Socioeconomic and geographical inequalities in adolescent fertility rates in Sierra Leone, 2008–2019

Augustus Osborne; Camilla Bangura; Bright Opoku Ahinkorah

doi:10.1371/journal.pone.0313030

Peer Review History

Original SubmissionAugust 14, 2024
10 Oct 2024 Decision Letter - José Antonio Ortega, Editor PONE-D-24-34863Socio-economic and geographical inequalities in adolescent fertility rate in Sierra Leone,2008-2019PLOS ONE Dear Dr. Osborne, 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. While the two referees find the article suitable for publication with some minor revisions, note that the conclusion and, in particular, the policy section, present recommendations and analisys that do not stem from this study such as the discussion of microcredit, Please make sure to fully revise these sections excluding comments on factors that are not included in the empirical analysis. Please submit your revised manuscript by Nov 24 2024 11:59PM. 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Kind regards, José Antonio Ortega, Ph.D. 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. Thank you for uploading your study's underlying data set. Unfortunately, the repository you have noted in your Data Availability statement does not qualify as an acceptable data repository according to PLOS's standards. At this time, please upload the minimal data set necessary to replicate your study's findings to a stable, public repository (such as figshare or Dryad) and provide us with the relevant URLs, DOIs, or accession numbers that may be used to access these data. For a list of recommended repositories and additional information on PLOS standards for data deposition, please see https://journals.plos.org/plosone/s/recommended-repositories. [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: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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 ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: 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) Reviewer #1: Explained responses 1. Is the manuscript technically sound, and do the data support the conclusions? To some extent. Some conclusions and recommendations do not match the study findings. Explanation is in specific comments 2. Has the statistical analysis been performed appropriately and rigorously? Yes. Rigor has been displayed by using four metrics (D, R, PAF, and PAR) to establish disparity given the large sample sizes in the DHS datasets and the multiple inequality factors. However clarity is required in the methods section on the measurement and ranges of the metrics as explained in the specific comments 3. Have the authors made all data underlying the findings in their manuscript fully available? Yes 4. Is the manuscript presented in an intelligible fashion and written in standard English? -The authors need to innovatively present table 1 graphically so as to illustrate the trends for AFR across the three years, otherwise it does not quite come out in a tabular form Below are some specific comments 1. Abstract, line 32 “Population attributable fraction decreased from -57.9 in 2008 to -23.9 in 2019” Did you mean to say decreased negativity as mentioned in previous text. Otherwise as it is now the value (PAF) increased between 2008 and 2019 regardless of being negative. 2. Introduction, line 48 The abbreviation AFR is used abruptly in the text without it full form. 3. Methods: Inequality measures, line 118 Given that this is a scholarly text, the word ‘lady’ should not be used in the text “The educational standing of the lady was categorized into four groups:” A more appropriate word can be used since women aged 15-19years were considered for the study 4. Methods: Statistical analysis, lines 125 – 134 - You mentioned in line 128 that the computation and analysis is in literature. However, before explaining the various interpretations of D, R, PAF, and PAR respectively, indicate the ranges of each to aid understanding, otherwise the text ends up being unclear without guiding the reader initially 5. Recommendations, lines 255 - 256 Just like in the abstract, You make recommendations on geographical location, “ensuring equitable access to family planning services and targeted interventions in rural areas are crucial steps towards achieving a more substantial and equal decline in national adolescent fertility rates.”. And yet in your findings inequalities were less likely to be influenced by location of residence hence a mismatch in your recommendation and your finding Reviewer #2: The manuscripts addressed a very important topic in reproductive health among a vulnerable population. The exploration of inequalities in adolescent fertility rate will shed a light on a critical public health issue and has significant implications for policymakers, healthcare workers and researchers working on addressing adolescent reproductive health disparities. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). 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Revision 1
11 Oct 2024 Author Response The Editor PLOS ONE 11th October 2024 Ref: PONE-D-24-34863 Title: Socio-economic and geographical inequalities in adolescent fertility rate in Sierra Leone,2008-2019 Response to Reviewers' comments Dear Sir/Madam, We want to express our sincere thanks for painstakingly reviewing our manuscript and providing valuable comments and suggestions. Please see our point-by-point response to the reviewers' comments and suggestions. Revisions are highlighted with track changes in the revised manuscript. ACADEMIC EDITOR: 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. While the two referees find the article suitable for publication with some minor revisions, note that the conclusion and, in particular, the policy section, present recommendations and analisys that do not stem from this study such as the discussion of microcredit, Please make sure to fully revise these sections excluding comments on factors that are not included in the empirical analysis. Response: Thank you. We have now revised that in the manuscript. 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 Response: Thank you. We have done so. 2. Thank you for uploading your study's underlying data set. Unfortunately, the repository you have noted in your Data Availability statement does not qualify as an acceptable data repository according to PLOS's standards. At this time, please upload the minimal data set necessary to replicate your study's findings to a stable, public repository (such as figshare or Dryad) and provide us with the relevant URLs, DOIs, or accession numbers that may be used to access these data. For a list of recommended repositories and additional information on PLOS standards for data deposition, please see https://journals.plos.org/plosone/s/recommended-repositories. Response: The dataset used can be accessed at https://dhsprogram.com/data/available-datasets.cfm Reviewer #1: Explained responses 1. Is the manuscript technically sound, and do the data support the conclusions? To some extent. Some conclusions and recommendations do not match the study findings. Explanation is in specific comments Response: Thank you. We have deleted that in the manuscript. 2. Has the statistical analysis been performed appropriately and rigorously? Yes. Rigor has been displayed by using four metrics (D, R, PAF, and PAR) to establish disparity given the large sample sizes in the DHS datasets and the multiple inequality factors. However clarity is required in the methods section on the measurement and ranges of the metrics as explained in the specific comments Response:Thank you. We have now revised to. The analysis was conducted using the online version of the HEAT software developed by the World Health Organisation (WHO) [30], which examines health disparities within and between nations across various health indicators and socioeconomic issues, including child, maternal, and reproductive health [34]. This study focused on four inequality metrics: difference (D), ratio (R), population-attributable fraction (PAF), and population-attributable risk (PAR). To clarify their interpretations, it is important to note the ranges of each metric: D can range from negative infinity to positive infinity, with a value of zero indicating no inequality and higher values reflecting greater inequality in adolescent fertility; R ranges from 1 to positive infinity, where a value of 1 signifies no inequality and values greater than 1 suggest increasing levels of adolescent fertility inequality; both PAF and PAR can take on values from negative infinity to positive infinity, with positive values indicating advantageous conditions and negative values reflecting unfavourable conditions, where greater magnitudes correspond to higher levels of inequality. The literature highlights the importance, computation, and analysis of these measures [34, 35]. In summary, higher values of D and R indicate greater inequality in adolescent fertility, while PAF and PAR values will be zero if no further progress can be made, meaning all subgroups have reached the same indicator level as the reference subgroup. 3. Have the authors made all data underlying the findings in their manuscript fully available? Yes Response: Thank you. 4. Is the manuscript presented in an intelligible fashion and written in standard English? -The authors need to innovatively present table 1 graphically so as to illustrate the trends for AFR across the three years, otherwise it does not quite come out in a tabular form Response: Thank you We have now provided a figure illustrating the trends in AFR across the three years. Below are some specific comments 1. Abstract, line 32 “Population attributable fraction decreased from -57.9 in 2008 to -23.9 in 2019” Did you mean to say decreased negativity as mentioned in previous text. Otherwise as it is now the value (PAF) increased between 2008 and 2019 regardless of being negative. Response: Thank you. Population attributable fraction increased from -57.9 in 2008 to -23.9 in 2019. 2. Introduction, line 48 The abbreviation AFR is used abruptly in the text without it full form. Response: Thank you. We have now revised in the manuscript. Adolescent fertility rate (AFR) 3. Methods: Inequality measures, line 118 Given that this is a scholarly text, the word ‘lady’ should not be used in the text “The educational standing of the lady was categorized into four groups:” A more appropriate word can be used since women aged 15-19years were considered for the study Response: We have now used the word women. Thank you. 4. Methods: Statistical analysis, lines 125 – 134 - You mentioned in line 128 that the computation and analysis is in literature. However, before explaining the various interpretations of D, R, PAF, and PAR respectively, indicate the ranges of each to aid understanding, otherwise the text ends up being unclear without guiding the reader initially Response: We have now revised to. The analysis was conducted using the online version of the HEAT software developed by the World Health Organisation (WHO) [30], which examines health disparities within and between nations across various health indicators and socioeconomic issues, including child, maternal, and reproductive health [34]. This study focused on four inequality metrics: difference (D), ratio (R), population-attributable fraction (PAF), and population-attributable risk (PAR). To clarify their interpretations, it is important to note the ranges of each metric: D can range from negative infinity to positive infinity, with a value of zero indicating no inequality and higher values reflecting greater inequality in adolescent fertility; R ranges from 1 to positive infinity, where a value of 1 signifies no inequality and values greater than 1 suggest increasing levels of adolescent fertility inequality; both PAF and PAR can take on values from negative infinity to positive infinity, with positive values indicating advantageous conditions and negative values reflecting unfavourable conditions, where greater magnitudes correspond to higher levels of inequality. The literature highlights the importance, computation, and analysis of these measures [34, 35]. In summary, higher values of D and R indicate greater inequality in adolescent fertility, while PAF and PAR values will be zero if no further progress can be made, meaning all subgroups have reached the same indicator level as the reference subgroup. 5. Recommendations, lines 255 - 256 Just like in the abstract, You make recommendations on geographical location, “ensuring equitable access to family planning services and targeted interventions in rural areas are crucial steps towards achieving a more substantial and equal decline in national adolescent fertility rates.”. And yet in your findings inequalities were less likely to be influenced by location of residence hence a mismatch in your recommendation and your finding Response: Thank you. We have deleted that in the manuscript. Reviewer #2: The manuscripts addressed a very important topic in reproductive health among a vulnerable population. The exploration of inequalities in adolescent fertility rate will shed a light on a critical public health issue and has significant implications for policymakers, healthcare workers and researchers working on addressing adolescent reproductive health disparities. Response: Thank you. We hope that we have adequately addressed the reviewers' comments, and we look forward to receiving a favorable outcome on our paper. Yours Sincerely, Augustus Osborne Corresponding Author https://doi.org/10.1371/journal.pone.0313030.r002
17 Oct 2024 Decision Letter - José Antonio Ortega, Editor Socio-economic and geographical inequalities in adolescent fertility rate in Sierra Leone,2008-2019 PONE-D-24-34863R1 Dear Dr. Osborne, 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, José Antonio Ortega, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): The review has addressed the comment made by the reviewers and the editor and it has been felt unnecessary to send the revision back to the reviewers. Reviewers' comments: https://doi.org/10.1371/journal.pone.0313030.r003
Formally Accepted
2 Dec 2024 Acceptance Letter - José Antonio Ortega, Editor PONE-D-24-34863R1 PLOS ONE Dear Dr. Osborne, 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. José Antonio Ortega Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0313030.r004

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