PONE-D-23-08111Postoperative Trichiasis  and Associated Factors Among Adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia.PLOS ONE

Dear Dr. Wassie,

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 Feb 09 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:

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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Mesfin Gebrehiwot Damtew (PhD)

Academic Editor

PLOS 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: 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: No

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: This paper describes a study in Ambassel District in Ethiopia where a regression was performed to determine if post-operative TT is correlated with several variables. The results demonstrate a correlation between post-operative TT and patient age, duration since surgery, epilation history, face washing, knowledge about trachoma, and post surgery azithromycin. This information is helpful to the community to inform resource alignment for supporting TT surgery. The study appears to have been designed and performed appropriately. However, the writing in this manuscript is not sufficient for publication at this time. A thorough copy edit is needed and then I would be very happy to re-review.

It is my understanding that this study was focused on trachomatous trichiasis rather than all cause trichiasis. If this assumption is correct, I recommend the following copy edits.

- Reword first paragraph to include background on what TT is and how it’s addressed (trachoma is the world’s leading cause of preventable blindness…morbidity from trachoma is called trachomatous trichiasis (TT)… TT can be managed through surgery … details of what that surgery entails…etc.)

- If you include this information about what trachoma is and where TT comes into play in the natural progression of the disease then you no longer need the paragraph about the WHO grading system.

- Why is the wealth index included as a figure – this information does not contribute to the study and so does not warrant a figure.

- The details on the status of implementation in Ethiopia should come after the paragraph on the global situation. Additionally, the Ethiopia sentence is unclear and needs a copy edit.

The methods sections read like a protocol rather than a manuscript. Please consolidate the language into one clear Methods section. For example, the sample size section could be one sentence in your methods where you describe the power and confidence of your sample size. Remove variables and operational definitions sections.

The analysis is generally appropriate. However, I’m concerned about confounding among some of the variables. I am also not convinced that martial status, responsibility in the household, and occupation should be included in the analysis as the sample is not balanced for these categories. Marital status is 74% married and 15% widowed (which may be confounded with age). Responsibility in the house was 90% head. Occupation was 93% farmer.

The claims in this paper align with previous literature and the authors demonstrate this consistency in the discussion. However, there is need for tightening the writing of this section and drawing the “so what” out a bit more.

Specific copy edits:

- Please use consistent capitalization in the title of this paper

- Consistently use either trichiasis or trachomatous trichiasis

- When providing data do not use terms like “nearly” or “about” if the value is 92% then just say that.

- Write out the word “percent” when using it on its own in a sentence rather than using %.

- Table 3. Remove “surgeons code” variables – unless you ran an analysis to see if there was a correlation between a particular surgeon and post-operative TT. If you did this, then please include in the text of the manuscript.

Select more meaningful Key Words

Reviewer #2: First and foremost, I'd like to thank the authors of this research for their contribution to Assessing the Postoperative Trichiasis and Associated Factors among Adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia. Herewith my comments and suggestions on each of the manuscript sections

1. Title

Seems good

2. Introduction

• I didn't comprehend the research's novelty. By properly demonstrating why this research was centered on this title, the authors of this manuscript should anticipate to convix both outsiders and insiders of the subjects. In short, the uniqueness of the study should be highlighted.

3. Method section

• The author of this manuscript should also explain how validity and reliability were ensured.

• How are the effects of confiding variables managed?

4. Results

• Good looking!

5. Discussion

• First, the author should clearly interpret what the results mean. Second, compare the findings with comparable populations and settings (attention to the level of heath care facility included). Third, state the possible explanation for the disparity between this study's findings and prior literature after careful review. Fourth, the possible public health implications should also be stated in the discussion section. The author should also state the strengths and limitations of the study.

• Firth, methodological discussion should be recommended (Attention to internal and external validity).

6. Conclusions and recommendations.

• The concussions section seems what expected from discussion section. For instances: The prevalence rate of postoperative Trichiasis in the study area was higher than most Ethiopian studies.

• The recommendation seems based on general facts. So, make a sound, actionable, and conclusion-based recommendation after revising the conclusion section.

7. References

• Should be relevant to the population and setting of this investigation.

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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.

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Reviewer #1: No

Reviewer #2: No

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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.

PONE-D-23-08111R1Postoperative Trachomatous Trichiasis  and Associated Factors Among Adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia.PLOS ONE

Dear Dr. Wassie,

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 07 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,

Mesfin Gebrehiwot Damtew (PhD)

Academic Editor

PLOS ONE

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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: (No Response)

**********

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: Partly

**********

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

Reviewer #1: 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 #1: 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 #1: 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 #1: I appreciate the author’s hard work on this study and believe it’s important for this information to be available for the global community. However, the paper still requires significant copy-editing. I have provided some initial suggested edits below, but the full paper would greatly benefit from a full copy edit by someone with experience publishing in an English language journal.

Since you abbreviate trachomatous trichiasis as TT early in the paper, continue using TT throughout rather than spelling out the full name.

Same comment on using POTT throughout.

Line 56 – rather than stating “…transmitted through contact with eye discharge” I recommend a broader statement, such as “…transmitted through contact with an infected person”. This is because the bacteria could be transmitted via nasal discharge or other fomites. (Trachoma - StatPearls - NCBI Bookshelf (nih.gov))

Line 58 – change “resulting in excruciating pain….” To say something like “causing pain and overtime can result in scarring of the cornea”. The large spectrum of clinical manifestations of TT means that some people do not develop scarring, but many do. So better for this language to reflect this. You all should cite this statement.

Line 59 – same comment at line 58 about the large spectrum of clinical manifestations. I would say “If left unmanaged TT can lead to visual impairment and blindness.” You all should cite this statement.

Line 60 – Trachoma is the leading cause of preventable blindness. I don’t think this is the correct citation. Please double check.

Line 61 – TT can be managed through surgery which involves….(briefly describe the procedure and cite the WHO manual)

Line 68 – what is “the plan”? since you give a true value “173,945” remove “about”. I think what you are saying is “In Ethiopia, 173,945 received TT surgery and 39,339,311 people received antibiotics through mass drug administration in 2017.”

Line 71 – all villages received health education….

Line 75/76 – suggest rewording “TT creates economic loss due to reduced productivity resulting form blindness and visual impairment.”

Line 77 – POTT negatively impacts perception and uptake of surgery in communities. Individuals are less likely to seek surgery when they witness POTT in their community. Additionally, re-operation has…..”

Line 85 – POTT

Line 88/89 – confusing wording

Line 219 – first time to mention PLTR – I suggest mentioning this approach in the background and you also need to spell out the acronym the first time you use it.

Aside from copy-edit. Could the authors please explain how they accounted for quality of original surgery? Were all the surgeons in the study of a certain caliber?

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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: No

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[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.

PONE-D-23-08111R2Postoperative Trachomatous Trichiasis  and Associated Factors Among Adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia.PLOS ONE

Dear Dr. Wassie,

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.

==============================

• In the abstract and other sections, put the AOR values within the brackets.
• Improve the writing style throughout the document. For instance, the statement “A multi-stage sampling technique was used to employ a total of 506 individuals” could be rephrased.
• Carefully check typo and punctuation errors throughout. e.g., infections off….. infections of; In the Amhara region 91,977 persons…..In the Amhara region, 91,977 persons
• The 4^th paragraph of the introduction needs to be moved up (either integrated into the first paragraph or so). You cannot talk about Ethiopia and Amhara region before global reports.  I generally recommend revising the flow of information in the introduction section.
• Justification needs to be supported with references. E.g., “Previous studies done in Ethiopia were few and limited only in urban areas” include these studies as references.
• The authors applied correction formula, which was not actually required.
• Sampling following house number does not seem acceptable as there are scattered households without numbering.
• In the tables, add the SI units for some variables.
• I also recommend operational definitions for some variables. e.g., knowledge, type of latrine, toilet utilization.

• Please submit your revised manuscript by May 20, 2024. 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,

Mesfin Gebrehiwot Damtew (PhD)

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Dear authors,

Both reviewers suggest the acceptance of the manuscript. Below find some more comments to improving the document.

• In the abstract and other sections, put the AOR values within the brackets.

• Improve the writing style throughout the document. For instance, the statement “A multi-stage sampling technique was used to employ a total of 506 individuals” could be rephrased.

• Carefully check typo and punctuation errors throughout. e.g., infections off….. infections of; In the Amhara region 91,977 persons…..In the Amhara region, 91,977 persons

• The 4th paragraph of the introduction needs to be moved up (either integrated into the first paragraph or so). You cannot talk about Ethiopia and Amhara region before global reports. I generally recommend revising the flow of information in the introduction section.

• Justification needs to be supported with references. E.g., “Previous studies done in Ethiopia were few and limited only in urban areas” include these studies as references.

• The authors applied correction formula, which was not actually required.

• Sampling following house number does not seem acceptable as there are scattered households without numbering.

• In the tables, add the SI units for some variables.

• I also recommend operational definitions for some variables. e.g., knowledge, type of latrine, toilet utilization.

[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

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

**********

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

Reviewer #2: N/A

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: (No Response)

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: Postoperative Trachomatous Trichiasis and Associated Factors Among Adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia.

Authors have incorporated all the correction suggested by reviewer. Now it may be accepted

Reviewer #3: The paper entitled ‘Postoperative Trachomatous Trichiasis and Associated Factors Among Adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia’ The title is very important and it is tries to address the current hot topics and the study makes significant contributions to the study area and beyond.

Line 75: ‘POTT negatively impacts perception and uptake of surgery in communities.’ A sentence cannot start by an abbreviation/acronym, so please write the long form of ‘POTT’.

Lines 145 &146: Include the Institutional Review Board (IRB) Committee decision reference number

Line 172: Editorial issue; ‘The Prevalence of Postoperative Trachomatous Trichiasis’. Here ‘Trachomatous’ should be written in bold.

Line 175: ‘Factors associated with postoperative Trachomatous Trichiasis’. Here also ‘Trachomatous’ should be written in bold.

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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: Tabarak Malik

Reviewer #3: No

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[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.

Postoperative Trachomatous Trichiasis  and Associated Factors Among Adults who underwent Trachomatous Trichiasis Surgery in Ambassel District, North-East Ethiopia.

PONE-D-23-08111R3

Dear Dr. Wassie,

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. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

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,

Mesfin Gebrehiwot Damtew (PhD)

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: