Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University teaching hospitals in northern Uganda

Emmanuel Musinguzi; Peninah Nannono; Moreen Ampumuza; Mathew Kilomero; Brenda Nakitto; Yakobo Nsubuga; Byron Awekonimungu; Rebecca Apio; Moses Komakech; Luke Odongo; Pebalo Francis Pebolo; Felix Bongomin

doi:10.1371/journal.pone.0307749

Peer Review History

Original SubmissionJune 5, 2024
7 Jul 2024 Decision Letter - Mohammed Hasen Badeso, Editor PONE-D-24-19464Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University Teaching Hospitals in northern UgandaPLOS ONE Dear Dr. Bongomin, 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 Aug 21 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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If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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. 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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear Authors, Appreciating the work you have done, please address the following points. 1. Though the manuscript is well written, I have seen some typographical and grammatical errors, and recommend you to go through the entire document. Here I have mentioned some i. Line 125 "was to be considered normal" - was considered normal ii. Line 139 "Data analysis plan" - Data analysis iii. Line 144 "will be described..."- was described iv. Line 149 -150- "Factors with p<0.05 were considered independent of undernutrition" did you mean "were considered independently/significantly associated with undernutrition" 2. Did you use mean or median for the continuous variables (line 143)? I saw mean age (line 175), mean MUAC (line 186), mean time taken to reach hospital (line 212) etc... 3. It is mentioned that the meantime taken to reach the hospital was 41.784 (line 212). Is it minute?, and is it by walk or car? please mention the means of transport as well. 4. redundancy of ideas- line 141 and 145. 5. The model you used for obtaining dietary diversity information of individual respondents, the 24-h recall method, should be mentioned in the limitations of your study too. Reviewer #2: The authors present findings from a study estimating the prevalence and risk factors of malnutrition among pregnant adolescent and young women in Northern Uganda. The article is well written, but requires proofreading prior to publication. For example, "STAT" on line 27 should read STATA. The mid upper arm circumference and the dietary diversity score both need to be described in more detail/background for readers not familiar with these measures. The authors present adjusted prevalence rates, but do not specify what was specifically adjusted for and why. What confounding/prognostic factors were adjusted in regression modeling? For example, age, functional capacity, current health status, etc. Were these factors considered? Please clarify. In Figure 1, how many participants were excluded due to illness and congenital arm deformities as described in the study population section? These are currently not shown. In the data analysis plan section, the authors say that regression results were interpreted based on the odds ratio (OR). However, regression model results are provided using the prevalence ratio (PR) in the results section. The odds ratio and the prevalence ratio are distinct measures. Which of these were modeled? The study does not specify how missing data was managed during the analyses. This information needs to be included. It is not clear what is meant by "an attempt was made to identify randomized respondents" on line 340. Was randomization employed in this study? On lines 336-337 the authors state that the cross-sectional nature of the study might affect the establishment of a casual relationship. I find this statement to be misleading and confusing because causation can never be established through an observational cross-sectional study. On line 279 the authors state "prevalence of undernutrition in our study was small compared...". Should this be "smaller" as a prevalence of 12.7% for undernutrition is not small. How was antenatal attendance measured/coded? Why does it have 9 levels? This is not clear in Table 1 or described in the text. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
9 Jul 2024 Author Response Dear Dr. Mohammed Hasen Badeso, Epidemiologist Academic Editor PLOS ONE Many thanks for this through work and fast feedback on our manuscript. We have revised then manuscript according to the reviewers’ comments and we hope this work is now acceptable for publication. Best, Dr Felix Bongomin. PONE-D-24-19464 Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University Teaching Hospitals in northern Uganda Reviewer #1: Dear Authors, Appreciating the work you have done, please address the following points. 1. Though the manuscript is well written, I have seen some typographical and grammatical errors, and recommend you to go through the entire document. Here I have mentioned some i. Line 125 "was to be considered normal" - was considered normal ii. Line 139 "Data analysis plan" - Data analysis iii. Line 144 "will be described..."- was described iv. Line 149 -150- "Factors with p<0.05 were considered independent of undernutrition" did you mean "were considered independently/significantly associated with undernutrition" Authors response: Thank you, these have been corrected. 2. Did you use mean or median for the continuous variables (line 143)? I saw mean age (line 175), mean MUAC (line 186), mean time taken to reach hospital (line 212) etc... Authors response: This was a typo, we have corrected it to mean and standard deviation. 3. It is mentioned that the meantime taken to reach the hospital was 41.784 (line 212). Is it minute?, and is it by walk or car? please mention the means of transport as well. Authors response: By walking, tis has been clarified. 4. redundancy of ideas- line 141 and 145. Authors response: Thank you, we have summarised this and deleted redundant statements. 5. The model you used for obtaining dietary diversity information of individual respondents, the 24-h recall method, should be mentioned in the limitations of your study too. Authors response: This has been added under strengths and limitations. Reviewer #2: The authors present findings from a study estimating the prevalence and risk factors of malnutrition among pregnant adolescent and young women in Northern Uganda. The article is well written, but requires proofreading prior to publication. For example, "STAT" on line 27 should read STATA. Authors response: Thank you. This typo has been corrected. The mid upper arm circumference and the dietary diversity score both need to be described in more detail/background for readers not familiar with these measures. Authors response: We have described this further. Thank you. The authors present adjusted prevalence rates, but do not specify what was specifically adjusted for and why. Authors response: Same as below, we have a sentence on this. What confounding/prognostic factors were adjusted in regression modeling? For example, age, functional capacity, current health status, etc. Were these factors considered? Please clarify. Authors response: We have added a sentence on this. Thank you. In Figure 1, how many participants were excluded due to illness and congenital arm deformities as described in the study population section? These are currently not shown. Authors response: None had chronic illness or arm anomaly. We have deleted this from the methods section. In the data analysis plan section, the authors say that regression results were interpreted based on the odds ratio (OR). However, regression model results are provided using the prevalence ratio (PR) in the results section. The odds ratio and the prevalence ratio are distinct measures. Which of these were modeled? Authors response: We modelled prevalence ratio and used modified Poisson regression. The study does not specify how missing data was managed during the analyses. This information needs to be included. Authors response: We have included a sentence in the analysis section. It is not clear what is meant by "an attempt was made to identify randomized respondents" on line 340. Was randomization employed in this study? Authors response: Thank you for the guidance, we agree this is confusing and we have deleted it. On lines 336-337 the authors state that the cross-sectional nature of the study might affect the establishment of a casual relationship. I find this statement to be misleading and confusing because causation can never be established through an observational cross-sectional study. Authors response: We agree, we have deleted this sentence On line 279 the authors state "prevalence of undernutrition in our study was small compared...". Should this be "smaller" as a prevalence of 12.7% for undernutrition is not small. Authors response: Thank you for this. This has been corrected. How was antenatal attendance measured/coded? Why does it have 9 levels? This is not clear in Table 1 or described in the text. Authors response: This was coded as frequency/number of times ANC was attended . We have clarified on this. Attachments Attachment Submitted filename: PONE-D-24-19464_Response to Reviewers Bongomin.docx https://doi.org/10.1371/journal.pone.0307749.r002
11 Jul 2024 Decision Letter - Mohammed Hasen Badeso, Editor Dietary diversity, undernutrition, and predictors among pregnant adolescents and young women attending Gulu University Teaching Hospitals in northern Uganda PONE-D-24-19464R1 Dear Author(s), 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, Mohammed Hasen Badeso, Epidemiologist Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0307749.r003
Formally Accepted
15 Jul 2024 Acceptance Letter - Mohammed Hasen Badeso, Editor PONE-D-24-19464R1 PLOS ONE Dear Dr. Bongomin, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Mr Mohammed Hasen Badeso Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0307749.r004

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