PONE-D-21-24134

Mothers’ Health Care Seeking Practice for Neonatal Danger Sign in Southern Ethiopia: Community Based Cross–Sectional Study

PLOS ONE

Dear Dr. Mesele,

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Sungwoo Lim, DrPH

Academic Editor

PLOS ONE

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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

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

Reviewer #1: No

Reviewer #2: No

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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: Yes

Reviewer #2: Yes

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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: No

Reviewer #2: No

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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: TITLE: edit to read maternal health seeking behavior.....

INTRODUCTION: focus your literature on WHO danger signs. which danger signs were studied and why? specify and justify.Wat guidelines are used in Ethiopia for neonatal care? how does a mother learn about these signs, if they don't attend anc/pnc? are there community health workers in Ethiopia?

METHODS: is it a retrospective study? how do you deal with recall bias? indicate ethical approval number.

RESULTS: ensure all percentages add to 100%, seen many errors.summarize the tables- combine column 2 and 3 eg. 169(41.2%). quantify herbal use meds. how is husband s education important in this study?

DISSCUSSION: discuss the results and don't repeat results here. requires to be re written focusing on neonate, danger signs and mother. which danger sign was highly missed and why? this will help to implement better guidelines and health seeking behaviour.

Reviewer #2: Review for:

Mothers’ Health Care Seeking Practice for Neonatal Danger Sign in Southern Ethiopia: Community Based Cross–Sectional Study

General comment:

This is an important topic that the study tries to investigate, and a community based study that potentially includes community members that might could easily be excluded from healthcare by their social or economic status. However, there could still be some improvements to the study. An assessment of the knowledge, and the attitudes in addition to the practice would have added a significant lot of value to validate the results. And to assess the practice, the mothers actually needed to have a knowledge of the danger of these danger signs. The factors associated with health care seeking practice identified in the study such as husband’s education status, access to media, urban residence, ANC follow ups etc, clearly point towards access ‘Knowledge’.

The writing could also be improved with the help of a native English editor.

Specific comments:

Abstract:

Online 34, the authors need to indicate what statistical tests were carried out before the sentence “A p-value of less than or equal to 0.05 in a multivariable……..”

Introduction:

On pg 10, line 91, the sentence that starts with “Solitary limited studies remained conducted in Ethiopia with respect to mothers’ practice towards neonatal danger signs” should be referenced. The findings in this solitary study should be mentioned and other studies in the region could be reviewed as well. The gaps in those other studies should then be outlined that this particular study promises to close. The real scientific addition from the study should then be articulated after this sentence: “ So this research is intended to assess the ……” lines 92-94

Methods sections

If the authors insist on only assessing the practice of health seeking for danger signs, then the study population should only include those mothers who recognized danger signs in their babies, and the sample size calculated should only be for these population. There is no need to include the mothers whose babies had no danger signs in the initial interviews and in the analysis.

The sampling procedure on Pg 11, lines 116-19 is not clear, how the coding was done and every 6th woman is selected- these need to be explained in more detail.

Results

As already stated above, the effective sample size in this study so far is 231 NOT 410. If it is logistically difficult to get more participants into the study, perhaps the authors should acknowledge this as a limitation in the discussion sections.

Is it possible that care seeking practice could also vary by the particular danger sign, it would be nice to see if there any particular signs for which mothers would most likely seek for care compared to others?

Discussions

Please include study limitations in the discussions as they could be several, add the strengths of the study as well.

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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.

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Reviewer #1: No

Reviewer #2: Yes: Pontius Bayo

[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.

PONE-D-21-24134R1Mothers’ Health Care Seeking Behavior for Neonatal Danger Sign in Southern Ethiopia: Community Based Cross–Sectional StudyPLOS ONE

Dear Dr. Mesele,

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 03 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,

Sungwoo Lim, DrPH

Academic Editor

PLOS ONE

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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: (No Response)

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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: Yes

Reviewer #2: No

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

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: No

**********

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: this is an important study , the corrections ahve been done adequately and the manuscript can be accepted now.

Reviewer #2: Comments:

1. While the subject matter in this study is important, the grammar still needs a lot of improvement at least to show some of the missing references and an understanding of definitions. For example in introduction: The first sentence line 54 requires an addition of a reference. The sentence is also technically confusing. Which is the newborn period? As far as I know, this period is up to one month while the infants are up to one year.

2. Many comments are not yet adequately addressed:

a. The authors acknowledge on line 77 pg13 that the ‘knowledge’ of danger signs influence the ‘practice’ of health seeking and their response is simply that this has been assessed separately. I suggest the authors include this in their literature review under introduction and provide the knowledge levels that currently exist.

b. The response “the term used ‘Solitary’ is not to stat only but to explain as little or no enough study have conducted in Ethiopia. Please understand what I want to say” is still not adequate in my view. I see the word ‘solitary’ has been changed to ‘limited’ but the issue raised in the comment was actually to discuss the findings of these limited studies and identify the gaps that this study would like to address. This is usually the origin of new studies covering the same subject.

c. In methods section: The issue of sampling and sample size remains largely unaddressed. Yes, the prevalence of danger signs is 56.3% but this is not what the study is set up for. It is the those who developed these danger signs we are interested in- how many sought care and what influenced their behavior?

**********

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: Yes: Dr Varsha Vekaria-Hirani

Reviewer #2: No

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[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.

PONE-D-21-24134R2Mothers’ Health Care Seeking Behavior for Neonatal Danger Sign in Southern Ethiopia: Community Based Cross–Sectional Study

PLOS ONE

Dear Dr. Mesele,

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 Jan 07 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:

• 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,

Sungwoo Lim, DrPH

Academic Editor

PLOS ONE

Journal Requirements:

Additional Editor Comments (if provided):

We think that current responses and edits do not sufficiently address comments raised by reviewers. Please make sure to adequately address reviewers' comments (attached below) with full details and revisions. 

Comments:

1. While the subject matter in this study is important, the grammar still needs a lot of improvement at least to show some of the missing references and an understanding of definitions. For example in introduction: The first sentence line 54 requires an addition of a reference. The sentence is also technically confusing. Which is the newborn period? As far as I know, this period is up to one month while the infants are up to one year.

2. Many comments are not yet adequately addressed:

a. The authors acknowledge on line 77 pg13 that the ‘knowledge’ of danger signs influence the ‘practice’ of health seeking and their response is simply that this has been assessed separately. I suggest the authors include this in their literature review under introduction and provide the knowledge levels that currently exist.

b. The response “the term used ‘Solitary’ is not to stat only but to explain as little or no enough study have conducted in Ethiopia. Please understand what I want to say” is still not adequate in my view. I see the word ‘solitary’ has been changed to ‘limited’ but the issue raised in the comment was actually to discuss the findings of these limited studies and identify the gaps that this study would like to address. This is usually the origin of new studies covering the same subject.

c. In methods section: The issue of sampling and sample size remains largely unaddressed. Yes, the prevalence of danger signs is 56.3% but this is not what the study is set up for. It is the those who developed these danger signs we are interested in- how many sought care and what influenced their behavior?

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

[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.

Mothers’ Health Care Seeking Behavior for Neonatal Danger Sign in Southern Ethiopia: Community Based Cross–Sectional Study

PONE-D-21-24134R3

Dear Dr. Mesele,

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.

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Kind regards,

Sungwoo Lim, DrPH

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All the comments have been adequately addressed.  

Reviewers' comments: