Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana

Martin Nyaaba Adokiya; Mohammed Bukari; Joyce A. Ndago; Robert B. Kuganab-Lem; Humphrey Garti; Matthew Y. Konlan; Amata Atinlie Amoasah; Zakari Ali

doi:10.1371/journal.pone.0286546

Peer Review History

Original SubmissionJanuary 12, 2023
23 Feb 2023 Decision Letter - Neetu Choudhary, Editor PONE-D-23-01016Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in GhanaPLOS ONE Dear Dr. Adokiya, 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 09 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 will update your Data Availability statement to reflect the information you provide in your cover letter. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 4. 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 If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know 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. 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 ****** 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: The study is important and will be of interest to an international audience. The written text would benefit from academic mentoring to strengthen unsupported claims and add substance to the conclusion ( rather than repeating the results). Statements need supporting from the evidence unless they are common knowledge for example, in the introduction, the points on boost to immune system, 36% global EBF, and Australia's EBF at 96% are all without citations to support the claim and the entire manuscript needs to be revised for this point. See also p13 A study in Australia found 9/10 children EBF at birth, no citation. Citation 12 is used to emphasize initiation of breastfeeding on the rise in Nigeria, yet the date of publication is 2010 and initiation does stray from the main point of EBF and this should be brought out in the text and not left to the reader to work it through. 'Adolescent' needs to be defined by age as used in this study ( and supported by literature) for an international audience. It needs to be stated if the ENVAC project captured data on prevalence of EBF, as the readers may consider the point. Study design, a diagram of the regions and numbers and levels of subgroups in the areas would be helpful for readers to visualize the communities. The important point is not to repeat what has already been stated well once. There is repetition on the mother child pairs which could be trimmed back. The use of the word 'targeted' on p7 sounds as though the participants were not voluntary participants, perhaps the word 'invited' could be used instead. Please describe the purposive sampling exactly and why this was necessary, and the random sampling and how this was done exactly. How was data collected, was it only by interview, that is all that they consented to? The definition of EBF in some studies includes no medicine, have you made your position clear on this ? P8 When reporting statistics it is preferable to use the same number of decimal places throughout see p9 68% v 92.6% (2 v 3 places). P10 mean age of children needs to be expressed as 'months'. Child not being sick as a predictor of EBF is rather a confusing way to report what is occurring the other way around- EBF a predictor that a child wont be sick, if other triggers are controlled for. The authors need to add to the conclusion on this. Reviewer #2: The current study looked at the exclusive breastfeeding rate (EBF) and its determinants among beneficiaries of a WFP-sponsored programme in Ghana's northern region. The authors reported a high prevalence of EBF and identified maternal education, a sickness episode in the previous two weeks, and the source of household drinking water as important determinants of EBF in the study setting. Overall, this is an important topic for the study setting. The study design and analytical techniques are sound in order to achieve the study's objectives. The manuscript is also well written in standard English. However, there are a few issues that must be addressed before the manuscript can be considered for publication in PLOS ONE. General observations: The manuscript requires extensive copyediting to correct grammar issues such as incorrect sentence structure, missing punctuation or articles, and inconsistent font size. A conceptual framework should also guide the variables included as potential predictors, as some do not have a scientific basis. The following are some specific remarks: Abstract When you use including, you want to show that there are many but only highlight a few. When the exact number of pillars is specified, the word namely is more appropriate. Make the study's purpose more specific; what about EBF was measured? Furthermore, the goal is stated as if the EBF rate was determined among women and children. The entire purpose sentence should be revised. The sentence “Participants were lactating women who benefitted from the ENVAC project using Social Behavior Change Communication (SBCC) and facilitated access to Complementary Nutritious Foods (CNF) through market and vouchers.” is confusing … those whose children or child? Introduction The introduction is well-written, and the problem is clearly stated and justified. Nonetheless, the authors should ensure that the manuscript is thoroughly copyedited; there are missing punctuations and font sizes that do not match other text within the manuscript. Methods Authors may have to redefine the study’s target population for clarity The study does not state whether the six purposefully chosen facilities were distributed evenly between the two areas, Sagnarigu and Tamale Metropolitan. It also does not specify how the overall sample was distributed among the various facilities chosen. Outcome variable: more information is needed to define the outcome variable properly. What was the recall period for giving breastmilk or foods? Exposure variable: I am surprised by the study variables' conceptualization, including the use of sickness in the previous two weeks as a potential predictor variable. EBF primarily affects children in their first six months of life. As a result, it will be interesting to learn from the current study that an exposure after 6 months predicts an outcome that occurred long before the exposure. Results The sample size needed to achieve the study's objectives was 340. 339 people were interviewed, however. Given that no adjustments were made to the sample size to account for non-response, not interviewing all 340 women has implications for generalising the findings. That should be addressed adequately. Table 1: The mean age of the children can be placed alongside their age variable. The categorisation of the timing of initiation of breastfeeding is problematic. Any child who was breastfed within 30 minutes is still eligible for the within 1 hour group. That should be reconsidered. Furthermore, did all of the women say they had ever breastfed? When the denominator is clearly indicated or defined, the EBF rate is easier to understand and interpret. Multivariate analysis: “… household main source of water of being pipe-borne were significantly associated with EBF” what does it mean? Furthermore, the narrative discusses the factors associated with EBF in general, so there is no need to attempt to indicate the direction when it is captured in the sentence following. What method was used to fit the multivariable model? Table 3 lacks variables such as maternal age categories and marital status. What factors influenced the exclusion of these variables? The section on data analysis mentioned comparison tests. I am curious what role they played in the current study. Discussion “A previous study reported a prevalence of about 70.0% of EBF in southern Ghana [24]. Though, there are geographical differences between northern and southern Ghana.” means? The explanation for the difference in prevalence rate between health facility-based designs and population-based designs is not entirely justifiable. The authors contend that the participants recruited at the health facility are distinct from community members. The question is where did those women come from? Similarly, the explanation for the link between water source and EBF may be implausible. Given the authors' explanation, I am wondering if the EBF rates will differ between women who fetch water from pipped sources and those who fetch from wells, assuming the travel distance is the same or similar. The current study's design and limited number of exposure variables should be viewed as significant limitations by the authors. Conclusion: check error ****** 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: Dr Michael Boah ******** [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.0286546.r001
Revision 1
20 Apr 2023 Author Response Response to reviewers We are grateful for the helpful comments and we have adequately addressed them. Comments Responses Reviewer 1 Comment: The study is important and will be of interest to an international audience. The written text would benefit from academic mentoring to strengthen unsupported claims and add substance to the conclusion ( rather than repeating the results). Response: We thank the reviewer for the comment. We have made a thorough revision of the paper and added references where required. We have also re-written the conclusion to derive from the study. Comment: Statements need supporting from the evidence unless they are common knowledge for example, in the introduction, the points on boost to immune system, 36% global EBF, and Australia's EBF at 96% are all without citations to support the claim and the entire manuscript needs to be revised for this point. See also p13 A study in Australia found 9/10 children EBF at birth, no citation. Response: We have revised the manuscript to include missing citations. Comment: Citation 12 is used to emphasize initiation of breastfeeding on the rise in Nigeria, yet the date of publication is 2010 and initiation does stray from the main point of EBF and this should be brought out in the text and not left to the reader to work it through. Response: Thank you for drawing our attention to the discrepancy. We have revised this section appropriately. Comment: 'Adolescent' needs to be defined by age as used in this study (and supported by literature) for an international audience. Response: We have revised and included the age of adolescents. We used WHO definition and have also provided the appropriate reference (Page 6, lines 40). Comment: It needs to be stated if the ENVAC project captured data on prevalence of EBF, as the readers may consider the point. Response: We have revised the introduction to addresses this concern (Page 7, lines 46-51) Comment: Study design, a diagram of the regions and numbers and levels of subgroups in the areas would be helpful for readers to visualize the communities. Response: We did not address this comment. We think that this information may not make difference. Comment: The important point is not to repeat what has already been stated well once. There is repetition on the mother child pairs which could be trimmed back. Response: We thank the reviewer for noting this, we have made extensive revisions throughout the paper to trim redundancies. Comment: The use of the word 'targeted' on p7 sounds as though the participants were not voluntary participants, perhaps the word 'invited' could be used instead. Response: We have revised the sentence to remove the word “targeted” and used “invited” as suggested by the reviewer to avoid ambiguity. Comment: Please describe the purposive sampling exactly and why this was necessary, and the random sampling and how this was done exactly. Response: We have made revisions to improve on the description of the sampling methods. See methods (page 8-9, lines 87-89). Comment: How was data collected, was it only by interview, that is all that they consented to? Response: Yes, data were collected by interview only. We have stated this clearly in the methods section (page 9, lines 95-96). Comment: The definition of EBF in some studies includes no medicine, have you made your position clear on this? P8 Response: We followed the standard WHO definition of EBF which includes medicines prescribed by a medical practitioner Comment: When reporting statistics it is preferable to use the same number of decimal places throughout see p9 68% v 92.6% (2 v 3 places). Response: We thank the reviewer for noting this and have revised to have consistent number of decimal places Comment: P10 mean age of children needs to be expressed as 'months'. Response: This has been revised appropriately Comment: Child not being sick as a predictor of EBF is rather a confusing way to report what is occurring the other way around- EBF a predictor that a child won’t be sick, if other triggers are controlled for. The authors need to add to the conclusion on this. Response: We have revised this after a careful reconsideration. Reviewer 2 Comment: The current study looked at the exclusive breastfeeding rate (EBF) and its determinants among beneficiaries of a WFP-sponsored programme in Ghana's northern region. The authors reported a high prevalence of EBF and identified maternal education, a sickness episode in the previous two weeks, and the source of household drinking water as important determinants of EBF in the study setting. Overall, this is an important topic for the study setting. The study design and analytical techniques are sound in order to achieve the study's objectives. The manuscript is also well written in standard English. However, there are a few issues that must be addressed before the manuscript can be considered for publication in PLOS ONE. Response: We thank the reviewer for agreeing to review our work and we have addressed all the comments raised herein. Comment: General observations: The manuscript requires extensive copyediting to correct grammar issues such as incorrect sentence structure, missing punctuation or articles, and inconsistent font size. A conceptual framework should also guide the variables included as potential predictors, as some do not have a scientific basis. The following are some specific remarks: Response: We thank the reviewer for their comments. We have extensively revised the manuscript to correct language errors. In addition, variables included in the model were examined in a first line analysis using Chi-square and Fisher exact test before variables were taken further for logistic regression file. An additional file containing the results for the preliminary bivariate analyses are included in the online additional files. Abstract Comment: When you use including, you want to show that there are many but only highlight a few. When the exact number of pillars is specified, the word namely is more appropriate. Response: We have noted this and have applied the revision where necessary. Comment: Make the study's purpose more specific; what about EBF was measured? Furthermore, the goal is stated as if the EBF rate was determined among women and children. The entire purpose sentence should be revised. Response: The purpose statement has been revised appropriately. Comment: The sentence “Participants were lactating women who benefitted from the ENVAC project using Social Behavior Change Communication (SBCC) and facilitated access to Complementary Nutritious Foods (CNF) through market and vouchers.” is confusing … those whose children or child? Response: The sentence has been revised. Introduction Comment: The introduction is well-written, and the problem is clearly stated and justified. Nonetheless, the authors should ensure that the manuscript is thoroughly copy-edited; there are missing punctuations and font sizes that do not match other text within the manuscript. Response: We have taken note of this and made the necessary revisions. Methods Comment: Authors may have to redefine the study’s target population for clarity. The study does not state whether the six purposefully chosen facilities were distributed evenly between the two areas, Sagnarigu and Tamale Metropolitan. It also does not specify how the overall sample was distributed among the various facilities chosen. Response: More information has been added on the study’s target population to improve clarity and information has also been included on how facilities were distributed as well as how the overall sample was distributed (See additional file, Table 1) Comment: Outcome variable: more information is needed to define the outcome variable properly. What was the recall period for giving breastmilk or foods? Response: We have revised to include the recall period (Page 9, lines 103-107). Comment: Exposure variable: I am surprised by the study variables' conceptualization, including the use of sickness in the previous two weeks as a potential predictor variable. EBF primarily affects children in their first six months of life. As a result, it will be interesting to learn from the current study that an exposure after 6 months predicts an outcome that occurred long before the exposure. Response: We have carefully reconsidered this observation and agree with the reviewer, hence, we have removed child sickness from the models. Results Comment: The sample size needed to achieve the study's objectives was 340. 339 people were interviewed, however. Given that no adjustments were made to the sample size to account for non-response, not interviewing all 340 women has implications for generalising the findings. That should be addressed adequately. Response: We have acknowledged this a limitation of the study (Page 18, lines 226-228) Comment: Table 1: The mean age of the children can be placed alongside their age variable. Response: We have placed mean age alongside the age variable, thank you. Comment: The categorisation of the timing of initiation of breastfeeding is problematic. Any child who was breastfed within 30 minutes is still eligible for the within 1 hour group. That should be reconsidered. Response: We agree that any child who was breastfed within 30 minutes is still eligible for the within 1 hour group. The responses were grouped into 30 minutes, within 1 hour and after 1 hour but were collapsed during the analysis, we have revised to retain the initial grouping Comment: Furthermore, did all of the women say they had ever breastfed? When the denominator is clearly indicated or defined, the EBF rate is easier to understand and interpret. Response: Yes, all the women said they were breastfeeding. Comment: Multivariate analysis: “… household main source of water of being pipe-borne were significantly associated with EBF” what does it mean? Response: We intended to say that households with access to pipe-borne water were more likely to practice EBF, the sentence has been revised for more clarity (page 13, lines 149-150). Comment: Furthermore, the narrative discusses the factors associated with EBF in general, so there is no need to attempt to indicate the direction when it is captured in the sentence following. Response: We thank the reviewer for noting this, various revisions have been made where necessary. Comment: What method was used to fit the multivariable model? Table 3 lacks variables such as maternal age categories and marital status. What factors influenced the exclusion of these variables? Response: We used Chi-square and Fisher exact test as first line analysis to identify initial associations and logistic regression was then performed using forced entry. Variables such as age categories and marital status had larger p-values (>0.2) in the first line analyses and thus were not entered into the multivariable models. Comment: The section on data analysis mentioned comparison tests. I am curious what role they played in the current study. Response: We have revised to clarify. Discussion Comment: “A previous study reported a prevalence of about 70.0% of EBF in southern Ghana [24]. Though, there are geographical differences between northern and southern Ghana.” means? Response: The statement “Though, there are geographical differences between northern and southern Ghana.” Has been deleted to improve clarity. Comment: The explanation for the difference in prevalence rate between health facility-based designs and population-based designs is not entirely justifiable. The authors contend that the participants recruited at the health facility are distinct from community members. The question is where did those women come from? Response: We agree with the reviewer’s observation and have revised appropriately (Page 15, lines 166-170) Comment: Similarly, the explanation for the link between water source and EBF may be implausible. Given the authors' explanation, I am wondering if the EBF rates will differ between women who fetch water from pipped sources and those who fetch from wells, assuming the travel distance is the same or similar. Response: We have revised to improve clarity (Page 16-17, lines 198-205) Comment: The current study's design and limited number of exposure variables should be viewed as significant limitations by the authors. Response: We have included this as a limitation in the discussion section. Comment: Conclusion: check error Response: We have revised the conclusion appropriately. Attachments Attachment Submitted filename: Response to reviewers 04202023.docx https://doi.org/10.1371/journal.pone.0286546.r002
4 May 2023 Decision Letter - Neetu Choudhary, Editor PONE-D-23-01016R1Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in GhanaPLOS ONE Dear Dr. Adokiya, 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. cols: These article types are not expected to include results but may include pilot data. ============================== Please submit your revised manuscript by Jun 18 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. 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, Neetu Choudhary, PhD Academic Editor PLOS ONE Journal Requirements: 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: Thank you for your revisions! However, the conclusion still needs revision. Please note the conclusion is not just summary of results. You can include key observations with some future implications. [Note: HTML markup is below. Please do not edit.] [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.0286546.r003
Revision 2
16 May 2023 Author Response Comment: Thank you for your revisions! However, the conclusion still needs revision. Please note the conclusion is not just summary of results. You can include key observations with some future implications. Response: We thank the Editor for the additional comments. We have revised the conclusion session of the abstract and main manuscript including possibly future implications. Attachments Attachment Submitted filename: Response to reviewers 05162023.docx https://doi.org/10.1371/journal.pone.0286546.r004
18 May 2023 Decision Letter - Neetu Choudhary, Editor Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana PONE-D-23-01016R2 Dear Dr. Adokia, 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, Neetu Choudhary, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0286546.r005
Formally Accepted
19 May 2023 Acceptance Letter - Neetu Choudhary, Editor PONE-D-23-01016R2 Exclusive breastfeeding among beneficiaries of a nutrition enhancement programme and its associated factors in Ghana Dear Dr. Adokiya: 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. Neetu Choudhary Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0286546.r006

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