A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study

Million Tirfe; Asnakech Alemu; Wondie Alemu; Mengistab Woldearegay; Getachew Asfaw; Heran Gerba; Duru Kadi; Atalay Mulu Fentie

doi:10.1371/journal.pone.0284038

Peer Review History

Original SubmissionJanuary 4, 2023
20 Feb 2023 Decision Letter - Arianit Jakupi, Editor PONE-D-22-35443A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional studyPLOS ONE Dear Dr. Fentie, 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. ============================== There are minor changes to be made on the manuscript. ============================== Please submit your revised manuscript by Apr 06 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. 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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. 5. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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. 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. 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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: In this manuscript, the authors have evaluated a three years antimicrobials consumption (imported and locally manufactured antimicrobials), as a retrospective cross-sectional investigation, in Ethiopia from 2017 to 2019, respectively. The rationale of manuscript is very good. The paper is well written and clearly organized. The authors have done a good job of presenting their work and clearly spent some effort on the editing, which has resulted in a paper that is easy to read. I have a few comments, but no major changes are suggested. 1. There should be a space between the word after or before it and all the references should be the same, a space before it or not. 2. At the table 4. You have present most commonly consumed antimicrobials by chemical substance group in Ethiopia between 2017-2019. Is there any explanation why is such a big difference at DID between the year 2017 and two other years (2018 and 2019)? 3. A number of similar studies have been published in past by a number of research groups. Moreover, current findings are also not conceptually and technically different from the earlier published studies. Due to the large sample, my recommendation is to the authors that they should emphasize and elaborate the novel findings and speculate what are the contribution of this study to previously published studies. Reviewer #2: Overall the article is written in a very comprehensive way. Chosen methodology is correct. Using DID gives comparable results and data for further drug utilisation studies. However it should be mentioned that it should be good to have also results that for the most consumed antibiotics in order to create a link with the resistance as well. One other suggestion is also to describe the fluctuations of different classes of antibiotics through the years and if there is supporting evidence in prescriptions of these antibiotics. ****** 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: Yes: Rozafa Koliqi 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.0284038.r001
Revision 1
6 Mar 2023 Author Response Date: March 7, 2023 Response Letter to the Editor and Reviewers We appreciate the editor and both reviewers’ time, comments and suggestions provided for our article entitled “A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study: Manuscript ID= PONE-D-22-35443”. Reviewer comments motivated thorough revision of the manuscript, which is being resubmitted along with a point-by-point response to address all reviewer concerns (Table below). All modifications are shown in the revised manuscript attached with file name of “Manuscript” for manuscript without track change and “Revised Manuscript with track changes” for the file highlighted with changes. Thank you for the valuable comments and we hope the editor and reviewers will be satisfied with our responses. Sincerely, Atalay Mulu Fentie, on behalf of all authors S.No Query by Response 1. Editor 1. 1.1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. All authors have thoroughly reviewed the manuscript and made changes as required to meet all of the PLOS ONE style requirements. In addition, all authors addressed identified grammatical and typographic errors (see the revised manuscript with track changes). 2. 1.2. In your Methods section, please confirm that all data sources you used were publicly available and anonymized. If this is not the case, please provide information on what permissions you were granted to access these data. Thank you so much. Now, we have included “All data sources used in this study were publicly available and anonymized” under source of data Methods sub-section of the revised manuscript. 3. 1.3. Thank you for stating the following financial disclosure: "No. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript" At this time, please address the following queries: a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” c) If any authors received a salary from any of your funders, please state which authors and which funders. d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. Now we have the final disclosure section as per your recommendations and on the revised manuscript it appears as follows: “This national survey was financially supported by Ethiopian Food and Drug Authority through the annual government budget allocated specifically for the consumption survey. However, the funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. In connection with this, the authors received no specific funding for this work.” 4. 1.4. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. We have amended the data availability statement as follows and included it on the revised manuscript. “Minimum data relevant to this study are anonymized and included in this article”. 5. 1.5. Please review your reference list to ensure that it is complete and correct. We have revised the reference section as per PLOS ONE reference writing guideline, and we hereby confirm it is complete and correct. 2. 2. Reviewer 1- Dr. Rozafa Koliqi 2.1. There should be a space between the word after or before it and all the references should be the same, a space before it or not. Thank you. As per the kind comment, we have thoroughly reviewed the manuscript and amended it accordingly. 2.2. At the table 4. You have present most commonly consumed antimicrobials by chemical substance group in Ethiopia between 2017-2019. Is there any explanation why is such a big difference at DID between the year 2017 and two other years (2018 and 2019)? It could be due to the acute watery diarrheal outbreak in Ethiopia in 2017 that leads the consumption of antimicrobials high. If you look at the consumption of Doxycycline, it was significantly higher given doxycycline was recommended on the emergency preparedness and management of acute diarrheal guideline as first line treatment. We have included the same on the discussion section of the manuscript on paragraph 4. 2.3. A number of similar studies have been published in past by a number of research groups. Moreover, current findings are also not conceptually and technically different from the earlier published studies. Due to the large sample, my recommendation is to the authors that they should emphasize and elaborate the novel findings and speculate what are the contribution of this study to previously published studies. Thank you for this comment and yes, recently we have developed the AMR prevention and containment national action plan of Ethiopia. In line to this, one of the strategic objective is research and surveillance to support all other intervention strategies and policies in which this study was conducted in accordance with it. Moreover, we have revised the Essential medicine list, standard treatment guideline, health insurance medicine list and community pharmacy list; and categorized antibiotics as per Access, Watch and Reserve (AWaRe). We tried discuss and present the antimicrobial consumption as per AWaRe category that will serve a baseline for further study as well as assess the five years national action plan impact on antimicrobial consumption and AMR. 3. Reviewer 2 3.1. Overall the article is written in a very comprehensive way. Chosen methodology is correct. Using DID gives comparable results and data for further drug utilisation studies. However it should be mentioned that it should be good to have also results that for the most consumed antibiotics in order to create a link with the resistance as well. One other suggestion is also to describe the fluctuations of different classes of antibiotics through the years and if there is supporting evidence in prescriptions of these antibiotics. Thank you for your suggestion. We tried to highlight the findings of studies conducted in Ethiopia regarding to antimicrobial resistance pattern/issue on the discussion section of the manuscript. Moreover, the reasons for fluctuation of the consumption was also discussed. The only supporting evidence we found is the issue of acute watery diarrhea in 2017 that significantly increased the consumption compared to 2018 and 2019. Attachments Attachment Submitted filename: Response Letter to the Editor and Reviewers.docx https://doi.org/10.1371/journal.pone.0284038.r002
21 Mar 2023 Decision Letter - Arianit Jakupi, Editor A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study PONE-D-22-35443R1 Dear Dr. Fentie, 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, Arianit Jakupi, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0284038.r003
Formally Accepted
28 Mar 2023 Acceptance Letter - Arianit Jakupi, Editor PONE-D-22-35443R1 A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study Dear Dr. Fentie: 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 Arianit Jakupi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0284038.r004

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