Trend and associated factors of cesarean section rate in Ethiopia: Evidence from 2000–2019 Ethiopia demographic and health survey data

Rahel Mezemir; Oladapo Olayemi; Yadeta Dessie

doi:10.1371/journal.pone.0282951

Peer Review History

Original SubmissionMarch 17, 2022
10 Oct 2022 Decision Letter - Faisal Abbas, Editor PONE-D-22-08008 Trend and associated factors of cesarean section rate in Ethiopia: evidence from 2000-2019 health survey of Ethiopia PLOS ONE Dear Dr. Abebe, 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. ============================== Major revisions ============================== Please submit your revised manuscript by Nov 19 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. 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Additional Editor Comments: major revisions. [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: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? 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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: 1) i think authors should not mention which software they have used for estimation in abstract. 2) In the last paragraph of introduction, please mention the value addition of the study. 3) Please add another section of literature review after introduction. 4) Why did you use this methodology,method of estimation,please give concrete justification, similarly, why did you select these variables, please explain in detail. 5) Always compare and contrast your findings with the existing literature and elaborate are they similar with the previous studies or there is any difference and how and why? 6) Conclusions, need a serious consideration. Please rewrite it, also add policy implications, limitations of the study and way forward. Reviewer #2: The paper is very poorly structured. The authors stated that they applied multilevel logistic regression model but I did not found the model in the paper. I did not found any which variables are used at first level, second level and so on. They have not mentioned the how many level variables were used in this study. The authors give unnecessary details of data. ****** 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: Yes: Muhammad Irfan Malik ******** [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. https://doi.org/10.1371/journal.pone.0282951.r001
Revision 1
14 Nov 2022 Author Response Academic editor 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming Response: Thank you so much for the suggestion; the file's name has been updated to reflect the requirement's style.Hopefully, the style requirements are stick to guideline. 2. . We suggest you thoroughly copy edit your manuscript for language usage, spelling, and grammar. Response: thank you again for your suggestion, the language usage, spelling, and grammar were amended and highlighted with yellow colour on the main manuscript in the file name “support information Reviewer reports: Reviewer #1: 1. I think the authors should not mention which software ,they used for estimation in the abstract. Response:The author’s would like to thank this reviewer for his constructive comments and suggestion. The suggestion was well accepted the authors removed Extended Mantel-Haenszel and STATA 14.1 software from the abstract of the main manuscript 2. In the last paragraph of the introduction, please mention the value addition of the study. Response:: Again the author’s would like to thank the reviewer for his critical reviewing the relevance of our work, The authors tried to list a few points on the additive value of this study, for instance, the study observing 24-year trend data which highlights national level characteristics.This could lead to policy decisions at the national level and it helps the concerned body that seeks large data (page number 5 and line number 99). Another additive value of this study.included important factors which were not listed in another study that was associated with cesarean section ratelike;,the size of the baby (very large, average, and small )and parity. 3. Please add another section of the literature review after the introduction. Response: The authors acknowledge the suggestion was given from the review, but it did not meet PLOS ONE's manuscript style requirements. According to PLOS ONE the style ofrequirement literature review is part of the introduction and authors follow this guideline ;thus, the literature review is included in the main manuscript at end of the introduction ( page 4, lines number 72-90). 4. Why did you use this methodology, and method of estimation, please give a concrete justification, similarly, why did you select these variables, please explain in detail. Response; I would like to thank the reviewer'squestion, it is an important concern. Briefly, the study was performed using cross-sectional data obtained from the Ethiopia demographic and health survey (EDHS) conducted in 2000, 2005, 2011,2016, and 2019. These all were nationally representative household surveys conducted by the Central Statistical Agency of Ethiopia. Therefore, the reason for using this methodology in the current study was: I. The EDHS is the only source of nationally representative household surveys that provide a wide range of data on several health indicators including cesarean sections. II. The current study investigates data starting from 1995 to 2019year, which was a 24-year trend of cesarean section rate in Ethiopia,thus, this kind of big data is difficult to access through the primary source data or chart review. Furthermore, this kind of national datais performed meticulously to give sufficient statistical power for analysis. III. As we explained previously, the data is big and conducted from eleven regions and two municipal governments of Ethiopia, so all the data is aresummarized in one big figure and making it easy for the reader to look into the whole picture of the problemand to identify the gap. Response; The reason for the selection of these variables that used in the current study was firstly, the author search different literature by using the following major database, PUBMED/MEDLINE, HINARI, Google scholar and the key terms used in PubMed search wascesarean section OR abdominal surgery ” AND “ trend OR pattern OR magnitude OR prevalence OR distribution ‘’AND” associated factors “AND “Ethiopia OR Africa OR/ world. after searching all this literature we selected the statistically significant variable. And then the author used two strategies to select these variables: A. individually choose the independent variable based on their relationship with or influence on the dependent variable B. and choose independent variable based on their contribution to the model’s overall performance in explaining the variance of and forecasting the dependent variable Finally, before running the final model, multicollinearity was assessed by using the variance inflation factor. Variables highly correlated with other independent variables were excluded from the final multinomial logistic regression model. 5. Always compare and contrast your findings with the existing literature and elaborate are they similar to the previous studies or if there is any difference and how and why? Response; The author’s thank the Reviewer for highlighting this point, the author made extensive amendments to the discussion part and saw in detail in the main manuscript. 6. Conclusions need serious consideration. Please rewrite it, and also add policy implications, limitations of the study, and way forward. Response; the author rewrite the conclusion and added policy implementation in the main document of the manuscript, but the author put the limitation of study at end of the discussion part(page 30, line number 413-41) because there is no separate heading for the limitation of the study in PLOS ONE manuscript guideline. Reviewer #2 1. The paper is very poorly structured. The authors stated that they applied a multilevel logistic regression model but I did not find the model in the paper. I did not find any of which variables are used at the first level, second level, and so on. They have not mentioned how many level variables were used in this study. The authors give unnecessary details of data. Response; Thank you very much for your constructive question and suggestion, (that shows the model below the description for the question. The four models were carried out for factors related to CS rate. The first model was an empty model that was used to calculate the random variability in the intercept and there was no variable in this model. The second model estimated the influence of individual-level factors on CS delivery. Variables like; the mother's age, ANC visit educational level, wealth quantile, BMI, parity, and birth order are included in model II ; The third model looked at how community-level factors are associated with CS delivery. The variable included in model III;are residence and region. The fourth model computed the influence of individual and community-level factors on cesarean delivery. The variable included in model IV is;the mother’s age at birth, education, BMI, parity, birth order, ANC visit, type of pregnancy, residence, and geographical region. the detail description (page 24-25), line number 331, ,Table 4. Multilevel multivariable logistic regression output for cesarean section rate among live births in Ethiopia 2016) Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0282951.r002
17 Jan 2023 Decision Letter - Temesgen Muche Ewunie, Editor PONE-D-22-08008R1Trend and associated factors of cesarean section rate in Ethiopia: evidence from 2000-2019 Ethiopia demographic and health survey dataPLOS ONE Dear Dr. Abebe, 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 Mar 03 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, Temesgen Muche Ewunie Academic 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. Additional Editor Comments: The authors should revise the figures and tables as per the Journal submission guideline, and try to produce figures with good resolution. [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: (No Response) Reviewer #2: 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 #1: (No Response) Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: 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 #1: (No Response) 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: (No Response) Reviewer #2: 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 #1: (No Response) Reviewer #2: The authors explore an import social issues of our society. The C-section is very common issue in developing countries. I really enjoyed the reading of this paper and I have some issues with the writeup. Authors have comprehensively addressed all the issues raised by me on previous draft of the paper. ****** 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 #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. https://doi.org/10.1371/journal.pone.0282951.r003
Revision 2
26 Feb 2023 Author Response Rebuttal letter Manuscript ID: D-22-08008 Manuscript Title: Trend and associated factors of cesarean section rate in Ethiopia: evidence from 2000-2019 health survey of Ethiopia I thank again the editor and two reviewers very much for their response and suggestions on tour manuscript. To show our response to each point raised by the editor as below. The authors included the response within the response to reviewers' box in the submission system and modifications are highlighted to changes the original version of the main manuscript. The authors addressed all the issues raised by the Editor. I hope that the response satisfied you all. The revisions significantly improved the manuscript. Sincerely On behalf of all the authors Rahel Mezemir. Response to comments 1. The authors should revise the figures and tables as per the Journal submission guideline, and try to produce figures with good resolution Response: The authors would like to thank the editors for their constructive comments and suggestions. The suggestion has well accepted the modification of the table and figure made according to PLoS one journal requirements. 2. Concerning the reference list, the authors changed the reference style from Vancouver to PLoS style in a word document in the menu of the reference style list .The authors did not use retracted paper in the reference list. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0282951.r004
28 Feb 2023 Decision Letter - Temesgen Muche Ewunie, Editor Trend and associated factors of cesarean section rate in Ethiopia: evidence from 2000-2019 Ethiopia demographic and health survey data PONE-D-22-08008R2 Dear Dr. Abebe, 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, Temesgen Muche Ewunie Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0282951.r005
Formally Accepted
6 Mar 2023 Acceptance Letter - Temesgen Muche Ewunie, Editor PONE-D-22-08008R2 Trend and associated factors of cesarean section rate in Ethiopia: evidence from 2000-2019 Ethiopia demographic and health survey data Dear Dr. Mezemir: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Mr. Temesgen Muche Ewunie Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0282951.r006

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