PONE-D-22-33271Healthcare waste generation and quantification in public health centres in Addis Ababa, EthiopiaPLOS ONE

Dear Dr. Tadesse,

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 May 05 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,

Aiggan Tamene

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

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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.0277209

- http://dx.doi.org/10.4314/ejhs.v28i2.4

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. Thank you for stating the following financial disclosure:

“No funders had no role in this study. I didnt get fund for this study”

At this time, please address the following queries:

a)        Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

b)        State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

c)        If any authors received a salary from any of your funders, please state which authors and which funders.

d)        If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

4. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide.

5. Please ensure that you refer to Figure 3 in your text as, if accepted, production will need this reference to link the reader to the figure.

6. Please upload a copy of Figure 6, to which you refer in your text on page 18. If the figure is no longer to be included as part of the submission please remove all reference to it within the text.

Additional Editor Comments:

Dear Author thank you for your work on this topic.

I have some comments and questions which are very important for the improvement of your paper before publishing

Abstract:

Comment #1 what is the importance of discussing the methods of health care waste disposal system although your title is on generation and quantification of HCW?

Did you assess the disposal system of HCW in this study?

Comment #2: Rewrite this sentence again there is a repetition of the words "The aim of the study was study to assess the type of healthcare waste generation and quantification from selected public health centers in Addis Ababa Ethiopia"

Comment #3: You assessed the type of healthcare waste generation. What type is it? Did you study the rate of HCW generation or the type of HCW generation?

Comment #4: Is the SPSS appropriate for data entry?

Comment #5: Based on research findings 3/4 of HCW is general waste. But you come up with 62.74% hazardous waste. What is the reason behind this finding? Can you give a justification?

Comment #6: Your objective is about waste generation rate and quantification, but your conclusion was for waste segregation and its management practice.

Comment #7: How can waste segregation improve the generation rate? Which one comes first?

Background:

Comment #1: For paragraph one where is its source? It is better to cite particularly the source.

All paragraphs did not explain the background information regarding the waste generation rate and its quantification. But it explains the practice of HCW management, its risks, and consequences for the environment and human beings. I suggest you rewrite the background and to full fill in some incomplete and nonsense paragraphs like paragraph five.

Materials and Methods:

Comment # 1: Why for you focused to study on a Health center setting only? Why not other hospitals?

Comment # 2: What by mean functional health centers? Were there any health centers nonfunctional at the study time?

Comment # 3: Your study's Inclusion and exclusion criteria are the same. Try to identify them and justify what you have done in your study.

Comment # 4: What was your role in data collection? Is it ethical for the researcher to measure the study variables?

Comment # 5: How you assured the health and safety of data collectors?

Comment # 6: How you categorized wastes as hazardous and general?

Results and Discussion:

As I have described in the part of Abstract how can segregation affect the generation rate?

Rewrite this limitation part sentence again [The study was conducted in public health centres healthcare waste generation and couldn’t represent healthcare waste outside the public health centers (private HCF)].

Conclusion:

Is it possible to conclude about the collection, segregation, and transportation and disposal system of HCW with your study objective, design, and findings?

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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: Yes

Reviewer #2: No

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

Reviewer #1: Yes

Reviewer #2: No

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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: No

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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: Yes

Reviewer #2: 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: Comment 1:- under the abstract section of background “Modern methods to dispose of healthcare waste have been introduced to most healthcare institution and yet there is evidence of healthcare waste mismanagement with reference to public health centres in Ethiopia” be written like “Healthcare waste management have been introduced to all healthcare institution within the country, yet there is evidence of poor healthcare waste management practice in public health centres in Ethiopia” or you can write it in other form.

Comment 2:- under the abstract section of background “The aim of the study was study to assess …….” Remove “study”

Comment 3:- under the abstract section of result “the mean (±SD) HCW generation rate in each section was 10.63±5.795 kg/day” is repeated.

Comment 4:- I don’t think it is appropriate to start your background with a paragraph like this “Healthcare waste management is very important due to its hazardous nature …….healthcare waste mismanagement with reference to public health centres in Ethiopia.” So you better remove it from the background”

Comment 5:- The sampling technique and sample size determination methods are not clearly stated.

Comment 6:- under the data collection tool and procedure section, you better clearly state how you prevent mixing of waste of different categories at the point of generation. (Your result “62.7% hazardous waste” showed how the segregation was poor)

Comment 7:- under result section of patient flow in the study health centers you better rewrite the narrative paragraph.

Comment 8:- What type of wastes did you consider as general waste? If possible, please classify general waste as plastic, garden wastes, papers etc.

Comment 9:- in the result section, You have used the unit gram and Kilogram at different parts for single variable like HCW generation rate per patient per day, so I suggest you better use either of one uniformly.

Comment 10:- the discussion and conclusion part has significant grammatical and structural problems, therefore you better revise these parts wholly.

Reviewer #2: While the document contains important strong points, there are significant issues with the methodological approach used by the author/s. I call on the author to review and resubmit after considering the comments forwarded

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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

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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: review comments.docx

PONE-D-22-33271R1Healthcare waste generation and quantification in public health centres in Addis Ababa, EthiopiaPLOS ONE

Dear Dr. Tadesse,

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 Sep 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,

Aiggan Tamene

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

Reviewer #3: All comments have been addressed

Reviewer #4: (No Response)

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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 #3: Partly

Reviewer #4: Partly

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

Reviewer #3: No

Reviewer #4: Yes

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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 #3: No

Reviewer #4: Yes

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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 #3: No

Reviewer #4: No

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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 #3: The manuscript is interesting and good in scientific content and has novelty. It is well fit with the scope and aim of the journal. However, I recommend that a major revision is warranted. A more detailed review can be found in the specific comments below. I ask that the authors specifically address each of my comments in their response.

Abstract:

#Abstract is written good but could you revise the background information. It should only key research gap on the topic.

Reviewing the submitted manuscript without adding the line numbers is very difficult. Authors must add the line number before submitting the revised version of the manuscript, if any. thus, I commented directly in the attached PDF through annotation tools.

Introduction: There are numerous paragraphs through the introduction. Authors are advised the provide complete introduction within 4-5 paragraphs break.

#Introduction needs more clarity with state of arts, objectives of the study for the scientific novelties of manuscript. #Additionally, the introduction should cover the recent literature related to this subject. Introduction is completely lacking with the citation from the years 2022; 2023.

#What are the differences between this study and others in the literature? The originality/novelty of the paper should be clearly stated in the introduction section.

#Please follow the literature review by a clear and concise state-of-the-art analysis. This should clearly show the knowledge gaps identified and link them to your paper goals. Please reason both the novelty and the relevance of your paper goals.

#Provide one nice and technically sound paragraph at the end of introduction section about what is covered in the manuscript. Before it also adds one section on Knowledge gaps in the introduction.

#In the statistical analysis section, the details of used software i.e. name, versions, and make must be mentioned.

I did not find any explanation about the importance of using the statistical analysis approach in the study

Discussion

#The discussion section still needs improvement and should be linked to the findings of the previous reports on this topic. discussion is elaborative but it needs more adequate discussion with supporting latest references. Discussion should be according to the results. Authors should state each citation to its specific discovery.

#I suggest reworking the discussion in order to more sufficiently frame the theoretical, empirical, policy and methodological concerns in the paper.

#The major defect of this study is the debate or argument on the significance of the work is not clearly stated in the introduction section. Hence, the contribution is weak in this manuscript. I would suggest the authors enhance the discussion to justify the novelty.

#Replace the older references with recent literature (2020-2023) in the discussion sections.

Refences:

#For citations and reference within the text, author must follow guide for authors. The references must be also in the format of the journal.

Others

#Unfortunately, the manuscript contains numerous typos, stylistic issues, and some grammatical errors. Manuscript should be checked once for any grammatical as well as typological errors like somewhere spaces and comma (,), if not given, this should be corrected.

#Table legends, figure captions, and foot notes need improvement. All legends, captions, and foot notes should have enough description for a reader to understand the figure without having to refer back to the main text of the manuscript. Avoid the use of abbreviation in figure legends.

All the sections of the manuscript should be revised properly. The manuscript requires major revision.

Reviewer #4: 1. The research gap and objective of the present study is missing in the “Background” section.

2. “Background” of any research should contain Research Background and Context, Research Question or Objective, Brief Literature Review, Significance and Purpose, Methodology, Outline of the Paper. Revised this section based on the above points.

3. Discussion is poorly written even after revision. Though reviewers have given their on discussion to improve but authors fail to incorporate it.

4. I would like to give an example regarding “Comment #5: Based on research findings 3/4 of HCW is general waste. But you come up with 62.74% hazardous waste. What is the reason behind this finding? Can you give a justification?”. In the response of this comment’s authors replied that “there is no segregation at the point of

5. Generation” but it is very surprising that authors did not provide any justification in the revised manuscript.

6. A thorough and extensive revision is required in the discussion is required which will not only based on the comparison of the result of the present study with existing literature but also authors have to justify the reason of getting this type of results which they have obtained.

7. Detail description on “Study design” is required with proper references.

8. These section “Study units”,“Source population”, “Study units” are not understandable. Author should rewrite this section with detail information.

9. It seems that authors has follows the own devolved methodology for the current study as Methodology section is badly suffering form proper citation.

10. Some equations are not readable also.

11. Conclusion is the crux of any paper. The conclusion of a research paper should typically include Summary of Findings, Interpretation of Results, Contribution to Knowledge, Limitations, Recommendations, Closing Thoughts. Remember to keep the conclusion focused, concise, and well-structured, leaving a lasting impression on the reader while summarizing the significance of your work. Rewrite the conclusion based on the above scenario.

12. Author should improve the English language.

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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 #3: No

Reviewer #4: No

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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.

Healthcare waste generation and quantification in public health centres in Addis Ababa, Ethiopia

PONE-D-22-33271R2

Dear Dr. Tadesse,

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,

Sylvester Chidi Chima, M.D., L.L.M, LLD.

Academic Editor

PLOS ONE

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 #3: 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 #3: Yes

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

Reviewer #1: Yes

Reviewer #3: Yes

**********

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

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

Reviewer #1: Yes

Reviewer #3: (No Response)

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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

Reviewer #3: Yes

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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: I would like to appreciate the author for your dedication. Almost all my comments been addressed and amendments had been made as per my comment.

Reviewer #3: (No Response)

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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: Yes: Abel Artwork

Reviewer #3: No

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