PONE-D-24-06799Number of antenatal care utilization and associated factors among pregnant women in rural Ethiopia: Zero-inflated Poisson regression of 2019 intermediate Ethiopian Demography Health SurveyPLOS ONE

Dear Dr. Negash,

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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ACADEMIC EDITOR: The discussion part requires restructuring and modification. In the current version it is narrow and does not properly discuss the study results. Suggested outline for the diascussion part:Discussion

1.1 Rationale of the study (why it was done)

1.1.1 Main findings of the study

1.1.2 What makes your study unique

1.1.3 What it adds to what we already know

1.2 Subject of the discussion

Comparison of your results with neighboring countries, with countries of the same

development levels (income), with developed high-income countries). Agreement and

disagreement with the studies compared

1.3 Sum up of the study, study strengths and limitations

1.5 Clinical implication

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Gulzhanat Aimagambetova

Academic Editor

PLOS ONE

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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

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

Reviewer #3: Yes

Reviewer #4: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

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Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: Dear author

Its a very well written and structured article

All the sections including abstract, methodology, results and discussion are very well described.

The results are displayed in detail and elaborate.

Reviewer #2: � Comments to Authors:

Abstract:

• please correct the number stated in line 42, written in bold in the following sentence (The highest percentage (29.65%) of antenatal care visits was observed from 25 to 2age.)

Title:

• The title of the study is clear, inclusive and precise to the study’s objectives and aims. The authors stated the study design distinctly.

Introduction:

• The introduction is well structured, clear, and straightforward. The authors had effectively introduced the concept of antenatal care in alignment with the WHO FANC strategy, and highlighted the importance of regular ANC in promoting the health of mothers and their newborns (live birth weight in specific).

• The rationale and aim of the study are well stated.

• The relevant statics sourced from the WHO and the 2016 Ethiopian Demographic and Health Survey by the authors have established a robust citation that contributes significant value.

Methods:

• The authors conducted a database study.

• The authors effectively described the geographical location and administrative divisions of Ethiopia, which provides more comprehension for the non-Ethiopian audience.

• The section provides a detailed overview of the study design, setting, data collection methods, and sample size determination. In addition, they included essential information, needed for further understanding of the analytical framework. However, mentioning some potential challenges in choosing method of analysis would be a qualitative addition.

• Concerning the data analysis, the authors have successfully mentioned the source of data and the justification for accessing it, which adds transparency to the research process.

Results:

• The authors conducted a thorough analysis of the results, supported by sufficient amount of data justifying the conclusion. Nevertheless, the analysis assumed a linear relationship between variables, overlooking potential confounding factors that could impact the accuracy of correlations. Therefore, further research may be warranted to validate these hypotheses.

• The authors sub-categorized the study variables, which provided a more inclusive perspective.

Discussion:

• In the discussion section, the authors have effectively compared their findings with those of similar studies and offered reasonable explanations for both the similarities and differences.

• Furthermore, the authors did highlight the study's limitations in a transparent discussion of these limitations.

• Further clinical application might be mentioned for policy makers, together with future direction and recommendation.

Conclusion:

• Correctly answered the research question.

• The authors were able to mention the most important research results in a concise and clear manner.

Reviewer #3: The study is well formated and quite informative on the level of health care through out the country, good analysis of the data of ANC depending on different variables including geography,religion,education and socioeconomy,make the study is more reflecting the culture in concern.

Reviewer #4: table on competing interest typographical error written as "no computing of interest"

ethics statement should be more robust. the NHS data that was used should be well spelt out

the result in the abstract and that in the method result and findings are different. likewise, the number of women studied were different. 2970 and 2896.7 were quoted. since no of pregnant women are whole numbers, the value of 2896.7 is not appropriate.

were the women interviewed to get the number of ANC visits they had or all data were taken from the NHS data. this is important as line 371-372 stated the factor of recall bias. if the data has been recorded, there should not be recall bias.

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Reviewer #1: Yes: Saida Abrar

Reviewer #2: Yes: Bayan Al Omari

Reviewer #3: Yes: Mohsen M A Abdelhafez

Reviewer #4: No

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Submitted filename: Peer_Review final 2.docx

Number of antenatal care utilization and associated factors among pregnant women in rural Ethiopia: Zero-inflated Poisson regression of 2019 intermediate Ethiopian Demography Health Survey

PONE-D-24-06799R1

Dear Dr. Habtu Kifle Negash,

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.

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Kind regards,

Gulzhanat Aimagambetova

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: