Community awareness, perceptions, and management practices related to pre-eclampsia: An exploratory qualitative study in Mbale City, Eastern Uganda

Enid Kawala Kagoya; Allan G. Nsubuga; Irene Atuhairwe; Prossy Nakattudde; Catherine Asiimwe; Chrispus Gidudu; Elizabeth Ajalo; Paul Waako; Julius Wandabwa; Lawrence Arach; Grace Mbabazi Atwakire; Milton Musaba; Ronald Kibuuka; Faith Nyangoma; Sheilla Mbanago; Joshua Mugabi; Violet Chemutai; Jesca Atugonza; Byron Jonathan Ewaala; Betty Nakawuka; Francis Okello; Richard Mugahi; Jackline Akello; Andrew Twineamatsiko; Moses Adroma; Kenneth Mugabe

doi:10.1371/journal.pone.0314674

Peer Review History

Original SubmissionNovember 15, 2024
12 Mar 2025 Decision Letter - Maurine Musie, Editor Dear Dr. Kawala, 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 Apr 26 2025 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. 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, Maurine Rofhiwa Musie, PhD 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 note that your Data Availability Statement is currently missing the repository name and/or the DOI/accession number of each dataset OR a direct link to access each database. If your manuscript is accepted for publication, you will be asked to provide these details on a very short timeline. We therefore suggest that you provide this information now, though we will not hold up the peer review process if you are unable. 3. Please amend either the title on the online submission form (via Edit Submission) or the title in the manuscript so that they are identical. [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? Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: No Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Thank you for the manuscript on such an important topic in maternal sphere. The Research results will need to be reorganized for a more logical coherence. The suggestions on how that can be achieved are detailed on the manuscript itself Reviewer #2: I commend the authors for coming up with a valuable piece of work written about community awareness of pre-eclampsia. To improve the paper, I suggest the following: First, correct the topic and running title registered on the website, as it is different from the uploaded paper. Community awareness will sound better than knowledge, as knowledge cannot be explored rather it can be assessed. Everywhere the word knowledge was used, kindly correct. The abstract is well written, however, under methods, clarify if the interviews conducted were individual face-to-face or focus group, and also add how the 81 participants were sampled. On the background, there was a mention of the high level of studies that were conducted, kindly clarify how many studies, where were they conducted, and recheck as only one reference was used for the stated sentence on studies. Under study design, clarify the reasons for using qualitative research design, your rationale? Under the study setting, agriculture was mentioned and linked to the study setting, was this the reason why this study was conducted there? I suggest the authors link the study setting with the problem under study, for example, having a higher number of women with pre-eclampsia or hypertensive disorders in pregnancy. The accessibility and utilisation rate of the health care facility, the number of pregnant women seen daily, the number of midwives to cater for these women. The number of hospitals or health care facilities that are catering for pregnant women etc. Under the study population, 18-49 women were the population, what was the rationale of using these women, the title says community not women, kindly recheck and correct this. Before data collection, how were the participants sampled, and the rationale of the sampling method, kindly add a sub-heading on sampling. Under data collection, line number three indicated that data was collected for the period of 2 days, how many participants were interviewed, was these face-to-face interviews or what, how many people were involved in data collection? I have seen about 81 participants, is it possible to interview 81 women in two days? How many minutes did the interviews last with each participant, where was it conducted, more information is needed. What guided the authors to say they have gathered enough data? Which language was used during data collection? Under the results, I was lost when I was reading this section, I suggest the authors to re-look at their results and structure them starting from the presentation as themes and sub-themes. Let figure 1 present the results as suggested (themes and sub-themes). When reading through this section, there are results which are presented which are not in the figure. The sub-theme on management and prevention of pre-eclampsia is not part of the topic. Kindly re-look at this section. When presenting your results, kindly start with the main theme, talk to it, then each sub-theme to be presented, supported by relevant quotes at least three quotes per sub-theme will be sufficient. Address this section, after addressing it, kindly recheck your discussion to align with the corrections suggested. Check my other comments in the paper. Align your conclusion with the study findings. References, inside citations are 14, in this section are only ten, kindly correct and include all the sources. ****** 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: Yes Reviewer #2: Yes** [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: PONE-D-24-50330.pdf Attachment Submitted filename: PONE-D-24-50330_reviewer.pdf https://doi.org/10.1371/journal.pone.0314674.r001
Revision 1
4 Apr 2025 Author Response Dear Reviewers Thank you so much for your concerns I have attached a revised version of the data set for your review and action Looking forward to hearing from you soon Kind regards Kawala Attachments Attachment Submitted filename: POINT BY POINT RESPONSE - Plos One.docx https://doi.org/10.1371/journal.pone.0314674.r002
20 May 2025 Decision Letter - Maurine Musie, Editor Dear Dr. Kawala, 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. Following peer review, I am pleased to inform you that the reviewers found your manuscript to be of significant value and relevance to our readership. However, they have suggested minor revisions Please submit your revised manuscript by Jul 04 2025 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. 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 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, Maurine Rofhiwa Musie, PhD Academic Editor PLOS ONE Journal Requirements: 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 Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: Thank you for amending your manuscripts with the suggestions made previously, however, they are minor corrections which must be attended to before the paper is published. Check my comments from the 1st attachment that needs your attention. In the abstract, clarity is needed the same applies in data collection on how many researchers were involved in the data collection, kindly indicate the numbers. Under research design, indicate the rationale of using the design that you chose. Under discussion, remove the recommendations, i have highlighted them in the manuscript, to be indicated under recommendation. ****** 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 #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 Attachments Attachment Submitted filename: PONE-D-24-50330_R1.pdf https://doi.org/10.1371/journal.pone.0314674.r003
Revision 2
25 May 2025 Author Response 21/May/2025 Enid Kawala Kagoya Busitema University Faculty of Health Sciences enidkawala@gmail.com To: The Editors PLOS ONE Subject: Resubmission of Revised Manuscript : Exploring Women’s Awareness and Perceptions of Pre-eclampsia in Mbale City, Uganda: An Exploratory Qualitative Study in Mbale City Dear Editors, I am writing to submit the revised version of our manuscript entitled "Exploring Women’s Awareness and Perceptions of Pre-eclampsia in Mbale City, Uganda: An Exploratory Qualitative Study in Mbale City " in response to the comments and guidance provided by the reviewers and editorial team. We have carefully considered all feedback and made thorough revisions to improve the clarity, depth, and scientific rigor of the manuscript. Specifically, we have addressed each reviewer’s comment point by point, revised key sections including the title, Abstract, introduction, methods, results, and discussion, and enhanced alignment between the study objectives, findings, and conclusions. We are grateful for the constructive feedback, which has significantly strengthened our work. We hope that the revised manuscript meets the expectations of the journal and look forward to your favorable consideration. Thank you for your time and continued guidance. Sincerely, Enid Kawala Kagoya On behalf of all co-authors Busitema University, Faculty of Health Sciences. Attachments Attachment Submitted filename: Rebbuttal- Plos One vr 10.pdf https://doi.org/10.1371/journal.pone.0314674.r004
17 Sep 2025 Decision Letter - Katherine Kokkinias, Editor Dear Dr. Kawala, 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. ============================== One reviewer has reassessed your manuscript, and their comments are available below. The reviewers have raised a number of concerns that need attention. The reviewer has queries about the methodology regarding the number of researchers and the reported number of interviews. They would also like more information on the community market and interview locations. They also had suggestions for the formatting of the manuscript to improve clarity. Could you please revise the manuscript to carefully address the concerns raised? ============================== Please submit your revised manuscript by Nov 01 2025 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. 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, Katherine Demi Kokkinias, Ph.D. Staff Editor PLOS ONE Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: No ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: Although previous comments were addressed, from the corrected information, they are suggestions i made which needs their attention. Under data collection, line 130-131, Recheck this information and correct or remove, it contradicts the six days indicated in line 125. If 28 researchers collected data for 2 days each collecting from 2 participants per day, it brings to the total of 112. Kindly correct your information. In addition, clarify if the 28 research midwives were trained to collect the face-to-face interviews. Under line 134, authors mentioned community markets as one of the places where data was collected, did the community markets provide a space that ensured the privacy of participants during the interviews? I'm asking because, given that markets are open public spaces, this raises concerns about maintaining ethical standards and confidentiality. Recheck information on data saturation under line 135-136, how was data saturation determined, considering that each researcher collected data from two participants per day? Could you kindly clarify the strategy used to identify when saturation was achieved apart from stating that it was reached when new information emerged whereas each researcher collected data from only 4 participants. Under results, line 162, correct as this is not a figure but a table. Still under the results, researchers gathered a substantial amount of data for this study, which could potentially support the development of two to three separate papers. This is merely a suggestion. I make this observation because the report currently relies on a single quote to support key findings, which does not adequately reflect data saturation. I recommend including at least three representative quotes to better substantiate the findings. Lastly, when presenting your results, refer the reader to the table as a form of a reminder of your presentation or reporting. Line 169, a sub-theme general understanding was indicated, support the sub-theme with quotes and be consistent, as this subheading is a sub-theme. Line 305, sub-theme4, be consistent in your writing; kindly check how it was done above. Correct these three sub-themes. ****** 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 #2: Yes: Thifhelimbilu Irene Ramavhoya ******** [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: Pre-eclampsia manuscript clean Vr 10.docx https://doi.org/10.1371/journal.pone.0314674.r005
Revision 3
6 Oct 2025 Author Response Dear Editor, We are pleased to submit the revised version of our manuscript titled “Women’s Knowledge, Perceptions, and Management of Preeclampsia in Eastern Uganda: A Qualitative Study” for reconsideration for publication in PLOS ONE. We sincerely appreciate the constructive and insightful comments provided by the reviewers. Their feedback has significantly strengthened the methodological clarity, analytical depth, and presentation of our findings. In response to the reviewers’ recommendations, we have made the following key revisions: 1. Clarified methodological details including the total number of interviews, training of research midwives, ethical considerations for interviews conducted in public settings, and procedures for ensuring privacy and confidentiality. 2. Elaborated on data saturation procedures and provided clearer timelines and descriptions of data collection activities. 3. Enhanced the Results section by including multiple representative participant quotes (at least three per theme) to improve thematic saturation and credibility. 4. Improved coherence between text and tables by adding explicit references to the corresponding tables throughout the Results section. 5. Revised language and structure to improve flow, clarity, and alignment with PLOS ONE’s reporting standards for qualitative research. We have also attached a detailed point-by-point response table outlining how each reviewer comment has been addressed in the revised manuscript, with corresponding line references Thank you Kawala Attachments Attachment Submitted filename: Point by point response - PLOS One Vr 12.docx https://doi.org/10.1371/journal.pone.0314674.r006
22 Jan 2026 Decision Letter - Junie Warrington, Editor Dear Dr. Kawala, 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 Mar 08 2026 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. A 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 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, Junie Paula Warrington, PhD Academic Editor PLOS One Journal Requirements: If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 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. Additional Editor Comments: Dear Dr. Kawala: Thank you for your thoughtful response to the reviewer's comment. Please note that additional clarification is requested by the reviewer. We ask that you provide a point-by-point response to the comments and incorporate the changes to the main manuscript. I look forward to the resubmission of your important work. Sincerely, J. Paula Warrington, PhD [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #3: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> 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 Reviewer #3: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #3: Yes ****** Reviewer #3: Overall, the manuscript addresses an important topic; however, there are several areas that require clarification and alignment to strengthen its rigor and readability. The title and objectives need to be consistent in clearly defining the study population, as there is currently a discrepancy between references to community perception and women’s perception. In the methods section, more detail is needed on recruitment procedures, participant identification, and whether parity (primigravida vs. multiparous) was considered, as these factors may influence knowledge and perceptions. The data collection approach should also be clarified, particularly whether interviews were conducted house-to-house or at a single outreach venue, and how independence of responses was ensured. In the results, the extent of misconceptions versus accurate understanding should be quantified or at least described more clearly, and further elaboration on the reasons behind women’s choice of traditional versus modern care would add depth. Addressing these issues will improve the clarity, credibility, and practical relevance of the study’s findings and conclusions. ****** 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 ******** [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. Attachments Attachment Submitted filename: Reviewer.docx https://doi.org/10.1371/journal.pone.0314674.r007
Revision 4
29 Jan 2026 Author Response We sincerely thank the reviewers for their detailed and constructive feedback. Each comment has been carefully addressed, and revisions have been made to strengthen the manuscript. Below is our point-by-point response. First Reviewer Comment: Title and Objective Alignment Comment: There is an inconsistency between the manuscript title and the stated objective. The title alternates between “community perceptions” and “women’s perceptions,” while the objective clearly identifies women of reproductive age. The title and objective should be aligned. Response: We acknowledge this inconsistency. The title has been revised as Community Awareness, Perceptions, and Management Practices Related to Pre-Eclampsia to reflect the broader community awareness context. To ensure alignment, the objective has been revised to clarify that women of reproductive age within the community were the primary respondents, representing community-level awareness. Revised Objective: To explore community awareness, perceptions, and management practices related to pre-eclampsia in Mbale City, Eastern Uganda, with a particular focus on women of reproductive age, and to examine how these factors influence health-seeking behaviors. Methods Clarification Added: Although the study focuses on community awareness, data were collected from women of reproductive age as the primary respondents. First Reviewer Comment 2: Study Design Comment: The study design should be clearly described. Response: We have clarified that an exploratory qualitative study design using face-to-face in-depth interviews was employed to capture detailed perceptions, awareness, and management practices related to pre-eclampsia in a low-resource urban setting. First Reviewer Comment 3: Study Site Comment: Provide more contextual information about the study site. Response: We have expanded the Study Site section: 1. The study was conducted in Mbale City, Eastern Uganda, a newly approved city with a high burden of pre-eclampsia. 2. Health records indicate that pre-eclampsia accounted for a substantial proportion of maternal admissions and deaths in 2020-2021, highlighting the relevance of this site for research. First Reviewer Comment 4: Study Population and Recruitment Comment: Clarify how participants were identified and recruited, and how representativeness was ensured. Response: Purposive sampling was employed. Trained Research Midwives approached women in markets, health facilities, community centers, streets, and selected households. Eligibility criteria: women aged 18-49 years and willing to participate. Recruitment across multiple locations ensured diverse perspectives and reduced selection bias. Parity Consideration: Parity was not used for stratification, but prior pregnancy experience was collected during interviews and considered in data interpretation. Data Collection and Independence: 1. Interviews were individual and private. 2. Conducted in homes, clinics, or quiet community spaces, lasting 30=45 minutes in English. Kindly note that those working in markets allowed us to take them to safe and quite places just above the market which we did. Second Reviewer Comment 5: Data Management and Analysis Comment: Clarify how data were managed and analysed. Response: Audio-recorded interviews were transcribed verbatim. 1. Transcripts were checked against recordings for accuracy. 2. Data were analyzed using ATLAS.ti with thematic analysis. 3. Five main themes and subthemes emerged. Re-analysis for Data Saturation (New): In response to the reviewer’s suggestion regarding the limited use of quotes and potential for multiple papers: • We conducted a thorough re-analysis of all transcripts. • Additional codes were extracted and mapped under each theme and subtheme to capture the richness of the dataset. • For each subtheme, we now include at least three representative quotes, reflecting diverse participants, experiences, and perspectives. Explicit references to Table 1 were added throughout the Results section to link narrative descriptions to the structured thematic summary. • These revisions demonstrate data saturation and substantiate the findings more robustly. Second Reviewer Comment: Subthemes Accuracy Comment: Check correctness of subthemes such as balanced diet, ANC attendance, and exercise. Response: We reviewed these subthemes and confirm they accurately reflect participant narratives. 1. No additions or deletions were necessary, and these have been retained. Second Reviewer Comment 7: Potential for Multiple Papers Comment: The dataset is rich and could support two to three separate publications. Response: � We acknowledge the richness of the dataset. � For this manuscript, we focused on the primary study objective, presenting comprehensive themes and subthemes. � The re-analysis and inclusion of additional codes and quotes strengthens this manuscript’s contribution. � Future analyses could explore cultural beliefs, management practices, or preventive strategies as separate manuscripts. Thank you for the opportunity to revise our manuscript. We appreciate the reviewer’s constructive feedback and have carefully addressed all the suggested minor revisions to improve the clarity and presentation of the study Attachments Attachment Submitted filename: Point by point response - PLOS ONE 14.pdf https://doi.org/10.1371/journal.pone.0314674.r008
2 Feb 2026 Decision Letter - Junie Warrington, Editor Community Awareness, Perceptions, and Management Practices Related to Pre-Eclampsia: An Exploratory Qualitative Study in Mbale City, Eastern Uganda PONE-D-24-50330R4 Dear Dr. Kawala, 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. For questions related to billing, please contact billing support . 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, Junie Paula Warrington, PhD Academic Editor PLOS One Additional Editor Comments (optional): The authors have satisfactorily addressed the comments from the reviewers, and the manuscript is deemed acceptable in its current form. Reviewers' comments: https://doi.org/10.1371/journal.pone.0314674.r009
Formally Accepted
Acceptance Letter - Junie Warrington, Editor PONE-D-24-50330R4 PLOS One Dear Dr. Kawala, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Junie Paula Warrington Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0314674.r010

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