PONE-D-23-19072Exploring the perception and patterns of utilization of traditional birth attendants by pregnant women in a rural local government area of Lagos, NigeriaPLOS ONE

Dear Dr. Oluwole,

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 08 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.

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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.

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,

Adetayo Olorunlana, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

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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: No

**********

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

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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 study provides relevant information on the perception of traditional birth attendants among pregnant women in a rural local government area in Lagos state. It was found that all the women had positive attitude towards TBAs and recommended continuous training and effective monitoring of TBAs. This is an interesting study that reveals rural women’s perceptions of TBA and their reasons for utilising them. This study is very topical, and findings can contribute towards strategies aimed at reducing maternal mortality especially in rural areas.

Please take note of the comments below to improve the manuscript.

1. Line 61 - 65: “TBAs help with initiating breastfeeding; providing health education on sexually transmitted illnesses (STIs), reproductive health, and nutrition; visiting mothers during and shortly following delivery to check for and educate them on the associated danger signs; and accompanying referrals to the health facilities for complicated deliveries”

Please note that this are not statutory functions of TBAs. This could be rephrased as: In certain settings, TBAs have been trained to perform other services which include helping with initiating breastfeeding ………

2. Line 125 – 127: “Respondents with scores of 0- 69% were considered to have a positive perception, and those with scores of 70% and above were considered to have a negative perception of TBAs. The higher the score, the more negative the perception of the respondents about TBA”.

Since a Likert scoring system was used, the lowest score obtainable is 15. It is thus not correct to state that scores of scores of 0- 69% were considered to have a positive perception, Rather state that scores less than 70% were considered to have….

3. Results: In the reporting of the results, the figures are presented differently in text e.g. 337 (97.1%) vs (344, 99.2%). Please be consistent.

4. Tables: Monthly household income (₦). Please write Naira in full.

5. Results: This study presents very important information on TBA in the rural community. However, there is no sound justification in differentiating between women who used only TBA and those that used TBA and health facility in the bivariate and multivariate analysis. Those that used both TBA and health facilities could have delivered their babies at the TBA. I will suggest focusing this study on the sociodemographic characteristics of women using TBAs, reasons for use of TBA and attitude of women that use TBA in Lagos. The perception of TBAs is already well elaborated in this paper, in the results and discussion, which is a strength of the paper.

6. Line 263. “That TBAs use sterile equipment for their service.8 However, only 8(2.3%) of respondents strongly agreed”

Please remove the number 8.

Reviewer #2: Review comments

General comments

The Authors are commended for conceptualizing this study and their intention to publish their research work. After going through the manuscript, I am of the opinion that there are certain aspects of the study that should be clarified

1. Concept/Title: The study was carried out among women attending ‘antenatal care’ from traditional birth attendants. The title of the manuscript did not bring this into focus. I wonder why assessing the perception of pregnant women on utilization of traditional birth attendants should be carried out among women already utilizing that service. I would have preferred such a concept to be a community based study. In line with the concept of the study, Authors should justify why this study is necessary.

2. Outcome variable: The outcome variable(s) of the study are not well defined. The rationale for using <70% of scores of respondents to categorize perception of respondents is not clear. Again, one wonders the relevance of pattern of utilization as determined in this study to current and future studies involving traditional birth attendants and to the body of knowledge generally. Authors should justify why that outcome variable is of interest.

3. Authors utilized data involving the spouses of the respondents who are less than the sample size of 347 in logistic regression analysis. This is wrong and should be reviewed. The entire results of the logistic regression analysis should be reviewed.

4. Authors should pay attention to guidelines of the Journal in presenting this manuscript especially the abstract section. Also, in presenting the logistic regression analysis in the abstract, Authors should use adjusted odd ratio and 95% confidence interval.

5. The background of the study is well written and Authors are commended for their great efforts.

The responses to the comments above will actually determine the merit of the manuscript in proceeding with the review process.

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Reviewer #1: No

Reviewer #2: Yes: EDMUND NDUDI OSSAI

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Submitted filename: Review comments.docx

PONE-D-23-19072R1Exploring the perception, utilization, and reasons for use of traditional birth attendants among rural dwelling pregnant women in Lagos, Nigeria.PLOS ONE

Dear Dr. Oluwole,

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.

Kindly pay attention to the methodology and the concept use for consistency.

Please submit your revised manuscript by Dec 10 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. 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,

Adetayo Olorunlana, Ph.D.

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.

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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: All comments have been addressed

Reviewer #2: (No Response)

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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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

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

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 #1: Yes

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 #1: All comments have been addressed appropriately. The title is better phrased. The results section has been written with consistency.

Reviewer #2: Review comments

General comments

Authors are commended for the good review of the manuscript. However, further revision will also be required before the manuscript could be accepted for publication. Authors should take note f the following points.

Title

The title gives the impression that this was a community based study.

The word ‘Exploring’ to a large extent suits qualitative studies more.

Authors should also note previous comments in this regard.

Abstract

Majority (70.3%) received antenatal care and delivery at TBA only.

Based on the statement above, Have the women delivered during the period of study? The statement also counters the title of the study. These should be clarified.

It will be good to state the outcome measure of the study in the abstract

There may be no need to report the factors since binary logistic regression analysis was performed

Materials and methods

Study area

Use the current population projection for Ikorodu LGA.

Do we justify the two stage process for recruitment of respondents since consecutive recruitment was used in recruiting the respondents?

Data analysis

Use IBM-SPSS and SPSS should be written in full

Figure 2

Reasons for using TBA services. Were the responses based on multiple response option? This should be clarified.

In the abstract , include the first four reasons.

Table 4

Since p value is a probability, p values of 0.000 should be presented as <0.001

Housewife is not an example of employment status, instead use unemployed.

Table 5

Authors did not indicate the basis for inclusion of variables into the logistic regression model after bivariate analysis. This should be stated.

Variables related to the spouses are less than the sample size included for the study and should be removed from the logistic regression model.

What are the implications of the adjusted odds ratios reported as negative figures?

Authors should include Study limitations before the conclusion section. It should be emphasized that this study took place at traditional birth homes by individuals already utilizing their services during pregnancy.

Conclusion

The use of ‘Respondents’ choice of health services’ utilization’ in this section is confusing and should be deleted. Appropriate terms as previously used in the manuscript should be maintained.

**********

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

Reviewer #2: Yes: EDMUND NDUDI OSSAI

**********

[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-23-19072R2Perception and reasons for utilization of antenatal care services among rural pregnant women attending traditional birth attendants' homes in Lagos, NigeriaPLOS ONE

Dear Dr. Oluwole,

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 Jan 04 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,

Adetayo Olorunlana, Ph.D.

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.

[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: (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 #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: 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: Review comments

General comments

I commend the efforts of the Authors in reviewing this manuscript. I am also of the opinion that certain aspects of the manuscript need to undergo further revision.

Authors should take note of the following observations.

1. Title of study: I suggest that the Authors should consider the suggestion below

Perception and reasons for choice of informal provider among women receiving antenatal care from traditional birth attendants in rural communities of Lagos state, Nigeria

2. Abstract

The acronym TBA was not introduced in the abstract.

Define the outcome variable, ‘utilization’ in the methods section so the result of regression analysis will be meaningful.

Include also in the methods section, how positive perception was determined.

Use; Predictors of use of TBA only included:

3. Methods

Study population

Line 94; …….., attending TBAs. This should be reviewed.

Line 99, p of 25.5% is a proportion and not a number

4. Data analysis

Use the new name for SPSS, Statistical Product and Service Solutions

What was the rationale for using scores <70% as having a positive perception. Any justification? Any reference?

Authors should also take another look at the scoring system for the variables. For example, TBAs can perform Caesarian section.

Utilization as an outcome variable was not explained in the Methods section.

Authors should use variables with p values <0.2 at bivariate analysis as basis for inclusion of variables into the binary logistic regression model.

Refer to, Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138:923-36.

5. Results

Socio-demographic characteristics

Line 135, The proportion 51.9% cannot be regarded as ‘about half’.

Table 1

Use Percent instead of Percentage

Include (n=317) for variables related to the spouses

6. Discussion

Page 317, should be use of TBA only

Page 318; Those with secondary education and lower used TBA only compared with those with post secondary education. This statement should be reviewed.

There is no need to discuss results of bivariate analysis when that of multivariate analysis are included in the same study.

Line 352; This study was community based with…….. This statement is not correct. The study is like a ‘health facility based’ study and not a community based study. The study took place among those assessing care among traditional birth attendants.

7. Limitation

Delete the first statement under this sub-heading. Keep the second statement. Recall the 100% positive perception of the respondents as obtained in this study and state that it may be due to the study being conducted among those assessing care among TBAs.

8. References

Authors should ensure that referencing style conforms to Journal guidelines.

**********

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: EDMUND NDUDI OSSAI

**********

[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.

Attachments

Attachment

Submitted filename: Review comments.docx

PONE-D-23-19072R3Perception and reasons for choice of informal provider among women receiving antenatal care from traditional birth attendants in rural communities of Lagos state, NigeriaPLOS ONE

Dear Dr. Oluwole,

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 Mar 16 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,

Adetayo Olorunlana, Ph.D.

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.

[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: (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 #2: Yes

**********

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

Reviewer #2: No

**********

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: 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: Review comments

General comments

I applaud the efforts of Authors in reviewing this manuscript to this very stage. Well done. I may request for a minor review of the manuscript which should be the last in the review process.

Authors should take note of the following points;

1. Basis for inclusion of variables into the logistic regression model after bivariate analysis. This was not stated all through the manuscript but from the results of the study as presented, Authors only included variables that were statistically significant at p<0.05. This may not be the best approach. I encourage Authors to use a cut off p value of <0.2 for inclusion of variables into the regression model after bivariate analysis. Refer to

Maldonado G, Greenland S. Simulation study of confounder-selection strategies. American Journal of Epidemiology. 1993;138(11).

2. The presentation of the Abstract was not done according to Journal guidelines. Authors should refer to the website of the Journal for guidance. Also, positive perception and utilization being the outcome variables ought to be defined in the methods section of the abstract. Authors should also have the key words indicated.

3. In the Background section, the first definition of TBA should suffice.

4. Authors should indicate the date internet articles were accessed in the reference section. They should also ensure that use of references conform to Journal guidelines.

5. Instead of ‘None’ for education of spouse, Authors should use No formal education and sample size, (n=337) should be placed under the Frequency column for uniformity. For table 2, reporting of results should be based on proportions instead of raw figures.

6. Provide the rationale for using <70% of the total score as basis for categorizing a respondent as having good perception of TBAs.

**********

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: EDMUND NDUDI OSSAI

**********

[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-23-19072R4Perception and reasons for choice of informal provider among women receiving antenatal care from traditional birth attendants in rural communities of Lagos state, NigeriaPLOS ONE

Dear Dr. Oluwole,

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 25 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,

Adetayo Olorunlana, Ph.D.

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.

[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: No

**********

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: 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: Review comments

General comment

I commend the Authors for the review of the manuscript so far. I was of the opinion that this review will be the last however there are some observations I have made which may necessitate another review of the manuscript by the Authors. I plead with the Authors to bear with me in this regard.

Authors should take note of the following points

1. Table 5: Predictors of health service utilization among the respondents. Authors included the educational level of the Spouse in the logistic regression model along with other variables. From table 1, there are 347 respondents of which 337 are living with their spouses. This means that the regression was done based on 337 which is the number common to all. This wrong. Authors should repeat the regression analysis without including the educational level of the Spouse. The inclusion of the educational level of the Spouse for further analysis should stop at the bivariate level.

2. Naming the outcome variable, ‘Use of health service utilization’ appear very confusing and may be misunderstood by Readers. The outcome measure should be utilizing only TBA services in current pregnancy. Authors are free to paraphrase the outcome measure as stated.

3. In the abstract, the results of the logistic regression analysis should be represented using adjusted odds ratio and 95% confidence interval. For example, Predictors of utilizing only TBA services in current pregnancy included …………

4. Define ‘positive perception’ in the methods section of abstract.

5. SPSS is currently referred to as Statistical Product and Service Solutions. Authors should reflect this correction in the manuscript.

6. Respondents should report the results of the bivariate analysis bearing in mind the difference in proportions. For example, ‘The highest proportion of respondents who utilized only TBA services, 80.9% had primary education while the least, 38.8% have attained tertiary education and the difference in proportions was found to be statistically significant, (χ2 =39.896, p<0.001)

7. Authors should present the tables in the manuscript in line with Journal guidelines. Authors should refer to the Journal website for guidance.

8. Authors should ‘expand’ the study limitation so as to enhance the understanding of Readers. The caption ‘Limitation’ may be deleted.

9. In table 3, use ‘estimated distance’ instead of ‘distance’. In Line 101, use ‘TBAs’. Line 141, use ‘name’ instead of ‘names’ Line 164, use ‘Less than half of the respondents, 43.6%.

10. Use ‘Percent’ instead of ‘Percentage’. p<0.001 instead of p=<0.001. In table 2 include the meaning of TBA as a foot note.

**********

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: EDMUND NDUDI OSSAI

**********

[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.

Attachments

Attachment

Submitted filename: Review comments.docx

PONE-D-23-19072R5Perception and reasons for the choice of informal provider among women receiving antenatal care services from traditional birth attendants in rural communities of Lagos state, NigeriaPLOS ONE

Dear Dr. Oluwole,

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 Jun 01 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,

Adetayo Olorunlana, Ph.D.

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.

[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: No

**********

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: 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: Review comments

General comment

My intention was to approve the publication of this manuscript based on this review. However on close scrutiny, there is a flaw in the analysis and interpretation of study findings which will be too grave to ignore. This may necessitate that the manuscript may require another revision before it could be accepted for publication. I urge the Authors to critically review this manuscript before the next submission.

Authors should take note of the following observations.

1. Binary logistic regression result. In the abstract, Authors made it look like having a health insurance coverage predicted the use of TBA only in the study which is the outcome variable. See also Lines 248-250 in the result section and lines 388-390 in the discussion section.

Compare these comments with what was showed in table 4 where a significantly higher proportion of respondents who had no insurance coverage, 76.3% utilized only TBA services when compared with those who had insurance coverage, 41.7% (p<0.001). See also the result in table 5 on the same independent variable. I wonder why there was a re-arrangement of the categories of the independent variable ‘Having insurance coverage’ in tables 4 and 5.

IBM-SPSS by default utilizes the last category of the independent variable as the reference category in logistic regression analysis. The question will be whether the Authors coded the variable, ‘Respondent having insurance coverage’ in two different forms in the data set. This is why the results of Chi square and logistic regression analysis are sometimes included in the same table.

Also, the result as displayed for the educational attainment of the respondents in tables 4 and 5 seem not to move in tandem. This is because at bivariate analysis (Chi square), 58.3% of respondents who had no formal education utilized only TBA services as against 38.8% for those who have attained tertiary education. However, at logistic regression analysis, the respondents who have attained tertiary education were 3.480 times more likely to utilize TBA services only.

Authors should endeavor to clarify these two observations in the next submission and if possible seek the services of a Statistician.

2. Minor corrections. Line 41, use ‘included’ instead of ‘include’.

In line 52, use ‘perceived spiritual protection’. Line 55 should be having no health insurance coverage. Report the finding on educational level accordingly after the re-analysis.

In line 68, use TBAs. Use TBAs also in line 71 and 82.

Line 195 should also be perceived spiritual protection.

Line 231, use higher proportion since the categories of the independent variable are two in number. Delete least in line 233.

In table 5, use p<0.001 instead of 0.000.

Authors should remember to report findings with regards to health insurance and educational level at logistic regression analysis accordingly.

**********

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: EDMUND NDUDI OSSAI

**********

[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.

Attachments

Attachment

Submitted filename: Review comments.docx

Perception and reasons for the choice of informal provider among women receiving antenatal care services from traditional birth attendants in rural communities of Lagos state, Nigeria

PONE-D-23-19072R6

Dear Dr. Oluwole,

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,

Adetayo Olorunlana, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: