Identifying priority double-duty actions to tackle the double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts

Violeta Magdalena Rojas Huayta; Rebecca Pradeilles; Hilary M. Creed-Kanashiro; Emily Rousham; Doris Delgado; Rossina Pareja; Edwige Landais; Nervo Verdezoto; Emma Haycraft; Michelle Holdsworth

doi:10.1371/journal.pone.0303668

Peer Review History

Original SubmissionFebruary 23, 2023
8 Aug 2023 Decision Letter - Chandan Kumar, Editor PONE-D-23-05420Identifying priority double-duty actions to tackle double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national expertsPLOS ONE Dear Dr. Rojas Huayta, 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 22 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. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. In the ethics statement in the Methods, you have specified that verbal consent was obtained. Please provide additional details regarding how this consent was documented and witnessed, and state whether this was approved by the IRB 3. Thank you for stating the following financial disclosure: Funding: This study was supported by the UK Medical Research Council (MR/S024921/1) and CONCYTEC/FONDECYT Perú (032-2019) through the Newton Fund. Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 5. Please remove your figures from within your manuscript file, leaving only the individual TIFF/EPS image files, uploaded separately. These will be automatically included in the reviewers’ PDF. 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: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A Reviewer #2: N/A ****** 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 ****** 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 ****** 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 paper addresses an incredibly important issue, and understanding the potential for nutrition policy actions which can address all forms of the double burden of malnutrition is a pressing priority. The paper has a great research question and overall a good research approach to answering the question. However, I found the presentation of the results of this analysis to just be too complex and confusing to get a cohesive picture of what is going on in Peru. The authors need to find a way to summarise their findings more effectively, perhaps by collapsing categories or summarising sections, or perhaps by using tables or figures to make the results more digestible. This applies particularly in the Discussion section where I hoped to find some more synthesis. It would also help in interpreting this information to know what the nutrition policy goals and objectives of the Peru government are to understand more the context of all the multiple policies discussed in the paper. Specific comments below. Introduction - This section needs to include more information on the Peru context in two ways. o Firstly what are considered drivers of DBM in this setting, some more background on the nutrition situation in Peru could be included. o What actually is the overarching government policy towards nutrition in the country. What are the stated aims? Is the double burden actually a priority? Are policy developments aimed at this double burden? Methods - I think that this section needs to be restructured or reordered. I was quite confused until around half way through what you had actually done. - For example you introduce your study participants at the start of the methods and say they will be ‘validating the evidence document’ without us knowing what that is. - I think you could be more clear and step by step in describing your study design. Discussion - Although we have a ‘Summary of findings’ section I don’t find that this section achieves its aim. There is so much complexity in this paper in indicators, domains, levels of implementation, levels of evidence regarding implementation etc. The authors really need to find an effective way to summarise all this information and give a clear picture about how overall the Peru government is going in achieving impact on DBM. In reading the results and discussion it was really not clear what the government was doing well and what they were not doing well, or what they intended to do well but had barriers to implementing. I am not sure how this can be done with so much material produced by the study, but it needs to be attempted. - As I mentioned in the introduction section you need some information on what Peru government policies are for nutrition. You could return to this in the Discussion and reflect on policy achievements against this, as well as against all of the indicators you have used. - Also to broaden the impact of the paper an assessment of what the Peru government has done well and what lessons for the international community more broadly can be drawn from this work would be helpful. Reviewer #2: This manuscript reports a review of government actions to solve double burden of malnutrition in infants and young children in Peru. The study is well designed. The paper is well written with detailed information and includes discussion of different viewpoints on double duty actions. However, there are some points that should be addressed. My comments are as follows: The tool created to assess the DDA in this study is a useful innovation. The authors should discuss how other researchers/countries should modify/adjust it to best suit their situation. - Some indicators especially the specific micronutrient supplementation may not be applicable to other settings/countries. For example, vitamin A deficiency may not be a problem but iodine deficiency is. So these indicators should be relevant to the country-specific problems/issues. - It might also be helpful to include maternal nutrition during lactation as one indicator. - Nutrition-specific interventions has a limit in reducing DBM prevalence. To further reduce it, nutrition-sensitive interventions by non-health ministries will play a more important role. For infrastructure support indicators, a platform for interaction between health and non-health governmental organizations such as agriculture, trade, education will be useful. Experts point out that there is a serious shortage of health workers, especially in counselling work. The authors should discuss how to deal with this problem. For example, using digital educational resources to reduce the burden on staff and educate caregivers and families should be considered. ****** 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 ******** [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. https://doi.org/10.1371/journal.pone.0303668.r001
Revision 1
2 Nov 2023 Author Response Reviewer #1 1.This paper addresses an incredibly important issue, and understanding the potential for nutrition policy actions which can address all forms of the double burden of malnutrition is a pressing priority. The paper has a great research question and overall a good research approach to answering the question. Authors’ responses Thank you for your positive feedback. Reviewer #1 2. However, I found the presentation of the results of this analysis to just be too complex and confusing to get a cohesive picture of what is going on in Peru. The authors need to find a way to summarise their findings more effectively, perhaps by collapsing categories or summarising sections, or perhaps by using tables or figures to make the results more digestible. This applies particularly in the Discussion section where I hoped to find some more synthesis. Authors’ responses We have reflected on your comment. We have added a summary of the main findings of this study, which are summarised in two parts at the beginning of the Discussion section: the policy measures that Peru is implementing well and those that need to be strengthened. This summary of findings allows the reader to get a coherent picture of what is happening in Peru. See lines 485-528 on page 22-23 Reviewer #1 3. It would also help in interpreting this information to know what the nutrition policy goals and objectives of the Peru government are to understand more the context of all the multiple policies discussed in the paper. Authors’ responses Thanks for the suggestion. In the introduction, the goals and objectives of the Peruvian government's nutrition policy have been added to better understand the context of all the multiple policies discussed in the document. This has been added lines 79 to 90 on page 4 Reviewer #1 4. Introduction - This section needs to include more information on the Peru context in two ways. o Firstly what are considered drivers of DBM in this setting, some more background on the nutrition situation in Peru could be included. o What actually is the overarching government policy towards nutrition in the country. What are the stated aims? Is the double burden actually a priority? Are policy developments aimed at this double burden? Authors’ responses We have added background information on the situation of the double burden of malnutrition in Peru, as well as: the country's governmental nutrition policy and stated objectives; the existence of policies aimed at addressing the double burden of malnutrition; and the prioritisation of the double burden of malnutrition in national policies. This has been added lines 61 to 90 on page 3-4 Reviewer #1 5. Methods - I think that this section needs to be restructured or reordered. I was quite confused until around half way through what you had actually done. - For example you introduce your study participants at the start of the methods and say they will be ‘validating the evidence document’ without us knowing what that is. - I think you could be more clear and step by step in describing your study design. Authors’ responses We have adopted your suggestion and have subsequently reordered the section to help simplify the process for readers. See lines 94 to 243 on page 4-11 Reviewer #1 6. Discussion - Although we have a ‘Summary of findings’ section I don’t find that this section achieves its aim. There is so much complexity in this paper in indicators, domains, levels of implementation, levels of evidence regarding implementation etc. The authors really need to find an effective way to summarise all this information and give a clear picture about how overall the Peru government is going in achieving impact on DBM. In reading the results and discussion it was really not clear what the government was doing well and what they were not doing well, or what they intended to do well but had barriers to implementing. I am not sure how this can be done with so much material produced by the study, but it needs to be attempted. Authors’ responses Thanks for the suggestion, we have improved the wording of the "summary of findings" section to enhance understanding of what the Peruvian government is doing well and what needs to be strengthened to tackle the double burden of malnutrition in children under 2 years of age. See lines 485-528 on page 22-23 Reviewer #1 7.- As I mentioned in the introduction section you need some information on what Peru government policies are for nutrition. You could return to this in the Discussion and reflect on policy achievements against this, as well as against all of the indicators you have used. Authors’ responses Your suggestion has been adopted and information on the Peruvian government's policies on nutrition has been added to the introduction and discussion section. See lines 79 to 90 on page 4 See lines 497-512 on page 22 See lines 523-528 on page 23 Reviewer #1 8.- Also to broaden the impact of the paper an assessment of what the Peru government has done well and what lessons for the international community more broadly can be drawn from this work would be helpful. Authors’ responses Thank you, your suggestion was included in the discussion section See lines 497-512 on page 22-23 Reviewer #2 1. This manuscript reports a review of government actions to solve double burden of malnutrition in infants and young children in Peru. The study is well designed. The paper is well written with detailed information and includes discussion of different viewpoints on double duty actions. However, there are some points that should be addressed. Authors’ responses Thank you for your overall positive feedback Reviewer #2 2. The tool created to assess the DDA in this study is a useful innovation. The authors should discuss how other researchers/countries should modify/adjust it to best suit their situation. Authors’ responses Thank you for the suggestion, which is now included in the section on strengths and limitations. See lines 672-682 on page 28-29 Reviewer #2 3. Some indicators especially the specific micronutrient supplementation may not be applicable to other settings/countries. For example, vitamin A deficiency may not be a problem but iodine deficiency is. So these indicators should be relevant to the country-specific problems/issues. - It might also be helpful to include maternal nutrition during lactation as one indicator. Authors’ responses Thank you for the suggestion, which is now included in the section on strengths and limitations. See lines 678-682 on page 30 Reviewer #2 4. Nutrition-specific interventions has a limit in reducing DBM prevalence. To further reduce it, nutrition-sensitive interventions by non-health ministries will play a more important role. For infrastructure support indicators, a platform for interaction between health and non-health governmental organizations such as agriculture, trade, education will be useful. Authors’ responses We agree with your point of view. Among the infrastructure support indicators, there is the intragovernmental interaction platform indicator, which was evaluated in this study. We have added more detail on this indicator in the results and discussion section. See lines 274-278 on page 12 See lines 504-509 on page 22-23 Reviewer #2 5. Experts point out that there is a serious shortage of health workers, especially in counselling work. The authors should discuss how to deal with this problem. For example, using digital educational resources to reduce the burden on staff and educate caregivers and families should be considered. Authors’ responses Thank you for the suggestion, we agree, we have added a paragraph about this in the discussion section See lines 662- 666 on page 29 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0303668.r002
6 Mar 2024 Decision Letter - Rohullah Roien, Editor PONE-D-23-05420R1Identifying priority double-duty actions to tackle double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national expertsPLOS ONE Dear Dr. Rojas Huayta, 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 Apr 20 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, Rohullah Roien 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 #2: 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 #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 ****** 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: 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 final version of the manuscript should be re-checked for typological errors and English corrections. For example on line 77, it should read ... 39.8% of children aged 6-59 months suffered from anaemia. ****** 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: No ******** [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. https://doi.org/10.1371/journal.pone.0303668.r003
Revision 2
13 Mar 2024 Author Response 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 Authors’ responses Thank you for your overall positive feedback 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 Authors’ responses Thank you for your overall positive feedback 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Authors’ responses Thank you for your overall positive feedback 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 Authors’ responses Thank you for your overall positive feedback 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: No Authors’ responses Thank you for your comment, we have checked the typographical and grammatical errors. 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 final version of the manuscript should be re-checked for typological errors and English corrections. For example on line 77, it should read ... 39.8% of children aged 6-59 months suffered from anaemia. Authors’ responses Thank you for your comment. We have again reviewed the final version of the manuscript for typological errors and corrections in English. We have also corrected the error noted in line 77 Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0303668.r004
29 Apr 2024 Decision Letter - Charles Odilichukwu R. Okpala, Editor Identifying priority double-duty actions to tackle double burden of malnutrition in infants and young children in Peru: Assessment and prioritisation of government actions by national experts PONE-D-23-05420R2 Dear Dr. Rojas Huayta, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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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 ******** 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: 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 #3: 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 #3: 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 #2: (No Response) Reviewer #3: (No Response) ****** 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: No Reviewer #3: Yes: Agatha Aduro-Agema ******** https://doi.org/10.1371/journal.pone.0303668.r005
Formally Accepted
8 May 2024 Acceptance Letter - Charles Odilichukwu R. Okpala, Editor PONE-D-23-05420R2 PLOS ONE Dear Dr. Rojas Huayta, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Charles Odilichukwu R. Okpala Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0303668.r006

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