Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: Findings from a health and demographic surveillance system

Kyu Han Lee; Atique Iqbal Chowdhury; Qazi Sadeq-ur Rahman; Solveig A. Cunningham; Shahana Parveen; Sanwarul Bari; Shams El Arifeen; Emily S. Gurley

doi:10.1371/journal.pone.0288746

Peer Review History

Original SubmissionSeptember 23, 2022
23 Nov 2022 Decision Letter - Forough Mortazavi, Editor PONE-D-22-26467Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: findings from a health and demographic surveillance systemPLOS ONE Dear Dr. Gurley, 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 Jan 07 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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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met. Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript. 3. You indicated that you had ethical approval for your study. Please clarify whether minors (participants under the age of 18 years) were included in this study. If yes, in your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent. 4. Please include your ethics statement in the Methods section of your manuscript. In the Methods section of your revised manuscript, please include the full name of the institutional review board or ethics committee that approved the protocol, the approval or permit number that was issued, and the date that approval was granted. Additional Editor Comments: Dear authors, Thank you for working on this topic. Please clarify how women especially uneducated ones could report difficult to diagnose birth complications such as labor/failure to progress, birth trauma or difficult delivery, high blood pressure, heavy bleeding during delivery, fetal malpresentation, high fever with abdominal pain, and high fever with smelly discharge,? How reliable are the collected data? [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: 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 ****** 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 ****** 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: Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: findings from a health and demographic surveillance system Thank you for providing this opportunity for me to review this manuscript. Please see my comments as follows: Abstract: 1. Please report how many women were assessed? 2. And please report timeline of the study. Methods 1. Please mention the design of the study. 2. Please provide reference for stillbirth, preterm birth and early neonatal death. 3. Please write the inclusion/exclusion criteria. 4. Overall, please re-arrange the manuscript according to STORBE guideline. 5. As some maternal and neonatal deaths are contributed to place of birth (home or hospital), birth attendant (skilled midwife or other health provider), or the number of prenatal care, there are need more information such as did adolescents delivered in hospital, and who was their birth attendants? skilled midwife or nurse? These information should be controlled when you report maternal or neonatal death. Results 1. What was the ratio of vaginal delivery to cesarean section and also what was the rate of vaginal delivery using instrument such as vacuum? 2. Please put some information such as educational level of participants and their husbands, household member in demographic table. 3. Please report maternal death and its cause. 4. Table 2: Authors mention severe headache with blurred vision. Did they mean preeclampsia? If so, please use its correct term. 5. Again, for high fever and smelly discharge, did they mean postpartum infection? 6. What authors mean about un-planned hospital delivery? Is that mean women delivered at home and only some of them go to hospital? 7. Please provide a table for multiple logistic regression, until readers to be able to see what confounders were controlled. Discussion 1. Please mention the objective/s of the study at the beginning of the discussion. 2. Discussion needs more comparison between the findings of the study and results of other studies. 3. What was the limitations of the study? 4. What was the conclusion according to the objectives of the study? ****** 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: Yes: Parvin Abedi ******** [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.0288746.r001
Revision 1
20 Dec 2022 Author Response Response to journal requirements: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf The manuscript has been revised to match the PLOS ONE style templates. 2. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met. Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/plosone/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript. The questionnaire has been completed and uploaded as Supporting Information S1 Checklist. 3. You indicated that you had ethical approval for your study. Please clarify whether minors (participants under the age of 18 years) were included in this study. If yes, in your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent. Married minors are included in this study. Written informed consent was directly obtained from these participants. This clarification has been added to the ethics statement, now in the Methods section (lines 83-86) 4. Please include your ethics statement in the Methods section of your manuscript. In the Methods section of your revised manuscript, please include the full name of the institutional review board or ethics committee that approved the protocol, the approval or permit number that was issued, and the date that approval was granted. The ethics statement has been added to the Methods section (lines 83-86). Response to Editor Comments Thank you for working on this topic. Please clarify how women especially uneducated ones could report difficult to diagnose birth complications such as labor/failure to progress, birth trauma or difficult delivery, high blood pressure, heavy bleeding during delivery, fetal malpresentation, high fever with abdominal pain, and high fever with smelly discharge,? How reliable are the collected data? Thank you for your comment. Complications were self-reported. To minimize potential reporting bias, we used common language rather than clinical definitions (e.g. high fever with abdominal pain) or included multiple terms that may represent the same conditions (e.g. prolonged labor, obstructed labor, or failure to progress). All questions were asked by data collectors who were trained to thoroughly describe these conditions. We included a clarification in line 151 and added a limitation statement in the discussion (lines 321-323). If there is a relationship between reporting and education, we would expect bias towards the null, with fewer complications reported among less educated adolescents. Response to Review Comments Reviewer #1: Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: findings from a health and demographic surveillance system Thank you for providing this opportunity for me to review this manuscript. Please see my comments as follows: Thank you for your insightful comments. Please see our responses below. Abstract: 1. Please report how many women were assessed? The total number was added in line 20. 2. And please report timeline of the study. The study years were added in line 20. Methods 1. Please mention the design of the study. The study design is a health and demographic surveillance system. It is included in the title and in the Methods section (lines 93-94). 2. Please provide reference for stillbirth, preterm birth and early neonatal death. References were added to lines 44-46. 3. Please write the inclusion/exclusion criteria. Data were from a health and demographic surveillance system with the only inclusion criterion being a resident of the catchment area. We have added a clarifying statement in lines 94-95. 4. Overall, please re-arrange the manuscript according to STORBE guideline. STROBE does not recommend a specific arrangement. According to the original article describing STROBE (Elm 2007), “the order and format for presenting information depends on author preferences, journal style, and the traditions of the research field.” If there are elements in reporting that the reviewer feels are missing, we are happy to address those. Reference: Elm et al. 2007. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61602-X/fulltext#article_upsell 5. As some maternal and neonatal deaths are contributed to place of birth (home or hospital), birth attendant (skilled midwife or other health provider), or the number of prenatal care, there are need more information such as did adolescents delivered in hospital, and who was their birth attendants? skilled midwife or nurse? These information should be controlled when you report maternal or neonatal death. Thank you for your thoughtful comment. We consider these factors to be mediators between adolescence and perinatal deaths, rather than confounders. We understand these mediators are critical for maternal health. However, for this study, we wanted to focus on what the public health community could do at the beginning of the causal chain, which in this case is child marriage, rather than untangling potential mediators of this relationship. Results 1. What was the ratio of vaginal delivery to cesarean section and also what was the rate of vaginal delivery using instrument such as vacuum? We’ve included the proportion of all singleton births with cesarean section and the proportion of all vaginal deliveries involving vacuum extraction in lines 240-242. 2. Please put some information such as educational level of participants and their husbands, household member in demographic table. To capture socio-economic indicators of study participants, we used a household wealth index instead, which is included in the demographic table (Table 1). Education level was not considered an optimal indicator as the upper bound would be limited by age (e.g., mothers aged 12-15 would only have partial secondary education), and would be less useful for comparing groups. 3. Please report maternal death and its cause. We identified a total 7 deaths among residents who had any pregnancy outcome (miscarriage or birth) between January and August 2019. All deaths were among women 19 to 35 years of age who had a singleton live birth. Six deaths were likely related to pregnancy, occurring within a month of birth. One death occurred approximately 9 months after birth. These results were added to lines 242-246. Unfortunately, the cause of maternal death was not systematically investigated. 4. Table 2: Authors mention severe headache with blurred vision. Did they mean preeclampsia? If so, please use its correct term. Complications were self-reported in a population that may not be familiar with clinical definitions such as “preeclampsia”. To minimize potential reporting bias, we used common language rather than clinical definitions (e.g. high fever with abdominal pain) or included multiple terms that may represent the same conditions (e.g. prolonged labor, obstructed labor, or failure to progress). All questions were asked by data collectors who were trained to describe these conditions. We included a clarification in lines 151 and added a limitation statement in the discussion (lines 321-323). 5. Again, for high fever and smelly discharge, did they mean postpartum infection? Please see response to #4 above. 6. What authors mean about un-planned hospital delivery? Is that mean women delivered at home and only some of them go to hospital? Yes, this meant the mother planned to deliver at home but ended up at the hospital for delivery. A clarification was added to lines 155. 7. Please provide a table for multiple logistic regression, until readers to be able to see what confounders were controlled. This information is available as Table S4. Discussion 1. Please mention the objective/s of the study at the beginning of the discussion. We have included the objectives of the study as requested. 2. Discussion needs more comparison between the findings of the study and results of other studies. We expanded our literature search to other studies including those in South Asia [lines 277-279, 302-304]. 3. What was the limitations of the study? We believe the main limitations of this study is 1) the role of out-migration and deaths among female residents (lines 319-320) and the self-reported nature of complications. We’ve added the second point in lines 320-323 in response to your earlier comment. 4. What was the conclusion according to the objectives of the study? A conclusion section was added (lines 339-343). Attachments Attachment Submitted filename: Response to Reviewers_PLOS One.docx https://doi.org/10.1371/journal.pone.0288746.r002
7 May 2023 Decision Letter - Fadhlun Alwy Al-beity, Editor PONE-D-22-26467R1Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: findings from a health and demographic surveillance systemPLOS ONE Dear Dr. Emily Gurley Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit . There is one minor comment by Reviewer 2 that I would like you to invite before we proceed Please submit your revised manuscript by Jun 21 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, Fadhlun Alwy Al-beity, MMed, PhD (ongoing) 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: 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: Yes 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: Yes 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: Thank authors as they responded all of my comments, and the manuscript is not ready for publication. Reviewer #2: The authors have addressed all comments well. While I have no concerns and its not necessary to make any edits, the one thing that might be helpful would be to provide an assessment in the discussion of how generalizable these results from a fairly small rural sub-district might be to all of rural Bangladesh. ****** 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: Russell S. Kirby ******** [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.0288746.r003
Revision 2
22 May 2023 Author Response We thank the reviewers for their feedback and comments. Please find our response to the comment listed by Reviewer #2. Reviewer #2: The authors have addressed all comments well. While I have no concerns and its not necessary to make any edits, the one thing that might be helpful would be to provide an assessment in the discussion of how generalizable these results from a fairly small rural sub-district might be to all of rural Bangladesh. We have added a statement on generalizability in the discussion section [lines 319-322]. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0288746.r004
4 Jul 2023 Decision Letter - Fadhlun Alwy Al-beity, Editor Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: findings from a health and demographic surveillance system PONE-D-22-26467R2 Dear Dr. Gurley Emily , 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, Fadhlun Alwy Al-beity, MMed, PhD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0288746.r005
Formally Accepted
10 Jul 2023 Acceptance Letter - Fadhlun Alwy Al-beity, Editor PONE-D-22-26467R2 Child marriage in rural Bangladesh and impact on obstetric complications and perinatal death: findings from a health and demographic surveillance system Dear Dr. Gurley: 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. Fadhlun Alwy Al-beity Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0288746.r006

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