PONE-D-21-08355

The extent of wealth poverty induced inequality in nutrition among children born during 2010-16 in India

PLOS ONE

Dear Dr. Khan,

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Kannan Navaneetham, PhD

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: Partly

Reviewer #2: No

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

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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

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Reviewer #1: No

Reviewer #2: No

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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: The title is to be simplified as “Poverty induced inequality in nutrition among children born during 2010-16 in India”

Would the authors be considering to use the word “gender” in leu of “sex” throughout the texts?

Authors are requested to ensure consistency in the use of terminology - ……..the economic inequality in ……;…..wealth based inequality…..; …..wealth poverty….;….poverty based inequality…..;……wealth disparity…;and so on…

Abstract section

Present tense form is to be used throughout.

……poverty gap in child nutrition is largest. <– the expression is not clear and also, we need to use “the” before largest.

Please capture urban / rural with place of residence.

The main texts

Overall, the flow of writing the texts including attention to the grammar deserves a thorough revisiting.

The uniqueness of the study deserves a better foundation with an explicit comprehension. Authors need to establish the impact of the study on “Lives and Society” over “Academic excellence” with a candid discussion for translating Science to Policy and Action.

Page3-4: This part of the texts is non-substantive in the context -> India still stands as the development paradox and in terms of overall human development index (HDI) ranks 130 globally though it has made an improvement in terms of absolute reduction in poverty, increase in life expectancy and improvement in education and standard of living but failed in terms of social progress in the last decade [14-17]. However, the inequality in developmental parameters like health, education and health care access are large within the country [18, 19]. At the same time it is also evident that it is the poor with low income show poor health status and malnourishment among

those children from the poor families [20, 21].

Instead, authors can capture potential contribution of this study to the development trajectory of India in the spotlight of Sustainable Development Goals.

Page3:…..the wealth gap in child health….. <– not understood.

Should we say, « wealth related inequality » as is captured in the texts or poverty induced inequality?

Page3: How Gonzalo-Almorox and Urbanos-Garrido method is different from Oaxaca-type decomposition? Please explain in “Methods” section. Is the “Method choice” having the “Power to change views”?

Page4: Authors have used data from the National Family Health Survey (NFHS)-2015-16. Stunting becomes evident during 1st 1000 days of life. How the authors claim that the effect on the children born in 2015/2016 are sufficiently understood to be inferred?

What is the formulation process of the mathematical models used in the study?

The steps followed to present the contribution of the determinants are not found in the texts.

How did the authors derive the percentage contribution of each of the determinants? Please explain in “Methods” section.

Page8: Such a claim –> [socially excluded groups scheduled caste or scheduled tribe.] requires to be supported by citation.

Page9: This hints about the differential of nutritional status among the

children of a specific birth order. How do we know that this could be the only reason?

Page9-10: [...to wealth poverty] <– can it be extent of material affluence?

Page11: [Analysing the wealth inequality among the children of different birth orders, it is found that children of first birth order (ECI: -.217; 95% CI: -.228,-.206) show the highest concentration of stunting and it is lowest among six and higher ordered births.] implying what?

Page12 and throughout the texts: Can we not use a lucid expression in lieu of [higher wealth poverty]?

Page14: what do the authors mean by -> [Chronic poverty situation….]?

Page14: what do the authors mean by –> [among children of different socio-demographic characteristics.]?

Page14: [….the gender pattern shows a diminished differential in stunting prevalence…..] <- not well understood.

Please put the legend appropriate for each figure.

Table1. Can we not use the word percentage distribution in the heading instead of using the word frequency?

Also, authors are requested to cluster the states / union territories by region and appropriately discuss the results from the analysis.

Table2. Please write the measure of prevalence in the header appropriately.

Table3. Please make the header explicit – not comprehendible at all, as it stands now. How have the authors addressed the inadequacy of sample size in the analysis?

Table 7. Does it mean that in 14 out of 36 States / Union Territories the scenario is better? If, so, can the authors bring some insights into the discussion interconnected challenges and systematic effects from the perspectives of systems thinking?

Reviewer #2: Stunting among children is quite an interesting topic especially for India, which is part of the BRICS block. However, I was surprised not to see anything about the COVID-19 shocks on stunting among children. One can not separate malnutrition from food security entirely, of which the pandemic has done a huge impact on food security and exacerbated health inequalities in general. Secondly, the decomposed model could not explain about 24% of the variations as some of the crucial determinants of stunting were left out. Decomposition by states is not meaningful if the underlying characteristics of the states are not known, not sure why the authors decomposed by states. Results were reported in present tense yet they should be reported in the past tense. The discussion was poorly written might need total restructuring as the study results were not related to existing study findings.

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Reviewer #1: No

Reviewer #2: No

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Attachments

Attachment

Submitted filename: Reviewed PONE-D-21-08355_reviewer.pdf

PONE-D-21-08355R1Poverty induced inequality in nutrition among children born during 2010-16 in IndiaPLOS ONE

Dear Dr. Khan,

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.

The revised paper was reviewed by the same set of reviewers. One reviewer has suggested that some of the responses can be appended into the manuscript and also raised concerns about the language. Kindly revise the paper accordingly. ​

Please submit your revised manuscript by Dec 02 2021 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,

Kannan Navaneetham, PhD

Academic Editor

PLOS ONE

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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.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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 #2: Yes

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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: No

Reviewer #2: 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: Abstract section

Reply: Thank you very much. The present tense is used in the abstract. The sentence is rephrased.

This is not an honest statement –

Page2: Line 8-> [… … … this paper examined… … …].

Page2: Lines19-26-> [About … … … place of residence (5%).].

Page2: Lines30-31-> [Mother’s education… … … across India.].

Reply: Thank you very much. The document has been revisited taking special care of the grammar.

Yes, to some extent but far below the acceptable level.

Highlights (not an exhaustive list) of the incorrect response

Page9: Line 199-> [As we utilized … … …], the word “utilized” is not the apt word here.

Page9: Lines205-207-> [The estimated partial effects from the probit model are used to compute the contributions of the explanatory variables considered in the study framework. In summary, the factor level contributions are calculated… … …] why present tense form in Method section and that too inconsistent use of tense in the section?

Page 10: Line 222-> [Mothers to… … …]?

Page15: Line354 and Page17: Line407-> All on a sudden expanded form of NFHS [National Family Health Survey] appears.

Results and Discussion section(s) are to be in the “past tense” form but the texts do not follow any consistent pattern of tense use.

Page15: Lines350-352-> Comprehension with no English structure – [Additionally, decomposed the CIs to estimate the elasticity, absolute contribution and percentage of contribution for each of the background characteristics used to define the sub-populations of the children.].

Reply: The usefulness of this study is discussed taking care of the policy perspectives within the scope of the study.

Misleading response; not found in the revised submission.

Reply: The cited literatures in this paragraph support the scientific content and substantiate the nexus between the present situation of the child health parameter in terms of stunting and India’s development in terms of absolute reduction in poverty, increase in life expectancy and improvement in education and standard of living. Within the scope of the study and to introduce the goal of the study this paragraph gives a brief overview of India’s development trajectory in the context of child stunting. There are many development goals under the SDGs which are targeted to achieve and India’s progress is quite convincing still child undernutrition remained one of the major public health challenges in India and almost two-fifth of the total children under age five in India are still stunted. Within the context and goal of this study, the introduction section gives a detailed snapshot of the problem and the rationale of the study. Thank you very much.

Observation in the earlier review not addressed.

Comment9: Page4: Authors have used data from the National Family Health Survey (NFHS)-2015-16. Stunting becomes evident during 1st 1000 days of life. How the authors claim that the effect on the children born in 2015/2016 are sufficiently understood to be inferred?

Reply: The NFHS survey is a cross-sectional survey and the age of the children and the anthropometric measures are measures on the date of interview. Thus this study is limited to measure the effect of first 1000 days of life. At the same time this study is limited to measure the cohort effect except the age fixed effect. To mention, NFHS surveys of different rounds provide the estimates of undernutrition among under five children and the datasets are grossly used the socio-economic and demographic patterns and determinants of different child health parameters including child undernutrition within a cross-sectional framework. Similarly, this study also used the data information from NFHS-4 and examined the inequality in child nutrition using a novel decomposition approach.

Response against this observation is required to be captured appropriately in the “data” of Method section.

Reply: Like the DHS surveys, NFHS also only provides the wealth based measure of household’s economic wellbeing. This measure is based upon the asset information from the households. Thus it could be said that wealth measure of economic wellbeing captures the material affluence of the household.

What prevents the authors not to capture in the texts?

Reply: Thank you so much. We have changed the heading.

Please use the right English – “percentage”.

Authors are requested to capture the excerpts of revised texts while responding to the review comments in addition to specifying the respective line number with the page highlighting changes.

Reviewer #2: I am satisfied with the adjustments made to my previous comments. The discussion has been completely overhauled reflecting more scientific arguments.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: 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.

Poverty induced inequality in nutrition among children born during 2010-21 in India

PONE-D-21-08355R2

Dear Dr. Khan,

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,

Kannan Navaneetham, PhD

Academic Editor

PLOS ONE

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