Practices and drivers of self-medication with antibiotics among undergraduate medical students in Eastern Uganda: A cross-sectional study

Gloria Nakato; Pamella R. Adongo; Jacob Stanley Iramiot; Joshua Epuitai

doi:10.1371/journal.pone.0293685

Peer Review History

Original SubmissionJuly 8, 2023
27 Sep 2023 Decision Letter - Joseph Olusesan Fadare, Editor PONE-D-23-21270Practices and Drivers of Self-Medication with Antibiotics among Undergraduate Medical Students in Eastern Uganda: A Cross-sectional StudyPLOS ONE Dear Dr. Epuitai, 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 Nov 11 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following financial disclosure: “Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health, U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), and President's Emergency Plan for AIDS Relief (PEPFAR) under Award Number IR25TW011213. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.” Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 3. 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. 4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes 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: The authors have produced an useful piece of work on the the prevalence and factors associated with self-medication in Uganda. Abstract 1. The following statement was mentioned twice in the abstract: "The major drivers for self-medication were having a minor illness, prior experience with the drug, and the perception that they were already healthcare workers" Background 1. Generic name need to be used for medications. Reviewer #2: Specific comments Page 3, Line 51: Ampiclox, Septrin: It is preferable to write the medications by their internationally recognized names or to use the trademark sign as superscript i.e. Septrin ® Page 8, Table 1: Distance to health facility? - This question may be relevant if the study is community-based or the university is non-residential. If the university has a health facility, you may want to re-consider inclusion of the question. Page 8, Table 1: Question – Are you a direct student? - For the sake of readers not from your region, kindly explain what is meant by direct and upgrading student Table 2 is too extensive (almost two pages): The authors are advised to revise it either by changing part of its contents to charts and including some as statements in the text. Page 9, Table 2: Question - Last time you self-treated? - For the sake of consistency, the authors are advised to stick to the term "self-medication" Page 9, Table 2: Source of antibiotics Drug shop/clinc: This may confuse the readers - drug shop/clinic. The authors may need to explain the difference using foot notes. Page 10, Table 2: At home - I will suggest using leftovers from previous use" instead of "at home Page 10, Table 2: Street: What is meant by this? Kindly clarify Page 11, Table 2: Acceptable practice, good practice: How does one differentiate between "acceptable" and "good " practice? Page 13, Line 155 : nearly all the respondents had ever used SMA: Please delete "ever". It gives a contrary meaning to the sentence. Page 15, Line 215: Conclusion: Please summarize. There is no need to repeat most of the study findings here ****** 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: Yes: Prof. Joseph Fadare ******** [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: Reviewers Comments Self Medication Uganda.docx https://doi.org/10.1371/journal.pone.0293685.r001
Revision 1
5 Oct 2023 Author Response We would like to extend our sincere gratitude for the helpful peer-review of our work as well as the privilege to re-submit a revised manuscript. We are happy to note that we have addressed the concerns as per the attached response to the reviewer’s comments. We have attached the manuscript with track changes to show the corresponding changes that were made on the manuscript in light of the reviewer’s comments. The manuscript has been revised as per the PLOS ONE style formats, while the ethics statement has also been included in section of methods and materials. We have revised the reference list and removed references which were outdated, repeated and or were not published in peer-reviewed journals. We thank you for the suggestion to include the role of the funders in the study. The funder’s statement now reads as: Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health, U.S. Department of State's Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), and President's Emergency Plan for AIDS Relief (PEPFAR) under Award Number IR25TW011213. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Comment Response Page Reviewer #1: The authors have produced an useful piece of work on the the prevalence and factors associated with self-medication in Uganda. We thank you for the positive appreciation of our work. Abstract 1. The following statement was mentioned twice in the abstract: "The major drivers for self-medication were having a minor illness, prior experience with the drug, and the perception that they were already healthcare workers" We thank you for the insightful observation regarding repeated statements in the abstract. We have taken note of the comment and revised it as per the guidance Line 32-33 Page 2 Background 1. Generic name need to be used for medications. We thank you for the helpful suggestion to use generic names for medications. We have taken note of the comment and revised it accordingly. As per the guidance, generic names have now been used in the work. Line 58-59 Page 2 Comment Response Page Page 3, Line 51: Ampiclox, Septrin: It is preferable to write the medications by their internationally recognized names or to use the trademark sign as superscript i.e. Septrin ® We thank you for pointing out this. We agree that medicines are written using their generic names. We have taken note of the comment and revised the naming of drugs to include generic names. Page 3, line 58-59 Page 8, Table 1: Distance to health facility? - This question may be relevant if the study is community-based or the university is non-residential. If the university has a health facility, you may want to re-consider inclusion of the question. We thank you for the insightful observation. Although the university is non-residential, all students have access to the teaching hospital which situated within the residential location for most participants. We have considered the guidance to leave out this variable as it may not be relevant for this study population. Page 8 table 1 Page 8, Table 1: Question – Are you a direct student? - For the sake of readers not from your region, kindly explain what is meant by direct and upgrading student We thank you for noticing the need to clarify this variable. We have taken note of the comment and revised this variable to mean the mode of university admission (diploma scheme or through high school) Page 8 Table 1 Table 2 is too extensive (almost two pages): The authors are advised to revise it either by changing part of its contents to charts and including some as statements in the text. Thank you for the insightful observation. We agree table 2 was long. We have considered the guidance to include some statements as text which now has reduced the content of table 2 Table 2 Page 10-11 Page 9, Table 2: Question - Last time you self-treated? - For the sake of consistency, the authors are advised to stick to the term "self-medication" We thank you for the comment to maintain consistency in the work. We have taken note of the comment and revised it accordingly. It is now captured as last time of self-medication Table 2 Page 9, Table 2: Source of antibiotics Drug shop/clinc: This may confuse the readers - drug shop/clinic. The authors may need to explain the difference using foot notes. We thank you for the comment. We have modified the naming to make it more meaningful for the readers. As guided, we have added the footnotes that describe what a drug shop is in our setting. We have added drugs sold in the streets to the section of drug shop/clinic since operate in almost the way Page 10 Table 2 Page 10, Table 2: At home - I will suggest using leftovers from previous use" instead of "at home We thank you for the suggestion to use the term leftovers from the previous use. We have revised it to ‘leftovers from previous use’ instead of ‘at home’ Table 2 Page 10, Table 2: Street: What is meant by this? Kindly clarify We thank you for the comment. We have modified the variable to ‘roadside selling point’ and added the footnotes to describe what that means Page 10 Table 2 Page 11, Table 2: Acceptable practice, good practice: How does one differentiate between "acceptable" and "good " practice? We thank you for the comment. We agree that it may be difficult to differentiate between ‘acceptable’ and ‘good’ practice. Because participants may have interpreted the two concepts synonymously, we have decided to combine the two. The variable is now worded as ‘acceptable/good/’ practice Page 11 Table 2 Page 13, Line 155 : nearly all the respondents had ever used SMA: Please delete "ever". It gives a contrary meaning to the sentence. Thank you for the insightful observation. We agree the modifier gives a different meaning to it. We have revised the statement to make it clearer Line 324 Page 13 Page 15, Line 215: Conclusion: Please summarize. There is no need to repeat most of the study findings here We thank you for the suggestion to summarize the conclusion. We have revised it as per the guidance. Page 15 Line 391-400 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0293685.r002
8 Oct 2023 Decision Letter - Joseph Olusesan Fadare, Editor PONE-D-23-21270R1Practices and Drivers of Self-Medication with Antibiotics among Undergraduate Medical Students in Eastern Uganda: A Cross-sectional StudyPLOS ONE Dear Dr. Epuitai, 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. ============================== Page 17, Lines 289-90: Please check the referencing - Organization WH - To be written as WHO (in full) Page 17: References nos 2-10 - Please check these references; names of journals are missing. This sometimes happens with the software being used for referencing. Page 18, Reference no 20 - Same comment as above ============================== Please submit your revised manuscript by Nov 22 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, Joseph Olusesan Fadare Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Thank you for implementing some of the points raised during the initial review in the updated manuscript. However, there are still some issues to be addressed before this manuscript can make progress. Please find below some of the issues to be addressed. Page 17, Lines 289-90: Please check the referencing - Organization WH - To be written as WHO (in full) Pages 17: References nos 2-10 - Please check these references; names of journals are missing. This sometimes happens with the software being used for referencing. Page 18, Reference no 20 - Same comment as above [Note: HTML markup is below. Please do not edit.] [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.0293685.r003
Revision 2
9 Oct 2023 Author Response We thank you for the guidance to revise the reference list. We have taken note of it and revised the reference list according. The reference in line 289 has now been corrected from Organization WH to World Health Organization (WHO). The names of journals have now been included in all the references where the names of the journals were missing (Line 289-342). We thank you once again for the insightful comments that have now resulted in an improved structure of the manuscript. Attachments Attachment Submitted filename: Response to Reviewers 09th Oct 2023.docx https://doi.org/10.1371/journal.pone.0293685.r004
10 Oct 2023 Decision Letter - Joseph Olusesan Fadare, Editor PONE-D-23-21270R2Practices and Drivers of Self-Medication with Antibiotics among Undergraduate Medical Students in Eastern Uganda: A Cross-sectional StudyPLOS ONE Dear Dr. Epuitai, 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. ============================== Thank you for updating the manuscript. However, there are some outstanding issues. This may be due to the reference manager used. I would advise doing some of the changes manually to ensure correctness. Please check the following: References 1-4, 8, 9,18 Please check reference 1 (Organization WH) to World Health Organization. ============================== Please submit your revised manuscript by Nov 24 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, Joseph Olusesan Fadare Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Thank you for updating the manuscript. However, there are some outstanding issues. This may be due to the reference manager used. I would advise doing some of the changes manually to ensure correctness. Please check the following: References 1-4, 8, 9,18 Please check reference 1 (Organization WH) to World Health Organization. [Note: HTML markup is below. Please do not edit.] [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.0293685.r005
Revision 3
11 Oct 2023 Author Response We thank you for identifying references which were missing the journal names. We have reviewed the reference list to ensure correctness (Lines 289-342). Reference name Organization WH has been corrected to World Health Organization. References labelled 1-4, 8, 9 and 18 now have journal names (1& 2: The Lancet Infectious Diseases; Reference 4: Plos One; Reference 8: Malaria Journal; Reference 9: Saudi Pharmaceutical Journal; Reference 18: Antibiotics) Attachments Attachment Submitted filename: Response to Reviewers 11th Oct 2023.docx https://doi.org/10.1371/journal.pone.0293685.r006
17 Oct 2023 Decision Letter - Joseph Olusesan Fadare, Editor Practices and Drivers of Self-Medication with Antibiotics among Undergraduate Medical Students in Eastern Uganda: A Cross-sectional Study PONE-D-23-21270R3 Dear Mr Epuitai, 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, Joseph Olusesan Fadare Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you for addressing the issues raised. Reviewers' comments: https://doi.org/10.1371/journal.pone.0293685.r007
Formally Accepted
11 Dec 2023 Acceptance Letter - Joseph Olusesan Fadare, Editor PONE-D-23-21270R3 Practices and Drivers of Self-Medication with Antibiotics among Undergraduate Medical Students in Eastern Uganda: A Cross-sectional Study. Dear Dr. Epuitai: 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 customercare@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. Joseph Olusesan Fadare Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0293685.r008

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