No statistical test was applied on the variables. Other comments: The article focuses on treatment cost which is divided into two types, 1. Medication cost and 2. Lab test cost. On the other hand the article describes number of units dispensed from the facilities. So these two parameters should be clearly separated by headings and discussed accordingly in separate results heading. Reviewer #2: Authors should be more clear on the methodology and presentation of results in approach that can be understood by a layman. The comments provided in the attached pdf documents should be addressed clearly and correctly. ****** 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: Yes: Oluwasola Stephen Ayosanmi ******** [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. Attachments Attachment Submitted filename: PONE-D-22-19266.pdf https://doi.org/10.1371/journal.pone.0279239.r001
Revision 1
30 Aug 2022 Author Response Academic Editor “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” Corrections were made to meet PLOS ONE’s style requirements. “2. Please update your submission to use the PLOS LaTeX template. The template and more information on our requirements for LaTeX submissions can be found at http://journals.plos.org/plosone/s/latex.” PLOS template was used in this submission. “3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well.” Full ethics statement was included in methods section. Lines 78-81 Reviewer #1: “1. The whole manuscript should be revised for improved English and grammatical mistakes.” Suggestion accepted. The manuscript has been proofread by a native speaker. “2. Line 38, %% should be corrected to %, similarly E.coli should be written as E.Coli. All bacterial pathogens name should be written in italic form.” Suggestion accepted. Correction was made. Lines 52-53 “3. Line 79, ‘The district is distributed in 21 ambulatory medical care centres, These health centres are distributed in rural and urban areas of the city and offer health services to 85% of the population’. According to WHO criteria, 30 prescription per facility should be analysed. So the sample size should be at least 630.” Observational burden of illness studies are widely used to characterize treatment patterns, resource utilization and costs associated with a disease. For a burden of illness study the aim of sample size calculation is to ensure sufficient precision in descriptive outcomes, e.g. characterized by the width of 95% confidence intervals (CIs). We followed sampling guidelines in cost-of-illness studies designed for practical application in real-world studies (1,2). The sampling approach used in our study complies with the methodological recommendations according to the guidelines for conducting health economics studies. 1. Johnston KM, Lakzadeh P, Donato BMK, Szabo SM. Methods of sample size calculation in descriptive retrospective burden of illness studies. BMC Med Res Methodol [Internet]. 2019;19(1):9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30626343 2. 1. Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol [Internet]. 2014;20(4):327. Available from: http://e-cmh.org/journal/view.php?doi=10.3350/cmh.2014.20.4.327 “4. Line 123, Estimation of annual cost is not clear. How total number of AD episodes per year of the same patient was calculated?” The annual cost was estimated as cost per episode per child in 2019 × total number of episodes in 2019. As this is a cost-of-illness study, all costs are imputed to each child to estimate an average cost. If the same child has had several episodes of the disease, this is already considered in the estimate. The methodology (1,2,3) for estimating disease costs provides an estimate of the burden resulting from the prevalence of the disease over a given period, most often a year. This is called the prevalence approach. 1. Hodgson TA, Meiners MR. Cost-of-Illness Methodology: A Guide to Current Practices and Procedures. Milbank Mem Fund Q Health Soc. 1982;60(3):429. Available from: https://www.jstor.org/stable/3349801?origin=crossref 2. Drummond MF: Methods for the economic evaluation of health care programmes. 3rd edition. Oxford: Oxford University Press; 2005. 3. Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol [Internet]. 2014;20(4):327. Available from: http://e-cmh.org/journal/view.php?doi=10.3350/cmh.2014.20.4.327 “5. Name of health facilities should be mentioned in a tabular form, mentioning the number of samples taken per facility.” Suggestion accepted. Data is displayed in a Supplementary Table S1. “6. I could not find the standard treatment of AD given by WHO. Please correlate your study with STGs of AD with WHO guidelines. You can add another variable of Adherence to STGs in your study. For your ease please read and cite the following article. https://dx.doi.org/10.21608/bfsa.2020.93568” The standard treatment of acute diarrhea is cited. A cost-of-illness study, such as this one, focuses on measuring the amount of resources used for a given disease and estimating the monetary expenditure. Therefore, a variable such as "adherence to standard treatment regimen" is not necessary (it is not a resource used). The implications derived from this variable go beyond our primary objective. “7. et al should be italic.” Suggestion accepted. “8. Conclusion should be rewritten. As lab test is necessary so I don’t think that treatment cost is increased due to unnecessary testing. So revise conclusion according to prescribed medicines and its cost based on local or multinational brands.” We politely disagree with the reviewer. According to the guidelines for treating acute diarrhea in children, laboratory testing is not necessary in the outpatient setting, as it will not modify the treatment. Therefore, the use of this resource reflects an unnecessary cost. “9. No statistical test was applied on the variables.” A cost-of-illness study, such as this one, focuses on measuring the amount of resources used for a given disease and estimating the monetary expenditure. Advanced statistical tests are not necessary. “Other comments: The article focuses on treatment cost which is divided into two types, 1. Medication cost and 2. Lab test cost. On the other hand the article describes number of units dispensed from the facilities. So these two parameters should be clearly separated by headings and discussed accordingly in separate results heading.” Suggestion accepted. Results were better discussed following the recommendation but meeting PLOS ONE’s style requirements Reviewer #2: “Authors should be more clear on the methodology and presentation of results in approach that can be understood by a layman. The comments provided in the attached pdf documents should be addressed clearly and correctly.” Suggestion accepted. This manuscript version has been corrected and rewritten to facilitate comprehension. All comments provided were properly addressed. 1. A definition of international dollar has been added. Lines 130-131. 2. Table 1 now includes information on comorbidities found in the sample. Line 152 3. Table 3 was reworked to improve comprehension. Line 176 4. US$ is used in the manuscript as the standard unit. “This part is not clear and confusing. The prevalence rate is not the same as the sample size. I disagree that you can extrapolate the data on national prevalence to estimate annual cost. The annual cost should stay within your sample size. This is because health cost will vary by location. So, you can not assume the cost in your location is the same as elsewhere.” Cost-of-illness studies can be described as prevalence-based or incidence-based approaches, depending on how the epidemiological data are used. Prevalence-based studies can use this procedure to extrapolate cost and resource data over a period of time (1,2). This is called a prevalence approach. We partially agree with the reviewer, as this type of estimation may have some limitations; however, this is discussed in lines 260-655. For this reason, it is advisable to perform a sensitivity analysis (lines 266-276). 1. Hodgson TA, Meiners MR. Cost-of-Illness Methodology: A Guide to Current Practices and Procedures. Milbank Mem Fund Q Health Soc. 1982;60(3):429. Available from: https://www.jstor.org/stable/3349801?origin=crossref 2. Jo C. Cost-of-illness studies: concepts, scopes, and methods. Clin Mol Hepatol [Internet]. 2014;20(4):327. Available from: http://e-cmh.org/journal/view.php?doi=10.3350/cmh.2014.20.4.327 “The term sensitivity analysis is not appropriate here. The information provided here can be included in the discussion but not discussed as sensitivity analysis” Suggestion accepted. We discussed this analysis in the proper section. Lines 265-274. “add " to the best of our knowledge"” “Remove the word reliable as there is no way your audience can confirm that adjective. It is ok to write that you provided data on resources used but you don't need to stress the reliability. The reliability of resources may be difficult to measure in this context.” Suggestions accepted. Lines 231-233 “If you say numerous studies, you should cite references backing that statement.” Suggestion accepted. Lines 246-247 “Rather say the result may not be generalized since it is a limitation and not that it can be generalized.” Suggestion accepted. We have rephrased the sentence to improve comprehension. Lines 291-293. Attachments Attachment Submitted filename: Response to Reviewers v1.docx https://doi.org/10.1371/journal.pone.0279239.r002
6 Oct 2022 Decision Letter - Nasser Hadal Alotaibi, Editor PONE-D-22-19266R1Medical cost of acute diarrhea in children in ambulatory carePLOS ONE Dear Dr. Jimbo, 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 20 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, Nasser Hadal Alotaibi 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. [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 #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: Partly Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No 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: The manuscript is improved as compared to last version. Authors have done a good job. English is highly improved. Reviewer #2: I think the authors have done justice to the earlier queries. However, the conclusion needs a slight modification. Rather than providing a need for more research, it might be nice to offer recommendation to mitigate the challenges identified from the study in the conclusion. I know that some recommendations were in the body of the discussion, but it would be nice to input a summarized version of the recommendation in the conclusion in a concise manner. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: Yes: Oluwasola Stephen Ayosanmi ******** [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. Attachments Attachment Submitted filename: PONE-D-22-19266_R1.pdf Attachment Submitted filename: Plos one reviewer comments by Azeem (Autosaved).docx https://doi.org/10.1371/journal.pone.0279239.r003
Revision 2
17 Oct 2022 Author Response Point by point response letter 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. Corrections were made to meet PLOS ONE’s journal requirements. Reference number 12 was changed. Brownlee, 2017. (With an erratum) by Elshaug, 2017. Line 340. Reviewer #1: “The manuscript is improved as compared to last version. Authors have done a good job. English is highly improved.” No changes were made. Reviewer #2: “I think the authors have done justice to the earlier queries. However, the conclusion needs a slight modification. Rather than providing a need for more research, it might be nice to offer recommendation to mitigate the challenges identified from the study in the conclusion. I know that some recommendations were in the body of the discussion, but it would be nice to input a summarized version of the recommendation in the conclusion in a concise manner. Corrections were made in the conclusion section. Lines 300-304. Attachments Attachment Submitted filename: Response to Reviewers v2.docx https://doi.org/10.1371/journal.pone.0279239.r004
5 Dec 2022 Decision Letter - Nasser Hadal Alotaibi, Editor Medical cost of acute diarrhea in children in ambulatory care PONE-D-22-19266R2 Dear Dr. Jimbo, 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, Nasser Hadal Alotaibi Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: 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 #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 #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 #2: The author was asked to improve on the concluding part of the manuscript. The author has addressed the concerns highlighted in the initial reviews ****** 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 #2: Yes: Ayosanmi Oluwasola Stephen ******** https://doi.org/10.1371/journal.pone.0279239.r005
Formally Accepted
8 Dec 2022 Acceptance Letter - Nasser Hadal Alotaibi, Editor PONE-D-22-19266R2 Medical cost of acute diarrhea in children in ambulatory care Dear Dr. Jimbo: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Nasser Hadal Alotaibi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0279239.r006

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