PONE-D-22-12369Spatial distributions of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health SurveyPLOS ONE

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Additional Editor Comments:

Dear Authors of Spatial distributions of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey

You welcome to consider PLOS ONE for your scientific work. Rigorous scientific review is very important step in science. Your manuscript requires major revision.

Academic editor’s comment

1. PLOS ONE requires data used for this scientific work. Even though you used freely available national data, you are requested to attach the specific data set you used for this analysis.

2. Add key-words from the abstract

3. We saw flaws, and different grammatical and typological errors, hence language edition with experts is required.

4. Please strictly follow the PLOS ONE journal guideline (insert line number for the manuscript, add key words…)

Reviewer 1 comment

- There is a 2020 EDHS report, authors should use more recent data for analysis as changes might of occurred in the country that might have improved or increased prevalence of childhood diseases and utilization of services

- The section on study design was used to describe Ethiopia instead of telling us the type of study, the target population. The study would benefit from a revision of this section.

- What do the authors mean by “probability proportional to segment size”.

- “A total of 10,417 caregivers or mothers of under-five children were interviewed” contradicts the sample size information in the abstract and the result section “10,641”

- “Sick” or “Seek”. I observed the use of the word sick a couple of times. Please correct the word as appropriate

- The term “the two-week prevalence of common childhood illnesses “is not clear. Am not sure this is the term used in the DHS report. Authors need to ensure consistency of terms compared to the EDHS report.

- “Table 1 shows the outcomes and potential predictors for health service utilization”. Table 1 didn’t differentiate between outcomes and predictors. Update table 1 to contain all these variables “age and sex of the child, woman-headed household, age of the mother or caregiver, mothers’ or caregivers’ education level, household size, wealth index, and distance to health facility”.

- This statement “The 94 clusters without sick children and 18 clusters from Somali region without shape files were excluded in the spatial analysis. Therefore, the results of the spatial analysis are based on 531 clusters” however it should be a part of methodology as a limitation of the study

- In the result section, I had expected to see the prevalence of each of the childhood disease which were mentioned in the methodology section however am seeing a description of the prevalence. Authors should endeavor to present the prevalence of the childhood disease

- “*lack adequate number of primary sampling units or observation per stratum to estimate the standard error to get the 95% CI for acute respiratory infection and diarrhoea”. Are you saying only one primary sampling unit had people seeking health care? I think authors should endeavor to check this analysis to ensure accuracy.

- Table 4 seems to be a description of measures. I believe this should be a part of the methodology section

- The figure 1 maps aren’t correct. Prevalence is percentage vales and should represent an area. Dot distribution analysis can’t be used to represent a prevalence analysis. Authors should replot the maps

- Figure 2 don’t represent spatial patterns. Please change the distribution curves to maps. This analysis is not properly carried out

Reviewer 3:

From the title remove S from the word Distributions, it should be distribution

Title: Spatial distributions of common childhood illnesses, healthcare utilisation and associated

factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey

Abstract:

Methods: From the second line “A total of 10,641 children under the age of five years were included in this analysis” so remove “the age of”

Change the phrase interpolation kriging by Kriging interpolation

Background

At the fourth sentence: As we previously have shown, mothers of sick children experience cultural, social, and poverty-related barriers to care-seeking. Replace this sentence by “As shown in our previous paper, mothers of sick children experience cultural, social, and poverty-related barriers to care-seeking”

Methods

Sampling: From the 1st sentence please remove the comma and phrase “which we”

Outcome measurement section: replace the phrase “In the survey, the health status was assessed by the answering to the question to the mother:” by In the survey, the health status was assessed by answering the question to the mother:

Data management part third paragraph 1st sentence replace the phrase “Spatial heterogeneity of significant high or low of common” by Spatial heterogeneity of significantly high or low common..)

Result

The 1st sub heading please replace the word characteristic by characteristics

As you know the result section should focus on what researchers found while the methods elaborate on what we did or what procedures we used. The following sentences should be part of methods not results section “Using hot spot analysis (Getis-Ord Gi*), we classified each cluster as being part of a spatial clustering with hotspot, cold spot at 90%, 95%, or 99% degree of confidence or insignificant. This tool identifies statistically significant spatial clusters of high values (hot spots) and low values (cold spots).” So take these sentences to methods section.

Interpolation of prevalence

The sentences that stated as “Based on the sampled clusters, a Kriging interpolation was used to predict the occurrence of illnesses and care utilization”. This is also methods we applied so remove from the result and put to methods section.

Discussion last paragraph:

Rephrase the paragraph “In our interpolation exercise, the estimated occurrence of common childhood illness was high in the North, central, and Western parts of Ethiopia. Sick child health service utilisation was low in Eastern, South-western and the North-eastern parts of the county. In contrast, care utilisation was more likely high in central, Western, North-eastern parts.”

The following sentences are methods no to be considered as discussion so please remove or take it to methods section.” as Ordinary Kriging and empirical Bayesian Kriging are powerful interpolation methods that optimize the weight (28). The interpolation produced smoothed maps of sick child health service utilisation by predicting the proportion of sick child health service utilisation in the un-sampled locations (enumeration areas).”

Reviewer 4

I would like to mention the following comments:

1- Sampling: DHS must be defined.

2- Sampling: The variation between strata are different in Stratified and cluster random sampling. It needs more explanation.

3- Reliability of questionnaire needs to be mentioned.

4- Due to season differences, two-week prevalence is different for diseases. For example, diarrhoea is more in warm seasons and acute respiratory infection in cold seasons. Please clarify the exact time of year.

5- The number of children in each family might also have an effect on illnesses.

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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: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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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: Yes

Reviewer #3: Yes

Reviewer #4: 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: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: The manuscript is very important to policy making on childhood illness and service utilization patterns which is essential for reducing child morbidity and mortality in Ethiopia. However, it is advisable for authors to revise the result section which has a lot of inconsistency in the analysis method and the presentation of results. I am concerned that great piece of work has not provided sufficiency in the results presented to demonstrate the kind of conclusion that has been provided. This paper will benefit greatly from revision of the methods and result section to ensure the findings are consistent.

I would expect authors to use the Ethiopia DHS 2020 for the revised submission of this manuscript

Reviewer #2: Overcoming the barriers to reduce infant mortality in sub Saharan Africa is of outmost importance. This work is a much needed contribution. Poverty and distance to the clinic were the major factors that affected service utilization according to this this study.

Question is ..how exactly did you measure maternal literacy what level of education did the mother have to be considered literate?

Reviewer #3: This is a very important study. Kindly pay attention to every comment and everything highlighted, underlined, or struckthrough in the attached reviewed manuscript. Hover the cursor on the highlight, underline, or strikethrough to see more comments. Kindly copy them out and address them.

Most of the statements under Results and Discussion sections are marked to be rephrased. They should be transferred to the appropriate sub-heading under Materials and Methods.

For the interpolation exercise under discussion, kindly state the implication of the results.

Reviewer #4: I would like to mention the following comments:

1- Sampling: DHS must be defined.

2- Sampling: The variation between strata are different in Stratified and cluster random sampling. It needs more explanation.

3- Reliability of questionnaire needs to be mentioned.

4- Due to season differences, two-week prevalence is different for diseases. For example, diarrhoea is more in warm seasons and acute respiratory infection in cold seasons. Please clarify the exact time of year.

5- The number of children in each family might also have an effect on illnesses.

Good Luck

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: Yes: Masoud Amiri

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Submitted filename: Reviewers comment.docx

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Submitted filename: PONE-D-22-12369_reviewer_revised.pdf

PONE-D-22-12369R1Spatial distribution of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health SurveyPLOS ONE

Dear Dr. Defar,

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 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:

• 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Rajesh Raushan, PhD

Academic Editor

PLOS ONE

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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.

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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 #2: All comments have been addressed

Reviewer #3: (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 #2: Yes

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: N/A

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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 #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: 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 #2: The authors spent time addressing the questions asked apart from the data which is not available on public domain but is otherwise accessible

Reviewer #3: Thank you for the great improvement from the previous version. Kindly address line 220 [Therefore, the results of the spatial analysis are based on 531 clusters.] It should be ... were based on ...

One other suggestion was not addressed - repetition. Lines 288-297 has repeated phrases/statement to lines 310-314. Harmonize these paragraphs. Make them one paragraph.

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Reviewer #2: No

Reviewer #3: No

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Spatial distribution of common childhood illnesses, healthcare utilisation and associated factors in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey

PONE-D-22-12369R2

Dear Dr. DEFAR,

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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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.

Additional Editor Comments (optional):

Thank you for addressing the relevant comments and revised manuscript accordingly in well scientific manner. When looking for explanatory variables regulating treatment seeking behaviour you have considered in the OLS model, household economic status and distance found significant are consistent with the previous study. But, the mother's education found insignificant possibly due to small sample size of literate mothers in some of the clusters, as most of the studies have found mother education as a strong regulating factors for health services utilization.

Just check for grammatical editing and follow requirement of PLOS ONE publication process.

Kind regards,

Rajesh Raushan, PhD

Academic Editor

PLOS ONE

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