PONE-D-23-21294Rural-urban disparities in full antenatal care utilization among women in Ethiopia: a Multivariate decomposition analysisPLOS ONE

Dear Dr. Addisu,

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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Trhas Tadesse Berhe, PhD

Academic Editor

PLOS ONE

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- https://doi.org/10.1371/journal.pone.0284382

- https://doi.org/10.1186/s12884-020-03236-9

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Dear Elsabeth Addisu

Following review of your article to PLOS ONE, we invite you to submit a major revision.

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Editor(s)' Comments to Author (if any):

• Please ensure that your abstract adheres to our Instructions for Authors' formatting guidelines.

• Kindly include the requested supplementary file.

• Ensure consistency in the description of your study design (Is this a community-based cross-sectional study?).

• Offer clear operational definitions for "Urban" and "Rural."

• Thoroughly depict the study area, period, design, data sources, study population, sample size determination method, sampling technique, inclusion and exclusion criteria, and other pertinent details.

Best regards , Trhas Tadesse ( PhD, associate professor in public health )

Reviewer 1:

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.

Response: yes

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

Response: yes

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.

Response: 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.

Response : 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)

Response : What is the research's ground-breaking and original discovery? I suggest that the authors consider delving deeper into the factors contributing to disparities among rural and urban mothers. The factors mentioned and addressed by the authors are commonplace and frequently discussed.

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: N/A

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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: What is the new and novel finding of this research works/

I would recommend the authors if they go a bit deep dive to the factors contributing for disparity among rural and urban mothers. What have been mentioned and addressed by the authors are of common and most frequently addressed factors

Reviewer #2: Dear authirs,

Tye strength of your paper is

a. Addressing sensituve.issues of maternal health

b. Upto dated data of mini EDHS,2019.

3. Working together for publication

4. High level analysis

However, you have failed to achieve;

1.Depth of the issue e.g MOH ANC new guideline was not cited

2. The methods is not clear and the selection of variables need strong conviction

3. The title, the objectives and the contents are somewhat inconsistent.

4. The consistency between the title and the contents and objective and role of authors should be clearly stipulated.

5. You didin' cite the DHS in some parts and even the citation is wrong.E.g see the reference section.

E.g. the sampling procedure and definitions are already stated in EDHS itself.

6. In general, all sections need meticulous explanation and justification.

7. Try to change the majority of the article.

Regards,

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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: Abebe Sorsa

Reviewer #2: No

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PONE-D-23-21294R1Rural-urban disparities in full antenatal care utilization among women in Ethiopia: a Multivariate decomposition analysisPLOS ONE

Dear Dr. Addisu,

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 05 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,

Doris Verónica Ortega-Altamirano, PhD

Academic Editor

PLOS ONE

Additional Editor Comments:

The manuscript you submit is good. However, it can improve if you take into consideration the suggestions of the reviewers. Please send the new version of the manuscript before July 5.

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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 #3: (No Response)

Reviewer #4: All comments have been addressed

Reviewer #5: (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: Partly

Reviewer #3: Partly

Reviewer #4: Yes

Reviewer #5: Yes

**********

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

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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 #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

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

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

Reviewer #2: Yes

Reviewer #3: No

Reviewer #4: No

Reviewer #5: 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 Reports

Title: Rural-urban disparities in full antenatal care utilization among women in Ethiopia: a Multivariate decomposition analysis

Number: PONE-D-23-21294R1

Review Comments

We acknowledge the recipients of the point-to-point responses of the authors to our previous comments and the incorporation of the comments in to the new submitted manuscript. In addition, we notify our receipt of the tracked changes of the accepted comments. Again, we acknowledge for conducting the study by team. The following are our comments;

a. On the title: Needs reframing and make it absorbing to the reader. For instance, If I were you, I may rewrite the title as “Rural-urban disparities in full antenatal care utilization among women in Ethiopia: A further Analysis of mini-EDHS, 2019”

b. On the abstract section

• The background is incomplete

• It lacks clarity and used inappropriate words E.g., ‘to see’

• The presentation of the result is also incomplete E.g., lacks confidence interval.

c. On the methods section

• It is known that urban dwelling women have higher full ANC utilization when compared with rural dwellers due to the gains in the urban dwelling. Hence, what new findings do this study report? Why was the specific type of analysis then employed?

• What was the reason behind the selection of those women aged 15 to 49 years (3979), the number of sampled women before your analysis in the actual EDHS, and yours (3,979)?

d. On the result and the consequent sections

� The rural dwellers have higher full ANC utilization that the urban one. Access, sampling?

� Try to address the similarity and the difference between the regions and ‘cultural difference’?

� It lacks proper description of the findings E.g., Use of figure.

� Strengthen the discussion section.

� The conclusion and the recommendation should be in line with the findings of the study. Likewise, specific recommendation should be conveyed.

� The manuscript didn’t declare ‘conflict of interest’

Regards,

Reviewer #3: First of all, I would like to thank the editor for inviting me to review this manuscript. Then, the authors for coming with an important topic.

Abstract

The document needs intensive revision for grammatical issues and sentence organization including use of tenses and conjugations in the appropriate place, and punctuations.

Suggest to modify the first sentence. To make it sound, don’t start with even though.

Methods: who did cross-sectional study? It is not your data, please refer the source of the data then state how they capture it. Otherwise, it seems you have actively participated in the data collection process.

Suggest to replace “prevalence” by other terms for explaining full antenatal utilization.

Report CI for rural and urban ANC utilization.

Rural ANC utilization was higher than urban. Your explanation have not supported your findings. ” So to narrow this gap, emphasis should be given to both resource distribution targeting to rural households, improvement of maternal education and creating a plat form to access information about the service and its relevance”. Please provide evidence based justification and recommend based on your findings.

Introduction

Line 52 and 53: suggest to modify the sentence

Line 54: use updated reference

Elaborate the introduction starting from extent of poor ANC utilization, its effect on maternal and newborn health, factors affecting ANC utilization and the observed disparities by country, region, and residence. Consequently, explain the interventions posed before for improving ANC utilization and gap of previous studies for showing disparities. Clearly set the gap. Keep flow of the sentences.

What is the relevance of studying urban and rural disparities? Reference 22, 14, and 15 also studied disparities in ANC utilization in Ethiopia. What values you added?

Line 75: “Because though” please revise the document for English grammar.

Methods and Materials

Line 92: better to report study population instead of sampled population.

If a mother provides two or three live births within five years, what measures are taken during sampling? Which ANC was taken? If there is disparities in ANC utilization for different pregnancies within a mother, in which category you classified this particular participant? This all needs to be clarified.

Results

Suggest to provide clear interpretation for your decomposition results. “That is, if urban women distribution of primary, secondary and higher education shifted to rural levels the rural-urban disparity would increase by 3.76%, 11.84%, and 15.27% respectively”

Suggest to describe about difference due to characteristics and difference due to coefficients in methods section.

Discussion

Inconsistent result is reported in result and discussion section. You reported “The disparity of full antenatal care utilization between rural and urban areas was high (rural prevalence was 27.73%, while in urban areas it was 15.52%)” , whereas in result section you reported “The result of this study showed that full antenatal care utilization among women in urban areas of Ethiopia was better than that of rural residents” in discussion.

Did you consider changes in characteristics (endowment) and change in behavior (coefficient) as a variable?

What is your base for discussing “changes in characteristics (endowment) than change in behavior (coefficient)”?

Line 227 to 229: suggest to provide evidence based justification for the particular finding. How you relate Muslim religion and ANC utilization. Here, you have to provide justification for the disparities occurred between urban and rural areas.

Add practical implication for pertinent findings.

Your Interpretations are not still clear in discussion. Please provide clear and simple interpretations.

Line 242 to 244. “This result is in line with studies conducted in Ethiopia (13, 14, 22),” if ample evidences are available in Ethiopia, what you have added???? You have used almost all references in your discussion from Ethiopia.

Line 256: add reference for your justification.

Reviewer #4: Question to be answered

1. What basic observational disparities the authors observed to do this decomposistion analysis inEthiopia?

2. Why not the authors accounted the effect of endowment and coeffient interaction explanation on the gaps of ANC utilization?

3. There are need of presentation of some findings further by tables/graphs, but missed. For example, line numbers 192 and 205

4. What will be the authors scientific recommendation for the covariate religion explanation for ANC urban-rural disparity? I recommend you to omit.

5. Why the authors lack similar findings of religious difference? Can you declare that it is a novel finding?

The overall comments and some questions are highlighted in the manuscript.

I also attached a separate file.

Reviewer #5: There are some places that need to be grammatically checked. I noticed that there are some places that are missing spaces. One such instance is between a word and the reference number. There are places that have spaces and some that don't. Another discrepancy I see is that you put commas for numbers greater than or equal to 1,000 (not referencing a year). Please make sure the spacing between the references follow the PLOS submission guideline.

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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 #3: No

Reviewer #4: Yes: Wolde Melese Ayele

Reviewer #5: 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.]

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Attachments

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Submitted filename: PONE-D-23-21294_reviewer.pdf

Attachment

Submitted filename: Question to be answered, deco.docx

Rural-urban disparities in fullantenatal care utilization among women in Ethiopia: A further Analysis of Mini-EDHS, 2019

PONE-D-23-21294R2

Dear Dr. Adissu,

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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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,

Doris Verónica Ortega-Altamirano, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

I am pleased to approve the version of manuscript PONE-D-2321294-R2.

The manuscript presents a useful study on understanding the phenomenon of using full antenatal care in women of reproductive age in Ethiopia.

Reviewers' comments: