PONE-D-23-41643A situational assessment of treatments received for childhood diarrhea in the Federal Republic of NigeriaPLOS ONE

Dear Dr. Gayawan,

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.

The study is highly relevant and will guide funders and decision makers in setting formulating priorities in prevention, care and treatment of under-5 diarrhea. Please review and address the comments listed below in addition to reviewers' (1 and 2) comments. Introduction:

• Consider making this section more concise focusing on the key objectives of the study.

Methods

• Please explicitly indicate the study design. Even though DHS data was used, but it will be important for readers to understand the study design.
• Datasets: the language used sounds like the data was primarily collected for this study. Please adjust the language.
• Will be good to briefly provide context about Nigeria geopolitical structure and also socioeconomic context of the 6 geopolitical zones (consider a map). This is important because some of the findings are closely related to these parameters.

Results & Discussion:

• Please consider splitting this section into “results” and “discussion” sections. The results can be concisely outlined for example in a table under relevant subsections or in any format the authors feel appropriate.
• Discuss findings chronologically in the discussion section.
•  Subsection “further discussion”: This is confusing. Inline with the structure of the study, results and discussion, consider the following:  moving components in this subsection to relevant subsections; creating a subsection “change in trends” for most of the contents in the “further discussion” subsection.
• Also ensure that all figures are presented in line with plosone figure guidelines: https://journals.plos.org/plosone/s/figures

Please submit your revised manuscript by Apr 05 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Ibrahim Jahun, MD, MSC, PhD

Academic Editor

PLOS ONE

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2. Thank you for stating in your Funding Statement: 

Gates Foundation [INV-009390 OPP1197730]

Peter Gething was additionally supported through funding provided jointly by Curtin University, the Telethon Trust and the Telethon Kids Institute under project ID RES-61992

Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now.  Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. 

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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: Partly

Reviewer #2: Yes

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

Reviewer #1: I Don't Know

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: Review: A situational assessment of treatments received for childhood

diarrhea in the Federal Republic of Nigeria

The study assessed for improvement in the case management of diarrhoea in children in Nigeria based on 3 Demographic health survey rounds conducted between 2008 and 2018. The study stratified changes in the proportion of children receiving oral rehydration therapy by venue of treatment and by state.

The study noted that there was significant improvement in the number of children who were seen in chemist or hospital facilities for diarrhoea who received oral rehydration therapy. However, the total number of children receiving oral rehydration therapy for diarrhoea in children was less than ideal due to state level variation in venue attendance and performance by the sites. The use of antibiotics, not particularly recommended in diarrhoea was rampant with negligible variation across venues. There was welcome reduction in the proportion of children with diarrhoea who received antibiotics in a few states.

Comments

The Study contributes important information which is useful for planning and evaluating interventions in the management of childhood diarrhoea.

The study is acceptable subject to the following major corrections.

1. The abstract section includes the following “Nationally, there have been substantial increases in the proportion of children under 5 years old with diarrhoea receiving the recommended oral rehydration therapy after seeking treatment at either a health clinic (0.57 [0.44{0.69; 95% CrI] in 2008; 0.70 [0.54{0.83] in 2018) or chemist/pharmacy (0.28 [0.17{0.42] in 2008; 0.48[0.31{0.64] in 2018).”

This was referred to in the results section lines 151-155, but the details of the change e.g 2008 values and the 2018 values should be included in the results and discussion section

2. Methods section: More comments on how the information on the history of antibiotic use for childhood diarrhoea was ascertained. How did mothers identify antibiotic pills or syrups- did they show the samples of what they had used, or show the child's prescription, was it simply based on recall, or was it assumed that if the child used any additional medication this was likely to be an antibiotic. More light should be thrown on this and some comments on the justification for and the limitations on the ascertainment of antibiotic use can be included in the discussion.

3. Conclusion: Lines 256-258 “While there have been substantial increases in the fraction of cases receiving treatment with recommended oral rehydration therapy at the national level” Line 148 Result section- says “results shows marginal increase (i.e 5%)”,… and does not to support the above conclusion.

Minor Corrections

1. Introduction:

The section is generally well written,

Line 38. “ Because it is rarely microbial caused….” microbial has been deleted and sentence replaced with ‘Because it is rarely caused by bacteria….” As most cases of diarhoea in children are indeed microbial, just that they are caused by viruses and not bacteria.

2. Typographical corrections e.g spelling of Rehydration- Line 145

3. Respective national values to be included as footnotes in relevant figures.

4. Other corrections as in the attached manuscript

Reviewer #2: This is a very well written manuscript. The technical aspects are very sound, and it makes for easy reading. It does not appear to have any ethical concerns. There are a few typographical/spelling errors but not of any significant magnitude.

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Reviewer #1: No

Reviewer #2: Yes: Patience Ngozi Obiagwu

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Attachments

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Submitted filename: PONE-D-23-41643_comments.docx

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Submitted filename: PONE-D-23-41643_Reviewed.pdf

A situational assessment of treatments received for childhood diarrhea in the Federal Republic of Nigeria

PONE-D-23-41643R1

Dear Dr. Gayawan,

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,

Ibrahim Jahun, MD, MSC, PhD

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 #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 #3: Yes

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

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 #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 #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 #3: We are unable to get reviewer 1 to validate the edits. Additionally, after several attempts we were not able to get additional reviewer to validate responses to reviewer 1 comments. To facilitate the manuscript forward I (Academic Editor) have acted as a reviewer to validate whether reviewer's 1 comments have been addressed. I am satisfied with the level of revision done and I can confirm that reviewer's 1 comments have been fully addressed.

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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 #3: Yes: Jahun Ibrahim

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