PONE-D-24-24195Awareness and its determinant factors towards breast examination to detect breast cancer among reproductive age women in Kenya: Multi level analysis of the recent Demographic and Health Survey dataPLOS ONE

Dear Dr. Wassie,

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 read the reviewers' and editor's comments carefully, and address all comments made by them.

Please submit your revised manuscript by Aug 17 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Essa Tawfiq

Academic Editor

PLOS ONE

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https://www.cell.com/heliyon/fulltext/S2405-8440(20)30598-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2405844020305983%3Fshowall%3Dtrue

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

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Additional Editor Comments:

The study examined women's awareness of breast cancer examination and associated factors in Kenya. This is very important that women have knowledge of the availability of such health services to seek care on breast cancer examination which can assist in early detection and timely treatment and surgical intervention of breast cancer. The findings from this study may have policy implications to improve care seeking behavior for breast cancer examination among women through designing and implementing evidence-based healthcare interventions at community level. The authors need to address all comments made the reviewers in order to improve the manuscript.

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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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?

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: 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: Review comments

Thank you for the opportunity to review this paper. The title of the paper is relevant and the findings has the potential to the health of women in Kenya and Africa at large. Kindly find my comments below

General comments

1. Authors need to reorganize the introduction and discussion sections into meaningful paragraphs to direct the readers

2. I suggest the authors make reference to studies published in Africa more in the discussion section to support the study context.

3. Authors should improve the discussion section by stating their findings, providing reasons and recommendations but not just stating findings that otherwise support or not support their findings. This will provide further insight to the readers

4. Manuscript editing and formatting is needed to improve reading

Abstract

Introduction:

5. “Breast cancer is the second most frequent malignancy in women with over 2.3 million new cases and 685,000 deaths worldwide” this statement should be rephrased since it is the same as in the introduction in the main text

Introduction

6. Include data on prevalence of breast cancer (BC) in SSA while also citing relevant studies in Africa including such findings in Kenya.

7. Include data on the awareness level of breast examination in SSA including Kenya if any

8. Also include information of the determinants of breast examination in SSA including Kenya

9. You need to clearly articulate the problem under investigation to give the readers an opportunity to appreciate why you are conducting this study or why this study is relevant.

Methods

10. Include detail information about the setting of the study

11. Include detail information about the source of data. You may look at a similar study published by (Afaya et al., 2023, which used demographic and health survey data from Lesotho) for guidance.

Design

12. Under design, include that this is a national population-based cross-sectional survey

13. Under study design, the statement “aware of exam breast for breast cancer (s1102c)” is not clear. If possible, state this clearly.

Variables

Dependent

14. “The variable aware of exam breast for breast cancer (s1102c)” from the maternal record (IR) dataset was chosen and recoded to create the outcome variable”.

I suggest you rather include this statement in this section instead of the study design. I suggest you also state the actual question that was asked to the participants about their awareness of breast examination.

Results

Demographics

15. The statement “nearly only one tenth (11.61%) hadn’t media exposure”. Is it “had no media” exposure? Rephrase if necessary

Discussions

16. The statement “This could be workers would be privates and government employed recruited from more literate women” is not clear. Kindly check and rephrase for clarity

Reviewer #2: Thank you for giving me the opportunity to review this important topic. Here are my comments.

Strengths:

1. Relevant and important topic

2. Large and updated data set

Weaknesses: The authors should address the following comments before acceptance.

Abstract:

1- Results: The authors should add AOR with 95%CI for significant variables.

2- Conclusion: Please be specific and policy relevant.

Introduction:

- The introduction needs to be comprehensively revises. The authors should add:

- The significance of breast examination in breast cancer detections.

- What was the level and determinants in earlier studies conducted in Kenya, If there are no studies the authors should

focus on other LMICs.

- What is the current national policy? Are there any interventions for improving awareness in Kenya now?

- The authors can also mention on the importance of research.

Methods:

-The authors should mention what variables were selected in MLR.

Results:

- Please write the results of MLR analysis in correct format: [AOR, 95%CI:]. The format used is not similar for all variables.

Discussion:

This needs a bit more work. At current form it is a repetition of the results. A good discussion should have four arms: 1) present key finding, 2) compare with other literature, 3) rational and 4) policy implication. I suggest you revise your discussion based on the above criteria. Present each key finding, compare with earlier literature, and provide policy and practical implications for them. Each finding should have a key implication for practice and policy.

Finally, I would highly recommend that you guys have a native English speaker (someone who grew up in an environment with English as their mother tongue) to review the readability of this article. I do think that you guys have decent English, but it comes across as janky and the flow is quite uneven. Being a non native English speaker I understand the struggle you guys are facing. Unfortunately, there is a limit to how much we can do on our own. It is imperative that we get our articles proofread by a native English speaker (preferably someone from America to ensure wider acceptance). Therefore, I strongly recommend improving the language of the the article.

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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: Yes: Muhammad Haroon Stanikzai

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[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.]

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Attachments

Attachment

Submitted filename: Review comments on breast examination PLOS ONE.docx

PONE-D-24-24195R1Awareness and its determinant factors towards breast examination to detect breast cancer among reproductive age women in Kenya: Multi level analysis of the recent Demographic and Health Survey dataPLOS ONE

Dear Dr. Wassie,

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.

==============================

ACADEMIC EDITOR: Please read the reviewers' and editor's comments carefully, and address all comments made by them.

==============================

Please submit your revised manuscript by Nov 22 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,

Yitagesu Habtu

Academic Editor

PLOS ONE

[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: (No Response)

Reviewer #2: (No Response)

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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: No

**********

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: No

**********

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 #2: No

**********

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: I see that the discussion section has a lot of disjointed paragraphs. These paragraphs could be well-aligned or merged to improve the reading and flow of the message. Statements that are talking about the same thing should be put together. Example;

“The result differences might be due to the sample size differences, as the current study is a national-based survey, in addition to the sociocultural differences of the given countries. The current result could be an alarming sign for policymakers and other stakeholders to implement socio-culturally acceptable ways of awareness-creation modalities to improve breast examinations to detect breast cancer in the country”.

This paragraph should be added to the first to make it a complete sentence

Reviewer #2: Dear Authors,

The authors have made several changes that were recommended in the initial review, and the current submission is a much more relevant and interesting article to read. The added discussion of factors that make the women of Kenya uniquely susceptible adds context and relevance to the study. There are still many points that need to be addressed before this manuscript can be accepted for publication.

Major Points:

Introduction: The Introduction is still an issue. As the first part of the article that a potential reader reads, it should be attractive and easy to read. You have to "sell" the article to the reader.

Results: The statistical methods employed should be explained in methods section.

Discussion: Discussion needs more work. Based on the previous comments, the authors should present key findings compare with other studies, possible explanations, and key practical implications.

Minor points:

Abstract:

- Methods: A total of 16,474 women were included. Please revise as: A total of 16,474 women of reproductive age were included.

- Results: Please follow correct spacing. The authors should give a space after comma. The are a lot of spacing and punctuation errors through out the manuscript.

- Conclusion: The authors recommend- Please revise as the study recommends. Please use small letter for Media.

Introduction:

- Please give a space between citation and preceding word. Line: 6: Respectively(2,3). It should be respectively (2,3). Please follow this in whole manuscript. Use your citations as per journal guideline

[2,3].

Methods:

- Study variables: Please remove the variable number and the data set number.

Results:

- weren't married: Were not married

- hadn't any information: had no information

- Please remove dot before . (Table 1).

Table 1. Please use one number after coma (18.93%, make it 18.9%). Please revise all table.

Table 1. What does non married mean?

Table 2. Please two numbers after coma. For example: 1.156 (1.014-1.318). It should be 1.15 (1.01-1.31). Please revise all table.

This manuscript need major editing for language and grammar. At its current form, the language of the article is not appropriate for academic publishing.

In the revised manuscript, please give page and line numbers (using continuous options). The authors also have to revise their data availability statement and how can be data accessed. I believe the data will have a repository link.

Thank you,

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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: Yes: Muhammad Haroon Stanikzai

**********

[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 second review.docx

Awareness and its determinant factors towards breast examination to detect breast cancer among reproductive age women in Kenya: Multi level analysis of the recent Demographic and Health Survey data

PONE-D-24-24195R2

Dear Dr. Wassie,

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.

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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,

Yitagesu Habtu Aweke, Ph.D

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #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 #2: Yes

**********

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

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 #2: 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 #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 #2: Please revise lines: It was coded as "Yes = 1" if the study participants had awareness of breast examination to detect breast cancer and “No = 0” if otherwise.

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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 #2: Yes: Muhammad Haroon Stanikzai

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