PONE-D-22-24145Prevalence, severity and associated risk factors of anemia among human immunodeficiency virus- -infected adults in Sawla General Hospital, southern Ethiopia: a facility-based cross-sectional study, 2019.PLOS ONE

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Comments to the Author

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Reviewer #1: Partly

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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?

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Reviewer #1: Yes

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Reviewer #1: No

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5. Review Comments to the Author

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Reviewer #1: I sincerely thank you for giving the opportunity to review this manuscript entitled as “Prevalence, severity and associated risk factors of anemia among human immunodeficiency virus- -infected adults in Sawla General Hospital, southern Ethiopia: a facility-based cross-sectional study, 2019.”. I hope this manuscript helps to understand the factors associated with anemia among PLWHIV. However, I have some comments that should be addressed by the authors of this manuscript.

1.In the variables section the authors stated that “Anemia was the dependent variable for this study. Age, sex, education, occupation, monthly income, residence, WHO clinical stage of HIV/AIDS, CD4 cell count, VL, body mass index (BMI), drug regimen type, duration of HIV infection, and HAART, were taken as dependent variables”. But the aforementioned variables are not dependent variable rather predictors or independent variables. In addition, I wonder if the authors of this manuscript have been measured the nutrition, disease related predictors of Anemia among PLWHIV. Since dietary intake is one of the known predictor of Anemia try to mention the common dietary practice in the study area, for instant what is the staple diet for most of the study population? Was the dietary data available? Is there any change in the dietary practice that might be differ from the other parts of Ethiopia? I advised the authors of this manuscript to clear out these things.

2.As indicated clearly in the manuscript you conducted a pretest. If there are any amendments/modifications resulted from pretest, please mention the result obtained

3.You stated that “Hosmer and Lemeshow's goodness of fitness for the logistic regression test was used to check model fitness” what was the result? Indicate the p-value

4.I also recommend to cite the references for the operational definitions

5.The result of the multivariate analysis also needs to be corrected “(AOR: 2.32; 95% CI: 1.08-4.94, P= 0.030); being on clinical stage III or more (AOR: 4.20; 95% CI: 1.06-16.62, P= 0.041); having CD4 count below 200 cells/mm3 (AOR: 4.32; 95% CI: 2.10-8.86, P= 0.000) and BMI below 18.5 kg/m2 (AOR: 3.82; 234 95% CI: 1.83-8.00, P= 0.000). As portrayed above the p-value for CD4 count and BMI was reported as 0.000, it should not be correct you may report as 0.001 or I strongly recommend to report only (AOR with 95%CI without reporting the p-value) since the aim of this study is to identify factors associated with anemia among PLWHIV. Apart from these please display only the result of the multivariate analysis in the table. Only the eight variables which have a p-value 0.2 logistic regression analysis and candidates of multivariate logistic regression analysis.

6.In the discussion section some of the reports were not completed for example Southwest Ethiopia _____ how much was the prevalence of anemia? Needs an intense revision and paraphrase to improve the readability of the manuscript…..I suggest to parphrase the following section; Various factors determine the risk of anemia among HIV-infected adults in multidimensional ways [3, 4]. In the current study, HIV-infected adults with CD4 cell count below 200 cells/mm3 (by264 4.32), BMI below 18.5 kg/m2 (by 3.82), clinical stage III or above (by 4.20), and having HIV infection for five or more years (2.32) have increased risk of anemia. Difficult to understand needs revision.

7.In general, this manuscript needs revision, i have some concerns about the grammar, and overall readability of the manuscript. Thus I will urge the authors of this manuscript to revise the text meticulously to fix the grammatical and typing errors and improve the overall readability of the text.

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Reviewer #1: No

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PONE-D-22-24145R1Prevalence, severity and associated risk factors of anemia among human immunodeficiency virus-infected adults in Sawla General Hospital, southern Ethiopia: a facility-based cross-sectional study, 2019PLOS ONE

Dear Dr. Alemayehu,

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 Apr 29 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

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Reviewer #1: (No Response)

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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: Partly

********** 

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: 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

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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: I would like to say thank you for allowing me to review this manuscript entitled “Prevalence, severity and associated risk factors of anemia among human immunodeficiency virus-infected adults in Sawla General Hospital, southern Ethiopia: a facility-based cross-sectional study, 2019.”. I saw some improvements compared with the previous version of the manuscript. However, still this manuscript needs further revision.

1. Since it is secondary data you couldn’t find all the needed information, I understand that. But try to mention the common dietary practice of the population found in the study area. What is the staple diet of the study subjects? Is there any change in the dietary practice that might differ from the other parts of Ethiopia? Add some clarification ‘context” in the methods section to better understand the case

2. The result of table 3 is also not clear. You said that only variables that have an association at P 0.2 will be recruited to the final model. “multivariable logistic regression analysis was done for the variables with P value 0.20 in binary logistic regression analysis to identify risk factors associated with anemia among HIV-infected adults. Based on the cutoff point, eight variables were taken as candidates for the multivariable logistic regression analysis. Finally, anemia among HIV-infected adults was significantly associated with being HIV-infected for five or more years (AOR: 2.32; 95% CI: 1.08-4.94, P= 0.030); being on clinical stage III or more (AOR: 4.20; 95% CI: 1.06-16.62, P= 0.041), having CD4 count below 200 cells/mm346 (AOR: 4.32; 95% CI: 2.10-8.86, P 0.001) and BMI below 18.5kg/m2 47 (AOR: 3.82; 95% CI: 1.83-8.00, P 0.001)”

But in the table, you report 14 independent variables which have no any importance i.e. variables that have a p-value 0.2 in the univariate analysis. The purpose of variable selection in the multivariate analysis is to select clinically important and statistically significant variables while excluding unrelated variables so as to control the confounding factors. Hosmer and Lemeshow describe a purposeful selection of covariates within which an analyst makes a variable selection decision at each step of the modeling process…like Forward, Stepwise, and Backward etc. Hence, the authors of this manuscript try to fix the analysis method and report a final multivariate model which contains only 8 variables. Otherwise, clarify the case ….plausibly.

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Reviewer #1: Yes: Mulualem Endeshaw

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Dear Dr. Alemayehu,

Thank you very much for submitting your manuscript to PLOS ONE, and for responding to our recent requests regarding your submission. PLOS ONE requires that research meets all applicable standards for the ethics of experimentation and research integrity (http://journals.plos.org/plosone/s/human-subjects-research). We reserve the right to reject any submission that does not meet our internal ethical standards, which in some cases are more stringent than local ethical standards.

Unfortunately, as you are not able to supply the original ethics approval document issued by Arba Minch University, we have concluded that your submission does not our ethical requirements for human subjects research submissions. We will therefore be overturning the provisional editorial accept decision, and will reject this manuscript.

I am very sorry that this issue was identified at such a late stage.

If in the future you are able to locate a copy of the original (signed/stamped) ethics approval document, you are welcome to submit the manuscript to PLOS ONE for further consideration. Please note that we might need to seek additional feedback from our editorial board on any resubmission before coming to a decision.

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Emily Chenette

Editor in Chief

PLOS ONE

PONE-D-22-24145R3

Prevalence, severity and associated risk factors of anemia among human immunodeficiency virus-infected adults in Sawla General Hospital, southern Ethiopia: a facility-based cross-sectional study, 2019

PLOS ONE

Dear Author(s),

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 supplemented with original ethics approval document issued by Arba Minch University by November 13, 2023. 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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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Mohammed Hasen Badeso, MPH in Field Epidemiology

Academic Editor

PLOS ONE

Journal Requirements:

1. 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 (if provided):

Dear Author(s),

Can you supply the original ethics approval document issued by Arba Minch University. Unless otherwise, we have concluded that your submission does not PLOS ONE ethical requirements for human subjects research submissions.

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Comments to the Author

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Reviewer #2: (No Response)

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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 #2: Yes

********** 

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

Reviewer #2: 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 #2: 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 #2: Yes

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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: General comments

1. In abstract it is better if you donot abbreviate terms (donot use Abriavation),You shall use full form

• HIV,SPSS,SGH,ART,BMI

2. In introduction (it is to wide please reduce to 1-1*1/2 page)

3. In methodology

• Study setting

o You shall abrievate sawla general hospital to SGH at line 97 b/c it is once abbreviated above

• Sampling technique put in sampling interval K value

• It is better if you put in figure format from total population to your sample with sampling interval

4. In data collection procedure it is better if you rewrite

o Clinical data as drug regimen, HIV stage, HAART exposure,duration of HIV

o Immunological variable as viral load and CD4

5. In operational definition pleas cite for definition HIV infected adults (15-64)

o Clearly explain frist line regimen and second line regimen you used for your research

6. In discussion it is better if you start with pathogenesis of HIV to cause anemia

7. In discussion and conclusion why you it is better to discuss for HIV infection duration, Since it have stastically significant association with anemia

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Reviewer #2: Yes:

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Prevalence, severity and associated risk factors of anemia among human immunodeficiency virus-infected adults in Sawla General Hospital, southern Ethiopia: a facility-based cross-sectional study

PONE-D-22-24145R4

Dear Author(s),

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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Kind regards,

Mohammed Hasen Badeso, MPH in Field Epidemiology

Academic Editor

PLOS ONE

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