PONE-D-23-11422Assessing the geographical variations in ovulatory cycle knowledge among women of reproductive aged in Sierra Leone: Analysis of the 2019 Demographic and Health SurveyPLOS ONE

Dear Dr. Gbagbo,

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Obasanjo Afolabi Bolarinwa, Masters

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?

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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

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Reviewer #1: Yes

Reviewer #2: Yes

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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: This is an interesting project that explores an important area of sexual and reproductive health. The authors have done a great job but a few of these suggestions can make the work better.

Abstract

“We investigated regions of Sierra Leone and other sociodemographic variables to determine where the needs for improved ovulatory cycle knowledge are greatest”.

This appears unclear. “Investigated regions” makes the sentence confusing. Maybe it can be written as: We investigated regions of Sierra Leone where the need for improved ovulatory cycle knowledge is greatest and associated sociodemographic variables.

Conclusion of the abstract: I think “understanding” should be added to the sentence that states: …that stakeholders should integrate comprehensive education on the importance of UNDERSTANDING the ovulatory cycle and its timing, into targeted family planning and reproductive health educational program

Background

Great job on the well-written background section, albeit I have a few comments.

o Indicators of ovulation are not exhaustive, because there might be other signs of ovulation that other women experience that have not been added here, I think the authors should make this obvious by adding “etc”.

o Has there been any similar study on this topic in the context of Sierra Leone? The authors appear very silent on this, if not, aside from informing programs and interventions, I think the authors should state that their study will fill this gap in knowledge.

Method

o Can a weblink for the DHS data be included somewhere in the Data Sources?

o In the data source, the authors should provide information about the data collection agency at the national level in Sierra Leone and any other international or local agencies that provided technical and financial assistance.

o Was there any rationale for not merging the exposure to mass media measured as the frequency of reading newspapers/magazines, listening to the radio, or watching TV? It is common in most studies to see a single measure of exposure to mass media based on these variables.

o Were there missing values in the data? How were they treated in the data analysis?

Results

o In the interpretation of the binary logit regression results, the authors should be careful of anthropomorphism. Hence, I feel the result should read “Women from the Northwestern region compared to the reference group of the Northern region” and other narratives should be directed to the women.

Discussion

o The study limitation/weakness stated by the authors appears too generic, and I do not see any reason why a longitudinal relationship between the region of residence/SES/demographic factors and the outcome interest would be needed.

Reviewer #2: This is an interesting piece that interrogate the geographical variable of level of ovulatory knowledge in Sierra Leone. Please find below a few observation for your attention

1. Arrange the key words alphabetically

2. Introduction

A. Kindly state the rationale for this study

B. What is the gap that necessitates this study

C. Is the issue peculiar to Sierra Leone and SSA?

D. Why was the study conducted in Sierra Leone and not Ghana or Ethiopia?

E. Kindly state the specific objectives

3. Method: show the site where the dataset was curated (under the data source)

What is the meaning of "2019 Sierra Leone survey was part of DHS version II)

4. Results

A. Describe statistics and methods used to examine the subgroups. State the level of interactions between regions

5. Discussion

A. State the policy implications for the study

B. State the contribution to knowledge derived from the results

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Reviewer #1: No

Reviewer #2: Yes: Chukwudeh Okechukwu Stephen

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Attachments

Attachment

Submitted filename: PLoS One_Review_Ovulation Knowledge.docx

PONE-D-23-11422R1Assessing the geographical variations in ovulatory cycle knowledge among women of reproductive age in Sierra Leone: Analysis of the 2019 Demographic and Health SurveyPLOS ONE

Dear Dr. Gbagbo,

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 Feb 10 2024 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'.
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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Obasanjo Afolabi Bolarinwa, Masters

Academic Editor

PLOS ONE

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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 #2: 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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #2: Yes

Reviewer #3: (No Response)

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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 #2: Yes

Reviewer #3: 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 #2: 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 #2: The observed comments has been included to enrich the quality of the manuscript. However, the authors has failed to state clearly the contribution this work has made to scholarly knowledge. Although, it has emphasized that lack of knowledge of the ovulatory cycle is a leading cause of unwanted pregnancy. Is this not a general knowledge? I will appreciate a clear cut contribution to scientific knowledge from this work, which is absolutely missing

Reviewer #3: (No Response)

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Reviewer #2: Yes: chukwudeh Okechukwu Stephen

Reviewer #3: Yes: David Bamidele Olawade

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PONE-D-23-11422R2Assessing the geographical variations in ovulatory cycle knowledge among women of reproductive age in Sierra Leone: Analysis of the 2019 Demographic and Health SurveyPLOS ONE

Dear Dr. Gbagbo,

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.

==============================

ACADEMIC EDITOR: Please respond to all reviewers comments==============================

Please submit your revised manuscript by Mar 14 2024 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,

Ahmed Mohamed Maged, MD

Academic Editor

PLOS ONE

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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 #2: 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 #2: Yes

Reviewer #4: Partly

**********

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

Reviewer #2: Yes

Reviewer #4: 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 #2: Yes

Reviewer #4: 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 #2: Yes

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 #2: This is a nice study that examined the link between ovulation and maternal mortality/NMR, and other pregnancy related complications.

It will be nice to add how many respondents were interviewed per household

Also add the policy implications of this study

Reviewer #4: Title: Assessing the geographical variations in ovulatory cycle knowledge among women of reproductive age in Sierra Leone: Analysis of the 2019 Demographic and Health Survey

General comments:

- Overall, the manuscripts lack an academic writing tone e.g. the manuscript is not attractive. The way the introduction of the manuscript was drafted is poor, the method should have been put in comparison to traditional methods or the advantage of the selected method over others, results should have clearly stated positive and negative associations separately, and conclusions should have more practical and actionable rather than showing directions. Thus, it would help if you redrafted the abstract.

Introduction

- I don’t think you can discuss this issue like you presented in the introduction section.

- In the first place you need to define what ovulatory cycle knowledge is

- For whom it is important

- I think you need a strong argument to show the topic is still valid in the presence of modern contraceptive methods. This is more of a traditional method and we do not recommend people follow it because of the costly mistakes, and differences in women's body physiology as the symptoms and signs you mentioned can only occur in some women. I won’t say it is not searchable but you need to play in the context and give enough ground to prove it important.

- Starting from the abstract to the introduction you need to answer the why questions, where is the gap, do we need this information why, and where will this information be applicable?

- Is this information important for policy decisions? Who is going to use this information why since modern contraception has better applicability?

- Thus, redraft the introduction section to fit your aim, and in this way, it will reveal what I can't see now from the existing context.

-

- Methods, results, and discussion

- Say something about DHS. Which type of DHS is the data coming from is that mini or main?

- How data customized for analysis should be discussed

- How missing data handled should be presented more clearly

- Results should be summarized in the same format and follow what was described in the method section

- Discussion should be formatted considering the contest requested above

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Reviewer #2: Yes: Chukwudeh Okechukwu Stephen

Reviewer #4: Yes: Girma Gilano

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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.

Assessing geographical variation in ovulatory cycle knowledge among women of reproductive age in Sierra Leone: Analysis of the 2019 Demographic and Health Survey

PONE-D-23-11422R3

Dear Dr. Gbagbo,

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.

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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,

Ahmed Mohamed Maged, MD

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 #4: All comments have been addressed

**********

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 #4: Yes

**********

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

Reviewer #4: 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 #4: 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 #4: 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 #4: no further comment for this specific version. however, the way they responded to reviewer four is not something expected

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Reviewer #4: No

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