Magnitude and determinants of improved household latrine utilization in Ethiopia: Multilevel analysis of the mini Ethiopian Demographic Health Survey (EDHS) 2019

Aragaw Tesfaw; Mulu Tiruneh; Melkalem Mamuye; Zebader Walle; Wondossen Teshager; Fentaw Teshome; Alebachew Taye; Wondimnew Dessalegn; Gashaw Walle; Asaye Alemneh Gebeyehu

doi:10.1371/journal.pone.0289427

Peer Review History

Original SubmissionDecember 22, 2022
14 Feb 2023 Decision Letter - Gizat Almaw, Editor PONE-D-22-34120Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019PLOS ONE Dear Dr. Tesfaw, 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 Mar 31 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, Gizat Almaw Academic 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 noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: - https://doi.org/10.1371/journal.pone.0241270 In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed. 3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. "Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. 4. Please amend the manuscript submission data (via Edit Submission) to include author Asaye Alemneh. 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 move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 6. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 4 and 5 in your text; if accepted, production will need this reference to link the reader to the Table. [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: No ****** 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 ****** 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: 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: Thank you very much for the opportunity given for me to review the manuscript entitled "Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019." As mentioned, the authors did a secondary data analysis that used to determine factors associated with an improved latrine Utilization based on the mini–Ethiopian Demographic Health Survey (EDHS) 2019 data set. Given that, I forwarded my comments that I believed which could help authors to improve the quality of their manuscript. General comment: Overall, despite the known limitation, this study may provide complementary evidence related to latrine Utilization in Ethiopia. I think, the manuscript need language revision and it would be good to refer similar research articles and or tools used for secondary data analysis and follow the writing styles of standard (peer reviewed) published articles. There is mix-up of words and or phrases that are commonly used to report primary studies. For example, phrases such as “This study was conducted in Ethiopia” may give wrong impression and it seems this study was designed to undertake independent study that collect primary research data. Hence, I suggest the authors should revise the document thinking as you are using a secondary data that was collected as part of the national survey. Specific comments #Introduction: Though the objective of the current study is stated in the abstract, the rationale and aim of the study is not clearly explained in the main document (introduction). Indeed, at the end of the last paragraph the author stated, “The findings of this study will help to increase utilization of improved latrines in the households of Ethiopia”. Can you please justify how? Rather, such type of studies often used to generate further and stronger information that can complement the original survey report. Please look at the national EDHS report that was published in May 2021 and articulate the objectives of your study to fil gaps that is not addressed in the report-Perhaps it is still possible to develop testable hypothesis based on your interest of outcome and the main exposure variable. It would be also good to present the conceptual framework that can explain the theoretical and logical relationship of study variables included in this study. Method: brief description of study settings, design and sampling procedures of the survey might be important but that should not be more detailed. Instead, you can cite the published report and explain the structure and composition of the main dataset related to the main outcome variable and related factor variables used for this study. Similarly, instead of describing in detail the general approaches (methods) used to conduct the survey, it is better to provide enough information on the techniques and procedures on how you extract the study variables and data used to achieve your main objective. From my reading (both the manuscript and EDHS survey report), I understood that authors included all eligible samples (households) who were participated in the 2019 mini–Ethiopian Demographic Health Survey. That might be Ok to include all participants, but a systematic sampling (selection) of study units using predefined criteria would be preferred. Meaning, once the maximum power is achieved for the specific objective, the authors should further consider quality of survey data. Not the sample size but such type of dataset requires advanced and sound data handling and management - that is mandatory while using secondary data analysis. Similarly, it is not the mathematical formula and or the general assumption (principles) rather authors should clearly explain their own practical analysis techniques and the respective outputs- that used to decide the next procedure. I think, definitions of terms should precede data management and analysis- not at the end of research methods. Results: like that of the method, the descriptive part of your result section reflected the setting and background characteristics of survey participant- it seems the original report. It is not focused as that was expected from secondary data analysis studies. It is not clear how and where the X2-test and the corresponding p-vale presented in Table-1 were generated while only the frequency and percentage of one-dimensional variables are presented- which is not cross-tabulated. In general, the descriptive findings and the whole results lack the standard criteria used for data visualization (presentation)- perhaps the results (Tabular presentation) reflect the methodological limitation and I felt authors should give more emphasis for data management. For instance, at least those important variables should be recoded or transformed using simple methods and then the reader could grasp the key findings related to this study. It is still difficult to understand the findings generated from the multilevel analysis (Modelling). It is not supported with descriptive reports that can provide additional information- If not mistaken I did not see any descriptive findings or estimates that compare the observed frequency related with the main outcome (Improved Vs Unimproved). I suggest either to modify the descriptive findings or add columns to include the observed frequencies [n (%)] in the multilevel analysis (Table 5). I think, authors should provide their response and explanation to clarify the above issues and then we can proceed to the next section. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [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: Reviewer comments (HT) _ PONE-D-22-34120.docx https://doi.org/10.1371/journal.pone.0289427.r001
Revision 1
1 Apr 2023 Author Response Thank you very much for all the comments provided regarding our manuscript entitled “Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019” which are fully accepted and included in the revised version. I have accordingly made necessary revisions on the paper following the comments provided from the reviewer and editor. For your kind consideration, please find a point-by-point response to the comments and a submitted new revised version of the manuscript. All new changes have been highlighted in dark blue in the main document in order to facilitate review. I hope that you will find the edits as per your expectation and I look forwards to hear from you Please kindly find our point-by-point response for the comments provided. Response to reviewer comments Subject: Reviewer comment for Research Article PONE-D-22-34120 Thank you very much for the opportunity given for me to review the manuscript entitled "Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019." As mentioned, the authors did a secondary data analysis that used to determine factors associated with an improved latrine Utilization based on the mini–Ethiopian Demographic Health Survey (EDHS) 2019 data set. Given that, I forwarded my comments that I believed which could help authors to improve the quality of their manuscript. General comment: Overall, despite the known limitation, this study may provide complementary evidence related to latrine Utilization in Ethiopia. I think, the manuscript need language revision and it would be good to refer similar research articles and or tools used for secondary data analysis and follow the writing styles of standard (peer reviewed) published articles. There is mix-up of words and or phrases that are commonly used to report primary studies. For example, phrases such as “This study was conducted in Ethiopia” may give wrong impression and it seems this study was designed to undertake independent study that collect primary research data. Hence, I suggest the authors should revise the document thinking as you are using a secondary data that was collected as part of the national survey. Author response: We would like to thank and appreciate the reviewer for providing important comments and suggestions. We have now modified the document based on the comments provided by the reviewer in the main document after reviewing some similar research articles in the area. Specific comments #Introduction: Though the objective of the current study is stated in the abstract, the rationale and aim of the study is not clearly explained in the main document (introduction). Indeed, at the end of the last paragraph the author stated, “The findings of this study will help to increase utilization of improved latrines in the households of Ethiopia”. Can you please justify how? Rather, such type of studies often used to generate further and stronger information that can complement the original survey report. Please look at the national EDHS report that was published in May 2021 and articulate the objectives of your study to fil gaps that is not addressed in the report-Perhaps it is still possible to develop testable hypothesis based on your interest of outcome and the main exposure variable. It would be also good to present the conceptual framework that can explain the theoretical and logical relationship of study variables included in this study. Author response: We accepted the reviewer comments and suggestions and we have now corrected/ modified in the main document based on the comments Method: brief description of study settings, design and sampling procedures of the survey might be important but that should not be more detailed. Instead, you can cite the published report and explain the structure and composition of the main dataset related to the main outcome variable and related factor variables used for this study. Similarly, instead of describing in detail the general approaches (methods) used to conduct the survey, it is better to provide enough information on the techniques and procedures on how you extract the study variables and data used to achieve your main objective. From my reading (both the manuscript and EDHS survey report), I understood that authors included all eligible samples (households) who were participated in the 2019 mini–Ethiopian Demographic Health Survey. That might be Ok to include all participants, but a systematic sampling (selection) of study units using predefined criteria would be preferred. Meaning, once the maximum power is achieved for the specific objective, the authors should further consider quality of survey data. Not the sample size but such type of dataset requires advanced and sound data handling and management - that is mandatory while using secondary data analysis. Similarly, it is not the mathematical formula and or the general assumption (principles) rather authors should clearly explain their own practical analysis techniques and the respective outputs- that used to decide the next procedure. I think, definitions of terms should precede data management and analysis- not at the end of research methods. Author response: We have corrected/ modified at the main document based on the comments Results: like that of the method, the descriptive part of your result section reflected the setting and background characteristics of survey participant- it seems the original report. It is not focused as that was expected from secondary data analysis studies. It is not clear how and where the X2-test and the corresponding p-vale presented in Table-1 were generated while only the frequency and percentage of one-dimensional variables are presented- which is not cross-tabulated. In general, the descriptive findings and the whole results lack the standard criteria used for data visualization (presentation)- perhaps the results (Tabular presentation) reflect the methodological limitation and I felt authors should give more emphasis for data management. For instance, at least those important variables should be recoded or transformed using simple methods and then the reader could grasp the key findings related to this study. It is still difficult to understand the findings generated from the multilevel analysis (Modelling). It is not supported with descriptive reports that can provide additional information- If not mistaken I did not see any descriptive findings or estimates that compare the observed frequency related with the main outcome (Improved Vs Unimproved). I suggest either to modify the descriptive findings or add columns to include the observed frequencies [n (%)] in the multilevel analysis (Table 5). I think, authors should provide their response and explanation to clarify the above issues and then we can proceed to the next section. Author response: We have corrected/ modified at the main document based on the comments. We add descriptive statistical analysis results in the revised document based on the reviewer suggestions. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0289427.r002
11 May 2023 Decision Letter - Gizat Almaw, Editor PONE-D-22-34120R1Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019PLOS ONE Dear Dr. Tesfaw, 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 Jun 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. 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, Gizat Almaw Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: [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.0289427.r003
Revision 2
25 May 2023 Author Response Thank you very much for all the comments provided regarding our manuscript entitled “Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019” which are fully accepted and included in the revised version. I have accordingly made necessary revisions on the paper following the comments provided from the reviewer and editor. For your kind consideration, please find a point-by-point response to the comments and a submitted new revised version of the manuscript. All new changes have been highlighted in dark blue in the main document in order to facilitate review. I hope that you will find the edits as per your expectation and I look forwards to hear from you Please kindly find our point-by-point response for the comments provided. Response to academic editor comments 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 Author response: We prepared our manuscript using PLOS ONE's styles /templates 2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: - https://doi.org/10.1371/journal.pone.0241270 In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed. Author response: We have now modified the document based on the comments provided by the editor in the main document 3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability. "Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized. Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access. We will update your Data Availability statement to reflect the information you provide in your cover letter. Author response: The data for this study will be obtained from the cross-ponding author on a reasonable request 4. Please amend the manuscript submission data (via Edit Submission) to include author Asaye Alemneh. Author response: We have included author Asaye Alemneh in the submission link based on the comments 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 move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. Author response: We have now put the ethics statement in the methods section of the main document based on the comments 6. We note you have included a table to which you do not refer in the text of your manuscript. Please ensure that you refer to Table 4 and 5 in your text; if accepted, production will need this reference to link the reader to the Table. [Note: HTML markup is below. Please do not edit.] Author response: We have corrected/ modified in the main document based on the comments Response to reviewer comments Subject: Reviewer comment for Research Article PONE-D-22-34120 Thank you very much for the opportunity given for me to review the manuscript entitled "Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019." As mentioned, the authors did a secondary data analysis that used to determine factors associated with an improved latrine Utilization based on the mini–Ethiopian Demographic Health Survey (EDHS) 2019 data set. Given that, I forwarded my comments that I believed which could help authors to improve the quality of their manuscript. General comment: Overall, despite the known limitation, this study may provide complementary evidence related to latrine Utilization in Ethiopia. I think, the manuscript need language revision and it would be good to refer similar research articles and or tools used for secondary data analysis and follow the writing styles of standard (peer reviewed) published articles. There is mix-up of words and or phrases that are commonly used to report primary studies. For example, phrases such as “This study was conducted in Ethiopia” may give wrong impression and it seems this study was designed to undertake independent study that collect primary research data. Hence, I suggest the authors should revise the document thinking as you are using a secondary data that was collected as part of the national survey. Author response: We would like to thank and appreciate the reviewer for providing important comments and suggestions. We have now modified the document based on the comments provided by the reviewer in the main document after reviewing some similar research articles in the area. Specific comments #Introduction: Though the objective of the current study is stated in the abstract, the rationale and aim of the study is not clearly explained in the main document (introduction). Indeed, at the end of the last paragraph the author stated, “The findings of this study will help to increase utilization of improved latrines in the households of Ethiopia”. Can you please justify how? Rather, such type of studies often used to generate further and stronger information that can complement the original survey report. Please look at the national EDHS report that was published in May 2021 and articulate the objectives of your study to fil gaps that is not addressed in the report-Perhaps it is still possible to develop testable hypothesis based on your interest of outcome and the main exposure variable. It would be also good to present the conceptual framework that can explain the theoretical and logical relationship of study variables included in this study. Author response: We accepted the reviewer comments and suggestions and we have now corrected/ modified in the main document based on the comments Method: brief description of study settings, design and sampling procedures of the survey might be important but that should not be more detailed. Instead, you can cite the published report and explain the structure and composition of the main dataset related to the main outcome variable and related factor variables used for this study. Similarly, instead of describing in detail the general approaches (methods) used to conduct the survey, it is better to provide enough information on the techniques and procedures on how you extract the study variables and data used to achieve your main objective. From my reading (both the manuscript and EDHS survey report), I understood that authors included all eligible samples (households) who were participated in the 2019 mini–Ethiopian Demographic Health Survey. That might be Ok to include all participants, but a systematic sampling (selection) of study units using predefined criteria would be preferred. Meaning, once the maximum power is achieved for the specific objective, the authors should further consider quality of survey data. Not the sample size but such type of dataset requires advanced and sound data handling and management - that is mandatory while using secondary data analysis. Similarly, it is not the mathematical formula and or the general assumption (principles) rather authors should clearly explain their own practical analysis techniques and the respective outputs- that used to decide the next procedure. I think, definitions of terms should precede data management and analysis- not at the end of research methods. Author response: We have corrected/ modified at the main document based on the comments Results: like that of the method, the descriptive part of your result section reflected the setting and background characteristics of survey participant- it seems the original report. It is not focused as that was expected from secondary data analysis studies. It is not clear how and where the X2-test and the corresponding p-vale presented in Table-1 were generated while only the frequency and percentage of one-dimensional variables are presented- which is not cross-tabulated. In general, the descriptive findings and the whole results lack the standard criteria used for data visualization (presentation)- perhaps the results (Tabular presentation) reflect the methodological limitation and I felt authors should give more emphasis for data management. For instance, at least those important variables should be recoded or transformed using simple methods and then the reader could grasp the key findings related to this study. It is still difficult to understand the findings generated from the multilevel analysis (Modelling). It is not supported with descriptive reports that can provide additional information- If not mistaken I did not see any descriptive findings or estimates that compare the observed frequency related with the main outcome (Improved Vs Unimproved). I suggest either to modify the descriptive findings or add columns to include the observed frequencies [n (%)] in the multilevel analysis (Table 5). I think, authors should provide their response and explanation to clarify the above issues and then we can proceed to the next section. Author response: We have corrected/ modified at the main document based on the comments. We add descriptive statistical analysis results in the revised document based on the reviewer suggestions. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0289427.r004
4 Jul 2023 Decision Letter - Aiggan Tamene, Editor PONE-D-22-34120R2Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019PLOS ONE Dear Dr. Tesfaw, 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, 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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(Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Overall, the authors addressed most of my previous comments and noted a significant improvement on the revised version. Hence, I believed the manuscript can fulfill the required criteria for publication with minor modification/ revision. Therefore, appreciating the authors commitment, who made further/ major revision and provided satisfactory responses, I would like to remind some of the previous comments, and I think it is better to look the paper once again before production/publication. Hope, you can still improve the language and other editorial/formatting Method and result section Do you mean you included all eligible samples (households) and variables from 2019 mini-EDHS? I think, you included all participates (HH) but only selected variable based on your specific objective. If that is the case; it should be stated as “We include all eligible samples (households) who were participated in the 2019 mini–Ethiopian Demographic Health Survey based on predefined selection criteria (study variables) related to the specific objectives. If you used the full dataset with different/ advanced analytical approaches, that is ok and you clearly described the statistical analysis procedure- though you can still make further data management such as creating new variables or recoding old variables. • For instance, Number of households member sharing toilet can be recoded in to two/three categories (e.g. < 5 and above) and then you can explain the procedure within data management section. • In table- 2: remove Type of toilet facility from the last row as it is a duplication of the second variable with merged categories. If interested to present findings for each type of latrine, you can illustrate using separate graphs or chart • As to my knowledge, simple statistical tests such as X2 and T- test are used to assess or determine the relationship or association between two or more variables – like that of table-4. While there is only one one-dimensional variables in Table- 1. Can you please justify the importance of are X2 - test and the corresponding P- value? If not better to delete the last two columns in table-1 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. 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Attachments Attachment Submitted filename: Comments for Manuscript Number PONE-D-22-34120.docx https://doi.org/10.1371/journal.pone.0289427.r005
Revision 3
15 Jul 2023 Author Response Thank you very much for all the comments provided regarding our manuscript entitled “Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019” which are fully accepted and included in the revised version. I have accordingly made necessary revisions on the paper following the comments provided from the reviewer and editor. For your kind consideration, please find a point-by-point response to the comments and a submitted new revised version of the manuscript. All new changes have been highlighted in blue in the main document in order to facilitate review. I hope that you will find the edits as per your expectation and I look forwards to hear from you Please kindly find our point-by-point response for the comments provided. Author response to reviewer I comments Reviewers' comments: Reviewer #1: Overall, the authors addressed most of my previous comments and noted a significant improvement on the revised version. Hence, I believed the manuscript can fulfill the required criteria for publication with minor modification/ revision. Therefore, appreciating the author’s commitment, who made further/ major revision and provided satisfactory responses, I would like to remind some of the previous comments, and I think it is better to look the paper once again before production/publication. Hope, you can still improve the language and other editorial/formatting Method and result section Do you mean you included all eligible samples (households) and variables from 2019 mini-EDHS? I think, you included all participates (HH) but only selected variable based on your specific objective. If that is the case; it should be stated as “We include all eligible samples (households) who were participated in the 2019 mini–Ethiopian Demographic Health Survey based on predefined selection criteria (study variables) related to the specific objectives. If you used the full dataset with different/ advanced analytical approaches, that is ok and you clearly described the statistical analysis procedure- though you can still make further data management such as creating new variables or recoding old variables. Author response: Thank you very much the reviewer for the constructive comments provided. As the reviewer said, in our analysis, we used the “HR data set” based on the guideline of DHS program statistics and the study population were household members who have used latrine in the past five year of the survey. A weighted sample of 8663 individuals were involved in the analysis. Therefore we accepted the comment and we included the suggested statement form the reviewer i.e. “We include all eligible samples (households) who were participated in the 2019 mini–Ethiopian Demographic Health Survey based on predefined selection criteria (study variables) related to the specific objectives”. • For instance, Number of households member sharing toilet can be recoded in to two/three categories (e.g. < 5 and above) and then you can explain the procedure within data management section. Author response: We have corrected based on the comment in the main document as suggested by the reviewer. We categorized number of household’s member sharing toilet as < 5 and ≥ 5 household members. • In table- 2: remove Type of toilet facility from the last row as it is a duplication of the second variable with merged categories. If interested to present findings for each type of latrine, you can illustrate using separate graphs or chart Author response: We have corrected based on the comment in the main document as suggested by the reviewer. • As to my knowledge, simple statistical tests such as X2 and T- test are used to assess or determine the relationship or association between two or more variables – like that of table-4. While there is only one one-dimensional variables in Table- 1. Can you please justify the importance of are X2 - test and the corresponding P- value? If not better to delete the last two columns in table-1 Author response: We have corrected based on the comment in the main document as suggested by the reviewer. As you have said, x2 test is just used for just measuring the association between categorical variables and it will be used as also the first step to run logistic regression model since it is one of the assumptions. But in our study we used it just for showing the association between each individual and community level factors with the outcome variable. Thank you for giving your time to review our paper for improvements Author response to reviewer -2 Title: Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019 General remarks: This paper evaluated Magnitude and Determinants of improved household latrine Utilization in Ethiopia, which are interesting information to capture. The manuscript can be accepted for publication after some revisions as below: Background: - Please clarify and provide references and clear examples related to “inconsistences between the study’s findings” in the sentence “However, prior studies on the issue are limited and outdated or focused on specific geographical regions in the country, moreover there are inconsistences between the study’s findings” Author response: thank you for the reviewer for the constructive comments provided. We have corrected the comments in the main document Results: - When compare with previous studies, the authors should have one or two sentences that discussed the similarity or consistent results of this study and previous studies. How consistent or similar? Author response: thank you again to the reviewer for the constructive comments provided. We have tried to explain the similarities or the consistence’s between our study and other study findings in the main document - Avoid using too much “The odds of”. You should use only one time. Author response: We have corrected in the main document - When discuss the “The variation of the fitted models after Multilevel Analysis”, need to assess which model is the most reliable and can be applied for other similar studies. Author response: thank you for the reviewer for the comments the provided. Regarding the models, we already discussed about in the methods section. In multilevel analysis due to the hierarchical nature of the data, we have fitted four different models. The first model was the null model which is an empty model developed without individual or community level variables and the second model (Model II) contained the effects of the individual-level variables on the response variable. The third model (Model III) included the influences of the community-level variables on the response variable, and the final model examined the effects of individual-level and community-level variables. The best model to be used in this case is the model which has the lower deviance statistics in relative comparisons between the models. So, a model with a lower deviance (a measure of model fitness) value was considered as the better-fitted model for this study. Therefore, the final model was the best model for our study. - Please mention that sex and age are not important factors. Is it consistent with previous studies? Author response: there are some studies which have found statistical significant association between sex, and age with latrine utilization. These studies are single area studies and most are conducted using a small size. In our study the data was collected at the household level as a national population based survey and age and sex data was taken from the head of the households. - Grammar errors: This because these are the big administrative cities in the country and the households in these cities have access to using an improved latrine facility as compared to other regions in the country; Determinate of improved Latrine utilization in Ethiopia, etc. Author response: we have corrected/edited in the main document Conclusion - English improvement should be conducted. - There should be included a number found from the result for low utilization of improved latrine. - In this part, the most recommended model for data analysis should be added. Author response: Thank you the reviewer for all the constrictive comments provided. We have corrected/edited in the main document. As mentioned in the methods section, the best recommended model for our study is the final model which was developed from both individual and community level factors and it has the lower deviance statistics. - The limitation and recommendations for future research and suggestion for more variables during the cross-country census survey for better understanding. Author response: Thank you the reviewer for all the constrictive comments provided. We have corrected/edited in the main document. We recommend further research to be done at multicounty level survey data i.e. by including Demographic health survey data’s of several countries for making comparisons. In addition further studies should be done also on the full EDHS data set when it is released. Conclusion: The paper had good information, however, it needs some revisions and improvement. Author response: Thank you for giving your time to review our paper for improvements Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0289427.r006
19 Jul 2023 Decision Letter - Aiggan Tamene, Editor Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019 PONE-D-22-34120R3 Dear Dr. Tesfaw, 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.0289427.r007
Formally Accepted
25 Jul 2023 Acceptance Letter - Aiggan Tamene, Editor PONE-D-22-34120R3 Magnitude and Determinants of improved household latrine Utilization in Ethiopia: Multilevel Analysis of the Mini Ethiopian Demographic Health Survey (EDHS) 2019 Dear Dr. Tesfaw: 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.0289427.r008

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