PONE-D-22-21448Maternal COVID-19 Infection and Associated Factors: A Cross-Sectional StudyPLOS ONE

Dear Dr. Lubeya,

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PLOS ONE

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“MKL& MM would like to acknowledge that some of their time is supported by the UNC-UNZA-Wits Partnership for HIV and Women’s Reproductive Health (Grant number: D43 TW010558). MKL & CCP would like to acknowledge that some of their time is supported by the TESA III Project funded by EDCTP (Grant number: CSA2020NoE-3104). JTP is supported by a career development grant from the US National Institutes of Health (K01 TW010857). We would further like to acknowledge the following research assistants: Ntungo Siulapwa, Kasukula Nathaniel Kaunda, Theresa Shema Nzayinsenga, Anthony Limbumbu, James Nyirenda and Mable Ndambo. Further, we would to thank Everlyn Chirwa and FaydesMalupande Banda, the Nurses in charge of the maternal COVID-19 clinics/wardS at the time of data collection We would also like to thank Caren Chizuni, Safe Motherhood Officer at Zambia’s Ministry of Health Headquarters for the technical support during the study period.”

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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: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

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: No

Reviewer #2: No

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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: 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: This is an interesting study this study aimed at investigating the prevalence

and factors associated with COVID-19 infection among pregnant women at the Levy Mwanawasa University Teaching Hospital and Women and Newborn Hospital of the University Teaching Hospitals in Lusaka, Zambia.

There are a number of issues:

ABSTRACT AND METHODOLOGY

The authors stated: COVID-19 diagnosis was made using a nasopharyngeal swab by PCR test.

The authors should clarify how the test was done either routinely or voluntarily? What is the testing protocols in the study hospitals? How long does the test take to come out? Who paid for the COVID-19 test?

How was the sampling technique achieved in the study?

RESULTS

The authors should begin by stating how many participants were assessed for eligibility and how many were recruited, excluded and reason for exclusion.

Reviewer #2: Reviewer comments

General comment

The tittle is interesting. I appreciate your view. As we know COVID -19 is a global pandemic and pregnant women have more risk than other population, Also no clinical trial was done for pregnant mothers, so knowing risk factors for COVID-19 is important for designing and implementing effective prevention strategies.

Specific comments

I try to address my comments part by part

Introduction

1. In the introduction section paragraph 2. You said “Since the early days of the pandemic, there has been conflicting literature regarding the risk of COVID-19 in pregnant women [5-7]”. What does it mean? I think all your cited article showed that pregnant women are more venerable for COVID-19 than the general population. What was the controversy idea?

Sample size calculation

1. Your sample is not correct. Based on your assumption your sample size 384 (before adding non response rate). After considering 10% of non-response rate the final sample size should be 422. Please check it.

Enrolment procedure

1. As you said in WNH-UTH and LMUTH on average, 9000 and 8000 pregnant women seen annually, also your study period was March and July 2021 (almost 5 months). Accordingly, approximately around 7000 pregnant women visited this two hospitals with in your study period, On the other hand your sample size is 385. How can you draw your sample? Please say something about your sampling technique (how the actual sample was drawn?

2. How do you manage if the women visited the hospitals for more than once during your study period?

Data collection tool

1. What is the difference between pilot study and pretest? Which one is included in the analysis?

Results

1. Some results not give a total of 352 study participant. For example ANC visit, BMI, marital status, education, employed.

2. Delete univariable analysis OR result from the text, it is enough to be presented in the table.

3. What is the final result (multivariable logistic regression) of chronic hypertension?

Discussion

Further, studies have shown that people of colour are at an increased risk for COVID-19 infection which could explain the high prevalence we found at this setting. If there is any evidence cite?

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Reviewer #1: Yes: George Eleje

Reviewer #2: No

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Maternal COVID-19 Infection and Associated Factors: A Cross-Sectional Study

PONE-D-22-21448R1

Dear Dr. Lubeya,

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,

Gbenga Olorunfemi, MBBS,MSC,FMCOG,FWASC

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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

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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: Partly

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

Reviewer #1: Yes

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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

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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

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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: The authors have addressed the comments raised in the earlier review. The manuscript now has better information.

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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: George Eleje

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