PONE-D-23-37734Determinants of Female Genital Mutilation/Cutting Among Women of Reproductive Age in Tanzania; an Analysis of the 2015–2016 Tanzania Demographic and Health Survey and Malaria Indicator Survey DataPLOS ONE

Dear Dr. Moshi,

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We look forward to receiving your revised manuscript.

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Joyce Jebet Cheptum

Academic Editor

PLOS ONE

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Additional Editor Comments:

This article needs to be reworked based on the comments as serious flaws in the methodology and results have been identified.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

Reviewer #3: No

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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: No

Reviewer #2: Yes

Reviewer #3: No

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

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

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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5. Review Comments to the Author

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

Reviewer #1: Title: it is confusing( somewhere it is determinant and somewhere it is prevalence), but in my reading I understood as it is a prevalence study, that's why you used a cross sectional study design,so please make your title as " prevalence and associated factors of FGM/C..."

Introduction section: the paragraphs need rearrangement, please keep the natural flow of ideas and your justification is not well stated, that is your interest of this study is not clear, why do you interested to conduct this study?

Your discussion is not presented in the intelligible way, please rewrite again

Your recommendation also poor, please write your recommendation based on your findings

You said "the study is without limitations......." but you put some limitations, what does that mean?

Reviewer #2: Thank you, dear editors, for you’re considering me to review this paper!

It is an interesting topic. However, I have the following comments to the authors for improvement:

Abstract:

Method: Do you appreciate the difference between a multivariate and a multivariable logistic regression? In the abstract section, you wrote multivariate logistic regression. Is multivariate logistic regression appropriate for your analysis?

Result: it is better to add the CI to AOR

Introduction

-It is good to refer to PLOS One as a guideline for reference citation. Your citation is superscripted.

Methods: you state that, ‘The study design was an analytical cross-sectional study design using secondary data and The Tanzania Demographic and Health Survey (DHS) and Malaria

The Indicators Survey (MIS) 2015–2016 dataset was used’.

-Why is pre-test? Since you used secondary data, why were sixteen (16) field teams used for data collection? Why Supervisor? Why interviewers?

-I expected the data to be extracted from the Tanzania Demographic and Health Survey (DHS) and Malaria Indicators Survey (MIS) 2015-2016 dataset as secondary data. But your data collection procedure describes how you collected primary data? Please try to describe the method clearly.

- Sample size calculation and sampling procedures are not clearly stated.

- NB: A more detailed method is needed to show how you extract your manuscript data from Tanzania Demographic and Health Survey (DHS) and Malaria Indicators Survey (MIS) 2015-2016 dataset.

Result:

- What is the importance of the relationship between the characteristics of women of reproductive Age and female genital Mutilation/Cutting Status? You have addressed the associated factors.

- How candidate variables selected for logistic regression analysis from a huge dataset?

-What are the reasons for the wide CI in Zones of Northern (28.41-296.546), Central (67.093- 689.423), Southern Highland (3.49 - 41.298), Lake (4.338 - 44.714) and Eastern (7.299- 80.017) in logistic regression model?

Reviewer #3: - There should be a clear objective for research

- What makes this research analytical? it is purely descriptive. if it is analytical cross sectional where is the hypothesis?

- There should be a clear methodology

- Should understand each components of research. the difference between result and discussion

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: PLOS ONE.docx

PONE-D-23-37734R1Prevalence and Determinants of Female Genital Mutilation/Cutting Among Women of Reproductive Age in Tanzania; an Analysis of the 2015–2016 Tanzania Demographic and Health Survey and Malaria Indicator Survey DataPLOS ONE

Dear Dr. Moshi,

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 15 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,

Joyce Jebet Cheptum

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 #2: All comments have been addressed

Reviewer #4: (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 #2: Yes

Reviewer #4: Yes

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

Reviewer #2: Yes

Reviewer #4: 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

Reviewer #4: 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 #2: Yes

Reviewer #4: No

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6. Review Comments to the Author

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

Reviewer #2: (No Response)

Reviewer #4: Prevalence and Determinants of Female Genital Mutilation/Cutting Among Women of Reproductive Age in Tanzania; an Analysis of the 2015–2016 Tanzania Demographic and Health Survey and Malaria Indicator Survey Data.

This is an interesting paper that uses survey data to assess the prevalence of FGM and factors associate with the FGM. The paper continues to add to the body of knowledge on FGM. Although the paper provides useful information on the factors that are associated with FGM in Tanzania, the structure and the presentation in the manuscript may need some copy editing and formatting to ensure flow before publication. Detailed areas of recommendations are provided below.

Title: The title is well written providing information on the population and the study setting as well as the design employed. I however believe this could still be shortened as it seems too long. Alternative descriptive words could be used in the main body of the manuscript. Tanzania is repeated twice in the e title and could be omitted to shorten the title. Second, is the use of the term ‘determinants. This implies that the study is showing a causal relationship when in essence the study’s focus is to assess the factors associated with FGM.

Abstract: The abstract is well structured and concise. The word determinant and factors associated are used interchangeably in methods section when in deed they are distinct

Introduction: Generally, the introduction section is ok and provides the context of the study as well as the justification. There are a few areas that may need to be refined ---for example, the sentence that begin with, “The procedure is performed using unsterilized tools…..” seems to generalize that all FGMs and provides a biased analysis of the problem. The statement that begins with “improperly performed…” imply that there are proper ways of performing FGM.

There is a missing ‘to’ after according in the third paragraph. The word female genital mutilation/cutting has been abbreviated as FGM and can use the abbreviation thereafter. Otherwise the authors keep going back and forth with the use of the abbreviation and full description in the body of the manuscript.

Any reference to the high prevalence rates in the areas listed in Tanzania?

Methods: It would be helpful to provide a description of the TDHS-MIS and then the methods for this study. As it is, the methods being described in this study belongs to the TDHS-MIS. How was the data collected/abstracted for this study? What data cleaning procedures were conducted? How was missed data managed/handled? The data from women who were missing the information on whether or not they underwent FGM could bias your results – I can imagine the social desirability bias could have affected your findings here.

Why was the age categorized? For women aged less than 20 years, what was the lower age limit. Similarly, what was the upper age limit for those who were 34 and above. I want to believe the survey collects data from all women, and if this is not correct then your study background or the survey in which your study is based on, needs to be well described.

In the dependent variable section, delete the sentence that starts with ..Literature…

Which statistical analysis software was used to conduct the analysis?

Results: The results on circumcision is confusing. Were participants asked a follow up question on whether the flesh was removed or not? If that is the case, this is not provided in the methods section to understand this finding. Additionally, the finding with about 9% of the participants reporting not knowing whether or not the flesh was removed is more confusing – how did these persons know that they underwent FGM/C? Was there an examination of the genitalia to determine the responses?

Some figures could be left out as a sentence in a text communicated the information effectively, otherwise the figure just repeats what is in the text. If inserting figure 4, then there is no need of explaining everything in that figure within the text.

Discussion: This section is a little hard to follow. For example, paragraph 2is a little loaded with a lot of information that is hard to make out the implication of the study’s findings in comparison with what has been published out there. Paragraph 3 of the discussion does not discuss any of the study findings.

Paragraph 5 of the discussion does not seem to have provided a probable justification for the wide CI in the findings. What could have explained the study finding that education levels and rural dwelling were not significantly associated with FGM? Yet other studies have documented so?

Conclusion: The statement in the conclusion on the next step based on the findings should be focused. It is too general to relate to the findings of the study. What can be done about the women who have already undergone FGM and want this act to continue, hence the likely of them engaging this to their young girls?

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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

Reviewer #4: No

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Prevalence and Factors Associated with Female Genital Mutilation/Cutting among Tanzanian Women Who Gave Birth in the Five Years Prior to the Survey: A Population-Based Study

PONE-D-23-37734R2

Dear Dr. Moshi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Joyce Jebet Cheptum

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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