PONE-D-22-20786A scoping review of adolescent nutrition in Ethiopia: transforming adolescent lives through nutrition (TALENT) initiativePLOS ONE

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Kind regards,

Chiranjivi Adhikari, MPH, MHEd., PhD Candidate

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Dear authors,

It is to observe really a diligent and scientific piece of work implicating public health nutrition in a great stuff, especially at policy level, in Ethiopiya and possibly to similar but contextual neighboring countries. With most of the technical and scientific parts praiseworthy, along with a well write-up, I, would like to convey my reverence to all the reviewers for their contribution, and so, by the authors to address their comments, along with the followings:

Comments to be addressed:

1. In fig. 2-8, it is praiseworthy that trend has been shown. Additionally, it would be a good idea to synthesize and infer with trend analysis, along with intercepts and linearity/non-linearity; with their p-values. Ideas can be traced from web-based calculator: EPITOOLS (Link: https://epitools.ausvet.com.au/trend)

2. As mentioned, the quality of the studies with JBI (lines 141-3), pls include the table of the assessment for all the studies in main or supplemental file, as guideline allows.

Comments that corrections may be needed!

3. In abstract, Jamuna Bridge Institute (JBI) checklist, may need to be recheced…

4. In PRISMA chart, were the finally added 10 studies gone through eligibility? As they have been found directly included (skipping other steps?) may be the figure re-adjusted

With regards,

AE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: N/A

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: No

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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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: Thank you for conducting a review on a less focused but important topic - adolescent health. I would like to put forward my comments on this:

1. The authors have conducted an explicit search, quality assessment of the included articles and also one of the limitations written was "unable to conduct meta-analysis", then why is it just mentioned only as a Scoping Review? Why can't this be a Systematic review?

2. In Quality Assessment section (line 142 - 143), it is mentioned - Low quality studies were excluded. If so, this can be a Selection bias. But, in Study selection section (line 152 - 153), it is mentioned - No studies were excluded. Please clarify.

3. Data availability - No (Some restrictions may apply), can you please mention what and which restrictions would apply for further clarification (as this is a review)?

4. In PRISMA diagram, spelling of Meta (between Eligibility and Screening section) is incorrect and some brackets are not closed. Please check. Also, in the last section of diagram "Included", it is mentioned "Studies included in quantitative synthesis (meta-analysis) (n=74)", but MA has not been conducted, kindly clarify.

5. If possible, title can be refined and made specific.

Reviewer #2: A nice paper on an important topic. Could just do with a few minor clarifications:

Abstract,

Line 22: diets, rather than diet

Lines 27, methods: I think ‘on adolescent nutrition’ is too vague. I appreciate that word limit is tight in the abstract but you specific ‘on prevalence and interventions for all forms of malnutrition, with no limits on study design’ ? or something similar? Otherwise it’s a slightly confusing start to the abstract. Especially since no intervention studies are mentioned in the results, you wonder if these weren’t included.

Introduction

Line 55: suggest changing ‘(overweight and obesity) is more important’ to ‘(overweight and obesity) is more prevalent’, since importance suggestions they don’t put ‘importance’ on undernutrition.

Line 58-60: “This, alongside persisting 59 undernutrition in large sections of the population results in a double burden of malnutrition in 60 LMICs, compounded by low levels of government investment to solve the problem” I would love to see a reference to this new and comprehensive review here. You may also find it helpful for the discussion section as it puts Ethiopia in the context of the rest of the region: Wrottesley SV, Mates E, Brennan E, Bijalwan V, Menezes R, Ray S, Ali Z, Yarparvar A, Sharma D, Lelijveld N. Nutritional status of school-age children and adolescents in low-and middle-income countries across seven global regions: a synthesis of scoping reviews. Public health nutrition. 2022 Feb 14:1-33.

Methods

Line 141: define acronym JBI on first use in the main text

It would be good to see some definitions of malnutrition in either the methods or the results. For example, you talk about ‘stunting’ in the results, but the definition of this isnt always standard so it would be good to know what you were defining as ‘stunting’ for this population age group. Same for the other anthropometry and the micronutrient deficiencies.

Results:

Figure 2-8 – I was avoid saying ‘trends’ but rather ‘reported prevalence’s’ because trends suggests that the assessment are linked to each other. I would also include the definition of nutritional status in the footnotes for the figures e.g. overweight and obesity based on WHO 2007 growth reference BAZ>+1

Diet diversity, lines 280-309: could you mention the tools used to assess DDS? This is always a confusing area in adolescent nutrition – which tools are validated and which tools are used, so good to mention that here. Same for tools used to assess food insecurity.

You don’t mention intervention studies, did you not find any?

Discussion:

You say “The review generally showed that there is more undernutrition (thinness and underweight)” – if you are talking about low BMI-for-age z-score, then just say thinness… if you are talking about weight-for-age z-score, say underweight. I think underweight can be removed from here. See: Lelijveld N, Benedict RK, Wrottesley SV, Bhutta ZA, Borghi E, Cole TJ, Croft T, Frongillo EA, Hayashi C, Namaste S, Sharma D. Towards standardised and valid anthropometric indicators of nutritional status in middle childhood and adolescence. The Lancet Child & Adolescent Health. 2022 Aug 24. Also, undernutrition generally includes micronutrient deficiencies too, so perhaps say “there is more undernutrition (thinness and micronutrient deficiencies)”

Define DDS when you first use it in the text

Limitations: I think the heterogeneity of studies requires a little more explanation – there are important learnings for nutritionists working with this age group around the lack of standardisation in research methods. Presumably, lots of the studies focused on different age groups within the 10-19 range? What other heterogeneity did you find? In definitions of malnutrition? Please expand

Reviewer #3: The review was good.

Abstract: Please check for Jamuna Bridge Institute or Joanna Briggis Institute..short form JBI

Introduction:

Line 45: second applies only to fetal life and infancy; remove it. 

Line 56-60: check it, Line 56-58 (remove it).

Line 77: Knowledge ..replace term with evidence or other appropirate terms

Line 78: Thus, this review aimed at understanding the nutritional statusof adolescents in Ethopia (delete it). the above line 76-78 give same meaning.

Results:

Please check line 197-98 once.

Provide reference for line 229-233.

In Line 248: Use another word for: "In the same survey"

Line 322-327: clearly rewrite

Line 332: delete "has produced 5 articles"

Eating disorder: rewrite last 4 line

Discussion: Discuss the main findings of the study with other study too (similar and contrast)

Strength and limitations: check the limitations for spelling error, also check for figure 1.

Conclusion: need to rewrite, highligting all research questions.

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Reviewer #1: Yes: Ms. Priyanka Akshay Shah

Reviewer #2: No

Reviewer #3: Yes: Rojana Dhakal

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A systematic review and meta-analysis of adolescent nutrition in Ethiopia: transforming adolescent lives through nutrition (TALENT) initiative

PONE-D-22-20786R1

Dear Dr. Abera,

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,

Chiranjivi Adhikari, MPH, MHEd., PhD Candidate

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear author(s),

Thank you for the updated version of the manuscript. Now, although it is suitable for acceptance, I still find "Jamuna Bridge Institute" in Abstract, in line 28. So, It needs further rigorous grammar, syntax and other checks at least once by all the authors, after keeping up the formats as per journal guideline.

So, I recommend to submit a final version.

With regards,

Chiranjivi, AE

Reviewers' comments:

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