https://orcid.org/0000-0003-3435-2445
Peer Review History
| Original SubmissionDecember 19, 2022 |
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PONE-D-22-34666Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of TshamilembaPLOS ONE Dear Dr. Mukala Mayoyo, 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 Mar 02 2023 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:
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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 2. Please provide copies of the interview guide and survey as supplementary files 3. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 4. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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? 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 ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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: No ********** 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 ********** 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: I wish to commend the authors for conducting and reporting on an interesting and original exploratory study on the highly relevant and neglected topic of mental health care in Africa. As pointed out by the authors, the burden of mental health in low- and lower middle-income countries is very high and remains largely unaddressed. The in-depth knowledge generated by field-based exploratory studies such as this one should prompt funding of further implementation research and service provision for mental health in resource-limited settings. PlosONE criteria for publication: 1.The study presents the results of primary scientific research. 2.To the best of my knowledge, results reported have not been published elsewhere. 3.Experiments, statistics, and other analyses are performed to a high technical standard and are described in detail. The methodology and results of the household survey and the focus group discussions would benefit from additional detail. 4.Conclusions need some revision and are not entirely supported by the data in their current form. The results should be presented in more detail and put into context with additional references to existing literature. The paragraph limitations should also describe strengths. 5.The article is presented in an intelligible fashion and is written in standard English. 6.The research meets all applicable standards for the ethics of experimentation and research integrity. 7.The article does not fully adhere to the STROBE guidelines for reporting of cross-sectional studies, the COREQ criteria for reporting qualitative research, nor community standards for data availability. General Review •What are the main claims of the paper and how significant are they for the discipline? This mixed-methods study explores the burden of mental health, and demand and provision of mental health care in one small health district of Lubumbashi, Democratic Republic of Congo, through a documents review, focus group discussions and a population household survey. The study describes a high burden of mental health and unmet demand for mental health care, as well as extremely limited access and offer of mental health services in general, and especially at the primary care. The study highlights gaps between existing policy and non-existent practice with regards to integration of mental health care in primary care services. It highlights vastly insufficient financing, the absence of non-governmental implementation and funding partners, inadequate training of health workers, and insufficient knowledge about the causes and treatments of mental health problems in the community, leading to stigma and inadequate beliefs. Interestingly, the study also identifies epilepsy as an important illness perceived by health workers as a mental health problem and the lack of adequate treatment for this important neglected disease. •Are the claims properly placed in the context of the previous literature? Have the authors treated the literature fairly? The claims would benefit from additional references to place the results in the context of previous literature. •Do the data and analyses fully support the claims? If not, what other evidence is required? The data and analyses fully support the claims of unmet needs for mental health care. The detailed proposed solutions however are not fully supported by the data. The range of possible responses to the evidence produced by the study should be widened and the uncertainty as to their effectiveness should be acknowledged and supported by additional references to existing data. •PLOS ONE encourages authors to publish detailed protocols and algorithms as supporting information online. Do any particular methods used in the manuscript warrant such treatment? Yes. The questionnaires used for the focus group discussions and the survey should be made available, as well as a detailed algorithm outlining the cross-sectional survey. •If the paper is considered unsuitable for publication in its present form, does the study itself show sufficient potential that the authors should be encouraged to resubmit a revised version? Yes. •Are original data deposited in appropriate repositories and accession/version numbers provided for genes, proteins, mutants, diseases, etc.? The original data are deposited in an appropriate repository. •Does the study conform to STROBE guidelines and the Fort Lauderdale agreement? The study will need to be revised to conform to the STROBE guidelines for reporting of cross-sectional studies. •Are details of the methodology sufficient to allow the experiments to be reproduced? No. Additional detail is necessary on the questionnaires (FGD and survey) and the methodology of the survey. •Is any software created by the authors freely available? No. •Is the manuscript well organized and written clearly enough to be accessible to non-specialists? Yes. •Is it your opinion that this manuscript contains an NIH-defined experiment of Dual Use concern? No. Line by line comments Abstract: Methods 46What type of survey was conducted? 48-51It is not clear how the burden of mental health problems was assessed, nor how demand was analysed, or how the district’s operational capacity was assessed. Results 60Which methods led to the conclusion that traditional medicine is the main source of care? Conclusion 64-67While I agree that integrating a basic package of mental health care into primary care seems to be relevant, it is not clear how the results support such a specific intervention. Mental health care seems to be lacking at all levels of the health care system and this study identified multiple barriers to access. Moreover, this study was conducted in one small health district, and one should be careful to generalize the findings to the entire country, or at least argue why the authors think the situation is similar in most areas. Introduction 89Beds in outpatient facilities seem contradictory. Maybe inpatient facilities? Methods 98-99Not clear. Earlier you mention that mental health care has been integrated in Guinea, and here you state that it is not widely integrated. 86-99 It seems you are conflating two issues into one: insufficient financing and lack of integration at primary care. 100Use of traditional medicine and other alternative approaches in a situation where no other mental health care is available seems a solution, albeit imperfect, rather than a problem. 118What does this DALY refer to? The burden of all mental health disorders in DRC or the burden due to suicide? How does this compare with other countries? 163Do these numbers refer to the health district of Tshamilemba or Lubumbashi? If Tshamilemba, does this mean there is one public PHC for 283 000 inhabitants? And 59 private clinics? If not, what are the numbers for Tshamilemba? 177In line 140 it is stated 10 000 population. 270It is not clear what this formula refers to and to measure which effect the sample size was calculated. Also, a reference is needed. 276-279 These numbers should be in the Results section 280 Survey questionnaires and focus group discussion guides should be made available in supplementary files and referenced. Results 366Unclear. Is this the proportion of all general consultations that was for mental health care? 370Table 3. Population is stated to be 10,000 and also 12,000 above. Need to harmonize numbers. What does (=2/1; 4/2; 4/1) refer to; need to clarify in the legend. In general, this table would be clearer if you specify the numerator and the denominator. 374Specify numerator/denominator 405Table 4. Title needs to specify that these are results from the household survey. The age comparison is not particularly useful. I would suggest removing it from the table and only referring to overall mean difference in the text. 405Table 4. Which definitions did you use for the mental health problems categories? For example, what is the difference between stress & anxiety problems? How did you define neuroses and psychoses? 414Young age was (NOT has been shown to be) a protective factor. In general, young age is not protective for substance use disorder and depression. It may be an interesting question to explore what this would be the case in this district of DRC. 442The data you describe on epilepsy are very interesting and reflect the importance of epilepsy as a major neglected neurological condition, with high stigma and grossly inadequate management. The fact that it is considered a mental health condition and inadequately treated with diazepam and promethazine is telling. 447The available treatments for psychiatric illnesses also seem to be severely lacking. 51539000 USD seems an extremely low amount for a country of 90 million inhabitants. Can you reference the source and also add the total national budget and the total amount allocated to health care. This would add some necessary perspective. Discussion Some general comments on the discussion. It would benefit from highlighting the results more and placing them in the context of existing evidence. Topics on which presenting existing evidence would be useful include mental health burden of disease and needs, mental health care offer in DRC and Africa, traditional healers as mental health providers, burden and care of epilepsy, access to medication for psychiatric disorders and epilepsy, access to counselling and psychotherapy. Your findings highlight significant stigma, both from providers and from the general public, surrounding mental health. This should also be addressed in the discussion. 533This urban area. The study only provides data on one area. 540I would be very cautious to suggest specific causes such as coronaphobia given that the study did not uncover any detailed diagnostic data and that the diagnostic term of neurosis is outdated and rather vague in this context. Rather highlight the need for further research to characterize the burden of mental health in DRC. 544-551 I agree it is very interesting, although unsurprising, that epilepsy is considered a mental health disorder. I would highlight that at the moment epilepsy is not managed appropriately as according to the results there were no proper antiseizure medications available besides diazepam, which is used only in for acute seizures. Maybe it is also worth highlighting the enormous unmet need of epilepsy treatment worldwide, with more than 70% of people living with epilepsy not accessing care1. 599 Remove with. 621Title should be Strengths and Limitations. Please also highlight strengths of your study. Conclusions While I agree that a pilot project would a valuable response to the unmet needs in mental healthcare described in the study, this article is not the place to provide a detailed plan for such a project. Conclusions should be based on the results and propose future directions for research and public health action. I would suggest to shorten the conclusions, base them more closely on the results, and add additional references on the proposed responses. ********** 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: Gilles Van Cutsem ********** [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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Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba PONE-D-22-34666R1 Dear Dr. Mukala Mayoyo, 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, Taofiki Ajao Sunmonu Academic Editor PLOS ONE Additional Editor Comments (optional): Great works. Article merit acceptance with the submission of rebuttal to the comments made by the expert reviewers Reviewers' comments: |
| Formally Accepted |
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PONE-D-22-34666R1 Mental health care in the city of Lubumbashi, Democratic Republic of the Congo: Analysis of demand, supply and operational response capacity of the health district of Tshamilemba Dear Dr. Mukala Mayoyo: 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. Taofiki Ajao Sunmonu Academic Editor PLOS ONE |
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