Socioeconomic, demographic and obstetric determinants of maternal near miss in Africa: A systematic review

Mory Diakite; Vincent de Brouwere; Bouchra Assarag; Zakaria Belrhiti; Saad Zbiri; Mohamed Khalis

doi:10.1371/journal.pone.0313897

Peer Review History

Original SubmissionJuly 21, 2023
23 Jan 2024 Decision Letter - Avanti Dey, Editor PONE-D-23-17858Socioeconomic, demographic, and obstetric determinants of maternal near miss in Africa: a systematic reviewPLOS ONE Dear Dr. DIAKITE, 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 manuscript has been evaluated by two reviewers, and their comments are available below. Could you please carefully revise the manuscript to address all comments raised? Please submit your revised manuscript by Mar 08 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. 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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 stating the following financial disclosure: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript" At this time, please address the following queries: a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution. b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” c) If any authors received a salary from any of your funders, please state which authors and which funders. d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 3. When completing the data availability statement of the submission form, you indicated that you will make your data available on acceptance. We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process. 4. Please amend either the abstract on the online submission form (via Edit Submission) or the abstract in the manuscript so that they are identical. 5. 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. [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: N/A Reviewer #2: I Don't Know ****** 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: No 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: Yes 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: I sincerely appreciate the editorial board of PLUS ONE journal for sending this interesting manuscript to me for review. I have gone through the article, and the followings are my observations and recommendations. General comments The review is well written and used appropriate reporting pattern, however I want to draw the attention of the authors to the followings; Research Topic 1.The research question is well formulated, however the external validity (generalization) may be limited as the words “in Africa” is not well captured by the review as most articles or studies in the review are restricted to few countries or particular region in Africa. The author may need to modify the title or include more studies from other parts of Africa. (I suggest inclusion of nationwide study on near- miss and maternal mortality in Nigeria, https://pubmed.ncbi.nlm.nih.gov/25974281/) Study Design 2.The Authors expectedly used the PRISMA reporting approach, but no flow chart was included in the review. A PRISMA flow chart that clearly and transparently outline flow of events should be included in the review. 3.The PECO approach was used in designing the research question, the author should include a statement on what informed the choice of this approach as against other approaches such as PICO or SPIDER especially since the review included mixed design methods. 4.Under the Search Strategy and data base search, the authors should include the number of hits or articles from different data bases; PubMed (n=), SCOPUS (n=), Science Direct (n=) etc. Also, inclusion of more data bases (Cochrane, Google Scholar, POPLINE, EMBASE etc) may also increase and capture studies from more countries in Africa which will increase the validity of the review. 5.The quality and bias assessment of the articles included in the study were not explicit enough, such as the criteria used in classifying the articles as being good, fair or poor. 6.The Synthesis of the review is not explicitly clear and Conceptual framework based on Adapted framework by Rosa Maria Soares Madeira Domingue et al used for the synthesis is not included in the review. Recommendation 7.The consideration of the above issues will improve the quality and robustness of the review. Reviewer #2: ABSTRACT: Some grammatical errors eg line 30 would better read --- maternal near miss follows similar predictors for ---. The results should be reported in past tense --lines 45-47. The recommendation in lines 51-52 should be more specific. Line 77, DO the authors mean introduction for the heading of the section instead of rationale? Lines 90-92 should be referenced. METHODS: Line 146 should be recasted. In line 183, the authors should specific what they mean by severe bleeding , perhaps also list clinical conditions that cause that. What about other clinical conditions like severe malaria in pregnancy or thromboembolic disorders, where there excluded? RESULTS: This should be reported in the past tense. eg lines 276-277. Lines 290-293 is written in French and so not understandable. The statement in lines 336-337 appears incomplete and lines 338-340 is not clear. DISCUSSION-It is not clear in line 369 what the authors mean by - between the residence and birth health care facility ( it does not seem complete). In line 372, the authors should qualify what they mean by young age. The explanation in lines 375-377 is not clear, how women with low educational level will not receive health information . The authors should also include the strengths of their study is there are any. ****** 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: 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. https://doi.org/10.1371/journal.pone.0313897.r001
Revision 1
21 Mar 2024 Author Response Responses to reviewers Dear Editor, Please find enclosed the revised version of our manuscript. We would like to thank the reviewers for their constructive comments, which in our view helped us to improve the manuscript. Please find below our responses to each of the comments. 2. Thank you for providing the following financial information: "The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation." Question a: Please specify the sources of funding (financial or material support) for your study. Provide a list of grants or organizations that supported your study, including funding received from your institution. Answer a: I hereby confirm that this study has received no financial support from any funder or institution. Question b: Indicate the role played by funders in the study. If funders had no role in your study, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation." Answer b: No funders played a role in study design, data collection and analysis, decision to publish, or manuscript preparation. Question c: If any authors received salary support from any of your funders, please indicate which authors and which funders. Answer c: None of the authors received salary support from any funder for this study. Question d: If you did not receive any funding for this study, please state: "The authors received no specific funding for this work." Answer d: The authors received no specific funding for this work. 3-When you completed the data availability statement in the submission form, you indicated that you would make your data available upon acceptance. We strongly recommend all authors to decide on a data sharing plan prior to acceptance, as the process can be lengthy and delay publication timelines. Please note that while access restrictions are currently acceptable, all of your data must be freely accessible if your manuscript is accepted for publication. This policy applies to all data unless public deposition would violate the protocol approved by your research ethics committee. If you are unable to comply with our open data policy, please revise your statement to explain your reasoning, and we will seek the editor's advice on an exemption. Rest assured, once you have provided your revised statement, the assessment of your exemption will not delay the peer review process Answer 3: As mentioned in my submission form, all data are accessible and have been provided during the process. However, if additional data are needed, please specify the nature of the required data. 4- Please modify the abstract in the online submission form (via Edit Submission) or the abstract in the manuscript so that they are identical. Answer 4: We have adjusted the abstract in the submission form to match exactly the content of the manuscript. For question 3, "Have the authors made all underlying data supporting the results in their manuscript fully available?" Critic #1: No We have made all available data accessible. However, if additional data are requested, we would like to know which ones so that we can provide them5. 1- The research question is well formulated, but the external validity (generalization) may be limited because the phrase "in Africa" is not well captured by the review, as most articles or studies in the review are limited to a few countries or specific regions in Africa. The author may need to modify the title or include other studies from different regions of Africa. Thank you for this comment. We mentioned Africa in the title, because in this systematic review the search of articles was done for all African countries and we included all articles available and published from any African country. We agree with the reviewer, the generalization of our findings should be interpreted with caution. To clarify that, we added the following sentence in the limitation section: “In this systematic review, most articles are limited to a few countries or specific regions in Africa, the generalization of our findings should be interpreted with caution.” 2- As expected, the authors utilized the PRISMA statement approach, but no flowchart was included in the review. A PRISMA flowchart clearly and transparently describing the sequence of events should be included in the review. The PRISMA flowchart has been included in this revised version of the manuscript. 3- The PECO approach was used in designing the research question; the author should include a statement regarding the rationale for choosing this approach over other approaches such as PICO or SPIDER, especially considering that the review involved mixed methods of design. Thank you for your comment. Our decision to utilize the PECO framework was guided by its alignment with the nature of our exposure-focused study. In this systematic review, we were primarily concerned with the "exposure" of various socioeconomic, demographic, and obstetric factors, rather than specific "interventions". The PECO framework is advantageous in such contexts as it facilitates an examination of how these exposures influence outcomes in our population. 4- The synthesis of the review is not explicitly clear, and the conceptual framework based on the adapted framework by Rosa Maria Soares, Madeira Domingue et al. used for the synthesis is not included in the review. We added the conceptual framework as supplementary materiel in this revised version of the manuscript. NB: We were unable to include this study because the results of severe maternal morbidity and maternal mortality were not differentiated, whereas we were specifically seeking factors associated with severe maternal morbidity (https://pubmed.ncbi.nlm.nih.gov/25974281/). Attachments Attachment Submitted filename: Responses to reviewers.docx https://doi.org/10.1371/journal.pone.0313897.r002
31 Jul 2024 Decision Letter - Renato Teixeira Souza, Editor PONE-D-23-17858R1Socioeconomic, demographic, and obstetric determinants of maternal near miss in Africa: a systematic reviewPLOS ONE Dear Dr. DIAKITE, 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 Sep 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, Renato Teixeira Souza Academic Editor PLOS ONE Additional Editor Comments: The manuscript has the potential to make a great contribution to the field; however, it has some limitations that undermine its clarity and reproducibility. Please provide a revised version along with a point-by-point response letter. [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: All comments have been addressed Reviewer #3: (No Response) ******** 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: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #3: N/A ****** 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: (No Response) Reviewer #3: I understand that this Topic is interesting and that data on LMIC need to be further investigated. The manuscript has improved after revision, but there are still some questions that need to be considered: -Abstract: -Methods: only descriptive or a metanalysis was considered? Why wasn´t the review registered? -Results are not clear and very vague (please include number of cases considered and how the determinants were considered: increased maternal age?? Married or single women were at increased risk?? It is not clear… -Conclusion has information not previously considered in the results… -Objectives: Consider using Maternal Near-Miss (MNM) and not “near-maternal acidentes” -Methods: was the review registered? -Is reference 17 the best for the definition of MNM, consider the WHO definition-2009 (Pattinson R, Say L, Souza JP, Broek Nv, Rooney C; WHO Working Group on Maternal Mortality and Morbidity Classifications. WHO maternal death and near-miss classifications. Bull World Health Organ. 2009 Oct;87(10):734. doi: 10.2471/blt.09.071001. PMID: 19876533; PMCID: PMC2755324.) -Flowchart: Please include abbreviations in footnote. Need to be more clear about exclusions: what were irrelevant results? Or out of context? -Table 1 is interesting, however very descriptive and there is no standard presentation of outcomes… it would be interesting to better describe that and include it as a limitation (variety of outcomes that were not compared- no possible meta-analysis??) -Discussion should clearly state what variables are specific or different from other continents and what is similar in other settings, especially LMIC. ****** 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. Attachments Attachment Submitted filename: PLOS ONE REVISED MANUSCRIPT PONE-D-23-17858R1.doc https://doi.org/10.1371/journal.pone.0313897.r003
Revision 2
27 Aug 2024 Author Response Responses to Reviewers: The following responses are for the Reviewer #3, the only one who made comments to our revised manuscript. 6. Review Comments to the Authors Question a: “Methods: only descriptive or a metanalysis was considered?” Answer to a: Not only were descriptive studies and meta-analyses considered, but all studies that examined the factors associated with maternal near miss were also included. Question b: “Methods: Why wasn´t the review registered?” Answer to b: Initially, we conducted a scoping review, and at that time, it was not yet possible to register this type of review on the PROSPERO platform. After the first submission of the article, we were advised to transform it into a systematic review and apply the PRISMA guidelines for writing systematic reviews. Unfortunately, it was no longer possible to register it. Question c: “Is reference 17 the best for the definition of MNM, consider the WHO definition-2009 (Pattinson R, Say L, Souza JP, Broek Nv, Rooney C; WHO Working Group on Maternal Mortality and Morbidity Classifications. WHO maternal death and near-miss classifications. Bull World Health Organ. 2009 Oct;87(10):734. doi: 10.2471/blt.09.071001. PMID: 19876533; PMCID: PMC2755324.) » Answer to c: We agree that the WHO definition provided by Pattinson et al. 2009 is excellent but its source is “Say L, Souza JP, Pattinson RC. Maternal near miss – towards a standard tool for monitoring quality of maternal health care. Best Pract Res Clin Obstet Gynaecol. 2009;23:287–96. doi: 10.1016/j.bpobgyn.2009.01.007 ». However, we followed your suggestion and cited Pattinson et al. 2009. Question d: “Flowchart: Please include abbreviations in footnote.” Answer to d: Done Question e: “Need to be more clear about exclusions: what were irrelevant results? Or out of context? » Answer to e: Irrelevant results and out-of-context studies are described on page 11 in the subsection on study selection. Question f: “Table 1 is interesting, however very descriptive and there is no standard presentation of outcomes… it would be interesting to better describe that and include it as a limitation (variety of outcomes that were not compared- no possible meta-analysis??)” Answer to f: We categorized the variables into major groups within each article. This is how the variables were organized. It is true that the lack of a meta-analysis is a limitation of our study. Question g: “Discussion should clearly state what variables are specific or different from other continents and what is similar in other settings, especially LMIC.” Answer to g: Done Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0313897.r004
4 Nov 2024 Decision Letter - Renato Teixeira Souza, Editor Socioeconomic, demographic and obstetric determinants of maternal near miss in Africa: a systematic review PONE-D-23-17858R2 Dear Dr. DIAKITE, 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, Renato Teixeira Souza Academic Editor PLOS ONE Additional Editor Comments (optional): After consulting the editorial office and confirming that a published protocol is not a requirement of the journal in order for this systematic review to be published, I would like to confirm that the article is suitable for publication. I had the opportunity to review it during the last round of revisions, and I recommend it for publication after the authors include minor amendments to address the last minor suggestions. 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 #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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #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 #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 #3: Thank you for the responses provided. The manuscript has improved. -I am still not comfortable with the Paragraph on Line 206, because of the definition of Nearmiss and then “severe complications”, that are not part of the standard maternal morbidity criteria. -The non- registered review might be a concern for the journal, but thanks for the explanation -The comment on metanalysis was about the current review. There was no metanalysis performed- just to make it clear that it was a descriptive evaluation of included studies, with the limitation of different outcomes considered…. This was also not reported as a limitation. -Table 1- 2010 study does not include data on results for socioeconomic characteristics (numbers, analysis… are the characteristics considered associated to MNM?) ****** 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 #3: No ******** https://doi.org/10.1371/journal.pone.0313897.r005
Formally Accepted
19 Nov 2024 Acceptance Letter - Renato Teixeira Souza, Editor PONE-D-23-17858R2 PLOS ONE Dear Dr. DIAKITE, 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. Renato Teixeira Souza Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0313897.r006

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