Prevalence and correlates associated with early childbearing among teenage girls in Ethiopia: A multilevel analysis

Abebe Debu Liga; Adane Erango Boyamo; Yasin Negash Jabir; Akalu Banbeta Tereda

doi:10.1371/journal.pone.0289102

Peer Review History

Original SubmissionJune 30, 2022
25 May 2023 Decision Letter - Lucinda Shen, Editor PONE-D-22-18542Risk factors and prevalence associated with early childbearing among teenage girls in Ethiopia: A Multilevel AnalysisPLOS ONE Dear Dr. Liga, 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. The manuscript has undergone a thorough review by two reviewers, and their comments are provided below for your reference. The reviewers have recommended English language copy editing to improve the presentation. Additionally, they have requested several clarifications regarding the study methodology to ensure the reproducibility of the reported methods. Please submit your revised manuscript by Jul 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. 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, Lucinda Shen, MSc Staff Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional 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. 2. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service. Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services. If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free. Upon resubmission, please provide the following: The name of the colleague or the details of the professional service that edited your manuscript A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a supporting information file) A clean copy of the edited manuscript (uploaded as the new manuscript file). 3. Thank you for stating the following financial disclosure: “No funding was obtained for this study.” At this time, please address the following queries: a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” c) If any authors received a salary from any of your funders, please state which authors and which funders. d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. [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: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. 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: No ****** 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: No ****** 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: good job. adolescent reproductive health is always at the center stage because of worsened maternal and newborn health indices. however, you need to describe the ethical processes in data collection or approval to use these secondary data. Reviewer #2: Authors must consider engaging an English language expert to help undertake a complete language editing of the entire research work; subject verb agreement, grammatical errors, unusually long sentences and to mention a few. The aim of the study is unclear. Methodology Authors should rephrase this statement for clarity--"This study was conducted in 2016 by the Ethiopian Demographic and Health Survey". If secondary data was obtained for this work, it should be clearly stated with appropriate referencing of primary data. Sections of the methodology indicate male and females ages 15-59 years were interviewed. Were males included in this study. Authors should please clarify. Authors indicated that all girls aged between 15 to 19 years were included in the study and those out of the range were excluded. How was consent obtained for females less than 18 years of age? Was accent sought from this age group in the primary data. Results There seem to be copious repetition of the results in the tables in the write up. Authors can consider stating just significant ones and leave the rest in the illustrated tables for readers to peruse. Discussion In-text referencing of CSA, 2016 should be properly done. Can authors identify some study limitations and how their study design or approach sought to curtail the limitations. ****** 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: Emmanuel Ugwa, PhD Reviewer #2: No ******** [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.0289102.r001
Revision 1
7 Jun 2023 Author Response 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. Author’s response: As suggested by the editor, we made an attempt to keep to the guidelines of the PLOS ONE style. 2. We suggest you thoroughly copyedit your manuscript for language usage, spelling, and grammar. If you do not know anyone who can help you do this, you may wish to consider employing a professional scientific editing service. Author’s response: According to the editorial suggestions, we rewrote the entire document using proper grammar. Whilst you may use any professional scientific editing service of your choice, PLOS has partnered with both American Journal Experts (AJE) and Editage to provide discounted services to PLOS authors. Both organizations have experience helping authors meet PLOS guidelines and can provide language editing, translation, manuscript formatting, and figure formatting to ensure your manuscript meets our submission guidelines. To take advantage of our partnership with AJE, visit the AJE website (http://learn.aje.com/plos/) for a 15% discount off AJE services. To take advantage of our partnership with Editage, visit the Editage website (www.editage.com) and enter referral code PLOSEDIT for a 15% discount off Editage services. If the PLOS editorial team finds any language issues in text that either AJE or Editage has edited, the service provider will re-edit the text for free. Upon resubmission, please provide the following: The name of the colleague or the details of the professional service that edited your manuscript Author’s response: The manuscript has been edited by Abebe Debu Liga, and Akalu Banbeta Tereda. A copy of your manuscript showing your changes by either highlighting them or using track changes (uploaded as a supporting information file) A clean copy of the edited manuscript (uploaded as the new manuscript file). 3. Thank you for stating the following financial disclosure: “No funding was obtained for this study.” At this time, please address the following queries: a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” c) If any authors received a salary from any of your funders, please state which authors and which funders. d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Author’s response: Amended it per the editorial comment (Please see the “Financial Disclosure Statement” section) Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. Author’s response: The data used for this study has been in the hands of the first and corresponding authors. So, it will be sent with a reasonable request. 5. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please delete it from any other section. Author’s response: Amended it per the editorial comment. [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: Yes Reviewer #2: Partly ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ________________________________________ 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. 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: No ________________________________________ 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: No Author’s response: We amended the grammar throughout the paper per the reviewer comment. ________________________________________ 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: good job. Adolescent reproductive health is always at the center stage because of worsened maternal and newborn health indices. however, you need to describe the ethical processes in data collection or approval to use these secondary data. Author’s response: At the end of the method section, we added the Ethical Approval Statement to the document. Reviewer #2: Authors must consider engaging an English language expert to help undertake a complete language editing of the entire research work; subject verb agreement, grammatical errors, unusually long sentences and to mention a few. Author’s response: According to the reviewers and editor suggestions, we rewrote the entire document using proper grammar. The aim of the study is unclear. Author’s response: We attempted to clarify the purpose of this study (please see the third sentence of the abstract's background and the last paragraph in the introduction). Methodology Authors should rephrase this statement for clarity--"This study was conducted in 2016 by the Ethiopian Demographic and Health Survey". If secondary data was obtained for this work, it should be clearly stated with appropriate referencing of primary data. Author’s response: We added the relevant reference for it (please see Data source section in the Methods) Sections of the methodology indicate male and females ages 15-59 years were interviewed. Were males included in this study? Authors should please clarify. Author’s response: Actually, only girls under the age of 19 were considered in this study. This study, on the other hand, was based on survey data collected by the Ethiopian Central Statistical Agency. So the data includes males, females, children, and so on. Therefore, we reported the number of males for this study for this reason. Finally, in order to provide a better understanding for the readers, we removed any information regarding Male and shaped it (please see Data source section in the Methods). Authors indicated that all girls aged between 15 to 19 years were included in the study and those out of the range were excluded. How was consent obtained for females less than 18 years of age? Was accent sought from this age group in the primary data. Author’s response: We used Ethiopian Demographic and Health Survey data, which was collected by the Ethiopian Central Statistical Agency, as we tried to explain in the preceding comment. As a result, since the data is secondary, there is no need to get consent from the participants concerning the data. Results There seem to be copious repetition of the results in the tables in the write up. Authors can consider stating just significant ones and leave the rest in the illustrated tables for readers to peruse. Author’s response: We amended it throughout the paper per the reviewer comment. Discussion In-text referencing of CSA, 2016 should be properly done. Author’s response: Amended it per the reviewer comment. Can authors identify some study limitations and how their study design or approach sought to curtail the limitations. Author’s response: Yes, when using primary data as the research analysis, researchers can find solutions to the limitations. However, this may not be the case when using secondary data. Additional Revisions 1. We revised the introduction using more recent sources. 2. We explained the method step by step. 3. We removed the Hosmer and Lemeshow tests from the method, as well as the corresponding findings, because in multilevel modeling, whether to evaluate whether the data is good or bad for the model, Tests of Heterogeneity is sufficient. 4. To have a better knowledge of multilevel modeling model comparison and adequate checking, we added the "Model comparison, adequacy, and heterogeneity checking" section in the methods part. 5. Since we previously displayed the odds ratio with the confidence interval for Z in the last table. Now, we therefore provided the odds ratio together with the corresponding confidence interval. Attachments Attachment Submitted filename: Rebuttal Letter.docx https://doi.org/10.1371/journal.pone.0289102.r002
4 Jul 2023 Decision Letter - Lebeza Alemu Tenaw, Editor PONE-D-22-18542R1Correlates and prevalence associated with early childbearing among teenage girls in Ethiopia: A Multilevel AnalysisPLOS ONE Dear Dr. Abebe 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 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, Lebeza Alemu Tenaw Academic Editor PLOS ONE Additional Editor Comments: - There is no clear description why you are intended to this study. - What are the gaps you have seen from the previous studies? - What does it mean teenage pregnancy? if it is pregnancy before the age of 18 years, how did you talk about marriage before 18 considered as a significant factor? - The other challenge in your result is you identified non modifiable factors like religion as significant factor, what will be your recommendation? - The recommendation is not based on your results. [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 #2: All comments have been addressed Reviewer #3: (No Response) ******** 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 #2: Yes Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: No ****** 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 #2: I commend the authors for revising the manuscript and effecting changes at the various points appropriately. Reviewer #3: Thanks authors as they provided response to previous comments, however, there are some comments that should be addressed by authors as follows: Abstract: Methods: Please write about instrument that you used for data collection. For instance how authors assessed media used by participants. Results: please provide the prevalence of early childbearing teenage as you stated in the title of manuscript. Introduction 1. Readers like to know is child marriage legal in Ethiopia? What is the legal age for marriage? 2. Please provide some information about health care of adolescents who got married for for instance if they receive contraception and other cares. Methods 1. As authors used data collection in 2016, readers would like to know the present situation of Ethiopia. Results 1. Please provide the number of teenagers who were pregnant along with the percentage. 2. Please report the number and percentages of teenagers who were pregnant in age of <15 and between 15 and 19. 3. Page 16, there are two lines that are repetition of their earlier lines, please remove them. 4. As in Table 1, authors stated the age in first marriage, I would like to know, did you have second marriage in your study? How many were pregnant without marriage? 5. Table 1: did you ask about non-modern contraception? 6. The age difference between teenagers and their husbands may play a role in teenagers pregnancy, please report it along with their occupation. 7. All tables: please report p=0.000 as p<0.0001. Discussion 1. In Comparison the rate of teenage pregnancy in the present study with other studies, indicate the year of the study. This is good to know if the teenage pregnancy is in decrease. 2. Please expand the results of the study regarding why Muslim teenagers have early pregnancy and more children? ****** 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 #2: No Reviewer #3: No ******** [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. Attachments Attachment Submitted filename: Revised Manuscript clean copy.docx https://doi.org/10.1371/journal.pone.0289102.r003
Revision 2
10 Jul 2023 Author Response PONE-D-22-18542R1 Correlates and prevalence associated with early childbearing among teenage girls in Ethiopia: A Multilevel Analysis PLOS ONE Title Modification: We interchanged the word “Correlates and prevalence” by “Prevalence and correlates” in the title. Additional Editor Comments: - There is no clear description why you are intended to this study. Author’s response: We elaborated more on it per the editorial comment in the last paragraph of the introduction. - What are the gaps you have seen from the previous studies? Author’s response: We elaborated more on it per the editorial comment in the last paragraph of the introduction. - What does it mean teenage pregnancy? Author’s response: We defined it on the first two citations of the introduction of this study. - If it is pregnancy before the age of 18 years, how did you talk about marriage before 18 considered as a significant factor? Author’s response: Dear editor, our study is only based on teenage girls under the age of nineteen, as we have pointed out in the exclusion and exclusion criteria. Even though marriage under 18 is illegal in Ethiopia, Ethiopian demographic and Health survey data show that most Ethiopian girls marry under the age of 18. As a result, marriage before 18 can be a significant factor associated with teenage childbearing. -Can we assess prevalence by Odds ratio? Author’s response: No, we can assess only the correlates (the associated factors) of teenage childbearing by Odds ratio. We only used the prevalence in the title to show the prevalence rate of early teenage childbearing, and we added the prevalence in the result of the abstract. -You have assessed the associated factors, so how can you know about the burden/ prevalence of teenage pregnancy? Author’s response: We also included its prevalence, as stated in the study's title. We incorporated the prevalence rate in the abstract and reported it as 10.26%. - There is no clear description about the sample size, procedure of extraction the participants. Author’s response: Amended per the editor comments. - The other challenge in your result is you identified non modifiable factors like religion as significant factor, what will be your recommendation? Author’s response: We have tried to elaborate on the possible explanations in the discussion, and conclusion. - The recommendation is not based on your results. Author’s response: We have tried to modify it. 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 #2: All comments have been addressed Reviewer #3: (No Response) ________________________________________ 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 #2: Yes Reviewer #3: Partly ________________________________________ 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: 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 #2: Yes Reviewer #3: No ________________________________________ 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 #2: I commend the authors for revising the manuscript and effecting changes at the various points appropriately. Reviewer #3: Thanks authors as they provided response to previous comments, however, there are some comments that should be addressed by authors as follows: Abstract: Methods: Please write about instrument that you used for data collection. For instance how authors assessed media used by participants. Author’s response: We used data from the Ethiopian Demographic and Health Survey, gathered by the Ethiopian Central Statistical Agency. We considered mass media exposure as watching television, listening to the radio, and reading a newspaper or magazine at least once a week. We incorporated it in the study variable section. Results: please provide the prevalence of early childbearing teenage as you stated in the title of manuscript. Author’s response: We have provided it per the reviewer’s comment. Introduction 1. Readers like to know is child marriage legal in Ethiopia? What is the legal age for marriage? According to Ethiopia's amended family code, getting married before reaching 18 is no longer acceptable. Author’s response: In the introduction's fifth paragraph, we elaborated on it. 2. Please provide some information about health care of adolescents who got married for instance if they receive contraception and other cares. Author’s response: In the end of introduction's fourth paragraph, we tried to elaborate about it. Methods 1. As authors used data collection in 2016, readers would like to know the present situation of Ethiopia. Author’s response: Due to a deficient national documentation system and the fact that past studies were conducted on a local scale, institutionally or regionally focused, there is no evidence available on the prevalence of early teen pregnancy in Ethiopia nowadays. Results 1) Please provide the number of teenagers who were pregnant along with the percentage. Author’s response: We have provided it in the second sentence of descriptive result as well as row 2 of table 1. 2) Please report the number and percentages of teenagers who were pregnant in age of <15 and between 15 and 19. Author’s response: We have provided it in the third sentence of descriptive result. 3) Page 16, there are two lines that are repetition of their earlier lines, please remove them. Author’s response: Removed the repetition and reshaped it. 4) As in Table 1, authors stated the age in first marriage, I would like to know, did you have second marriage in your study? How many were pregnant without marriage? Author’s response: The number of participants who were pregnant without marriage was not considered in our study. 5) Table 1: did you ask about non-modern contraception? Author’s response: We did not gather the data ourselves. We used data from the Ethiopian Demographic and Health Survey, gathered by the Ethiopian Central Statistical Agency. They collected data on 16,583 women in total, but only 3,498 of those women provided all the necessary information. Also, they gathered data on non-modern methods of contraception, and the EDHS report showed that some respondents used them; however, when the missing data was cleared, none of the women who used non-modern methods of contraception were included. 6) The age difference between teenagers and their husbands may play a role in teenagers pregnancy, please report it along with their occupation. Author’s response: We accepted this insightful recommendation. However, we chose only eleven variables for consideration at the beginning of this study out of a huge number of variables in the Ethiopian Demographic and Health Survey data. Therefore, it is now challenging to include the husbands' age and work status at this point because doing so results in the responses of the women not being matched unless all variables are selected at the same time. In order to perform it now, it takes time. We hope that you can understand this problem. 7) All tables: please report p=0.000 as p<0.0001. Author’s response: We amended it throughout the table per the reviewer comment. Discussion 1. In Comparison the rate of teenage pregnancy in the present study with other studies, indicate the year of the study. This is good to know if the teenage pregnancy is in decrease. Author’s response: We provided it in the document. 2. Please expand the results of the study regarding why Muslim teenagers have early pregnancy and more children? Author’s response: We have tried to elaborate on the possible explanations in the discussion. ________________________________________ Attachments Attachment Submitted filename: R2-Rebuttal Letter.docx https://doi.org/10.1371/journal.pone.0289102.r004
12 Jul 2023 Decision Letter - Lebeza Alemu Tenaw, Editor Prevalence and correlates Associated with early childbearing among teenage girls in Ethiopia: A Multilevel Analysis PONE-D-22-18542R2 Dear Dr. Abebe 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, Lebeza Alemu Tenaw Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0289102.r005
Formally Accepted
31 Jul 2023 Acceptance Letter - Lebeza Alemu Tenaw, Editor PONE-D-22-18542R2 Prevalence and Correlates Associated with early childbearing among teenage girls in Ethiopia: A Multilevel Analysis Dear Dr. Liga: 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. Lebeza Alemu Tenaw Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0289102.r006

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