Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic

Bibhu Thapaliya; Samata Kumari Yadav; Sanju Bhattarai; Santosh Giri; Suprich Sapkota; Abriti Arjyal; Helen Harris-Fry; Naomi Saville; Sara Hillman; Sushil Baral; Joanna Morrison

doi:10.1371/journal.pone.0284796

Peer Review History

Original SubmissionNovember 11, 2022
17 Feb 2023 Decision Letter - Hanna Landenmark, Editor PONE-D-22-31111Health worker perspectives on access to antenatal care in rural plains Nepal during the pandemicPLOS ONE Dear Dr. Morrison, 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 see the reports from two reviewers below. Both reviewers have requested additional detail or clarification, particularly in the Methods section. Please submit your revised manuscript by Apr 02 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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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: I Don't Know ****** 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: Overall, well written and well executed project. I have these minor comments As lines 61 - 128 are providing context on the situation in Nepal, I think it's best suited to be placed under "Setting" from line 131 as a "General Setting" subheading and then a subsequent "Specific Setting" subheading provided for the current information provided from line 132 - 161. For Clarity; lines 200 to 202 can have "Ethical consideration" as a subheading At the result section, the qualitative results and quantitative results are not immediately distinct. Including a table especially for the quantitative aspect of the study could help bring out clearly the outcomes of this aspect of your mixed method study. Line 403 should be checked for clarity of thought and if needed broken into two sentences. Does "during, ..."relate to access to the phone or to ANC? Reviewer #2: REVIEWERS COMMENTS The study is objective is good. There are few comments however to be answered. ABSTRACT 1.LINE 14-16: Not sure what you mean by health workers and community health volunteers. Aren’t community health volunteers part of health workers? MATERIAL AND METHODS SETTINGS 2.Are there health facilities in the district that provide above primary health care? Were they included in the study? QUALITATIVE SAMPLING 3a. Line 164: How many health posts were in the district? Why did you opt for the 8 you used in the study? 3b. How were the interviews conducted? Direct or over the phone QUANTITATIVE SAMPLING 4a.Line 188: How did you sample the 52 FCHVs for the study? What do you mean by 52 were available for study? Were the others under quarantine or they simply refused participation? 4b. Did you conduct direct interviews? 4c. line 200: Why verbal consent by some participants? Were they not accessible? RESULTS 5. Line 325: I get the impression that tele medicine existed prior to the COVID-19 pandemic, didn’t you have the problem of lack of mobile phone access prevailing pre-pandemic? If it existed before the pandemic, how severe was it during the pandemic era? LIMITATION 6. Line 413: the sentence should be looked at again. “Has” for ‘his’? DISCUSSION 7. Line 387: I wish your quantitative data had covered other areas beyond IFA such as how many health posts lacked PPEs, how many PPEs were requested by each facility studied and how many were supplied. Without these facts, the statement on line 388 becomes questionable. REFERENCES 8. Line 452: Not sure the journal which published the case study 9. Line 474: 2078? An error in the year? 10. Line 490: can you take a look again at the reference, 2064? 11. Line 585: the date for the publication ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
11 Mar 2023 Author Response Reviewer #1: Overall, well written and well executed project. Response: Thank you for appreciating our paper and project. I have these minor comments As lines 61 - 128 are providing context on the situation in Nepal, I think it's best suited to be placed under "Setting" from line 131 as a "General Setting" subheading and then a subsequent "Specific Setting" subheading provided for the current information provided from line 132 - 161. Response: We do not discuss the specific setting of the study in the introduction section, and headings mention the country context (Nepal). We have added to methods section heading we have added ‘study setting’ to clarify that this paragraph describes the specific context of the study. For Clarity; lines 200 to 202 can have "Ethical consideration" as a subheading. Response: We have added the subheading “Ethical consideration” to the mentioned lines as per your suggestion. At the result section, the qualitative results and quantitative results are not immediately distinct. Including a table especially for the quantitative aspect of the study could help bring out clearly the outcomes of this aspect of your mixed method study. Response: We have disaggregated our quantitative and qualitative sample in the methods section. Our quantitative data are not extensive, and therefore we feel they do not warrant a separate section. Line 403 should be checked for clarity of thought and if needed broken into two sentences. Does "during, ..."relate to access to the phone or to ANC? Response: Thank you for your suggestion. We have changed the line 403 to make it clearer. Reviewer #2: REVIEWERS COMMENTS The study is objective is good. There are few comments however to be answered. ABSTRACT 1.LINE 14-16: Not sure what you mean by health workers and community health volunteers. Aren’t community health volunteers part of health workers? Response: Thank you for your comment. Female Community Health Volunteers have no formal qualifications, and their role is mainly health promotion as described on page 4. They are a distinct cadre separate from health workers. MATERIAL AND METHODS SETTINGS 2.Are there health facilities in the district that provide above primary health care? Were they included in the study? Response: There were hospitals providing higher levels of health care in the district headquarters. These were not included in this study because we chose to focus our research on primary health care only. QUALITATIVE SAMPLING 3a. Line 164: How many health posts were in the district? Why did you opt for the 8 you used in the study? Response: We sampled the eight health posts because we were already in contact with health workers from those health posts for another study (which has now been published and is referenced in the paper Saville et al. 2023). We have added the words ‘conveniently sampled’ to clarify that our sampling of health posts was convenient. 3b. How were the interviews conducted? Direct or over the phone Response: The interviews were conducted directly, and we have added this detail to the paper on age 9. QUANTITATIVE SAMPLING 4a.Line 188: How did you sample the 52 FCHVs for the study? What do you mean by 52 were available for study? Were the others under quarantine or they simply refused participation? Response: There are a set number of FCHVs working under each health post. We sampled half the FCHVs working under the eight health posts. We have deleted the sentence about their availability as we agree with reviewers that it is confusing. 4b. Did you conduct direct interviews? Response: Yes, we conducted direct interviews, and we have added this to the text. 4c. line 200: Why verbal consent by some participants? Were they not accessible? Response: Some participants had low literacy and therefore we took verbal consent to participate from those participants. We have added to the text to clarify this. RESULTS 5. Line 325: I get the impression that tele medicine existed prior to the COVID-19 pandemic, didn’t you have the problem of lack of mobile phone access prevailing pre-pandemic? If it existed before the pandemic, how severe was it during the pandemic era? Response: FCHVs and health workers were meant to interact with pregnant women over the phone pre-pandemic. This was problematic before and during the pandemic because not all women had access to phones. Pre-pandemic FCHVs and health workers could interact face to face with women who didn’t have access to phones, but with lockdown preventing movement this was challenging. We have added to this paragraph on page 17 to clarify why lack of access was particularly troubling during the pandemic. LIMITATION 6. Line 413: the sentence should be looked at again. “Has” for ‘his’? Response: We have corrected this in our manuscript. DISCUSSION 7. Line 387: I wish your quantitative data had covered other areas beyond IFA such as how many health posts lacked PPEs, how many PPEs were requested by each facility studied and how many were supplied. Without these facts, the statement on line 388 becomes questionable. Response: We have removed the part about PPE in line 388. REFERENCES 8. Line 452: Not sure the journal which published the case study Response: Thank you for your comment. We have corrected the references for this case study. 9. Line 474: 2078? An error in the year? 10. Line 490: can you take a look again at the reference, 2064? Response: The documents are published under the Nepali calendar, and the reference years are correct. If we changed the reference years, readers would not be able to find the references. 11. Line 585: the date for the publication Response: We have added the date of publication. https://doi.org/10.1371/journal.pone.0284796.r002
10 Apr 2023 Decision Letter - Seth Amponsah-Tabi, Editor Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic PONE-D-22-31111R1 Dear Dr. Morrison, 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, Seth Amponsah-Tabi Guest Editor PLOS ONE Additional Editor Comments (optional): Dear, the revised session is much better. I deem your responses to comments as appropriate. Reviewers' comments: https://doi.org/10.1371/journal.pone.0284796.r003
Formally Accepted
14 Apr 2023 Acceptance Letter - Seth Amponsah-Tabi, Editor PONE-D-22-31111R1 Health worker perspectives on access to antenatal care in rural plains Nepal during the COVID-19 pandemic Dear Dr. Morrison: 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. Seth Amponsah-Tabi Guest Editor PLOS ONE https://doi.org/10.1371/journal.pone.0284796.r004

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