PONE-D-23-41265Burden and determinants of occupational injuries among sanitary workers in public hospitals, eastern EthiopiaPLOS ONE

Dear Dr. Tolera,

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. There are concerns in how you analyzed data, with logistic regression a poor choice for common outcome in a cross-sectional study. Fortunately, the remedy is simple as per my comments below.  Presentation of too many significant figures detracts from usefulness and readability: I make specific suggestions to address this in my comments below. Please also consider how much you gain by using p<0.05 for variable selection: it is not method of model-building that is favored for observational studies. Do your results change in any important way if you do not exclude any variables from regressions but simply present all effect estimates and then discuss their magnitude and precision of their estimates? 

Please submit your revised manuscript by Jun 14 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,

Igor Burstyn

Academic Editor

PLOS ONE

Journal requirements:

1. When submitting your revision, we need you to address these additional requirements.

Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at 

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and 

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf.

2. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified (1) whether consent was informed and (2) what type you obtained (for instance, written or verbal, and if verbal, how it was documented and witnessed). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information.

If you are reporting a retrospective study of medical records or archived samples, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information.

3. We note that your Data Availability Statement is currently as follows: [All relevant data are within the manuscript]

Please confirm at this time whether or not your submission contains all raw data required to replicate the results of your study. Authors must share the “minimal data set” for their submission. PLOS defines the minimal data set to consist of the data required to replicate all study findings reported in the article, as well as related metadata and methods (https://journals.plos.org/plosone/s/data-availability#loc-minimal-data-set-definition).

For example, authors should submit the following data:

- The values behind the means, standard deviations and other measures reported;

- The values used to build graphs;

- The points extracted from images for analysis.

Authors do not need to submit their entire data set if only a portion of the data was used in the reported study.

If your submission does not contain these data, please either upload them as Supporting Information files or deposit them to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories.

If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially sensitive information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., an ethics committee). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. If data are owned by a third party, please indicate how others may request data access.

4. Please amend the manuscript submission data (via Edit Submission) to include author Tesfaye Gobena, Nega Assefa, Abraham Geremew and Elka Toseva.

5. Please amend either the abstract on the online submission form (via Edit Submission) or the abstract in the manuscript so that they are identical.

6. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 

Additional Editor Comments:

Please revise your article using detailed feedback from reviewers as well as my comments that follow.

1.Please include copy of all questionnaires – in original language -- that you used as supplementary materials.

2.Translate key questions that you asked, such as about the outcomes and report in text; Saying that Boolean logic was used is both not adequate and not necessary if you give actual question and response options.

3.Report all percentages to with precision of 1/10, not 1/100, such that 97.29% should be replaced with 97.3%/ Make correction in text and tables. You simply do not have information with precision of 1/100 of 1% when you have <1000 subjects.

4.Report all COR and AOR (adjusted and unadjusted odds ratios) within 1 decimal place: e.g., 3.6, not 3.61. Make corrections to text and tables throughout.

5.For “mean ± SD for age, work 41 experience, educational status, and monthly income” please report precision within one decimal place or less.

6.You cannot conclude that “In order to reduce these risks, appropriate work-related policy relating 53 occupational health and safety be enacted. Further, enforce the implementation of occupational health 54 and safety practices within hospitals is necessary.” The reason for this is that you did not evaluate any interventions. Please remove all such claims from conclusions but feel free to speculate on plausible interventions in the discussion, esp. if there is evidence to support some specific interventions.

7.Among keywords, “determinants” is too vague. Determinants of exposure, outcome, something else? Please revise.

8.Table 3: round up all p-value to within 1 significant figure. Do not highlight values <0.05 with a *, because it is not appropriate to stress null hypothesis testing in observational studies, where non-random errors dominate.(Wasserstein and Lazar 2016)

9.The rate of self-reported occupational injuries was rather high, 44%, which makes logistic regression a poor tool for approximating relative risk. For OR to approximate RR, the rate of events should be in the range of 10% or less. A more appropriate method of data analysis is to estimate prevalence ratios (PR) using any number of available approaches. In STATA, modified Poisson regression (Zou 2004)is a sensible (better) method. I strongly recommend all analyses be re-done using PR. Please read this for description of implementation of the recommended analytical approach in STATA: https://stats.oarc.ucla.edu/stata/faq/how-can-i-estimate-relative-risk-using-glm-for-common-outcomes-in-cohort-studies/.

References

Wasserstein, R. L. and N. A. Lazar (2016). "The ASA's Statement on p-Values: Context, Process, and Purpose." The American Statistican 70: 129-133.

Zou, G. (2004). "A modified poisson regression approach to prospective studies with binary data." Am.J.Epidemiol. 159(7): 702-706.

[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: Partly

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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: No

Reviewer #3: No

**********

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: Reviewer comments

Manuscript Number = PONE-D-23-41265

Title: Burden and determinants of occupational injuries among sanitary workers in public hospitals, eastern Ethiopia

Dear authors, you need to address and clarify the following comments before publication

Abstract, line 33 delete from after sample size 809

Introduction

Line 60, what do you mean collect solid garbage? Is there liquid garbage?

Method

Line 117 what is mean Out of 5680 hospital staff of 568, about 809 of these were cleaners and waste collectors? What is your justification to take all sanitary workers as a sample? Why you no need sample among sanitary workers?

Line 135, If you took all sanitary workers, what is the need of sample size determination part?? Justify it?

Line 121. The map of your study area needs scale, and proper naming of figure is required

Line 151. 2.5 selection procedure. There is no proportional allocation, just you took the whole population? What is the need of stating sample selection?

Line 153, they are not selected?

Line 172 your study period was from May 30th, 2023 to August 30th, 2023, why the title of figure 2 is 2022?

Line 175 unfinished sentence

Line 181. 2.6.2 Independent Variables, what is the difference between Institutional variables and Working environment variables? May be enabling variables?

Line 202 contents of the questionnaire not question?

Line 208 the 7 days Boolean logic questionnaire not mentioned in your abstract of line 34

Line 210, what are Determinants questions: eighteen standard questions were prepared for associated factors mean? Are they different from other independent variables?

Line 228 Key informant interview = Is it data collection or analysis part? Justify why you need to summarize like quantitative data?

Line 247. What are the languages used for data collection?

Line 262, what is MRL?

Line 282 Table 1 Sociodemographic table: Is there separate division of labour for cleaners and waste collectors in the Ethiopian hospital human resource structure? Waste collectors from municipality or have their own?

Line 288, Burden of occupational Injuries, the calculation and narration is not clear?

Line 310, where do you get neutral attitude?

Table 3 and Table 4, If you ran logistic regression why you need to calculate X2 for comparison, please justify?

Table 4, Variables, Sex, Had MSD and conduct supervision are they significant?

Line 321. How do you measure Knowledge, attitude and practice as shown in your Table 4?

Line 330. 3.6 Assessment from IPC as KII, the analysis and result for Key Informant Interview is not clear please make it clear as qualitative data finding?

Line 465, strength, the study had no sample, instead all populations assessed

Line 480, Conclusion. You don’t have a variable indicating unsafe hygiene, how do you conclude in the first sentence?

Line 484. Have you addressed the rules , policies and regulations related to OHS?

Thank you

Reviewer #2: REVIEWER’S COMMENTS

Abstract

• Line 33: “Data were collected from 809 from hospital sanitary workers” should be read as “Data were collected from 809 hospital sanitary workers”

• Line 34: The occupational injury….., “The” should be deleted.

• Lines 36 – 38: “Binary and multiple logistic regressions were used to explore the relationship between dependent and independent variables. The crude odds ratio (COR) and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were used to present the analysis.” Binary logistic regression reports crude ratio and multiple logistic regression also reports adjusted odds ratio so it is not necessary to include “The crude odds ratio ……..”. Authors can add “Statistical significance was determined at a 95% confidence level” after “…………. “between dependent and independent variables”.

• Line 39: Authors indicated in the methods section of the abstract that 809 respondents were used for the study. However, in the results section of the abstract, they indicated 729. The authors should clarify the inconsistency.

• Lines 41 – 42: Authors should indicate the unit of measurement of age and work experience.

• The results section is not very clear. Authors should consider re-writing the results to make them clearer.

Introduction

• Line 65: “They often cited” should be written as “They are often cited”.

• Lines 69 – 70: This needs to be revised to make it clearer.

• Line 73: “but also they are facing with a variety of…” should be written as “but also they face several occupational ….”.

• Line 97: Reference (35) should be in square brackets, [35].

Methods

• Line 109 – 111: “In terms of study areas, public hospitals within a 200km radius of Harar were chosen from three regions and one administrative city”. This statement is not clear. The authors should justify why they selected the study areas.

• Lines 114 – 117: “From …..” the content should be checked and it is a bit unclear.

• Line 115: The word “daily” should be deleted.

• Lines 116 – 117: The (mean+SD) values in the bracket are 4 but the parameters are three (bed occupancy, outpatient flow and inpatient). This should be rectified.

• Line 117: “Out of 5680 hospital staff of 5680” This statement should be checked as 5680 is repeated.

• The map of the study area is blurred. Authors should replace it with a clear map.

• Line 122: Section 2.2 “Source and study population” should be revised to read “Study population”.

• Line 134: The sentence is incomplete.

• Line 135: Section 2.4 - Sample determination. The entire section is not clear. Authors should be specific on how they estimated the sample size for the study.

• Line 151: Section 2.5 Selection Procedures should be written as “Sample selection procedures”. Authors should explain how they arrived at the sample size for each of the four study States.

• Line 165: About Figure 2. According to the information in section 2.5, Dire Dawa City has a total sample size of 82. However, it says otherwise in the Figure. The same applies to the Oromia Regional state.

• Line 175: “………workers’ representatives (KII-2) were purposely selected from each eight”. The authors should check this statement again as there may be an error with the use of “eight”.

• Lines 192 – 194: Authors should check the time shifts as they overlap and create confusion for readers.

• Lines 228 – 246: The information presented here does not form part of quantitative data. Key informant interviews are ways of collecting qualitative data. Authors should kindly revise.

• Line 258: “independent variable” instead of "variable independent”

• Lines 267 – 274: Section 2.10 Ethical statement. Authors should take the entire section out.

Results

• Lines 288 – 289: “Of these, 43.59% (95%CI: 39.87, 47.42) and 50.00% (95%CI: 35.52, 64.47) were cleaners and solid waste collectors, respectively”. The percentages of cleaners and solid waste collectors should sum up to 100%. This needs to be cross-checked.

• Table 3: Authors should provide a note under the table to explain the meaning of values with single asterisks.

• Line 330: Section 3.6 – Assessment from IPC as KII. This section per the methods is supposed to be qualitative. However, nothing shows under the results section. Authors should present their qualitative findings.

Discussion

• The discussion could be improved by revising the qualitative aspect to reflect the suggested revision in the results section.

• Authors should only discuss the findings based on the objectives of the study and delete any other thing that is not related to the objectives of the study.

• The authors could improve the discussion by including the implications of the findings.

Conclusion

• This will have to be reconsidered after effecting all the suggested corrections.

General comment

• There are many errors in the manuscript that need to be corrected. I suggest authors proofread the entire manuscript. Some parts have been highlighted yellow and green and I do not know the rationale for doing that. Authors should ensure they submit a clean document.

• A few mentions of the errors can be found in lines 53, 102, 103 115, 138 – 140, 192, 248 – 249, 256, 472, 473 – 474, and 486 – 487.

Reviewer #3: Abstract:

In the methods, include the sampling technique and data collection methods. Include the statistical analysis in a concise manner.

The results should include the factors found to increase the risk of occupational injuries. IPC should be provided in its full form.

Conclusions should be concise and based on important findings. Avoid making comments on policy implications that are not based on the findings.

Methods:

The purpose of mentioning mean, range, and standard deviation (mean ± SD) by bed occupancy (lines 114 to 117) is unclear.

The sentence “Out of 5680… and waste collectors” (lines 117-118) is not clear.

In the inclusion criteria, it is mentioned that newly recruited SW working for more than a month were included in this study. This would bias the results because the occupational injuries that occurred within the last 12 months influence the findings of prevalence by the respondents who joined as SW for more than a month.

Sample size determination: p-value for sample size calculation, p-value for age and PPE has been considered which is not appropriate, these should be avoided.

There is no sampling technique to include respondents

There should be criteria for selecting KIs (lines 175 to 177)

In independent variables (2.6.2), variable related to stress symptoms should be mentioned.

Results:

The results indicate that 729 out of the 809 calculated samples were respondents. It's important to explain why others did not respond.

In Table 2, there is a mistake in the total number of categories in the columns.

Limitations:

There may be a recall bias in reporting occupational injuries in the last 12 months; how this has been addressed should be mentioned.

Conclusions:

The comments (lines 484–488) regarding policy implications are not supported by the findings; however, these can be discussed in discussion.

**********

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: It is my review

Reviewer #2: No

Reviewer #3: No

**********

[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: Reviewer comments.docx

Attachment

Submitted filename: Reviewers Comment.pdf

PONE-D-23-41265R1Burden and determinants of occupational injuries among sanitary workers in public hospitals, eastern EthiopiaPLOS ONE

Dear Dr. Tolera,

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 Jul 27 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,

Igor Burstyn

Academic Editor

PLOS ONE

Additional Editor Comments:

Authors do not seem to have submitted point-by-point response to reviewers. Please create a separate document which you respond in detail to every comment of 3 reviewers and academic editor. You can use the same format as your "To Editor1.docx". In each of these point-by-point responses state if you agree or disagree with the comment. If you disagree, explain why. If you agree, state how the manuscript was altered. It is not enough to simply color-code the changes, because this skips the essential contextualization of why you are making changes.  TO DO THIS GO BACK TO COMMENTS ON THE ORIGINAL SUBMISSION AS THE ARE CURRENTLY ARE NOT DEEMED AS ADDRESSED DUE TO LACK OF POINT-BY-POINT RESPONSE TO THEM FROM YOU.

Please also address the following critique:

1. As per pervious comments from me, delete all "Asterisk shows statistically significant at *p-value<0.001; 350 **p<0.01; ***p<0.05, ****p <0.20; *****p>0.20" and show exact p-values instead, rounded up to 1 significant figure in Tables (Table 3, Table 4. Do not cite any p-values or "statistical significance" in text.

2. In Table 5, p-values cannot be >1, because p is a probability lies between 0 and 1, included, by definition.

[Note: HTML markup is below. Please do not edit.]

[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-23-41265R2Burden and determinants of occupational injuries among sanitary workers in public hospitals, eastern EthiopiaPLOS ONE

Dear Dr. Tolera,

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 07 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,

Igor Burstyn

Academic Editor

PLOS ONE

Additional Editor Comments:

Please respond point by point to my comments that were at the end of last decision letter. You already responded to 3 reviewers (thanks!) but you also MUST respond to my comments, editor's. Once all this is done, your revision will be reviewed otherwise it may be rejected for failure to follow instructions.

[Note: HTML markup is below. Please do not edit.]

[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-23-41265R3Occupational Injuries and Associated Factors among Sanitary workers In Public Hospitals , Eastern EthiopiaPLOS ONE

Dear Dr. Tolera,

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 Oct 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,

Igor Burstyn

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:

Thank you for extensive revisions.

Reviewers have some specific corrections and questions that they wish you to consider.

Furthermore, while you say that you included all the questionnaires in the original language, these do not appear to be in the file that was submitted for our review. Can you please ensure that it is included in the next version and reference such supplemental materials in text, where methods are described.

[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 #1: (No Response)

Reviewer #3: 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 #1: Yes

Reviewer #3: Yes

********** 

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

Reviewer #1: Yes

Reviewer #3: 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 #3: 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 #3: 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: Dear authors,

It is a great improvment, and I fill some editorial and clarification commonts to be addressed for the better ment of the paper quality

Reviewer comments # 2

Title of manuscript: Occupational Injuries and Associated Factors among Sanitary Workers in public hospitals, eastern Ethiopia

Manuscript Number: PONE-D-23-41265R3

Abstract

Line 41: selected at randomly. Should be selected randomly or selected at random.8 (Eight data collectors)

And 8 should be written in letters as a starting of new sentence on the same line

Line 42. 809 when you start a sentence, please use the letter no number

Line 44. What is descriptive statistical?

Line 46. Bivariate and multivariate regression is used for more than one outcome variable.

What is the difference between bi-variable VS Bi-variate?

Line 62: The study also found that SWs those other acquired occupational diseases within hospitals, What is this?

Method and materials

Line 117: At stage 1st ??? at 1st stage or at stage one?

Line 118 Vs line41?? Then eight public hospitals were selected at random from a total of fourteen public hospitals with an equal probability allocated to each region. Vs Out of 16 hospitals, 8 of them were selected at randomly. What is the number of hospitals in the Eastern Ethiopia?

Line 129 figure one. The geographical coordinates should be indicated for the study area.

Line 148. 5% contingency is not the write term for study participants. Instead use nonresponse rate

Line 154-155 please make it clear the abbreviation part for hospitals?

Line 240. What is some key Quantitative and quantitative information from KII? I think KII is used to gather qualitative data to enrich the quantitative finding, please elaborate more?

Line 285: what is Accordingly, the value o was 0.93,?

Line 309: Please be consistent with data presentation in brackets (44.0% (95%CI: 40.4, 47.7). Of these, 92.2% (95%CI: 88.7,94.90%) and 7.8% (95%CI: 5.1, 11.3%). Either use % for all or leave it for all.

Table 3. Bi-variate ? VS Multi-variable in table 4, how do you relate the two tables? If your outcome variable is one, how you use multivariate analysis?

Thank you

Reviewer #3: Thank you, authors; you have addressed all my queries and comments satisfactorily.

However, Table 2 is too long; for better understanding, separate it into 'injury type', 'body part injured', and 'reasons for injuries'.

There is still scope for editing to further improve the English language.

********** 

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 #3: No

**********

[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.

Occupational Injuries and Associated Factors among Sanitary workers In Public Hospitals , Eastern Ethiopia: A Modified Poisson regression Model Analysis

PONE-D-23-41265R4

Dear Dr. Tolera,

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,

Igor Burstyn

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you for undertaking revisions and responding to comments. While modified Poisson regression is not particularly novel in health research, if you feel that you need to highlight it in the title, I trust that this would be helpful to researchers in your domain.

Reviewers' comments:

none.