“I could not bear it”: Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative study

Eleonore Baum; Sied Abdi; Nicole Probst-Hensch; Jakob Zinsstag; Birgit Vosseler; Rea Tschopp; Peter van Eeuwijk

doi:10.1371/journal.pone.0293137

Peer Review History

Original SubmissionMarch 30, 2023
6 Sep 2023 Decision Letter - Taofiki Ajao Sunmonu, Editor PONE-D-23-08854“I could not bear it”: Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative studyPLOS ONE Dear Dr. Baum, 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 Oct 21 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Taofiki Ajao Sunmonu 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. Please amend your current ethics statement to address the following concerns: a) Did participants provide their written or verbal informed consent to participate in this study? b) If consent was verbal, please explain i) why written consent was not obtained, ii) how you documented participant consent, and iii) whether the ethics committees/IRB approved this consent procedure. 3. Thank you for stating in your Funding Statement: “This 10-year project is part of the Jigjiga University One Health Initiative (JOHI) co-funded by the Swiss Agency for Development and Cooperation (SDC) Project no. 7F-09057.02.01. The project is implemented by Jigjiga University (JJU), Swiss Tropical and Public Health Institute (Swiss TPH) and the Armauer Hansen Research Institute (AHRI). The project is also supported through the doctoral program at OST - Eastern Switzerland University of Applied Sciences and the scholarship program from the Swiss School of Public Health (SSPH+). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now. Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. Please include your amended Funding Statement 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. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): it would be nice if the sample size of the study could increaed as suggested by the reviewers. [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: No Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: N/A ****** 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: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Although, this study aims to explore the perceptions and notions of chronic pain among Somali pastoralists but I think this illustration cannot add more to the scientific research and the authors better use a control group from other country or another population to strenghthen the study. Reviewer #2: I reviewed a manuscript titled "Perceptions of Chronic Pain Among Somali Pastoralists in Ethiopia." This is a small descriptive study that looked at a diverse group of adult pastoralists and agro-pastoralists dealing with chronic pain in Ethiopia. The study used ethnographic research techniques. Pastoralists are a group often marginalized socially and geographically, known for enduring many hardships in their daily lives. When it comes to chronic pain, they mainly rely on traditional and spiritual health practices, with Western biomedical approaches being quite rare. The authors referenced a study by Kawza et al., which found that only 10% of pastoralists in Southern Ethiopia used biomedical healthcare facilities when they were sick. Main strength of this study is how it enhances our understanding of the sociocultural aspects of pain perception within this isolated population. However, a major weakness lies in the small sample size and the potential bias towards patients who use biomedical healthcare facilities. ****** 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 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.0293137.r001
Revision 1
30 Sep 2023 Author Response RESPONSE TO REVIEWERS Manuscript: PONE-D-23-08854 Manuscript title: “I could not bear it”: Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative study Comments from the Editor It would be nice if the sample size of the study could increased as suggested by the reviewers. Response from the Author Thank you for your suggestion. We are convinced that qualitative studies with smaller sample sizes can provide valuable insights into a marginalized population that so far has been neglected in this field of research. We have now added more information on the sample size of the preceding focus group discussions in the methods section. We also mentioned this as a major strength of our study. Thereby, we can increase the overall sample size of the study. - Methods section, p. 7, lines 181-186 - Strengths and limitations section, p. 23, lines 572-575 Comments from Reviewer 1 Although, this study aims to explore the perceptions and notions of chronic pain among Somali pastoralists but I think this illustration cannot add more to the scientific research and the authors better use a control group from other country or another population to strenghthen the study. Response from the Author Thank you for this comment. We argue that qualitative research has a great deal to offer when trying to gain in-depth insights into persons' illness experiences. From our point of view, the findings are completely novel in this field of research. To our knowledge no other study has examined chronic pain experience in this unique context and in this marginalized population. Indeed, these initial findings can provide valuable insights and orientation for future studies (as described in the "strengths and limitations"). In addition, by drawing on studies investigating Somalis and/or pastoralists in other countries, we can make relevant comparisons (e.g., lines 483-493). Furthermore, we made sure to now point out that the various settings of this study also allowed for interesting comparisons (home as well as biomedical). - Methods section, p. 7, lines 181-186 - Strengths and limitations, p. 23, lines 570-575/590-593 Comments from Reviewer 2 I reviewed a manuscript titled "Perceptions of Chronic Pain Among Somali Pastoralists in Ethiopia." This is a small descriptive study that looked at a diverse group of adult pastoralists and agro-pastoralists dealing with chronic pain in Ethiopia. The study used ethnographic research techniques. Pastoralists are a group often marginalized socially and geographically, known for enduring many hardships in their daily lives. When it comes to chronic pain, they mainly rely on traditional and spiritual health practices, with Western biomedical approaches being quite rare. The authors referenced a study by Kawza et al., which found that only 10% of pastoralists in Southern Ethiopia used biomedical healthcare facilities when they were sick. Main strength of this study is how it enhances our understanding of the sociocultural aspects of pain perception within this isolated population. However, a major weakness lies in the small sample size and the potential bias towards patients who use biomedical healthcare facilities. Response from the Author Thank you for your considerations and for highlighting these important points. We added further information on the utilization of health services specifically for Somali pastoralists. As elaborated briefly above, we are convinced that qualitative studies with small sample sizes can provide valuable insights into a population, for which we have very limited information on pain perception. The small sample size was mentioned in the "strengths and limitations" section of the paper. We have now added more information on the sample size of the preceding focus group discussions. Indeed, most interviews took place in biomedical healthcare facilities. However, we also interviewed n=5 pastoralists affected by chronic pain in their home. We elaborate on this in the section "Setting and recruitment". In addition, we highlight the pastoralists' care itineraries in the results, thereby describing steps taken before they came to the health facility. In the "Conclusion", we added the recommendation to investigate how pastoralists are burdened by chronic pain and how they cope with chronic pain within their communities. - Background section, p. 4, lines 88-94/99-103 - Methods section, p.7, lines 181-186 - Results section, p. 10, lines 268-269 - Strengths and limitations, p. 23, lines 572-575/591-593 - Conclusion section, p. 24, lines 598-600 Attachments Attachment Submitted filename: Response to reviewers_.pdf https://doi.org/10.1371/journal.pone.0293137.r002
6 Oct 2023 Decision Letter - Taofiki Ajao Sunmonu, Editor “I could not bear it”: Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative study PONE-D-23-08854R1 Dear Dr. Baum, 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, Taofiki Ajao Sunmonu Academic Editor PLOS ONE Additional Editor Comments (optional): The authors have satisfied the concerns raised in the article and it is pubblishable in this present form. Congrattulations. Reviewers' comments: https://doi.org/10.1371/journal.pone.0293137.r003
Formally Accepted
3 Nov 2023 Acceptance Letter - Taofiki Ajao Sunmonu, Editor PONE-D-23-08854R1 “I could not bear it”: Perceptions of chronic pain among Somali pastoralists in Ethiopia. A qualitative study Dear Dr. Baum: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Taofiki Ajao Sunmonu Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0293137.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .