PONE-D-23-35125Tuberculosis treatment success rate, associated factors and outcomes in St.Kizito Hospital, Matany, Napak district, Karamoja region. A retrospective study.PLOS ONE

Dear Dr. MUGERWA SSENTONGO,

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PLOS ONE

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Comments to the Author

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Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: 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: Thanks for submitting the manuscript to PLOS one

Interesting data about the clinical outcomes in TB patients in Napak District, Southern Karamoja, However I have several concerns and comments below.

Title: I suggest author to be clearly about what is the outcome, author should state for example associated factors and treatment success. and this study includes only the TB drug susceptible so author should state the population clearly in the Title.

- Journal: Please check again for the journal Format and should follow journal format.

-Language: Please check and proof the English Language again throughout the whole manuscript.

- All abbreviations should state the full name first.

Introduction

- Line 54: I don't quite understand "single infectious agent" please use other word.

- Please add more previous study about factors associated with treatment success or failure and tell more about your study gap of knowledge why author would like to conduct this study. Are there any differences about the factors between your population VS others

Methods

- What is customized proforma, may be used other word.

-Study setting. Because we have more than one method for TB diagnosis and also TB laboratories. Author have to state how your institutes register patients with TB, what is your criteria for TB diagnosis and LAB (PCR, AFB or others)

Inclusion: Why author includes only TB drug susceptible patients?

Definition: To make reader understand more, Authors have to give the definition >> New and relapse drug susceptible TB by the standard and reliable guideline. Author have to give the definition for all the treatment outcomes and which guideline author used for the reference.

Statistical analysis: This study is retrospective study. I would like to ask author why author use poison rather than logistic regression for factors associated with treatment outcome.

Result.

Table 1 should add more data: Body weight, underlying disease. For sex and residence can show only female or yes.

For table 1 please add the definition of disease classification in the method session.

For table 1 add more data about the TB drug regimens and duration of anti-TB drug treatment

For table 1 add more data about patients' compliance, % Hospitalization, IPD or OPD patients.

Table2: add the full name for all the abbreviation at the footnote under the table ex. cPR,aPR

For Table 2 I suggest author the show only one outcome (Treatment success or failure).

Discussion

I don't quite understand the phase ".......... in a nomadic community which is highly mobile". please clarify

" In the study, we found that a majority of the participants complete TB treatment" In my opinion, 56% of patients are not the majority.

Please discuss the prevalence in your study VS others

Please check the references, some paraphrase didn't state the Ref. ex. This is comparable to what has been in other studies (Ref.???).

-Please clarify more why Hypertension and endocrine abnormalities associated with poor outcome ?

-Please clarify more why Drug interaction related to HIV positive and low prevalence of treatment failure

- What is your strength and limitation

- I suggest author to add the discussion more about the system between the year 2020 and 2021. Are there any different systems between these 2 years because this study's result showed the different treatment outcome.

Reference

Check all the format of the references

Hope these comments might help authors for better manuscript.

Reviewer #2: The authors report a retrospective study on the Tuberculosis treatment success rate, associated factors and outcomes in St.Kizito Hospital, Matany, Napak district, Karamoja region. I have several concerns that should be addressed

General

The authors need to proofread their manuscript to correct all grammatical errors in the manuscript. I have identified several problems with grammar/spelling/punctuation. For example, the word “repported” in line 44 is misspelt, while writing 1st January 2020 in the Study Design paragraph, the “st” should be Superscripted, to mention a few.

Introduction

The authors started using the term DR-NCDs without first explaining the meaning of it. I know this has been explained in the abstract, but it is recommended that when you start writing the main text, all the initials are explained again. The authors should make sure all the abbreviations are explained before starting to use them.

Results

Generally, the authors should not use abbreviations in the titles of the tables. The rule is also for a table to be able to stand alone and be understandable, so it is recommended that all abbreviations used in the table should be explained below the table, as footnotes.

In Table 1, Nutritional (MUAC) is classified as Green, Yellow, and Red without clarifying what the colours represent.

I also suggest that the results for Table 2 should be re-written because the way the paragraph is written now is confusing. My suggestion is that the authors could first mention all the factors and then start explaining them one by one.

Discussion

While reporting the limitation of the study, the authors should have mentioned the inability to obtain data which might have influenced their results. The characteristics that may impact TB treatment outcomes among pastoralist communities include Mobility and Accessibility, Cultural Practices, Livelihood Priorities, Socioeconomic Factors, Education Levels etc.

Reviewer #3: 1. Inclusion and exclusion: I am afraid that excluding those with missing age, gender and disease type would introduce bias in the estimates. The authors need to assess if complete case analysis did not produce biased results. By doing multiple imputation and then compare results (complete case vs imputed data) to check if there is consistence in the findings would help.

2. Inclusion and exclusion: Since those not evaluated were also initiated on treatment, I think they should be part of the denominator. Excluding them especially if they are many can lead to overestimation of the treatment success rate. Can the authors estimate the treatment success rate with the "not evaluated" included?

3. Inclusion and exclusion: Please clarify why the multi-drug resistant TB patients were excluded.

4. Under methods and materials, the authors mention to have used a customized proforma to abstract data. A reference to this proforma at its first mention would be helpful.

5. Study variables: A clear definition of the primary outcome should be given. I suppose this was a proportion. If yes, please define the primary outcome mentioning the numerator and the denominator.

6. Under data management and analysis, the authors mention to have used a modified poison regression to estimate prevalence ratios. Did the authors fit the model with robust standard errors? Since Poison regression if used for binary outcome, it can estimate confidence interval for the prevalence that exceeds a 1, and consequently this affects estimates for the prevalence ratio. Please check that robust standard errors were used and mention this in the analysis methods.

7. It's not clear how a multivariable Poison regression model was built. What factors were considered in the multivariable model and how did the authors arrive at a final fit. Also, how did they decide which factors to include in the model? All these details are needed to make things clear and for reproducibility reasons.

8. Under results in Table 2, it seems like all variables in the data were included in the multivariable analysis and no model building was considered. Would the results be different if only variables with say a p-value at bivariable analysis less than 0.1 were included? Did the authors check for multicollinearity? What about overdispersion, noting that Poisson model assumes equality of variance and mean, which assumption if it does not hold, the model can give misleading results. A negative binomial would be helpful.

9. In reference to my point 1, would the results in Table 2 remain the same if missing data were considered (instead of excluding them)?

10. Below table 2, statements like "Nutrition status", "HIV status" and others look like hanging statements. Please revise the paragraph as you list the significant factors.

11. Please add line numbers to the manuscript as this will make the review process easier.

12. Somewhere you are missing full stops. For example, a full stop is missing before the statement that begins "We used chis-square to test ..."

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: Review comments.docx

Treatment success rate and associated factors among drug susceptible tuberculosis individuals in St.Kizito Hospital, Matany, Napak district, Karamoja region. A retrospective study.

PONE-D-23-35125R1

Dear Dr. Sentongo,

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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Kind regards,

Hamufare Dumisani Dumisani Mugauri, Ph.D. Public Health

Academic Editor

PLOS ONE

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

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

Reviewer #2: Yes

Reviewer #3: 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 #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: No

**********

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 authors have addressed all of the comments which I raised previously. I have no further comments

Reviewer #3: All my comments were addressed. There are however a few typos, which I suggest to authors to pay keen attention or consider sending their paper to an English reviewer. Examples below;

1. In Line 164, "A TB" patient should be "a TB patient"

2. Line 185, "P-value" should be "p-value"

3. Line 208, "susceptibel" should be "susceptible"

4. Line 129, "Patient" should be "patient", "Positive" should be "positive"

5. Line 137, "was document" should be "was documented"

6. etc...

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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 #2: No

Reviewer #3: No

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