PONE-D-22-22129Adherence to the Test, Treat and Track Strategy for Malaria Control Among Prescribers, Mfantseman Municipality, Central Region, GhanaPLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

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Reviewer #1: Introduction:

The main aim of the study is “to assess the level of adherence to the T3 strategy”. It appears the assessment has been done at two distinct levels (1) Identify the outcome (by review of patient records) (2) Identify the exposure variables (an important component is interview of the prescribers). Since the methods of assessment of these two are completely different, they may be mentioned separately. For example, there is confusion about study population and study subjects (the study subjects should come from the study population).

Methods:

Study population (lines 121-127): A brief description about the health care system (where does the patient go first? Is it free or on payment? Who is authorized to treat? What is the routine method for diagnosis of malaria? Who were the prescribers? How follow up is enforced? Etc). Some background information regarding educational background and health care responsibility of medical officers, physician assistants, and nurse prescribers may be mentioned.

Sample Size: The necessity of sampling will be realized only when the total number of records available for analysis is known. It will be easier for the readers to understand if the values of each component of the formula for sample size calculation is mentioned (e.g, there is no mention of the confidence level.)

Sampling: What was the justification of using systematic random sampling instead of simple random sampling? What was the interval?

Outcome: Each individual component of the outcome (T3) can be treated as independent, because they are influenced by different predictors. For example testing will depend on the availability of the RDT and laboratory facilities, while treating will depend on availability of antimalarial drugs. Therefore, individual components of T3 can be treated as outcome and appropriate exposure variables may be selected accordingly.

Exposure variables: Since the prescribers belong to three different categories (e.g, medical officers, physician assistants, and nurse prescribers), whose professional competence may vary widely, the influence of these categories on the outcome can be studied separately. Since, predictor variables have not been defined clearly, all sorts of associations have been tried.

Discussion:

Discussion has concentrated more on the comparison with other studies but less on the possible causes of failure.

Reviewer #2: The manuscript entitled "Adherence to the Test, Treat and Track Strategy for Malaria Control Among

Prescribers, Mfantseman Municipality, Central Region, Ghana" submitted for publication mainly analysed the data retrospectively on 414 febrile patients attended the Saltpond Municipal Hospital and Mercy Women’s Catholic Hospitals for treatment. Of them only 180 (43.5%) were tested with 138 (76.7%) testing positive. But all have been administered with antimalarials. Of the total cases only 127 (30.7%) were adhered to T3 strategy. The information is of regional importance .

Comments

1. The introduction section should highlight the importance of the study from programme point of view.

2. The authors should check the discussion section because many from line no 258 to 310 missing and 310 -326 wrongly uploaded.

Reviewer #3: Comments

The research article entitled “Adherence to the Test, Treat and Track (T3) Strategy for Malaria Control among prescribers of Mfantseman Municipality, Central Region, Ghana” submitted by Agbemafle and others have analysed the outpatient records of 414 febrile patients, attended Saltpond Municipal Hospital and Mercy Women’s Catholic Hospitals in Mfantseman Municipality, Ghana in 2020. The authors attempted mainly to find out the rate of adherence to T3 strategy introduced for malaria elimination by the WHO in 2010. The authors have found that of the out of total febrile cases, 43.5% were tested with 76.7% test positivity rate, but all febrile cases have been administered with antimalarials. Of them only 30.7% have adhered to T3 strategy. This is a very important observation from programme point of view.

However, the following comments may be looked at before publication.

1. The introduction section has not clearly mentioned the objective/importance of the present study

2. The method section needs improvement. The authors should have mentioned only the essential and critical steps in different sub headings

3. In the result section the manufacturer of RDTs used for diagnosis and the partner drug of ACT administered should be clearly mentioned.

4.The caption of Table 2 should be precise.

5. The discussion section is missing many of the sentences from line 258- 326.

Recommendation: The data presented in the manuscript bears regional importance and hence most suitable for regional publication.

Other areas attempting for maximum adherence to T3 (which is essential for malaria elimination) may take clues, if published.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Madan Mohan Pradhan

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Adherence to the Test, Treat and Track Strategy for Malaria Control Among Prescribers, Mfantseman Municipality, Central Region, Ghana

PONE-D-22-22129R1

Dear Dr. Odikro,

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

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Kind regards,

Anupkumar R. Anvikar, M.D.

Academic Editor

PLOS ONE

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