PONE-D-21-40464

Designing and testing the effectiveness of a post caesarean section home care guide in preventing postpartum complications in Central Tanzania: Protocol

PLOS ONE

Dear Dr. Mdoe,

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 Sep 08 2022 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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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,

Jennifer Yourkavitch

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Thank you for this protocol for a study investigating a very important issue. Please respond to all points raised by the reviewers.

The Academic Editor was one of the reviewers.

Please also have someone edit this to ensure correct English grammar. Standard proofreading (fixing small errors related to tense and number) would eliminate many errors.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

Reviewer #2: Partly

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3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: Yes

Reviewer #2: No

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4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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

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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 #1: No

Reviewer #2: No

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the opportunity to review the paper titled “Designing and testing the effectiveness of a post caesarean section home care guide in preventing postpartum complications in Central Tanzania; Protocol.” I am very enthusiastic about the proposed research as I agree that there is a dearth of research on this topic and currently poor practice in this area.

Unfortunately, there are numerous errors in writing throughout the manuscript. Below, I highlight some of these issues on the first few pages, but as the authors will note, there are so many that this was not possible to do for the entire paper. I strongly recommend engaging in a peer-editor to clean this up so that the very valuable content is not lost in minor errors in writing.

Even with concerns in the writing, the content is clear enough for my enthusiasm to remain. I do highlight a few technical points for them to consider in this next stage.

1. Reference 2 is dated.

2. More facility delivery is the only reason there is more c/section (last line first paragraph, page 4), and so that needs to be expanded. Then when I looked into the reference to understand what that paper is saying, reference 3 is for “Five national academies call for global compact on air pollution…” This is clearly not the right reference.

3. To that end – please check *ALL* for your references. Many of them are incorrectly formatted.

4. In addition, I want to call your attention to a few new articles recently out that should be included. None of these negate this proposal. If anything, it supports the claim that this area is critically neglected.

- Discharge instructions given to women following delivery by cesarean section in Sub-Saharan Africa: A scoping review. Musabeyezu et al. https://doi.org/10.1371/journal.pgph.0000318

- New global WHO postnatal guidance is welcome but misses the long-term perspective. Bick et al.

- Also look up the WHO guidelines referenced in the Bick et al paper.

5. The search criteria need a lot of work. Some examples:

- If I just copy and paste the first bullet into pubmed, nothing comes up. That is concerning.

- There are many ways to spell cesarean; your terms only look at one.

- By looking at “post cesarean section” together in quotes, then you miss just cesarean. I write a lot about post-c-section surgical site infections. In none do I write “post cesarean section” exactly.

6. You need more detail than “hand searching”

7. Will you use multiple coders in your qualitative analysis?

8. Be careful – it is not a rickets scale.

9. Can you provide the tool described on Page 16 for knowledge assessments?

10. For your sample size calculation, Your z_beta is for 80% power; for 90% power, you need 1.282. Fine to just clarify and power at 80% power.

11. For your sample size calculation – not totally unreasonable, but not conventional to put at exact observed levels from other studies. It is fine to keep, but also fine to let those studies guide you but not completely drive what you do.

12. I really don’t expect that your intervention will cut the SSI rate by 2/3. (From 16% to 4.9%). Personally, I would not power for this as: 1) Even if a good intervention, this is not the sole (or even primary) driver of SSI. 2) Even if you don’t have significant declines in SSI rates, good messaging/communication to moms has lots of benefits.

13. You power for binary measures, but then your primary analysis (page 24) treats scores as continuous. Either need to change your sample size calculation approach or your analysis approach.

14. Editing issues found on the first few pages. (As noted above, it was not possible to make this level of editing throughout, but this is hopefully illustrative of what will need to be done throughout.)

• Page 2, second line. Should be plural “infections”. Also needs to be SSIs. Need to check throughout the paper, as anywhere there is SSI it may, or may not, need to be written as SSIs.

• Page 2, make validation plural: “Following a series of validations…”

• Page 4, first line, need a comma between intervention and performed. “…. Intervention, performed to…”

• Page 4, change from into to in, to read “… may result in complications…”

• Page 4, “…hospitalization, increase helath cost,…” add ‘d’ to increase, fix spelling, add s to cost, to read “… hospitalization, increased health costs,…”

• Page 4, add “and” to “… for her baby, and maternal death.”

Reviewer #2: Please edit for English grammar.

This study has a nice design--the mixed methods approach is appropriate.

Please clarify "intervention" on p. 8: "...evaluation of the intervention in increasing knowledge of

home care and preventing postpartum complications." Are you evaluating the training or the guide? How would you separate training and guide in this circumstance.

p.11: I don't understand this sentence: "Data extraction will be guided by the validated to ensure collection of relevant data from all retrieved document, risk of errors in transcription is minimized, to guarantee precision in data

collection and to serve as a record (30)."

p. 12 "Purposive sampling technique (32) will be used to recruit 5-25 participant (Creswell, 2016) based on principle of data saturation (33)." Which participants? midwives or mothers? Do you intend to conduct interviews until you've reached saturation?

You could consider making full transcriptions of interviews for accuracy and easier coding.

For the post-test with mothers, will you also evaluate if the recommended practices were applied?

I don't think 30 mothers are enough to use multivariable regression. Your question for multivariable analysis is not clear. What is the exposure? All mothers were counselled on the new guidance. (Phase 3).

On p. 17 you introduce prevention of post-partum anemia. But the purpose of the guide to that point is to prevent SSI. Preventing, identifying, treating anemia involves a different protocol. Many factors contribute to anemia.

Why not randomize mothers to the intervention?

How will you choose controls (the non-equivalent control group)? Will you match on certain characteristics? That decision has implications for the analysis.

How will you prevent "contamination" in the education and training of midwives to those not involved with the intervention?

The mothers cared for by the intervention midwives will be the intervention mothers. For controls, you will have to enroll 2 mothers cared for by non-intervention midwives, correct? Text on p.23 indicates the intervention assignment is by hospital; I do not see that explained earlier in the protocol.

To mitigate other causes of SSI, you might create a scoring system based on info in patients' files that indicates risk of SSI from issues other than home care. You could then control for that score.

The dependent variables you list in the figure--shouldn't they be just knowledge and SSI? Are you following mothers to determine if SSI develops? For how long will you follow them?

State the dependent and exposure variables clearly for each quantitative assessment.

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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: No

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[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.

PONE-D-21-40464R1Designing and testing the effectiveness of a post caesarean section home care guide in preventing surgical site infection in Central Tanzania: ProtocolPLOS ONE

Dear Dr. Mdoe,

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 Dec 09 2022 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,

Jennifer Yourkavitch

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

Please respond to all reviewer comments. Please number the lines in all versions of the manuscript.

Note that the Academic Editor is Reviewer #2 and those comments are included here.

These suggestions refer to the tracked changes version:

1. P. 17-18: Say more about the purposive sampling of midwives (what criteria) and the convenience sampling of post CS women (between certain days or something else?).

2. You said that you removed references to anemia but it is still in the Phase 4 Objective 1 and there is reference to hemoglobin level and anemia status on pages 26 and 27. Please recheck the entire document to remove all references to anemia.

3. I see the addition of matching criteria for post-CS women. What are the matching criteria for nurse midwives?

4. Phase 4 dependent variable--should it be SSI incidence? Is knowledge measured by a score? How will SSI be measured? By count? An outcome variable that is a count should be analyzed with Poisson regression. The knowledge score could be analyzed with linear regression. It's not clear why you are using logistic regression.

5. If you are assessing the outcomes at three time points, then you need to account for time in the statistical models. You could use a time-to-event analysis for SSI, for example. You could consider a time course analysis or a generalized estimating equation. Please ask a statistician to review your methods. The approach to analyzing SSI should be described separately from the approach to analyzing the change in knowledge.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.

Reviewer #1: Yes

**********

2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.

Reviewer #1: Partly

**********

3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.

Reviewer #1: No

**********

4. Have the authors described where all data underlying the findings will be made available when the study is complete?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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: No

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.

(Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Overall, I have seen improvements in the revised document, but note that the paper still has considerable typos and grammar issues to be resolved. These are largely in newer sections, so perhaps that wasn’t reviewed?

1. There is a disconnect for me in this statement: “In Tanzania mainland, the prevalence of CS is 6% (2); although anecdotal evidence shows the facility rate of CS to be as high as 48%. This can be explained by increased proportion of deliveries occurring at the health facilities (3).” I cannot figure out how increased facility deliveries would result in facility c-section rates of 48%.

2. Remove the , from “… guideline further, admits paucity of studies…”. (That entire paragraph has lots of typos and needs close editing)

3. Note, in this sentence: “Studies have shown that no or less information is provided to post CS mothers regarding home care after CS (13)”. This is more accurately “A study in Haiti showed that…” Also, when I looked up reference, and I saw that reference 13 has Harvard misspelled.

4. On page 7, there is a hanging “To design”. Not sure what that is for?

5. You have maintained keeping the “post” in all of your search terms despite my previous comment. When you search that first line, you get “Your search was processed without automatic term mapping because it retrieved zero results.”. These terms *will not work*.

6. The authors reference a validated tool, but don’t provide it: “Data extraction will be guided by the validated tool…” (I believe the reference provided is for an approach, not a tool.) Are they going to develop and validate a tool? If so, this needs to be clarified.

7. As you discuss developing the guide, note this new consensus guidelines has since been published and should be referenced. Kateera et al, “Safe recovery after cesarean in rural Africa: Technical consensus guidelines for post-discharge care”. These are meant to be a guide still needing further adaptation, and so the steps you outline still apply. But it would be a failing to not start with this initial work.

8. For the Phase 3 analysis, I am very confused. The authors reference binary outcomes (logistic regression, Chi-squared tests) but I cannot tell what is the binary outcome. They also reference a continuous outcome, but this is more obvious – changes in scores.

9. You have left anemia in Objective 1 of Phase 4, but have responded to the reviewer that you have removed anemia from the study.

10. I previously commented on my disbelief that this intervention could drop SSIs by 2/3, and the authors responded that this was guided by effect sizes observed in another study. But that study had a **totally** different intervention and study population. I maintain my earlier comment – this intervention is important, but don’t overstate its ability to impact SSIs given the complexity of where SSI risk sits.

11. You need to put the “Analysis of categorical data” as a header

12. The second reviewer suggested creating SSI risk scoring system to control for in analysis. You responded to their comment, but I didn’t see these changes reflected in the document. I am not entirely sure this is a good idea, because particularly for east Africa, I am not sure these risks have been well studied.

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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

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[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.

PONE-D-21-40464R2Designing and testing the effectiveness of a post caesarean section home care guide in preventing Surgical Site Infection in Central Tanzania; ProtocolPLOS ONE

Dear Dr. Mdoe,

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 Feb 26 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,

Jennifer Yourkavitch

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 (if provided):

Please upload the response to reviewers for Revision #2, which you emailed to the academic editor.

You use the terms "mother", "woman", and "female" throughout the manuscript. Please use one term consistently. I suggest using "woman."

Please again review for English grammar word usage and punctuation. It gets better with each revision but there are still approximately two errors on each page. For example, there are several instances where you use a semi-colon incorrectly, as in the Abstract methodology section. The journal does not provide editing services so you want your submitted manuscript to be correct.

There are 5 descriptions of search terms but only four questions (p.10). It's not clear why you would conduct 5 separate searches.

P. 11--"data extraction will be guided by the validated tool..." What is the tool you are referring to here?

P. 29 study power. You say 80% but then have (0.84). Is that a typo?

Do you want to add a Limitations section to the Discussion? If so, please include the possibility of uncontrolled confounding in the estimates derived from the statistical models.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

None

[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.

PONE-D-21-40464R3Designing and testing the effectiveness of a post caesarean section home care guide in preventing Surgical Site Infection in Central Tanzania; ProtocolPLOS ONE

Dear Dr. Mdoe,

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 26 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.

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Jennifer Yourkavitch

Academic Editor

PLOS ONE

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Attachments

Attachment

Submitted filename: Revised Manuscript without track changes_jy.doc

Protocol for designing and testing the effectiveness of a post caesarean section home care guide in preventing surgical site infection in Central Tanzania

PONE-D-21-40464R4

Dear Dr. Mdoe,

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,

Jennifer Yourkavitch

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: