PONE-D-23-02020Utilization of Non-pneumatic Anti-shock Garment for Treating Obstetric Hemorrhage and Associated Factors among Obstetric Care Providers in Ethiopia: A Systematic review and Meta-analysis

PLOS ONE

Dear Dr. Addisu,

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.

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• Methods section: Carefully revise methods section, for example, clarify  how the systematic review and meta-analysis conducted without registering and checking PROSPERO? Follow our journal requirement for reviews and meta-analysis. Recheck search strategy, variable definitions, inclusion/exclusion criteria. Data analysis  needs to be refined by considering analysis by region, conducting meta regression to investigate the source of heterogeneities.
• Results section: Substantially reinvestigate and sharpen it as per the reviewers’ comment.
• Discussion section is not sharp and not strong, carefully revise it  based on your  data/findings.

Please submit your revised manuscript by Jun 08 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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We look forward to receiving your revised manuscript.

Kind regards,

Philipos Petros Gile, MA

Academic Editor

PLOS ONE

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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: Partly

Reviewer #3: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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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

Reviewer #3: Yes

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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

Reviewer #2: Yes

Reviewer #3: No

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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: Title: Utilization of Non-pneumatic Anti-shock Garment for Treating Obstetric Hemorrhage and Associated Factors among Obstetric Care Providers in Ethiopia: A Systematic review and Meta-analysis

Thank you for considering me to review this manuscript. The paper raises one of the effective interventions to reduce maternal mortality secondary to postpartum hemorrhage particularly in developing nations including Ethiopia. I put my concerns as follow:

General

#1. First of all, I recommend the authors to strictly follow the journal “authors’ submission guideline” to organize the manuscript. For example, give continuous line number to specifically locate the comments. The figures must be submitted as a separate file in tiff format. In addition, mentioning the author’s title (Mr, Dr…) in the author list is not advisable; you can fill such information in the system.

#2. Better to avoid the abbreviations from the abstract section; moreover, you mistakenly abbreviate NASG as NSAG in the 6th line of the background in the abstract section.

Abstract

It lacks some key points. First, the background section must not be directly copied from the introduction section; rather some paraphrasing and synthesis are mandatory. Second, the method must address the total number of journal articles retrieved from the listed databases before screening for eligibility; by which software you analyze the data and so forth. Third, in the result section you have to mention how many obstetric care providers are involved in the studies included. Finally, the conclusion is almost a copy of the result section and needs further revision. In general, as the abstract is the stand-alone summary of the whole work you have to rewrite it by incorporating the above-mentioned points and other pertinent information.

Methods

#1. How did you conduct this systematic review and meta-analysis without registering it in PROSPERO? How do you know the need of review unless you checked it in PROSPERO? Moreover, unless you register the title how do you stop further duplication by other authors before this paper is published? It is also unethical to conduct systematic review and meta-analysis in such a way.

#2. Under the “searching strategies and source of information” subheading; there is duplication of ideas that needs further proof reading. E.g. The searching strategies for google scholar was written two times.

#3. The attempts made to access gray literature were not well expressed or poor. Even all the studies included in the analysis are published. How do you see it?

#4. Measurement of KA: modify the operational definition; what if the participants exactly score 50% for K; under which group you categorize them. Furthermore, did all the studies included in this review measure knowledge and attitude by the same items and operationalize them in the same way?

Result

#1. There is high heterogeneity among studies even after the subgroup analysis. This may be due to methodological or statistical problems in the primary studies. Hence, it would be better to further identify the source of the problem and come up with an acceptable value. You actually mention as a limitation, however the problem is serious enough and reanalysis must be done after further evaluation of the primary studies and excluding those of poor quality.

#2. In general, I appreciate the attempts made by the authors. However, the results in this paper need further investigations; some of the measures of effects reported are not trustworthy. For example, Figure 9. “Having two or more NASG within the health facility increases the odds of NASG use for PPH treatment by 10.59-fold (OR = 10.59, 95%CI = 6.59, 17.01)”. When you look at each primary study, there is too wide confidence interval that may be due to small sample size or wrong analysis. Hence, it would be better to check the quality of the primary studies again, particularly the analysis.

Reviewer #2: It is good to see such good research,the way use statistical methods, flow of ideas. It is the manuscript technically sound.

The manuscript presented in tables and figures.

Why you not did sub group analysis by region? And you did not do meta regression to investigate the source of heterogeneities.

Reviewer #3: I am grateful for your efforts since I find your study to be very fascinating and to cover the underrepresented populations, especially in emerging nations like Ethiopia. After mentioning this, the authors should revise the suggestions that follow

Abstract part

Include the software used to analysis the data

Introduction

Generally it lacks coherence

Please be concentrated on your study population and objectives throughout the manuscript

Write the statement of the problem with the following structure

In the first paragraph the definition and importance of your outcome variable

Paragraph 2 show the magnitude or severity of the problem from global to local

Paragraph 2: consequence of the problem

Paragraph 3: Common determinants of the utilization of Anti-Shock Garment

Paragraph 4: efforts made to increase the utilization of Anti-Shock Garment

Paragraph 5: show the gap clearly

Method part

Avoid redundancy “whereas the searching strategy for google scholar was: "Non-pneumatic Anti-shock Garment" and "utilization" and ("associated factors" or "determinants") and "Ethiopia"

Avoid numbering from the inclusion criteria (write in sentence case)

Result part

In the first paragraph the number in text and in fig 1 is inconsistence 64 vs 61

In the inclusion criteria you say “published between January 1, 2010 and January 1, 2023,” but in the result part “ All studies were published between 2020 and 2023 and have a low risk of bias”

In subgroup analysis use another variable for example region to solve heterogeneity in steady of study design

Discussion part

Your discussion is not strong and persuasive. So, you are expected to search exhaustively and waste your time on it. You are also expected to discuss on the implications of the findings in context of existing research.

The paper also needs extensive grammatical correction and rephrasing

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Reviewer #1: No

Reviewer #2: Yes: Kelemu Abebe

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Comments for Author.docx

PONE-D-23-02020R1Utilization of Non-pneumatic Anti-shock Garment for Treating Obstetric Hemorrhage and Associated Factors among Obstetric Care Providers in Ethiopia: A Systematic review and Meta-analysisPLOS ONE

Dear Dr. Addisu,

This is the last reminder as we have invited you for resubmission. 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.

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,

Philipos Petros Gile, MA

Academic Editor

PLOS ONE

Journal Requirements:

1. 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:

The paper still needs minor refinement, including proof reading. Editorial staff will follow all the requirements before processing the paper.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Almost all of the concerns raised in the previous review were well addressed. However, the manuscript still needs further proof reading. For example, look at the abbreviation in line 34 "NSAG". Furthermore, the justification given for high heterogeneity, which is "We have seen several meta-analysis studies with high heterogeneity published in high-quality journals like PLOS One, BMJ Global Health, and Cochrane Libraries". Better to give scientific justification with reference. Being published in high ranking journal does not always show the quality of the paper.

Reviewer #2: The manuscript is well written, has a clear and concise title that accurately reflects the content of the study.it is a public health concern and global issue.

The authors have made significant contributions to the subject, pointing out important gaps that need to be filled by future studies.

I recommend the acceptance of this publication research manuscript for publication in this journal.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Kelemu Abebe Gelaw

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[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.

Utilization of Non-pneumatic Anti-shock Garment for Treating Obstetric Hemorrhage and Associated Factors among Obstetric Care Providers in Ethiopia: A Systematic review and Meta-analysis

PONE-D-23-02020R2

Dear Author,

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.

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Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

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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

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