PONE-D-23-25273Lessons from the deployment and management of public handwashing stations in response to the COVID-19 pandemic in Kenya: A cross-sectional, observational studyPLOS ONE

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Please reduce the words in the abstract to 250 words.

I don’t see the knowledge gap in the introduction

I think lines 81-91 on page 4 should be put in the method, also the line

I suggest removing the sampling calculation to supplementary material

Line 199-202 -> Why is the font size different?

Line 246-249 -> only one asterisk for two footnotes?

Line 259-260 -> It is strange that the quote appears here without any explanation/narration before.

Table 3 -> Please report statistical results properly.

I think the 5 tables (and some of them are big tables) are too much. Please consider reducing them and putting some in the supplementary.

There should be a conclusion section. Please make the last paragraph in the discussion as your conclusion section.

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

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: 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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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: 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: Thank you for the opportunity to review the manuscript titled: Lessons from the deployment and management of public handwashing stations in response to the COVID-19 pandemic in Kenya: A cross-sectional, observational study

The authors sought to assess the functionality, usability and accessibility of rolled public handwashing stations in a COVID-19 pandemic context to improve their operation and maintenance and to inform strategies for future rollouts. The authors referenced multiple complementary methodologies and primarily found that the distribution of public handwashing facilities can have a limited lifetime, highlighting some implications of their findings. On the whole the manuscript was an interesting read and of value to PLoS One. There are some opportunities to bolster the manuscript. The main feedback is that additional clarification of the methods/measures and alignment of the results per the listed methodologies is sorely needed.

Here are my detailed comments and suggestions:

Abstract

Line 21: clarify that financial support was also provided

Include other results- qualitative and exit surveys. Quantitative data were collected through spot checks, caretaker surveys, user observations and user-exit interviews; whereas qualitative data were collected using key informant interviews, focus group discussions and in-depth interviews

Introduction

89: Include that fabricated stands, soap and soap holders were also a part of phase III.

98: define was it meant by operation and maintenance (O&M) and the specific tasks the caretakers were to carry out

It is unclear how soap and water were provided

Methods

111: Clarify that it is a mixed method study design

156: mention the factors relating to the functionality of the facility

158: Clarify how maintenance is different from sustainability

173 Quantitative variables is the wrong header, consider data collection and management

183 Define status of soap, water, and tap. Also define HWSs characteristics

(handwashing commodities, location, visibility, and accessibility). How was number of people seen within a HWSs measured?

190: describe the outcome variable of the multinomial regression

198: move to section before qualitative data. How was effective use of HWS, behavioral change communication, level of knowledge and awareness of the accessibility of HWS and availability of handwashing products defined. Clarify variables by data sources- caretaker surveys, user observation, and user exit surveys.

Results

228-229: Confirm the distribution of the overall study population- all the exit users interviewed. The distribution of 97% by study population has limited value. Consider presenting row percentages.

Table 2: Clarify what HWS accessible to children under 12yrs/ older persons means. For example, is this a height requirement?

The footnotes do not have a reference on the table

270-272: It is unclear how this analysis was conducted. The unit of analysis appears to be the HWS but the indicator being measured is handwashing technique. Was only one handwashing experience observed at each HWS? To clarify this discrepancy I recommend making the unit of analysis each handwashing observation (the 411 user observations).

Reviewer #2: Introduction:

The introduction has a clear practical reason of evaluating the intervention. However, some theoretical review perhaps can be added to explain about factors that influence the effective use of technology that guide the development of study instrument and discussion.

Methods:

Very clear

Results:

Figure 3 was very dark

It is not clear which one is the results from multinomial regression model

Is there any analysis to look at the influence of public place and the functionality of the HWS? In some cases, more informal sites will have more risk of not functioning facilities.

Discussion:

It has provide good discussion about the HWS provision intervention and how to increase lifetime and usability. It would be better to integrate the discussion with any model or theory to discuss the importance of all significant factors. Appropriate technology criteria, sustainable technology concept, or technology acceptance model can be some of important concept can be used in discussing the findings.

Conclusion:

Would be better to have a sub title for conclusion

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Reviewer #1: Yes: Bolanle Olapeju

Reviewer #2: Yes: Ni Made Utami Dwipayanti

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Lessons from the deployment and management of public handwashing stations in response to the COVID-19 pandemic in Kenya: A cross-sectional, observational study

PONE-D-23-25273R1

Dear Dr. Munai,

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,

D. Daniel, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I think all comments from Reviewers and me have been addressed well. Thank you

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

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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

**********

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

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 #2: 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

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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: Dear Authors

Thank you for revising the manuscript based on the reviewers' comments. The manuscript now are very clear stating the research gap and provide more concise methods and results sections. I have seen the inclusion of existing theory to discuss the findings.

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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 #2: Yes: Ni Made Utami Dwipayanti

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