Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12–23 months in Ethiopia. A spatial and multilevel analysis

Getanew Aschalew Tesfa; Delelegn Emwodew Yehualashet; Addisu Getnet; Kirubel Biweta Bimer; Binyam Tariku Seboka

doi:10.1371/journal.pone.0279399

Peer Review History

Original SubmissionJune 7, 2021
1 May 2022 Decision Letter - Ejaz Ahmad Khan, Editor PONE-D-21-18735Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. a spatial and multilevel analysis.PLOS ONE Dear Dr. Tesfa, 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. Minor revision as per the comments of the reviewers is required. Please submit your revised manuscript by Jun 15 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. 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Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 5. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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. Is the manuscript technically sound, and do the data support the conclusions? 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript reports the analysis of data regarding vaccination coverage in Ethiopia. The text is clear and the analysis well performed wuth adequate methods. The main finding is the low complete basic childhood vaccination rate with large geographical variation within the country. A further analysis allowed to identify determinants of complete vaccination, such as mothers age and primary education, religionhealth facility delivery, residence in rural area, and region of residence. I suggest to edit the text and to slightly modify the abstract, specifying that some of those factors are associated with complete vaccination (i.e. mother age or religion) while other with incomplete vaccination (i.e. some specific regions). Reviewer #2: Manuscript title: Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. a spatial and multilevel analysis. Reviewer comments: The authors presented an intriguing public health issue in Ethiopia. I thoroughly read the manuscript and well written. However, I have some questions for the authors that I would like to see included in the revised manuscript. 1. The manuscript contains numerous typographical errors that should be addressed in the revised manuscript. 2. You conducted a four-model multilevel binary logistic regression analysis. My main concerns are: • Have you checked the interaction between individual level factors with the level factors? For instance, interaction between religion and regions of the participants? • If no why? and If so, what were your findings? 3. You've used a null model (a model without any variables). What was the percentage of complete basic childhood vaccination that could be explained by level 2 factors? To what extent does one's place of residence and/or region explain complete basic childhood vaccination? What exactly was the ICC? Was it significant? 4. The manner in which you write the relationship between the individual level factor age and complete vaccination is not as simple. Please keep it short and simple for the layperson to understand. 5. How can inequalities in immunization service be used to justify low coverage of complete basic childhood vaccination? Do you mean that Ethiopia's immunization coverage is low? If this is the case, could you please provide evidence and explain how immunization coverage affects complete basic childhood immunization? ****** 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:** Giovanni Rezza 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. 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Revision 1
20 May 2022 Author Response …. point by point response...…. Academic editor comments: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Thank you for the comment. We tried to revise the manuscript based on PLOS ONE's style requirements. 2. Please provide additional details regarding participant consent in the Methods section. Thank you for the comment. We explained it. Refer page 7 line 171-175. 3. Please note that PLOS ONE is unable to publish previously copyrighted maps or satellite images, or images created using proprietary data. For these reasons, we cannot publish images generated by software which copyrights their output (such as Google Maps, Street View, and Earth). In order to use these images in your submission, we require explicit permission from the copyright owner to publish the figures under the CC BY 4.0 license. At this time, please kindly clarify the following regarding Figure 2: a) Where did the authors obtain the maps, basemaps, shapefiles, map data, etc. in Figure 2? b) If any of the map images have been previously copyrighted, we require specific consent from the copyright holder to publish these images in PLOS ONE, under the CC BY 4.0 license. Authors' response: Editor, thank you for the concern. Figure 2 is not copyrighted rather we have done using ArcGIS and SaTScan software based on the shapefile of Ethiopia received from Ethiopian Central Statistical Agency (CSA) and GPS data (longitude and latitude) from the measure demographic and health survey (DHS) program by explaining the objective of the study through online requesting and allowed us to access the shapefile and GPS data. Because we need to analyze the spatial distribution of complete basic childhood vaccination, we cited the shapefile's source. Therefore, the map presented in our study is not copyrighted; rather it shows the result of our spatial analysis. c) Were any sample data used in the map in Figure 2 proprietary data (e,g,. from ArcGIS and/or SaTScan)? Authors’ response: Thank you for the concern, editor. We used ArcGIS and SaTScan statistical software to illustrate the spatial distribution of complete basic childhood vaccination using data from the measure DHS program. After describing the objective of using the data, we obtained the data and acquired approval from the Measure DHS program. The DHS dataset is open to the public, and figures obtained as a final analysis result are not copyrighted. 4. Please review your reference list to ensure that it is complete and correct. Thank you. We tried to review it carefully. Reviewer #1: 1. I suggest to edit the text and to slightly modify the abstract, specifying that some of those factors are associated with complete vaccination (i.e. mother age or religion) while other with incomplete vaccination (i.e. some specific regions). Thank you very much for the comments. We tried to revise it carefully. Reviewer #2: 1. The manuscript contains numerous typographical errors that should be addressed in the revised manuscript. Thank you very much for the comment. We tried to make a substantial revision on the typography. 2. You conducted a four-model multilevel binary logistic regression analysis. My main concerns are: • Have you checked the interaction between individual level factors with the level factors? For instance, interaction between religion and regions of the participants? • If no why? and If so, what were your findings? Thank you for the comment. Refer page 6 line 156-159. 3. You've used a null model (a model without any variables). What was the percentage of complete basic childhood vaccination that could be explained by level 2 factors? To what extent does one's place of residence and/or region explain complete basic childhood vaccination? What exactly was the ICC? Was it significant? Thank you for your interesting comment. We included it based on your comment. Refer page 13 line 253-259 and Table 4 page 16. 4. The manner in which you write the relationship between the individual level factor age and complete vaccination is not as simple. Please keep it short and simple for the layperson to understand. Thank you for the comment. We rephrased it. Refer page 13 line 270-273. 5. How can inequalities in immunization service be used to justify low coverage of complete basic childhood vaccination? Do you mean that Ethiopia's immunization coverage is low? If this is the case, could you please provide evidence and explain how immunization coverage affects complete basic childhood immunization? Thank you for the comment. We corrected it. Refer page 17 line 306-311. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0279399.r002
25 Oct 2022 Decision Letter - Demisu Zenbaba Heyi, Editor PONE-D-21-18735R1Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. a spatial and multilevel analysis.PLOS ONE Dear Dr. Tesfa, 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, Demisu Zenbaba Heyi, MPH 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: Please, address previous reviewer comments properly e.g. why you not calculated the PCV(proportion of change in variance for Model I, II, II), and better to calculate the median odds ratio for all models as well? [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they would 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. https://doi.org/10.1371/journal.pone.0279399.r003
Revision 2
7 Nov 2022 Author Response General comment (Journal Requirements) 1. 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. Response: thank you very much for your suggestion. We tried to revise our reference and change was made on the following references. - L Arevshatiana, C.C., SK Lwangac, AO Misored, P Ndumbee, JF Sewardf, P Taylorg. An evaluation of infant immunization in Africa: is a transformation in progress? ; Available from: https://www.who.int/bulletin/volumes/85/6/06-031526/en/.: Removed and Replaced by: Lindstrand, A., et al., The World of Immunization: Achievements, Challenges, and Strategic Vision for the Next Decade. The Journal of Infectious Diseases, 2021. 224(Supplement_4): p. S452-S467. - Organization, W.H. Immunization, Vaccines and Biologicals. Available from: https://www.who.int/immunization/documents/immunological_basis_series/en/. : removed - Ministry of Health-Ethiopia. Expanded Program on Immunization (EPI). Available from: https://www.moh.gov.et/ejcc/am/EPI. Removed and replaced by: Belete, H., et al., Routine immunization in Ethiopia. The Ethiopian Journal of Health Development, 2015. 29. - 14. Federal Ministry of Health, E. ETHIOPIA NATIONAL EXPANDED PROGRAMME ON IMMUNIZATION COMPREHENSIVE MULTI-YEAR PLAN 2011 - 2015. 2010; Available from: https://bidinitiative.org/wpcontent/files_mf/1405630243EthiopiaComprehensivemultiyearplanfor20112015Year2010.pdf. Removed and replaced by: Boulton, M.L., et al., Vaccination timeliness among newborns and infants in Ethiopia. PLOS ONE, 2019. 14(2): p. e0212408. Editor comment 2. Please, address previous reviewer comments properly. Why you not calculated the PCV (proportion of change in variance for Model I, II, II), and better to calculate the median odds ratio for all models as well? Response: Thank you for your insight. We have already addressed it. Please refer page 14, line 280-290 and Table 4, page 16. Attachments Attachment Submitted filename: Response to Reviewers_v2.docx https://doi.org/10.1371/journal.pone.0279399.r004
14 Nov 2022 Decision Letter - Demisu Zenbaba Heyi, Editor PONE-D-21-18735R2Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. a spatial and multilevel analysis.PLOS ONE Dear Dr. Tesfa, 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 following previous reviewer comments are not addressed: Have you checked the interaction between individual level factors with the level factors? For instance, interaction between religion and regions of the participants? If no why? and If so, what were your findings? The manner in which you write the relationship between the individual level factor age and complete vaccination is not as simple. Please keep it short and simple for the layperson to understand. How can inequalities in immunization service be used to justify low coverage of complete basic childhood vaccination? Do you mean that Ethiopia's immunization coverage is low? If this is the case, could you please provide evidence and explain how immunization coverage affects complete basic childhood immunization? Please submit your revised manuscript by Dec 29 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, Demisu Zenbaba Heyi, MPH Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0279399.r005
Revision 3
17 Nov 2022 Author Response *************** We note that your Data Availability statement states the following: "Data is available online from https://www.dhsprogram.com/data. A letter of permission for the use of the data was secured from DHS program. We used 2019 EMDHS dataset." Before we can proceed, please clarify if the authors had special access to the data that other researchers would not have. If not, please also provide a direct link to the dataset. Response: The data is publicly available and anyone can access it through reasonable request. The sole requirements for accessing the Demographic and Health Survey (DHS) program datasets are registration and a justification of the request's objective. ****************************** ….point by point response... 1. Have you checked the interaction between individual level factors with the level factors? For instance, interaction between religion and regions of the participants? If no why? and If so, what were your findings? Response: Thank you for your comment. Understanding geographical distributions of complete basic childhood vaccination and identifying associated predictors is crucial for designing effective policies and strategies that help to improve vaccination coverage. Keep in mind this, the first main specific objective of our study was to identify the spatial distribution of complete basic childhood vaccination. To attain this objective and to answer the question of where the hotspots for low vaccinations are located, spatial statistical analysis is required. So, our spatial analysis looked at only the dependent variable. Second, to identify potential predictor variables, regression analysis is required. Hence, we used multilevel multivariable logistic regression analysis. As stated above we identified predictors using regression analysis and regression models consider linear relationships (stationary relationships). Since one of the assumptions of regression models is that relationships are constant across the entire study area. Therefore, estimates generated in this model assume averages. Due to that, we didn't consider the interaction between individual-level factors with the level factors. However, we have checked the absence of multicollinearity between these independent variables using the variance inflation factor. 2. The manner in which you write the relationship between the individual level factor age and complete vaccination is not as simple. Please keep it short and simple for the layperson to understand. Response: we revised it accordingly and corrected it as follows “Maternal age was significantly associated with complete basic childhood vaccination. Children born to mothers who were 20-24 years old were approximately two times (AOR=2.12, 9S%CI: 1.06-4.24) more likely to be fully vaccinated than children whose mothers were 15-19 years old.” Refer page 13, line 263-266 (on the tracked version) 3. How can inequalities in immunization service be used to justify low coverage of complete basic childhood vaccination? Do you mean that Ethiopia's immunization coverage is low? If this is the case, could you please provide evidence and explain how immunization coverage affects complete basic childhood immunization? Response: Thank you for your constructive comment. We mean that variability of immunization service access across areas might be one of the reasons for the low prevalence of complete basic childhood vaccination. Since our study was done based on the national representative data that took into account both rural and urban areas, the overall prevalence of complete basic childhood vaccination was varied compared to previous studies that were done in specific districts. Anyways, in order to minimize such type of misunderstanding, we have made some modifications in that sentence and additional explanations were added in the main document. Refer page 17, line 305-309 (on the tracked version) Attachments Attachment Submitted filename: Response to Reviewers_v3.docx https://doi.org/10.1371/journal.pone.0279399.r006
7 Dec 2022 Decision Letter - Demisu Zenbaba Heyi, Editor Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. a spatial and multilevel analysis. PONE-D-21-18735R3 Dear Dr. Tesfa, 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, Demisu Zenbaba Heyi, MPH Academic Editor PLOS ONE Reviewers' comments: https://doi.org/10.1371/journal.pone.0279399.r007
Formally Accepted
27 Dec 2022 Acceptance Letter - Demisu Zenbaba Heyi, Editor PONE-D-21-18735R3 Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. A spatial and multilevel analysis. Dear Dr. Tesfa: 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. Demisu Zenbaba Heyi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0279399.r008

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