PONE-D-24-15982Burden and etiology of neonatal meningitis at Hawassa University Comprehensive Specialized HospitalPLOS ONE

Dear Dr. Ali,

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.

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Please submit your revised manuscript by Jul 20 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Tebelay Dilnessa, MSc

Academic Editor

PLOS ONE

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Additional Editor Comments:

Dear Author,

I acknowledged author's work entitled: Burden and etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital. Even though, a single author the results illustrated the burden of meningitis among children. Therefore, this study will be useful for prevention and control of bacterial meningitis among children in the study area. The manuscript is more or less in line with the vision, objectives and instructions of PLoS One.

Title: ‘Burden and etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital’ It is better writer as, ‘Burden and bacterial etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia’

Abstract

• Lines 9: ‘Introduction’ better replaced by ‘Background’.

Introduction

• Line 82: …………………HUCSH, better written as, Hawassa University Comprehensive Specialized Hospital (HUCSH).

Materials and Methods

• No sample size determination and sampling technique was described.
• Line 101: ‘Bacteria were identified using standard bacteriological techniques. Which bacteriological technique?
• Specimen collection and processing needs to be well written.
• What standard microbiological procedures were employed in specimen collection, isolation, identification susceptibility testing and throughout the procedure?
• How could you standardize the suspension preparation during performing antimicrobial susceptibility testing?
• An ethical approval was also needed. What have you done for children positive for the microorganisms?

Results

• Table descriptions should be described well in terms of person, place and time.
• Line 124: Table 2, words/phrases like: ‘CONS, GPR, NLF GNR’ requires legend or a full form as they appear for the first time.
• Please follow the manuscript writing protocol of PLOS ONE for figure preparation and presentation.
• What is your base to classify the age group?
• Why you missed to include the associated risk factors?

• Authors tried to compare their findings with different reports from worldwide. They also better justify the reason for variation among results of different research findings with respect to theirs’ based on actual situation.

Conclusions

• Normally, conclusion emanates from the research.

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The title "Burden and etiology of neonatal meningitis at Hawassa University Comprehensive

Specialized Hospital" needs modification" because fungal and viral agents are not considered throughout the manuscript. Simply modify the title, like the aim explained in the abstract section (L13–15).  Lines 13–15 and 16–18,  in the introduction and methods sections of the abstract, respectively, reveal different participant inclusions. A similar source population must be used, whereas all newborns less than 90 days of age and suspected newborns are explained, respectively. Moreover, it is stated that "At HUCSH, isolation and identification of

19 bacteria were performed using standard microbiological techniques". Since it is retrospective, it must be explained in a different way. In the results of the abstract section, "Line 1: The age of 767 (72.3%) was between 8 and 90 days" is unclear. L52-53 "Among the various etiologies of meningitis, bacteria are responsible for the highest burden.

53 worldwide" is unrealistic. What about viruses? L69-71: "Death and neuropsychological sequelae from meningitis are higher in low-income countries because of a lack of facilities to manage the cases as early as possible." What about other very important factors? Additionally, words like burden, magnitude, and prevalence are not used consistently at the beginning of your research question, and it is better to use only one of them throughout the document. Consider L17 VS 83. Are you studying infants (L-89) or newborns? Line 91: silly mistake, the year (needs correction). Lots of information is missed in data collection, transportation, handling, and data quality control. L130 to L132 "This life-threatening illness poses a significant risk, particularly in low-income countries, where it is associated with a high case fatality rate and long-term complications," needs rewriting (similar meaning by different phrases).

Generally, there are some typos and grammar issues to accept after minor revision.

Reviewer #2: General comments

The topic is very interesting and concerned with vulnerable study group. However the manuscript prepared as simple description. for example the author considered sex, age and the year of visit as independent variable but not tried to see the relationship between the outcome variable and independent variables. therefore much effort is needed to improve the manuscript.

specific comments

Abstract

Result:

#27-28 Coagulase- negative Staphylococci (CONS) were the most common agents of meningitis. (Please include the percentage and absolute no)

#29 Acinetobacter species (n=12.2; 13.3%) followed by Escherichia coli (n=9; 10%) and Klebsiella pneumonia. ‘n’ stands for absolute number, so it should be corrected

Conclusion:

#34-35 The overall magnitude of culture-confirmed meningitis was high. What is your based to say high? Have you compared with previous study in Ethiopia or any other country considering the confidence interval? Otherwise difficult to say high or low.

Introduction

No overall data related to the burden were documented at national level. Please consider to include it. You may get it either from EDHS or from systematic review studies.

Methods

Study design and area

Please mention the catchment area of the Hospital and the environmental factors that might be associated with meningitis. Please also write the detail of Hospital service and the number of clients seeking services.

#91 from 2019 to 202. Kindly correct this figure

Study participants and data collection

Please briefly explain how the sumple collected and how the isolation and identification carried out.

Data analysis and interpretation

Your study is simple descriptive. On the other hand your finding compared with other findings. Though you reported demographic characteristic, you didn’t associated your finding. Therefore I kindly revise your result accordingly.

It would be better if you show the trend of meningitis burden across the year too.

Discussion

The discussion part needs detail explanation, Justification needs scientific ground.

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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.

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: Yes: Zigale Hibstu

Reviewer #2: 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-24-15982R1Magnitude and etiologies of neonatal meningitis at Hawassa University Comprehensive Specialized HospitalPLOS ONE

Dear Dr. Ali,

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 30 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,

Tebelay Dilnessa, MSc

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:

• The author significantly improves the paper, still it requires a line by line through proofreading and make a correction in terms of punctuation and editorial issue.
• Title: Burden and etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital’ It is better written as, ‘Burden and bacterial etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia.’ If you have any reason not to revise title you can raise the reason.
• Add some analysis techniques (Chi-square, P-value, etc) in the abstract as well as in the methods part.
• Line 82: Study area design
• Line 220: Data availability statement

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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: 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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

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 #1: Yes

Reviewer #2: 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: Yes

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 #1: The authors have adequately addressed comments raised in a previous round of review the and I feel that this manuscript is now acceptable for publication. The manuscript technically soundful and the data support the conclusions. The manuscript is presented in an intelligible fashion and written in standard English.

Reviewer #2: Title

Line 1: Magnitude and Bacterial profile…….

Abstract

Line 13: Magnitude and Bacterial profile…….

Introduction

Please make one paragraph on how the new borne acquire the infection

Line 40-41: The sentence need citation

Line 41-42: The sentence need citation

Methods

Line 82: Study area desin – correct spelling error

Line 85: The study time or period should be the first date of the date record up to the last date of data record.

Line 86: south of Addis Ababa, capital City of Ethiopia

Results

Line 138: age group of 0 to 8 days, correct the range

Line 132-133: The magnitude of culture-confirmed meningitis was high among females and among those who were within the age range of 8 to 90 days. However your analysis indicated the p value is greater than 0.05 (0.18). is it possible to higher or lower? Please recheck it?

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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: Yes: Zigale Hibstu Teffera

Reviewer #2: 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.

Burden and bacterial etiology of neonatal meningitis at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia

PONE-D-24-15982R2

Dear Dr. Ali,

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,

Tebelay Dilnessa, MSc

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: 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

**********

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: (No Response)

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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: No

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