Noncommunicable disease behavioral risk factors in Sub Saharan Africa: A protocol of systematic review and meta-analysis

Assefa Andargie Kassa; Segenet Zewdie; Mekuanint Taddele

doi:10.1371/journal.pone.0311322

Peer Review History

Original SubmissionDecember 26, 2023
13 Aug 2024 Decision Letter - Sheila Rizzato Stopa, Editor PONE-D-23-40052Noncommunicable disease behavioral risk factors in Sub Saharan Africa: A protocol of systematic review and meta-analysisPLOS ONE Dear Dr. Kassa, 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. Conducting a systematic review and meta-analysis on noncommunicable diseases in the Sub-Saharan Africa region is undoubtedly a significant effort for both the scientific community and the public health services. The topic addressed is extremely pertinent given the burden and the urgent need to fill knowledge gaps in the field, specially in lower-income countries. Please ensure to identify the changes suggested by the reviewer in your text when submitting the revised manuscript. Kindly submit your revised manuscript by Sep 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. 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We look forward to receiving your revised manuscript. Kind regards, Sheila Rizzato Stopa Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. 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 amend the manuscript submission data (via Edit Submission) to include author Mekuanint Taddele. 3. 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. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions? The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field. Reviewer #1: Partly ******** 2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses? The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory. Reviewer #1: Yes ****** 3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable? Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible. Reviewer #1: Yes ****** 4. Have the authors described where all data underlying the findings will be made available when the study is complete? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. 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 ****** 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 ****** 6. Review Comments to the Author General Recommendations Please, in accordance with the PRISMA-P final checklist, provide the email addresses of all the authors of the protocol. Abstract - Methods: I suggest that the registration be incorporated into the text of the abstract rather than listed as a separate item. - Keywords: "Behavioral risk factors" was not found in the MeSH terms. Introduction - In the first paragraph, the authors chose to discuss the insufficiency of evidence that noncommunicable diseases can be transmitted from person to person through infection, vectors, biological inheritance, or genetic transmission. While the statement of insufficient evidence may be a cautious way to express the lack of data proving any form of direct transmission, it is important to emphasize that there is a substantial body of evidence identifying and describing behavioral risk factors for noncommunicable diseases. This is the primary focus of the study, and I suggest prioritizing this aspect in the introduction. Therefore, I recommend revising this first paragraph. - Adding a justification in the introduction about the choice of the Sub-Saharan Africa region could enhance the context and relevance of the study. - Line 51: I suggest replacing the word "malignancies" with "cancer." - Lines 71 and 72: Include examples of societal factors, which include intricate interactions between socioeconomic and environmental parameters. - Considering that the study population will include only adults (aged 18 years or older), I recommend adding this specification to the objective, in line with PRISMA-P recommendations. For example: “Therefore, the objective of this study is to determine the pooled prevalence of noncommunicable disease behavioral risk factors among adults in Sub-Saharan Africa (SSA).” Materials and Methods - The authors chose to specify the review questions; however, a systematic review can also provide information about gaps in knowledge, thereby informing future research efforts. In other words, it is important to avoid arbitrary decisions regarding inclusion criteria and data extraction. Therefore, I suggest making it clear that the review may not fully address all the questions. - Justification for the Use of CoCoPop: I recommend including the following addition to justify the use of CoCoPop: “The condition, context, and population (CoCoPop) components of the review questions are used to specify the eligibility criteria for studies on prevalence and incidence.” - Condition: for the condition, I suggest adding strategies or justifications for including different methods for calculating indicators. For example, in various studies and countries, the calculation of indicators such as alcohol abuse or even fruit and vegetable consumption may differ. How will the authors address these biases across different studies? Providing this clarification can enable careful planning and anticipate potential issues. - Line 154 and 155: the population was previously cited as being aged 18 years or older. Ensure consistency in the description. - Line 208: describe the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Discussion - Line 212: the term used here was "alcohol abuse," but previous citations used "harmful." Ensure consistency in terminology throughout the manuscript. ******** 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. https://doi.org/10.1371/journal.pone.0311322.r001
Revision 1
14 Sep 2024 Author Response Dear Editor and Reviewer, We would like to thank you for the valuable feedback on our manuscript (Manuscript ID: PONE-D-23-40052). We appreciate the time and effort taken to review our work and are grateful for the constructive comments that have helped us improve the manuscript. Below, we provide detailed responses to each of the Editor and reviewer’s comments, and we have revised the manuscript accordingly. Response to the Editor 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. Response: Thank you. We attempted to adhere to the journal style requirement. 2. Please amend the manuscript submission data (via Edit Submission) to include author Mekuanint Taddele. Response: Thank you, we included Mekuanint Taddele 3. 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. Response: We amended and checked all references for completeness and correctness. We used the PLOS-one reference style consistently. We have checked that there are no papers that have been retracted. We included about 14 additional references in the revised manuscript to make it up to date and more comprehensive. Response to reviewer comments General Recommendations • Please, in accordance with the PRISMA-P final checklist, provide the email addresses of all the authors of the protocol. Response: Thank you. We included the e-mail addresses of all authors per the recommendation (see page 1, line 16 & 17). Abstract • Methods: I suggest that the registration be incorporated into the text of the abstract rather than listed as a separate item. Response: Thank you, we included as a text at the end of the abstract (separate item is removed). • Keywords: "Behavioral risk factors" was not found in the MeSH terms. Response: We divided the phrase “Behavioral Risk factors” in to “Behavior” and “Risk factors”. Introduction � In the first paragraph, the authors chose to discuss the insufficiency of evidence that noncommunicable diseases can be transmitted from person to person through infection, vectors, biological inheritance, or genetic transmission. While the statement of insufficient evidence may be a cautious way to express the lack of data proving any form of direct transmission, it is important to emphasize that there is a substantial body of evidence identifying and describing behavioral risk factors for noncommunicable diseases. This is the primary focus of the study, and I suggest prioritizing this aspect in the introduction. Therefore, I recommend revising this first paragraph. Response: We appreciate this comment and we revised this section by including the burden and impact of behavioral risk factors globally and regionally. (See the revised manuscript from pages 3-6 for details). � Adding a justification in the introduction about the choice of the Sub-Saharan Africa region could enhance the context and relevance of the study. Response: We included justifications for the choice of SSA. We choose this region for its Rapidly Rising NCD Burden, High Prevalence of Behavioral Risk Factors, Lack of Region-Specific Data, and Policy and Intervention Relevance. This is incorporated in the last three paragraphs of the revised manuscript (Page 5 & 6). � Line 51: I suggest replacing the word "malignancies" with "cancer." Response: Thank you for the detailed concern to improve our manuscript and we accepted the comment, and corrected accordingly. � Lines 71 and 72: Include examples of societal factors, which include intricate interactions between socioeconomic and environmental parameters. Response: We appreciate this concern. Societal factors refer to the social, economic, and environmental conditions that shape the behaviors, health, and well-being of individuals and populations. These factors include socio-economic factors (income, education, employment, housing, social class, …), environmental factors (Physical environment, urbanization, climate change, health services and infrastructures), cultural and social networks (community support, cultural beliefs and practices, social cohesion, discrimination and social exclusion), Political and policy context (health policies, social policies, regulations, political stability). However, we removed the paragraph containing these concepts to make the background section focused on behavioral risk factors. � Considering that the study population will include only adults (aged 18 years or older), I recommend adding this specification to the objective, in line with PRISMA-P recommendations. For example: “Therefore, the objective of this study is to determine the pooled prevalence of noncommunicable disease behavioral risk factors among adults in Sub-Saharan Africa (SSA).” Response: Thank you, we specified “adult population” in the objective statement. Materials and Methods � The authors chose to specify the review questions; however, a systematic review can also provide information about gaps in knowledge, thereby informing future research efforts. In other words, it is important to avoid arbitrary decisions regarding inclusion criteria and data extraction. Therefore, I suggest making it clear that the review may not fully address all the questions. Response: Thanks. We agree with this comment as these questions are included within the objective. we prefer to avoid explicit listing of review questions. � Justification for the Use of CoCoPop: I recommend including the following addition to justify the use of CoCoPop: “The condition, context, and population (CoCoPop) components of the review questions are used to specify the eligibility criteria for studies on prevalence and incidence.” Response: We accepted this comment and corrected accordingly. � Condition: for the condition, I suggest adding strategies or justifications for including different methods for calculating indicators. For example, in various studies and countries, the calculation of indicators such as alcohol abuse or even fruit and vegetable consumption may differ. How will the authors address these biases across different studies? Providing this clarification can enable careful planning and anticipate potential issues. Response: Thank you. We included tools that should be employed in the measurement of the outcome. We expect high potential heterogeneity across studies with respect to outcome measurements. We planned to accommodate all these variations based on the tools used to assess the outcomes. As far as studies used tools like self-reported surveys or standardized tools, we will include them in the review irrespective of the cultural and other socio-economic variations of the included population. To account such variations group specific analysis will be done in the meta-analysis. � Line 154 and 155: the population was previously cited as being aged 18 years or older. Ensure consistency in the description. Response: Thank you. Corrected as “18 years or older”. � Line 208: describe the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Response: We accepted the comment and included description how the GRADE framework could be applied in systematic reviews of prevalence. Discussion � Line 212: the term used here was "alcohol abuse," but previous citations used "harmful." Ensure consistency in terminology throughout the manuscript. Response: Thank you. Comment accepted and we used “harmful use of alcohol” consistently. Sincerely, Assefa Andargie Kassa (Corresponding author) Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0311322.r002
18 Sep 2024 Decision Letter - Sheila Rizzato Stopa, Editor Noncommunicable disease behavioral risk factors in Sub Saharan Africa: A protocol of systematic review and meta-analysis PONE-D-23-40052R1 Dear Dr. Kassa, 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, Sheila Rizzato Stopa, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0311322.r003
Formally Accepted
29 Sep 2024 Acceptance Letter - Sheila Rizzato Stopa, Editor PONE-D-23-40052R1 PLOS ONE Dear Dr. Kassa, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Sheila Rizzato Stopa Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0311322.r004

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