Market-based approach to promoting home fortification of diets with micronutrient powder through volunteer frontline health workers: A qualitative study

Mahfuzur Rahman; Md. Fakhar Uddin; Tahmeed Ahmed; Haribondhu Sarma

doi:10.1371/journal.pone.0283306

Peer Review History

Original SubmissionFebruary 9, 2022
3 Oct 2022 Decision Letter - Ilias Mahmud, Editor PONE-D-22-04029Market-based approach to promoting home fortification of diets with micronutrient powder through volunteer frontline health workers: A qualitative studyPLOS ONE Dear Dr. Rahman, 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 23/10/2022. 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, Ilias Mahmud, PhD 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. We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 4. 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. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 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 paper describes a qualitative evaluation of an existing market-based intervention promoting the sale of MNP by FHW in four districts of Bangladesh, with two identified as high performing and two identified as low performing. Overall, the writing and analysis could be tightened and strengthened. There are some interesting and relevant findings, but the design (high and low performers) is not relevant in the way the results are reported and it’s unclear if sample sizes are sufficient for the stratification despite authors reporting they reached saturation. More details are needed regarding the original program and evaluation methods. The conclusions focus on more implementation science research needed but there’s a gap/role for government and oversight of interventions and policies that warrant mentioning. Some specific suggestions and questions below. It seems the FHW also play a role as trouble shooters when caregivers experience problems with MNP, but not clearly stated in initial descriptions. Also, text doesn’t describe how FHW link IYCF/MNP and how/if support other IYCF so please clarify. Both WHO and HF-TAG state that MNP should be integrated with IYCF programs. Reader doesn’t know what this means “(c1, c2, c3, c4…cn),” possibly refers to counseling opportunities? What was the suggested MNP intake regimen being suggested by FHW? Overall, there’s no description of how FHW were trained and how program was supposed to be implemented and be effective, other than high level saying FHW sold MNP to mothers. Reader finds out part way through the paper that FHW sell other products. Authors assume reader understands their program without providing information. More details about program design would help reader understand results (e.g., how are FHW recruited, trained, how often are they supposed to get supplies to sell, interact with caregivers? Authors reported trouble counseling mothers, but were they even trained to address this?) Switches from FHW to CHW mid-way through paper. Further details (e.g., #, %) about how high/low performers and low sales were defined and assessed, this would improve reader understanding of differences between the two groups. Also, paper explicitly says anemia reduced as a criteria for high/low but no evidence provided. Reports number when saturation occurred but not planned number of interviews, what were potential # to be interviewed? It’s unclear in methods total number of FGD vs individual interviews (or other types) conducted, suggest presenting in a table with numbers described for each (e.g., was it 2 FGD with 15 mothers total, for example? Noted later some of this is stated in results, but that’s too late and overall unclear to reader how many individual vs FGD vs other). Noting samples sizes are low and should be stated as a limitation, minimum sample size for stratification in qualitative data collection is 3 (and that’s low) and authors note 2 per multiple stratifications, recognizing limited number of districts. Achieving saturation at 2 interviews is a limitation. Was a software used for coding and analysis? Suggest avoiding acronyms for BRAC job descriptions - for readers unfamiliar it’s a challenge to remember what they mean and there are multiple used throughout the paper. “On due payment” means to pay later? It seems there’s uncontrolled delivery of interventions in the area that are not coordinated or known (?) by government with so many delivering MNP for free or different price points. It would be impossible to be successful with higher cost product in this environment unless others were perceived inferior. Deserves mention of role of govt to approve interventions and coordinate etc. The design was focused on high and low performers, which is a good idea, but the authors do not present/discuss results using that stratification. Were there no differences? Either way, this should be noted in results or discussion. Reference #1 has been updated for WHO in 2020 and 2011 is old/out of date. Appreciate there has not been too much published on market-based sales of MNP, but noted many references are ~10 y old and the authors tend to cite themselves. Reviewer #2: I found this paper relevant and useful for the health sector of Bangladesh. A particular timeline of intervention and how it impacted the overall adaption of strategies into government level of sustainability could have been added. However, the paper as it is currently publishable and will benefit global research community. ****** 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: Shamim Ahmed ******** [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.0283306.r001
Revision 1
20 Nov 2022 Author Response Responses to reviewers’ comments We appreciate the very thoughtful reviews of the previous version of the manuscript. We have updated the text in response to the reviewers’ queries and feedback. A point-by-point response to each of the reviewers’ comments is included below. We believe these changes have substantially improved the manuscript. We hope you will find this revised manuscript appropriate for publication in PLOS ONE. Many thanks for your consideration. Reviewer #1: This paper describes a qualitative evaluation of an existing market-based intervention promoting the sale of MNP by FHW in four districts of Bangladesh, with two identified as high performing and two identified as low performing. Overall, the writing and analysis could be tightened and strengthened. There are some interesting and relevant findings, but the design (high and low performers) is not relevant in the way the results are reported and it’s unclear if sample sizes are sufficient for the stratification despite authors reporting they reached saturation. More details are needed regarding the original program and evaluation methods. The conclusions focus on more implementation science research needed but there’s a gap/role for government and oversight of interventions and policies that warrant mentioning. Some specific suggestions and questions below. It seems the FHW also play a role as trouble shooters when caregivers experience problems with MNP, but not clearly stated in initial descriptions. Also, text doesn’t describe how FHW link IYCF/MNP and how/if support other IYCF so please clarify. Both WHO and HF-TAG state that MNP should be integrated with IYCF programs. Response: Thank you for your valuable comment. In the revised manuscript, we have described how a FHW under the home fortification of diets with MNP program has been involved in multiple tasks including promotion of IYCF practices and selling health commodities such as oral dehydration saline, iodized salts etc. along with MNP. (Page 7) Reader doesn’t know what this means “(c1, c2, c3, c4…cn),” possibly refers to counseling opportunities? Response: We completely agree with you. It indicates counseling opportunities. We have mentioned it in the revised manuscript. (Page 5) What was the suggested MNP intake regimen being suggested by FHW? Overall, there’s no description of how FHW were trained and how program was supposed to be implemented and be effective, other than high level saying FHW sold MNP to mothers. Reader finds out part way through the paper that FHW sell other products. Authors assume reader understands their program without providing information. More details about program design would help reader understand results (e.g., how are FHW recruited, trained, how often are they supposed to get supplies to sell, interact with caregivers? Authors reported trouble counseling mothers, but were they even trained to address this?) Response: Thank you so much for your valuable comments. As you suggested we have incorporated program details including FHWs recruitment, training, roles and activities in the revised manuscript. (Page 7) Switches from FHW to CHW mid-way through paper. Response: Thank you for noting this. As you suggested we have made correction and used FHW throughout the revised manuscript. Further details (e.g., #, %) about how high/low performers and low sales were defined and assessed, this would improve reader understanding of differences between the two groups. Also, paper explicitly says anemia reduced as a criteria for high/low but no evidence provided. Response: Thank you for noting this. In the revised manuscript, we have given examples of criteria such as percentage points of anemia reduction for defining low and high performing districts. (Page 9) Reports number when saturation occurred but not planned number of interviews, what were potential # to be interviewed? It’s unclear in methods total number of FGD vs individual interviews (or other types) conducted, suggest presenting in a table with numbers described for each (e.g., was it 2 FGD with 15 mothers total, for example? Noted later some of this is stated in results, but that’s too late and overall unclear to reader how many individual vs FGD vs other). Noting samples sizes are low and should be stated as a limitation, minimum sample size for stratification in qualitative data collection is 3 (and that’s low) and authors note 2 per multiple stratifications, recognizing limited number of districts. Achieving saturation at 2 interviews is a limitation. Response: Thank you for your valuable comments. As you suggested we have given a table containing number of in-depth interviews, FGDs and key informant interviews in the revised manuscript. We have also mentioned the planned number of interviews and FGDs. (Page 10-11) Was a software used for coding and analysis? Response: Thanks for your comments. We used Microsoft Word Document to tabulate the textual data and manually codded on those. We have written this in the revised version of the manuscript. (Page 13) Suggest avoiding acronyms for BRAC job descriptions - for readers unfamiliar it’s a challenge to remember what they mean and there are multiple used throughout the paper. Response: Thanks for noting this. As you suggested we have omitted acronyms of BRAC job descriptions throughout the paper. “On due payment” means to pay later? Response: Thanks for your question. Yes, we have written ‘Over-due payment’ meaning pay later. In the revised manuscript, we have mentioned it in parenthesis for making it reader-friendly. (Page 20) It seems there’s uncontrolled delivery of interventions in the area that are not coordinated or known (?) by government with so many delivering MNP for free or different price points. It would be impossible to be successful with higher cost product in this environment unless others were perceived inferior. Deserves mention of role of govt to approve interventions and coordinate etc. Response: We agree with you. We have mentioned this in the discussion section of the revised manuscript. (Page 27) The design was focused on high and low performers, which is a good idea, but the authors do not present/discuss results using that stratification. Were there no differences? Either way, this should be noted in results or discussion. Response: Thanks for your valuable comments. Although the main evaluation was conducted in the low and high performing districts, in this paper we focused on overall market-based approach to promoting home fortification of diets with MNP through FHWs regardless of study areas. In addition, during data analysis we did not find any differences in the promotion of home fortification of diets with micronutrient powder through FHWs in the study areas. As you suggested we have mentioned it at the beginning of result section. (Page 14) Reference #1 has been updated for WHO in 2020 and 2011 is old/out of date. Appreciate there has not been too much published on market-based sales of MNP, but noted many references are ~10 y old and the authors tend to cite themselves. Response: Thank you for your comment. We have replaced the reference#1with the updated one and accordingly modified the texts. Reviewer #2: I found this paper relevant and useful for the health sector of Bangladesh. A particular timeline of intervention and how it impacted the overall adaption of strategies into government level of sustainability could have been added. However, the paper as it is currently publishable and will benefit global research community. Response: Thank you for your valuable comments. As you suggested we have incorporated particular timeline of intervention in the revised manuscript. We have also discussed the overall impact of it on the overall adaptation of strategies into government level of sustainability in the discussion section of the revised manuscript. (Page 27) Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0283306.r002
7 Mar 2023 Decision Letter - Ilias Mahmud, Editor Market-based approach to promoting home fortification of diets with micronutrient powder through volunteer frontline health workers: A qualitative study PONE-D-22-04029R1 Dear Dr. Rahman, 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, Ilias Mahmud, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed 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: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 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 #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: Yes 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: (No Response) ****** 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: Yes: Shmim Ahmed ******** https://doi.org/10.1371/journal.pone.0283306.r003
Formally Accepted
15 Mar 2023 Acceptance Letter - Ilias Mahmud, Editor PONE-D-22-04029R1 Market-based approach to promoting home fortification of diets with micronutrient powder through volunteer frontline health workers: A qualitative study Dear Dr. Rahman: 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 Dr. Ilias Mahmud Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0283306.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .