PONE-D-22-20619Age of First Diagnosis and Incidence Rate of Uterine Fibroids in Ghana. A Retrospective Cohort Study.PLOS ONE

Dear Dr. EDZIE,

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 manuscript is a beneficial study examining the age-adjusted incidence and preferred age of onset of uterine fibroids in Ghana, Africa, but it lacks novelty. There is some text suggesting the possibility of early diagnosis as to why the incidence is increasing, but the background, for example, the increased use of ultrasound equipment in Ghana or the introduction of MRI scans, is unclear, so it is ultimately difficult to find a basis for the claims made. Also, although the initial diagnosis is discussed, it is difficult to understand whether this is because the public's understanding of uterine fibroids has improved or because check-ups have become more frequent, as there is no information on gynecological check-ups in the country. The background and discussion sections require significant revision. We look forward to receiving your revised vesion in soon.

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We look forward to receiving your revised manuscript.

Kind regards,

Kazunori Nagasaka

Academic Editor

PLOS ONE

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Additional Editor Comments:

This is a very useful study examining age-adjusted incidence and preferred age of onset of uterine fibroids in Ghana, Africa, but lacks novelty. There is some text suggesting the possibility of early diagnosis as to why the incidence is increasing, but the background, for example, the increased use of ultrasound equipment in Ghana or the introduction of MRI scans, is unclear, so it is ultimately difficult to find a basis for the claims made. Also, although the initial diagnosis is discussed, it is difficult to understand whether this is because the public's understanding of uterine fibroids has improved or because check-ups have become more frequent, as there is no information on gynaecological check-ups in the country. The background and discussion sections require significant revision.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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

Reviewer #1: 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: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

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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: Age of First Diagnosis and Incidence Rate of Uterine Fibroids in Ghana. A Retrospective Cohort Study.

Title

• Please review the title, the study design and what was done do not match. Is this relay a cohort study?

English language check

• Language is not clear some sentences could be paraphrased. Please use clear unambiguous professional English throughout the manuscript.

Abstract

• The first sentence should be paraphrased (line 37-39).

• Please stick to using one term throughout the text for consistency and easy flow of ideas (uterine fibroids). Other terms can be introduced and left as such.

• Clearly describe this as a disorder

• Our setting (Line 40)- be specific is it rural or urban?

Introduction

• The introduction is not well written.

• Provide some few statistics on what is happening globally, in Africa and in Ghana to give a clear picture of what is currently happening.

• Line 66-67-the sentences is not clear, paraphrase.

• Line 67-68 work on the flow of ideas, this does not read well.

• Line 76-77 be more specific, is it possible to link the sentence to line 64-65.

• Paraphrase line 82-84.

• The aim could be highlighted or overemphasized for clarity.

Methods

• Describe the study design fully

• Paraphrase line 106-108, “assessed” is not the correct term to use.

• Line 116-118 restructure the sentence does not read well.

• Line 123-126 paraphrase

• Line 127 “consecutively selected” use a better term

• Justify why this is a cohort study

Ethics

• Line 156 please give the official name of the ethical review committee.

Results

• For tables that do not fit in one page enable repeat table titles.

• Line 164-165, line 181“the rests” paraphrase

• Results are fairly well presented.

Discussion

• Line 213-214 add references

• Line 276-277 not clear

• Reference lines 234,239 and 241.

• Consider restructuring the discussion and paraphrasing the sentences for easy flow of ideas.

• Note that there is comparability of the studies referenced, your study was only covering South Central Ghana and most of the studies were national.

Limitations

• Not fully explained.

• What are the strengths of the study?

Conclusion

• It is fairly well stated and linked to the aim.

General comment

• The writing style and the English language can be improved to ensure that the paper can be clearly understood by the international audience, the current phrasing makes comprehension difficult.

• Citations can be presented better to help with the flow of ideas and to avoid repetition.

Reference

• Consistency in presentation (i.e. highlighting and underlining)

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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

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Attachments

Attachment

Submitted filename: Review comments_21.09.2022.docx

Age of First Diagnosis and Incidence Rate of Uterine Fibroids in Ghana. A Retrospective Cohort Study.

PONE-D-22-20619R1

Dear Dr. EDZIE,

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.

Kind regards,

Kazunori Nagasaka

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Dear Authors,

Thank you very much for sending us your responses and the revised manuscript.

I think the manuscript is well-improved and acceptable for publication on Plos One.

Congratulations, and we look forward to your future manuscript.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

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

Reviewer #1: 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

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

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: Age of First Diagnosis and Incidence Rate of Uterine Fibroids in Ghana. A Retrospective Cohort Study.

Abstract

• Line 39. The incidence rate is high among women of all races and ages, needing much attention.

-Consider paraphrasing the above sentence.

Introduction

• The introduction is well written.

• The objectives are very clear.

Results

Table 1. Socio-demographics of the Participants and Annual Mean Age Comparison.

- Please consider presenting age in one row to save space.

- e.g Age 17-61 (36.29 (8.08) years)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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