Prevalence and risk factors of childhood diarrhea among wastewater irrigating urban farming households in Addis Ababa

Adane Sirage Ali; Sirak Robele Gari; Michaela L. Goodson; Claire L. Walsh; Bitew K. Dessie; Argaw Ambelu

doi:10.1371/journal.pone.0288425

Peer Review History

Original SubmissionFebruary 7, 2023
10 Apr 2023 Decision Letter - Aiggan Tamene, Editor Transfer Alert This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present. PONE-D-23-03536Prevalence and Risk Factors of Childhood Diarrhea among Wastewater Irrigating Urban Farming Households in Addis AbabaPLOS ONE Dear Dr. Ali, 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 May 25 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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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No 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: Materials and Methods: The sanitary situation of the study area (lines 105–111) may be deleted, and this can be discussed in the discussion. There is no sampling technique used to select the households. It is mentioned that the sample size was determined based on a ‘longitudinal study designed to investigate the incidence of diarrhea’, but the title and objective of the study specify that the prevalence of diarrhoea would be investigated; this is inconsistent and the study is not a longitudinal study. This study's design is also not mentioned explicitly. Furthermore, it is unclear how the researcher knew, prior to data collection, that the selected households had children under the age of 5. It appears that the questionnaire was pretested on the same population, which is not appropriate. Results: Out of the 402 sample size, 386 responded; however, the total number of participants in some variables is different and inconsistent with the responded size in tables 1 and 2. It is preferable to write ‘p<0,05’ rather than ‘P<0.05’. In the results section, only findings should be given; there should be no discussion or citation of other studies. It is not clear how many under-5 children suffered from diarrhea out of the total number children studied in the previous two weeks. Conclusion: The statement in lines 355–356 is not supported by the findings. Reviewer #2: PONE D 2303536 In abstract Please specify the method that you used for respondent selection Introduction Add the implication of your study to international readers and future research Are the people in Addis Ababa drink from irrigation system? Is the wastewater-contaminate river water as the primary source of drinking water? How the irrigation water become the risk factor of diarrhea in that place? are people of Addis Ababa consumed raw vegetable from farming area that used wastewater irrigation? You should elaborate this information in introduction. Add the previous study that claimed there are microbiological contamination in vegetable or drinking water sources in addis ababa. How many diarrhea cases in your study area ? Inform the reader, your study respondent and why? Material and method Why you only choose two river (Big Akaki and little Akaki) as your study site? I attach structured questionnaire in supplementary material section Is there any Inclusion and exclusion criteria for your respondents? Make sure you have number registration for STATA software. Result and discussion What are protective wears for farmworker that you mean in the result? why it is influence diarrhea cases in Addis Ababa? How children are exposed to diarrhea? Add some citation from the previous studies to discussion section! Why walking through the farm during irrigation will influence diarrhea cases in children? Based on your study result, what are your recommendation to prevent diarrhea? What your study implication for further research? Please make sure your bibliography style in accordance with PLOSone journal style! ****** 6. 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Revision 1
25 May 2023 Author Response Response to comments contain three parts - A. Revisions made as per journal requirements - B. Responses given to the academic editor’s comment - C. Responses given to the reviewers’ comments A. Journal requirements 1. PLOS ONE - Style requirements - File naming are modified following the PLOS ONE’s style 2. Professional language editors (two of the authors are native English speaker, from Newcastle University, UK. F Dr Claire Walsh – Co-author School of Engineering, Newcastle University (UK), Email: claire.walsh@ncl.ac.uk Telephone: +44 (0)191 208 6647, Twitter: @clwnewc https://www.ncl.ac.uk/engineering/staff/profile/clairewalsh.html F Dr. Michaela Goodson – Co-author Email: michaela.goodson@newcastle.edu.my Address: Newcastle University Malaysia Jalan Sarjana 1, Educity@Iskandar Iskandar Puteri, Johor, 79200 https://www.ncl.ac.uk/numed/people/staff-profiles/michaelagoodson.html 3. ORCID iD for the corresponding author I updated my profile information in the editorial manager. https://orcid.org/my-orcid?orcid=0000-0003-1962-1774 4. Your ethics statement should only appear in the Methods section of your manuscript. Ethical statement is included at the end of methods part, just after data analysis section. 5. We note that Figure 1 in your submission contain [map/satellite] images which may be copyrighted. Figure 1, map of the study area is the map of the 10 sub-cities of Addis Ababa with overlaying rivers (SRTM 30x30 ArchGIS 10.8). We generated the map by GIS Software using map data and shapefiles within the public domain and with open access licenses from https://www.usgs.gov/centers/eros/science/usgs-eros-archive-digital-elevation-shuttle-radar-topography-mission-srtm-non www.usgs.gov (https://www.usgs.gov/centers/eros/science/usgs-eros-archive-digital-elevation-shuttle-radar-topography-mission-srtm-non) B. Response to the editor Dear Editor, first up, we express appreciation to your timely processing of our manuscript and your comments. We seriously considered yours and the reviewers’ comments. We hope that we addressed to all the clarifications, questions and comments forwarded in a given timeframe. We kindly request you to see the detail responses for your ‘5’ issues are answered together with the reviewers’ comments. 1. [Issue 1, e.g. Clarification of the research question and better alignment of the objectives with the methodology] Clarification is given in the introduction and methodology part. The research questions/problem statements are elaborated rewriting in an improved way and adding more points. 2. [Issue 2, e.g. Expansion of the literature review to address earlier relevant studies and establish the context for your work] We revised the introduction part as per the comments. Furthermore, additional references/earlier works in related areas are used for elaboration. 3. [Issue 3, e.g. In-depth description of the data collection and analysis procedures to ensure reproducibility] Based on the comments and suggestions given, the methodology part including the study design, sample size determination and sampling techniques are revised accordingly. 4. [Issue 4, e.g. Consideration of alternative explanations for the findings and a more nuanced interpretation of the results] Parts of the finding and interpretation which was not clear; and need better clarification, we made revisions. 5. [Issue 5, e.g. Improvement of the manuscript's structure, organization, and clarity] We made internal structural changes of the manuscript. We clarified unclear and less explained statements and ideas throughout the text. C. Response to Reviewers Response to reviewer #1 Thank you, dear reviewer. Giving fully consideration, we tried to respond to your comments one by one. Material and Method The sanitary situation of the study area (lines 105–111) may be deleted, and this can be discussed in the discussion We shifted it to the discussion part accordingly. There is no sampling technique used to select the households. Sampling technique is included in section 2.2. It is mentioned that the sample size was determined based on a ‘longitudinal study designed to investigate the incidence of diarrhea’, but the title and objective of the study specify that the prevalence of diarrhoea would be investigated; this is inconsistent and the study is not a longitudinal study. Correction is given. At the beginning, the sample size was determined for a longitudinal study, but later on, we changed it to a cross-sectional study. Now, we took the correction accordingly. This study's design is also not mentioned explicitly. - Now in this revision, we further elaborated the design at sections 2.2 and 2.3 Furthermore, it is unclear how the researcher knew, prior to data collection, that the selected households had children under the age of 5. It appears that the questionnaire was pretested on the same population, which is not appropriate. - We used an inclusion - exclusion criteria such as “only wastewater-irrigating farming households”, “only farming households having children under the age of 5 are included”. Thus, we included only those households who have children under the age of 5 are included in the study. The tools were pre-tested on those farming households who were not selected by simple random sampling. Results: Out of the 402 sample size, 386 responded; however, the total number of participants in some variables is different and inconsistent with the responded size in tables 1 and 2. - Yes, we corrected it. The major difference was typographical errors. Some missed values may also be in some variables, but statistically considered during analysis. - We corrected all P-values to be written consistently. It is preferable to write ‘p<0,05’ rather than ‘P<0.05’. - Thank you very much for your comments. I think both ways are possible but I checked the PLOS ONE journal style, it follows the full-stop style, i.e. p<0.05 rather than p<0,05 In the results section, only findings should be given; there should be no discussion or citation of other studies. - We revised it accordingly. It is not clear how many under-5 children suffered from diarrhea out of the total number children studied in the previous two weeks. We revised it. We added a statement in the prevalence section, which an equivalent number for the 22.3% of the participants, i.e. approximately 86 children. Conclusion: The statement in lines 355–356 is not supported by the findings. - We revised the statement. Response to reviewer #2 Thank you, dear reviewer. Giving fully consideration, we hope that we addressed to all your clarifications and comments one by one. Abstract Please specify the method that you used for respondent selection We revised it by adding specific approaches we applied during study population selection. Introduction Add the implication of your study to international readers and future research. We added an elaboration as per the comments given. Are the people in Addis Ababa drink from irrigation system? - No, the river is severely polluted. However, those farming households along the rivers in addition to using the wastewater for irrigation, they use it for cloth washing, for bathing, washing vegetables and livestock drinking. Is the wastewater-contaminated river water as the primary source of drinking water? - No, it is not source of drinking water. How the irrigation water become the risk factor of diarrhea in that place? Wastewater pathogens can reintroduced into the households in several ways including washing bodies, clothes and vegetables with the irrigation water, cloth contamination, using working clothes at home, and bringing farm tools to home without onsite washing. Once the pathogens reach to the domestic environment, it can be ingested directly from hand to mouth, through food, plate and drinking water contamination and soon. Children at home touch the contaminated clothes, boots, farm materials and can contract the pathogens. Are people of Addis Ababa consumed raw vegetable from farming area that used wastewater irrigation? You should elaborate this information in introduction. Yes. The wastewater irrigation supplies more than 90% of the leafy vegetables and more than 65% of all types of vegetables. Those leafy vegetables such as lettuce and chard, which normally eaten raw, are produced from the wastewater irrigation and sold everywhere in the city. Add the previous study that claimed there are microbiological contamination in vegetable or drinking water sources in addis ababa. We added literatures related with this part. How many diarrhea cases in your study area? We included in section 3.2. Inform the reader, your study respondent and why? We revised the problem statement part in the introduction section. Material and method why you only choose two rivers (Big Akaki and little Akaki) as your study site? They are the only rivers in the city, cross the city from north to south. They receive all types of pollutants from multiple sources including households, hotels, restaurants, government institutes, industries, hospitals and other health service sectors. Although the rivers are severely polluted, they are intensively used for vegetable production, livestock drinking, cloth washing, construction etc. Therefore, they are becoming a threat to the public health. Attach structured questionnaire in supplementary material section. The questionnaire can be given as supplementary material Is there any Inclusion and exclusion criteria for your respondents? Yes, we have. Now, in this revised version we added inclusion criteria at section 2.2 Make sure you have number registration for STATA software. Yes, I was using licensed software. Result and discussion What are protective wears for farmworker that you mean in the result? Protective wears include those wears protecting the farm workers’ body and clothes from wastewater during occupation. These include boots, plastic protective coating, masks etc. Why it is influence diarrhea cases in Addis Ababa? The third highest diarrhea prevalence in the country is found in Addis Ababa. WASH condition in Addis Ababa is very poor. Sanitation condition is very poor (indicated in the discussion part). There is no full water supply coverage in the city, particularly in the slum areas. Almost all the city water supply is intermittent. These conditions are usually associated with increased occurrence of diarrhea. How children are exposed to diarrhea? Add some citation from the previous studies to discussion section! We revised accordingly. Included in the discussion part. Why walking through the farm during irrigation will influence diarrhea cases in children. During irrigation activity, most farmers without any protective wears walk across the farm to channelize the irrigation water, which causes direct contamination of the foot and clothes. Moreover, walking through splashes the irrigation water and contaminate the farmers’ cloth. There is no onsite body washing practice in all of the farm workers, which implies that the farmers go home with their contaminated body and clothing and reintroduce wastewater pathogens to domestic environment, where children normally touch and manipulate everything. Based on your study result, what are your recommendation to prevent diarrhea? Our recommendation spans around awareness creation/ education and improving WASH conditions among the farming households. What your study implication for further research? As a way forward, ways to reduce wastewater-related pathogen loads such as by employing onsite wastewater treatment need to be considered. Please make sure your bibliography style in accordance with PLOSone journal style! We changed the bibliography from ‘numbered’ style to ‘Vancouver superscript bracket’ style. Attachments Attachment Submitted filename: Response to the comments.docx https://doi.org/10.1371/journal.pone.0288425.r002
22 Jun 2023 Decision Letter - Aiggan Tamene, Editor PONE-D-23-03536R1Prevalence and Risk Factors of Childhood Diarrhea among Wastewater Irrigating Urban Farming Households in Addis AbabaPLOS ONE Dear Dr. Ali, 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 Aug 06 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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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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, Aiggan Tamene 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. 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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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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: (No Response) Reviewer #2: 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 Response) Reviewer #2: Yes ****** 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: Minor changes are required to the updated document. The author(s) revised ‘p<0.05’ but some ‘P<0.05’ yet to be revised. In the text, the reference number should be cited sequentially, such as [6]. Materials and Methods: It is stated that twelve urban framing sites were chosen for data collection. It should be mentioned that how many of the twelve urban framing sites, were wastewater-irrigated farming sites and how many were non-wastewater-irrigated farming sites? The calculated sample size was 407, although it is mentioned that data was collected from 402 households, with responses obtained from 386 of them. Results: In the title of Table 1, ‘occurrence of diarrhea’ should be included. In the tables, the number of responses against each variable is not comparable; therefore, it is preferable to mention the total number of responses against each variable. Conclusion: It was indicated that the households may be exposed to toxic chemicals; this should be discussed in the discussion before making any comments in the conclusion. Reviewer #2: (No Response) ****** 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: Yes: RATNA DWI PUJI ASTUTI ******** [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.0288425.r003
Revision 2
25 Jun 2023 Author Response All the comments given are properly addressed. - We made necessary revisions as per the comments given by changing “P<0.05” to “p<0.05”. - References numbers are updated and corrected throughout the paper. - We corrected the typographic error in sample size - We revised the table as per the comments given by adding " occurrence of diarrhea". - the errors on table are also corrected. - We made the necessary amendments in the conclusion part. Attachments Attachment Submitted filename: Response to Reviewers comments.docx https://doi.org/10.1371/journal.pone.0288425.r004
29 Jun 2023 Decision Letter - Aiggan Tamene, Editor Prevalence and Risk Factors of Childhood Diarrhea among Wastewater Irrigating Urban Farming Households in Addis Ababa PONE-D-23-03536R2 Dear Dr. Ali, 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, Aiggan Tamene Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0288425.r005
Formally Accepted
4 Jul 2023 Acceptance Letter - Aiggan Tamene, Editor PONE-D-23-03536R2 Prevalence and Risk Factors of Childhood Diarrhea among Wastewater Irrigating Urban Farming Households in Addis Ababa Dear Dr. Ali: 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 Mr Aiggan Tamene Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0288425.r006

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