PONE-D-23-11412Antenatal care service utilization disparities between urban and rural communities in Ethiopia: a negative binomial Poisson regression of 2019 Ethiopian Demography Health SurveyPLOS 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: 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: 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: 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: The article on variation of ANC in urban and rural Ethiopia is interesting or order to make policy informed decision on reduction of mother and child death. Please see below observations

1. line 60-61 show the progress made in reducing MMR globally

2. Make the narrative sequential. After highlighting the global issues on ANC, discuss the issue as if affect developing countries, then Africa before focusing in Ethiopia (Line 67)

3. Line 72 Fourth trimester is basically not for monitoring fetal condition, except in cases of pregnancy elongation.

4. Move line 73-76 to paragraph 2

5. Line 89 Please state the previous studies refer

6. Line 94 state or show the previous study

7. Line 95-98 where was these studies conducted

8. line 98 Ten years ago (Kindly specify year e.g 2023)

9. Line 103-105 Please recast as this is not the first research on the subject. Highlight the gap that this study fill

10. Line 255-256 is not clear

11. Line 255-264 state the reason for high ANC in urban region

12. Line 286-288 state tat ANC varies by religious affiliation. Do not state the type of religion

Reviewer #2: Abstract

The abstract extends far beyond the word limit required by the journal which should be about 300 words and I feel that the authors need to abide by this word limit.

The background section of the abstract does not seem to present any rationale for this study which should inform the objective of the study. This is because obviously, there are numerous studies in the context of Ethiopia that have explored ANC utilization and geographical disparities inherent in it. Providing the justification for the study here in the background will give the readers a quick idea of why the study is important and needed.

The result section presented in the abstract will need to be written again to present the most important and significant result, which will ensure that the authors align with the 300-word limit required by the journal.

The conclusion section of the abstract seems like a summary of the results already presented in the previous section. The authors should provide a better conclusion for their study and provide policy or programmatic recommendations or implications for future studies in Ethiopia.

Introduction

The paper will require professional editing services to rid it of various grammatical issues.

Lines 73-76 can be added to the previous paragraph.

The information in lines 83-88 should be added to lines 67-72 because the information being discussed in both sections is similar and falls under the same theme of ANC recommendations and utilization.

Most earlier studies talked about in lines 77-78, what have they found in urban areas? Is the aim of this study to compare evidence from rural areas with these studies??

Has there been no study in Ethiopia where the level of ANC in rural and urban areas has been compared? I am afraid that you have not provided enough justification for your study and this needs to be clearly provided in this study. Also, the gap could be methodological, if previous studies have not employed count models to study ANC, you can fill that gap in addition to what you have discussed as the justification for the present study.

Methodology

To avoid going beyond the journal word limit, I think there isn’t any need to provide much information on the study setting. Rather, those words can be used to provide more information about the EDHS data (check the 2019 EDHS report for more information).

On what basis were the study variables (independent variables) selected for this study? Did the authors consider the need to include variables are the household and community level considering that the study aims to compare urban and rural contexts?

The authors need to provide more information on the outcome variable. How was the question asked in the survey? What did the response from the respondents look like? Is the response a count variable??

While it is understandable that your data is over-dispersed and violates the assumptions of Poisson regression, hence the need for other count models. I think it will be good to better inform your readers about the reason behind your decision to choose negative binomial regression. What does the distribution of your outcome variable look like? Is the outcome variable zero-inflated? These and more are issues to discuss in order for NB regression to be considered the most suitable.

Also, the authors should provide more information on model selection criteria.

The authors can also provide a bar chart showing the distribution of the outcome variable [ANC].

It would also be great to see the authors present mathematical notations of their NB regression models (see previous studies that have employed NB regression for this).

Similar studies that have employed count models to study ANC that could provide guidance to the authors

https://link.springer.com/article/10.1007/s40745-021-00328-x

https://www.tandfonline.com/doi/full/10.1080/03630242.2016.1222325

https://journals.sagepub.com/doi/full/10.1177/24551333211030349

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228215

Results

The authors should consult some other studies that have employed count models for the best practices in the interpretation of the results of count models, especially the IRR.

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Reviewer #1: Yes: Chukwudeh Stephen Okechukwu

Reviewer #2: Yes: Oluwatobi A. Alawode

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Attachments

Attachment

Submitted filename: ANC_Ethiopia_Count Model_Review.docx

Antenatal care service utilization disparities between urban and rural communities in Ethiopia: a negative binomial Poisson regression of 2019 Ethiopian Demography Health Survey

PONE-D-23-11412R1

Dear Dr. Endale,

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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Kind regards,

Obasanjo Afolabi Bolarinwa, Masters

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

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

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

Reviewer #1: I Don't Know

Reviewer #2: 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 #1: Yes

Reviewer #2: No

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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 #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: Thank you for updating the manuscript. Well Done. Kindly proofread the manuscript for English Language and context to ensure that it aligns with global standards.

Reviewer #2: The authors have attended to the issues identified in the article during the first round of review. Paper can be read again for grammatical and stylistic issues.

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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: Chukwudeh Okechukwu Stephen

Reviewer #2: No

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