PONE-D-21-13771

Facilitators and barriers of pregnant women’s intention to use maternal waiting home in Southern Nations, Nationalities and Peoples Region, Ethiopia

PLOS ONE

Dear Dr. Mosa,

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 Sep 19 2021 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: http://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,

Michelle L. Munro-Kramer, PhD, CNM, FNP-BC

Academic Editor

PLOS ONE

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. 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

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

"Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

3. Please amend the manuscript submission data (via Edit Submission) to include author Manayeh Mulusew.

Additional Editor Comments (if provided):

Thank you for submitting your manuscript on this important topic. Both reviewers noted that this manuscript could be a substantial contribution to the literature, while also identifying numerous areas where clarification and copy editing are necessary. I recommend that the authors carefully attend to each reviewer comment. In addition to the reviewer comments, I would also suggest:

1) Page 12, lines 100-102, providing some context/definitions on what the different administrative regions mean (e..g, kebeles, health posts)

2) Page 13, lines 142-143 & Page 14, lines 152-156, more details are needed on the training for data collectors. How were they trained and what does it mean that they had close supervision? Did the data collectors complete the survey or did participants complete the survey or did it depend on literacy?

3) I also concur with Reviewer #1, that submitting the questionnaire is very valuable, but not all readers will review it. It is therefore important to provide examples of the survey items within the text.

We look forward to receiving your revised manuscript.

[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: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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: Yes

Reviewer #2: Yes

**********

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: No

**********

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 article adds to the growing literature being published on maternity waiting homes and adds specific insight relevant to the Ethiopian context. Additionally, it adds to the specifically scarce literature on intention to use MWHs. The authors provide sufficient justification for the research as there is currently no information on intention to use MWHs in the specific region of Ethiopia in which the research was conducted. The article generally appears scientifically sound and the conclusions are supported by the data. Generally, the writing is clear and the processes are easy to follow. The authors cite relevant literature about MWHs. I have a number of major and minor ones to be addressed before publication of the article should be considered.

Major revisions

1) Title: The title of the article is inaccurate. This article is not about barriers and facilitators to pregnant women’s intention to use MWHs. It is about the factors associated with that intention – Women’s individual-level characteristics and their obstetric history. Other articles have been published about the barriers and facilitators to use MWHs and usually have asked women qualitatively what their experience has been.

2) Premise of article: All of the questions in the survey ask specifically about intention to use MWHs for 15 days but this is not brought up in the methods, discussion, or limitations. This aspect needs to be addressed. It could be considered a major limitation of the study as women who may have intended to use the MWH for only 10 days or even for 18 days, may have answered all of the intention to use questions in the negative because of how specific they were. While 15 days may be recommended by the Ethiopian Ministry of Health (assumption), it does not mean all women will follow this directive to the letter. I suggest including the 15 day aspect in the article title, explaining it in the methods, including it in table titles and subheadings, and discussing the implications of the 15 days in the discussion, including as a limitation. Include an explanation on why the 15 days was specifically chosen, how it relates to government policy or other MWH use guidelines if at all, and how it relates to the average length of stay of MWH users in Ethiopia and elsewhere.

3) Introduction: Paragraph 2 of the introduction (or a small additional paragraph) should include findings to date on the impact of MWHs on maternal and neonatal health outcomes. While an important study in Ethiopia was cited, there are other articles which address the impact of MWH in sub-Saharan Africa on maternal mortality, facility delivery rates, stillbirths, and caesarian section rates. Lines 86-87 should be moved to this paragraph and include those citations.

4) Introduction: The last sentence of the introduction is passive. I suggest making it active and engaging. For example: “…sustainable development by providing relevant MWH information and advice to policy makers and implementers in Ethiopia.” See my point below on weaving this into the discussion.

5) Methods: When discussing sampling, clarify and simplify the description. The sentences jump back and forth between source and sample populations. Describe the linear process followed from identifying the source population to selecting the sample

6) Methods: How were the education categories in the questionnaire chosen? These do not appear to be standard, such as what is used in the Demographic and Health Surveys. The authors should include a citation if they have one.

7) Methods: Give examples of questions included in the survey for intention to use MWHs, attitudes toward MWHs, and subjective norms toward MWHs. Not all readers will examine the supplemental questionnaire, so having an example of each in the text would be helpful. However, I appreciate the authors including the questionnaire, it was helpful to have.

8) Methods: Was gestation age considered in the exclusion criteria or in the analysis? It was asked in the survey but not included in the tables. What if the woman had not considered use of the MWH because they were only a few weeks pregnant? Gestational age of the respondents should be included in Table 1 and in the linear regression model if significantly associated with MWH intention.

9) Methods: In the questionnaire, all behavioral belief and outcome evaluation questions were written in the positive and many sound leading. There are no negative views of the MWHs for participants to agree or disagree with. Include an explanation in the methods for how these questions were developed and why the authors chose to write them all in the positive. The authors should include discussion around the possibility of social desirability bias and acquiescence bias in the limitations section. Were the midwives who collected the data from within the health facilities accessible to the population? This could also increase social desirability bias if the participants knew them.

10) Methods: The article would benefit from having a study setting to provide more information on the health system in this region of Ethiopia and the state of MWHs. Since the government is encouraging MWH use, has it also built new MWH structures or are the structures community constructed? Are MWHs only located at primary health centers, only at hospitals, or both?

11) Discussion: In the first sentence of the discussion (lines 262-263), the authors write that the purpose of the research was to find out what factors influenced pregnant women’s decisions to use MWHs. This is not supported by the results. The authors only know what demographic characteristics about the women and their previous obstetric history are associated with intention to use MWHs. They do not know what goes into women’s decision-making regarding barriers they face to access, desire for a safe delivery, have permission or support from their partner, etc.

12) Discussion: The discussion is missing policy or implementer implications. There is a sentence about this in the conclusion that should be included in the discussion and expanded upon. What this research means in terms of suggestions for what Ethiopia’s national strategy regarding MWHs is a critical missing piece.

13) The article requires English language editing and revisions specifically for sentence structure and grammar, particularly verb tense. The writing could generally be tightened up and shortened. The sampling and “factors associated with intentions to use MWHs” are two particular examples of sections that could be tightened up.

14) It would be helpful to provide the location of a cvs file for the data in addition to or instead of the SPSS file as not everyone uses or has access to SPSS. A csv file would allow even users with free software (such as R) to analyze the data. This does not need to be included as a supplementary file, though it can be. It could be housed in a data repository.

Minor revisions

1) General: Consistently use maternity waiting homes throughout the article and the title. The authors switch between maternal and maternity throughout the text when discussing the waiting homes.

2) Abstract, Conclusions: “Almost half” should say “More than half”

3) Key words: Use key words not already included in the title of the paper to reach more readers. I suggest: obstetric care, maternal health, maternal waiting home, sub-Saharan Africa

4) Introduction: What does the sentence beginning paragraph 3 mean? While the list of factors associated with MWH use is technically accurate, it is not engaging for the reader. Consider breaking it down into smaller sentences with logical groupings. For example, the authors could group by individual, interpersonal, and health systems factors.

5) Methods: In the text and tables, clarify which pregnancy the questionnaire asked about. For example, for “Number of ANC visits”, it is unclear whether this is about the current pregnancy or the last one.

6) Methods: How were the reference categories chosen in Table 3. Clarify in the methods.

7) Methods: Lines 124 through 126 on principal component analysis should be moved to the analysis section and include a citation.

8) Methods: I am unclear what the sentence on lines 126 to 127 means. Please clarify.

9) Methods: Lines 151 to 152: “The questionnaire’s validity and reliability was determined in a scientific manner.” The meaning of this sentence is unclear.

10) Table 1: How was time to reach health facility determined and by what transport method? Were women asked time without reference to transport method? Clarify in the methods and in the indicator title in Table 1.

11) Table 1: What does “Number of households” mean? Does this mean number of household members? Clarify.

12) Results: Include the table reference in parentheses, in the first sentence in which data from the table is described. For example, the reference to Table 3 should be in the first sentence of the sub-section, not the last.

13) Discussion: include citations for known barriers to accessing health facilities (lines 276-278)

Reviewer #2: Because PLOS ONE does not copyedit accepted manuscripts, the authors should employ an editor to assist with ambiguous and grammatical errors that appear throughout the text. There are multiple grammar and sentence structure corrections that are required prior to publication.

**********

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: No

Reviewer #2: No

[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.

Attachments

Attachment

Submitted filename: Manuscript Review_PONE-D-21-13771.doc

PONE-D-21-13771R1Pregnant women’s intentions and factors associated with maternity waiting home utilization in rural districts of Hadiya Zone, Southern EthiopiaPLOS ONE

Dear Dr. Mosa,

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.

The manuscript has been evaluated by two reviewers, and their comments are available below.

The reviewers have raised a number of concerns that need attention.

Could you please revise the manuscript to carefully address the concerns raised?

Please submit your revised manuscript by May 13 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,

Sebastian Shepherd

Associate Editor

PLOS ONE

Journal Requirements:

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. 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 #3: (No Response)

**********

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 #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: 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 #3: 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 #3: 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 article adds to the growing literature on maternity waiting homes internationally and specifically in Ethiopia. The authors have addressed all previous comments from reviewers. It is a much stronger article and ready for publication.

Reviewer #3: Major comments;

1. Researchers used systematic sampling technique to recruit respondents. But it is not clear how the sampling frame was established? Did you do household listing? And subsequent household was contacted in cases of no pregnant woman in the selected household. It means that every pregnant woman did not have an equal chance of selection and induces bias.

2. Most previous studies identified maternal education and distance to health facility predicts use of/ intention to use MWHs. But in this study these variables are not included in the multivariable analysis. Please force retain them in the multivariable analysis and discuss and interpret possible lack of association with the outcome variable

3. Number of ANC visit would possible be confounded or modified by gestational age. Please add gestation age in the analysis and possible interaction term. Otherwise, interpretation of # of ANC would be misleading and ambiguous

4. Multiple grammatical errors that need to be fixed.

Minor comments;

1. The Title seems a qualitative study design. I would drop “Facilitators and barriers” and replace associated or predictors factors

2. Line 57, replace majority by most

3. Line 58-61, update by MiniDHS 2019 findings

4. Line 69, remove, between that and MWHs

5. Line 72-73, contradictory evidence regarding wealth. Check that

6. Paragraph 3 is too long and difficult to catch. Reorganize/theme factors and narrate in a separate paragraph

7. Line 92-93, significance of the study is a bit exaggerated. Discount to … would help program managers and service providers to design appropriate interventions….and provide appropriate care for pregnant women….

8. Sub-title the settings, design, sample size and sampling techniques

9. Line 101, define kebele here; that means move the definition in line 105 here

10. Line 123, how fundal height is measured at home?

11. Line 124-127, move it to “Measurement” section

12. In the definition of terms like positive subjective norms, please give items included to measure such terms

13. Line 147, report exact value of alpha

14. Line 147, what are the local languages used? Hadiyigna and Amharic? Please specify

15. Line 149, change hadiya to Hadiya. Same comment throughout the manuscript

16. Line 150, specify what changes did researchers made after pre-testing

17. Line 179, what type of treatment? This is confusing as this is a household survey.

18. Line 183, replace majority by most

19. Line 182, as researchers replace respondents/household, I don’t think there is a need to report response rate.

20. Line 189-190, specify obstetric complication and ANC4+ are from current or past pregnancy

21. Table 1, categorize marital status as in union and not in union; number of households not clear if it is to mean number of household members correct as such; time taken to reach facility in minutes; specify means of transport (it is walking, by car, etc.)

22. Table 2, number of ANC visits ever received; change still birth to stillbirth

23. Discussion section, use odds of… rather than more likely…

24. Line 314-15, recall bias is a problem not only for the outcome variable but also for the predictor variables too. Please also add social desirability bias and mention techniques you applied to minimize such biases

25. Line 329, please acknowledge Hossana College of Health Science for funding the study

**********

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: No

Reviewer #3: Yes: Gizachew Tadele Tiruneh

[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-21-13771R2

Pregnant women’s intentions and factors associated with maternity waiting home utilization in rural districts of Hadiya Zone, Southern Ethiopia

PLOS ONE

Dear Dr. Mosa,

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.

==============================

Reviewers have continued to note that this manuscript could make an important contribution to the literature on maternity waiting homes. I had the pleasure of reviewing the manuscript myself during its initial evaluation. After assessing your most recent response to reviewers, I have identified multiple items raised by Reviewer 3 that have not been sufficiently addressed in your resubmission. These require a Major Revision to the manuscript. Please address the below listed items and resubmit the manuscript. I have retained Reviewer #3's original numbering below for ease of comparing with your most recent response to reviewers. I have included a few clarifying notes within parentheses.

Unaddressed Points Raised by Reviewer #3:

1. Researchers used systematic sampling technique to recruit respondents. But it is not clear how the sampling frame was established? Did you do household listing?

2. Most previous studies identified maternal education and distance to health facility predicts use of/ intention to use MWHs. But in this study these variables are not included in the multivariable analysis. Please force retain them in the multivariable analysis and discuss and interpret possible lack of association with the outcome variable.

3. Number of ANC visit would possible be confounded or modified by gestational age. Please add gestation age in the analysis and possible interaction term. Otherwise, interpretation of # of ANC would be misleading and ambiguous

9. Line 101, define kebele here; that means move the definition in line 105 here (i.e. define Kebele the first time it is mentioned in the text)

10. Line 123, how fundal height is measured at home? (i.e. gestational age)

12. In the definition of terms like positive subjective norms, please give items included to measure such terms (ensure items used to construct this indicator are explained within the methods)

17. Line 179, what type of treatment? This is confusing as this is a household survey. (Is this treatment at the health facility as the interviewers were midwives? This requires explanation within the text)

I concur with Reviewer #3 regarding the need to clarify gestational age within the analysis as gestational age does not appear to have been accounted for. If gestation age was an eligibility criteria it should be described in the methods as such. If it was not considered within the study, that should be explained in the limitations. I further concur with Reviewer #3 that "positive subjective norms" requires further explanation within the methods. While "5 items" is stated on Line 146, information on what those five items are is not provided.

In addition, as PLOS ONE does not offer copy-editing services at the final stage of publication, this manuscript still requires some English editing for sentence structure, grammar, and word choice. The manuscript also requires editing for minor formatting issues (e.g. double spaces within tables, incorrectly located header for Table 3, the spelling of "newborn" without a hyphen).

==============================

Please submit your revised manuscript by Jun 18 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,

Jeanette L Kaiser, MPH

Guest Editor

PLOS ONE

[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.

PONE-D-21-13771R3Pregnant women’s intentions and factors associated with maternity waiting home utilization in rural districts of Hadiya Zone, Southern EthiopiaPLOS ONE

Dear Dr. Mosa,

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 Oct 16 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,

Jeanette L Kaiser, MPH

Guest Editor

PLOS ONE

Additional Editor comments:

Thank you for your submitted revisions. Comments from the reviewers are included below. The reviewers advise additional copy editing of the manuscript for grammar, spelling, and spacing. As PLOS ONE does not provide copy editing services before publication, this is the responsibility of the authors. Please ensure all grammatical, spelling, and formatting errors are corrected with resubmission of your manuscript. [Note: HTML markup is below. Please do not edit.]

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: (No Response)

Reviewer #3: All comments have been addressed

**********

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

**********

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

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

**********

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: No

Reviewer #3: 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 #2: Grammatical, spelling and spacing errors throughout the manuscript.

In response to reviewer #3, the authors have added definitions of terms but they seem misplaced in the manuscript. I would recommend using a secondary section in the methods section where these definitions are listed and not just dropped into the methods section.

Please add information on the informed consent process of participants within the data collection description for better flow.

How is “wealth status” calculated/defined?

Line 297-299: “This finding implies that, as long as the issue of service quality is addressed, women in the wealthier quintiles can be encouraged to use MWHs.” I don’t believe the authors provide the data to support this statement.

Reviewer #3: Minor comments

1. This paper would benefit from an academic editor

2. Fix grammatical errors such as line 84, change the word moms to mothers or women; line 85, don't hyphenate newborns; line 92, remove double ","; line 116, change the word are by were and specify the period; line 120 change the word Health Centers to health centers; line 133-134, the sentence is not clear ( is that to mean proportional allocation was made to Kebeles?); line 149 drop "for institutional"; line 169 and 173 change the word was to were; line 219 change multifarious to multiparous; line 309 change the word above to more

3. Line 129, the source population is 1.65 million; why the authors applied finite population correction is not clear.

4. Line 134-137, the sampling interval is not specified; still it is not clear how researchers locate households once systematically selected. Did researchers use local guiders or HEWs to locate households? Please specify

5. Drop some of the operational definitions like SFH; nothing adds to this paper.

6. Line 225, indicate these percentages are from those who intend to stay at MWHs, not from the whole sample

7. Table 3, the values for the variable "distance to health facility" is not correct; please fix it; also add percentage values

**********

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 #2: No

Reviewer #3: No

**********

[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-21-13771R4Pregnant women’s intentions and factors associated with maternity waiting home utilization in rural districts of Hadiya Zone, Southern EthiopiaPLOS ONE

Dear Dr. Mosa,

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.

ACADEMIC EDITOR: The reviewers have noted that this manuscript has made great progress but still requires English language proofing and editing. Reviewer #3 has provided specific instances where the writing can be clarified and improved. Please make these minor changes and resubmit.

Please submit your revised manuscript by Jan 28 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,

Jeanette L Kaiser, MPH

Guest Editor

PLOS ONE

Journal Requirements:

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. 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 #3: (No Response)

Reviewer #4: (No Response)

**********

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 #3: Yes

Reviewer #4: Yes

**********

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

Reviewer #3: Yes

Reviewer #4: Yes

**********

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 #3: Yes

Reviewer #4: 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 #3: No

Reviewer #4: Yes

**********

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 #3: Dear authors,

• Title: change to "Pregnant women’s intentions to use maternity waiting homes and its associated factors in rural districts of Hadiya Zone, Southern Ethiopia"

• Still, this needs to be edited by an academic editor. Please also fully address the comments. For instance, the following grammatical errors are not addressed: line 84, change the word “moms” to “mothers or women”; line 85, don't hyphenate newborns; line 116, change the word “are” to “were” and specify the period; line 149 drop "for institutional"; line 170 change the word “was” to “were”;

• Line 26, change the word "raise" to "expand"; line 28, drop the phrase "across the world"' line 69, drop the word "dangerously"; line 75-78, change by "Furthermore, only about half women were delivered by a skilled provider and 34% of women received a postnatal care check-up within the first two days after birth [3]."; line 76, change "Antenatal" to "antenatal"; line 166, drop the word "LMP";

• Lines 92-93, drop "giving birth in a health facility, receiving skilled care from a trained provider [17, 19]" No temporal relationship between use of MWHs and skilled delivery, unless we asked for previous skilled assistance.

• Table 3, the percentage values for education, distance to health facility, and attitude could not add up to 100%; please fix it by adding column percentages similar to other variables

• Line 132-33, The sentence “Proportional allocation was made to the number of households.” is not clear and how many kebeles were included in the study is not clear. Please replace this with the following sentences in your original manuscript “A lottery method was used to pick ten rural kebeles. According to the approximate number of pregnant women in each kebele, the sample size was distributed proportionally.”

• Check again or consult a statistician about the finite population correction. I think it is applied when the target population (i.e., the entire pregnant women for which the survey data are to be used to make inferences) not the source population (i.e., pregnant women residing in the PSU) is finite

Regards,

Reviewer #4: The document has improved greatly. The authors can improve the document by correcting typo

and grammatical errors and proofing

**********

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 #3: Yes: Gizachew Tadele Tiruneh

Reviewer #4: Yes: Dr Sialubanje Cephas,

School of Public Health

Levy Mwanawasa Medical University

Lusaka, Zambia

csialubanje@yahoo.com

**********

[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.

Pregnant women’s intentions to use maternity waiting homes and its associated factors in rural districts of Hadiya Zone, Southern Ethiopia

PONE-D-21-13771R5

Dear Dr. Mosa,

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,

Jeanette L Kaiser, MPH

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

Congratulations on the acceptance of you manuscript.

Reviewers' comments:

n/a