Food insecurity and early childhood development among children 24–59 months in Nigeria: A multilevel mixed effects modelling of the social determinants of health inequities

Otobo I. Ujah; Omojo C. Adaji; Innocent A. O. Ujah; Russell S. Kirby

doi:10.1371/journal.pone.0316381

Peer Review History

Original SubmissionApril 2, 2024
25 Jun 2024 Decision Letter - Mohammad Nayeem Hasan, Editor PONE-D-24-13325Food Insecurity, the Social Determinants of Health Inequities and Early Childhood Development among Children 24-59 months in Nigeria: A Multilevel AnalysisPLOS ONE Dear Dr. Ujah, 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 Aug 09 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, Mohammad Nayeem Hasan 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 [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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 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 ****** 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: Food Insecurity, the Social Determinants of Health Inequities and Early Childhood Development among Children 24-59 months in Nigeria: A Multilevel Analysis General comment This is a very important manuscript that addresses an important aspect of human health and development i.e. the association between food insecurity and child development at an early age. It is equally noteworthy that authors have incorporated a theoretical framework to better explain this association and determinants. Despite the fact that the manuscript is well thought-through and carried out, especially the analysis section, it still suffers from some minor errors. Consider addressing these comments. Keywords Kindly consider spelling out FIES Introduction 1. Won't it be ideal to use only HFI or only FI rather than using them interchangeably? Please check and correct if necessary. 2. Please the date for publication for reference [12] is rather 2016 and not 2010. Please update reference. 3. For this statement “The plausible mechanisms underlying the association between FI and ECD have been described by Aurino and colleagues [13].” It would have been better to rather provide a statement that describes the plausible mechanism underlining the association between FI and ECD. Kindly consider revising it. 4. The authors did not adequately address why their research centred on children in the sub-group 24 to 59 months. Either ECD includes only children within this age bracket or should provide reason(s) why this age group is important/relevant within the context of FI and ECD. Research questions 1. Kindly correct sentence number 2. Study design and data source 1. Kindly state that the study was cross-sectional. Ethical considerations 1. “This study was considered not human participants research and therefore did not require institutional review board review.” Kindly reframe to reflect that although this study is a human participant research, IRB review and approval may not be required because this present study is an analysis of secondary data. And prior ethical approval had been acquired by the primary data collectors [citation]. Figure 1 1. Please the numbers do not add up. The mistake starts from the third box. Please check and correct. Outcome assessment 1. If the tool was developed for children aged 2 to 4 years, why is the age group in this study 24 to 59 months? Exposure variable 1. Correct Table 1 to Table 2. Confounding variables 1. Wouldn’t it be ideal to state that these confounding variables were based on the 4 levels of the EST framework? Or at least 3 levels since the MICs may not contain data on government policies and legislation? This is particularly relevant as authors stated in the theoretical framework section that EST “… framework will guide our analytic strategy, the interpretation of our findings and inform how … ” Table 2 narration “When comparing across early child development categories, children who were not developmentally on track were more likely to be older, face functional difficulties, have mothers with less than a higher level of education, reside in households with two or more children under 5 years of age, be affiliated with a religion other than Christianity, reside in poor households, and live in rural areas and in the Northern region (p < 0.001; Table 1).” 1. With regards to the above statement, authors may have to present statistics and corresponding p-values for each of the associations stated above. E.g. “… children who were not developmentally on track were more likely to be older (52.2% versus 31.2%, p < 0.001), face functional difficulties (3.8% versus 1.6%, p < 0.001), etc 2. Add “as compared to those who are on track” to the end of the paragraph. Table 2 1. What is the basis for providing unweighted frequencies with weighted percentages? Won’t weighted results throughout be appropriate? Even more so, the reviewer is not able to identify weighted results from unweighted results in the subsequent rows and columns. 2. When updating make sure all the numbers add up. 3. The mean age is not in the Table. 4. In most places, authors have referred to table 2 as table 1. 5. Please write out in full the classification of the wealth index. 6. Would it be better to present mean and standard deviation in this format (3.6 ± 0.25)? Statistical analysis 1. Once a phrase has been abbreviated do not spell it out in subsequent occurrence. E.g. PVC. Conclusion Although the reviewer has read through the entire manuscript further comments are no longer possible due to lack of line numbers. Which makes it almost impossible to make specific references to exact phrases. However, the manuscript has merit and provides critical information on aspects of scientific literature that have not been extensively explored, particularly in developing countries. Kindly address these preliminary concerns. Good luck. ****** 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: Yes: Addae Yaw Hammond ******** [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.0316381.r001
Revision 1
12 Aug 2024 Author Response Reviewer #1: Food Insecurity, the Social Determinants of Health Inequities and Early Childhood Development among Children 24-59 months in Nigeria: A Multilevel Analysis General comment This is a very important manuscript that addresses an important aspect of human health and development i.e. the association between food insecurity and child development at an early age. It is equally noteworthy that authors have incorporated a theoretical framework to better explain this association and determinants. Despite the fact that the manuscript is well thought-through and carried out, especially the analysis section, it still suffers from some minor errors. Consider addressing these comments. Reviewer’s comments Keywords Kindly consider spelling out FIES Author’s response: Done Reviewer’s comments Introduction 1. Won't it be ideal to use only HFI or only FI rather than using them interchangeably? Please check and correct if necessary. Author’s response: We have used FI throughout to maintain consistency Reviewer’s comments 2. Please the date for publication for reference [12] is rather 2016 and not 2010. Please update reference. Author’s response: Please note that although the paper by Lu et al. (reference 12) was published in 2016, the data cited in our introduction is from 2010. However, we have revised this sentence to better convey the central idea (Page 3, line 54). Reviewer’s comments 3. For this statement “The plausible mechanisms underlying the association between FI and ECD have been described by Aurino and colleagues [13].” It would have been better to rather provide a statement that describes the plausible mechanism underlining the association between FI and ECD. Kindly consider revising it. Author’s response: In the revised manuscript, we have expanded the introduction section to provide the interconnected pathways linking FI and ECD based on the points emphasized by Aurino and colleagues. (Page 3, line 59-66) Reviewer’s comments 4. The authors did not adequately address why their research centred on children in the sub-group 24 to 59 months. Either ECD includes only children within this age bracket or should provide reason(s) why this age group is important/relevant within the context of FI and ECD. Author’s response: We have provided an explanation for limiting our study to children 24-59 months in the revised manuscript (Page 4, line 89-92). Reviewer’s comments Research questions 1. Kindly correct sentence number 2. Author’s response: Corrected (Page 4, line 81-82). Reviewer’s comments Study design and data source 1. Kindly state that the study was cross-sectional (Page 5, line 140). Author’s response: We have stated this in the revised manuscript (Page 5, line 114) Reviewer’s comments Ethical considerations 1. “This study was considered not human participants research and therefore did not require institutional review board review.” Kindly reframe to reflect that although this study is a human participant research, IRB review and approval may not be required because this present study is an analysis of secondary data. And prior ethical approval had been acquired by the primary data collectors [citation]. Author’s response: We have revised this (Page 6, line 135-138). Reviewer’s comments Figure 1 1. Please the numbers do not add up. The mistake starts from the third box. Please check and correct. Author’s response: Thank you for this observation. We have detected the error and revised the manuscript accordingly. Reviewer’s comments Outcome assessment 1. If the tool was developed for children aged 2 to 4 years, why is the age group in this study 24 to 59 months? Author’s response: We have changed this to 24-59 months in the revised manuscript (Page 9, line 174) as contained in page 17 of THE EARLY CHILDHOOD DEVELOPMENT INDEX 2030: A NEW MEASURE OF EARLY CHILDHOOD DEVELOPMENT (https://data.unicef.org/wp-content/uploads/2023/09/ECDI2030_Technical_Manual_Sept_2023.pdf) Reviewer’s comments Exposure variable: Correct Table 1 to Table 2. Author’s response: Corrected (Page 11, line 201) Reviewer’s comments Confounding variables 1. Wouldn’t it be ideal to state that these confounding variables were based on the 4 levels of the EST framework? Or at least 3 levels since the MICs may not contain data on government policies and legislation? This is particularly relevant as authors stated in the theoretical framework section that EST “… framework will guide our analytic strategy, the interpretation of our findings and inform how … ” Author’s response: We have revised this (Page 13, line 211-222). Reviewer’s comments Table 2 narration “When comparing across early child development categories, children who were not developmentally on track were more likely to be older, face functional difficulties, have mothers with less than a higher level of education, reside in households with two or more children under 5 years of age, be affiliated with a religion other than Christianity, reside in poor households, and live in rural areas and in the Northern region (p < 0.001; Table 1).” With regards to the above statement, authors may have to present statistics and corresponding p-values for each of the associations stated above. E.g. “… children who were not developmentally on track were more likely to be older (52.2% versus 31.2%, p < 0.001), face functional difficulties (3.8% versus 1.6%, p < 0.001), etc 2. Add “as compared to those who are on track” to the end of the paragraph. Author’s response: We have revised this (Page 16, line 300-309). Reviewer’s comments Table 2 1. What is the basis for providing unweighted frequencies with weighted percentages? Won’t weighted results throughout be appropriate? Even more so, the reviewer is not able to identify weighted results from unweighted results in the subsequent rows and columns. Author’s response: We avoid presenting weighted observations/frequencies to prevent any potential misrepresentation. Instead, we prefer to present the actual sample size alongside weighted percentages to maintain transparency and clarity. Moreover, the footnotes have been appropriately provided in the table describing which results are unweighted and weighted. As an example, see the following papers: a. Pietrzak, R. H., Tsai, J., & Southwick, S. M. (2021). Association of symptoms of posttraumatic stress disorder with posttraumatic psychological growth among US veterans during the COVID-19 pandemic. JAMA network open, 4(4), e214972-e214972. b. Hahn, H., Burkitt, K. H., Kauth, M. R., Shipherd, J. C., & Blosnich, J. R. (2023). Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System. Health Services Research, 58(2), 392-401. 2. When updating make sure all the numbers add up. Author’s response: We have reviewed the numbers in the Table to ensure that all the numbers add up. The mean age is not in the Table Author’s response: The mean age for the sample has now been included in the revised manuscript. 4. In most places, authors have referred to table 2 as table 1. Author’s response: Thank you for this observation. We have corrected this throughout the entire manuscript. 5. Please write out in full the classification of the wealth index. Author’s response: Done. 6. Would it be better to present mean and standard deviation in this format (3.6 ± 0.25)? Author’s response: We have presented this in the suggested format in the revised manuscript. Reviewer’s comments Statistical analysis 1. Once a phrase has been abbreviated do not spell it out in subsequent occurrence. E.g. PVC. Author’s response: We have revised this (Page 14, line 255). Conclusion Although the reviewer has read through the entire manuscript further comments are no longer possible due to lack of line numbers. Which makes it almost impossible to make specific references to exact phrases. However, the manuscript has merit and provides critical information on aspects of scientific literature that have not been extensively explored, particularly in developing countries. Author’s response: We acknowledge that errors exist across several aspects of our manuscript and have effected corrections where identified. https://doi.org/10.1371/journal.pone.0316381.r002
17 Nov 2024 Decision Letter - Vinay Kumar, Editor PONE-D-24-13325R1Food Insecurity and Early Childhood Development among Children 24-59 months in Nigeria: A Multilevel Mixed Effects Modelling of the Social Determinants of Health InequitiesPLOS ONE Dear Dr. Ujah, 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 Jan 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. 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, Vinay Kumar, Ph.D. 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. Additional Editor Comments: This manuscript "Food Insecurity and Early Childhood Development among Children 24-59 months in Nigeria: A Multilevel Mixed Effects Modelling of the Social Determinants of Health Inequities" needs changes as per reviewers suggestions [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 #2: (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 #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 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: The reviewer has provided responses and where appropriate have effected changes in the manuscript to reflect reviewers comments. Reviewer #2: Congratulations to the authors on this important contribution to the knowledge base on FI, ECD, and the applications of the socioecological model. You’ve produced a very strong analysis, thorough manuscript, and a strong addition to the literature. I particularly applaud the balance of clarity and precision in describing the models (Methods section), and the richness of the Discussion which manages to tie many broad topics together coherently. Best of luck and I look forward to reading future studies by the authors. My specific comments are below for your consideration, some of which imply edits and others which are only to note: Overall, this manuscript would benefit from a final review by an English-speaking editor. There are minor spelling/grammatical errors, most often in missing words and inconsistency in capitalization and spelling of words used multiple times (e.g., socioecological). But, more notably, copyediting would be useful to ensure that ideas and connecting words are clear. In a number of sentences throughout, and quite notably in the Abstract (e.g., lines 14-15, 29-31, 36), the language used is not effective in communicating the idea. Line 21 (Abstract): Could you consider replacing the unweighted N with the weighted N, as the latter is reported in the Analytic Sample section and tables and is perhaps more useful to readers? Throughout: Please consider adding commas in numbers >3 digits long. Tiny thing, but helps avoid errors and misinterpretations. Lines 47-50 (Introduction): These two sentences seem not to support, but to contradict each other. Revisit to verify that “very low FI” does correspond with “lower odds” as mentioned (line 49). Lines 81-96 (Objectives): Are these objectives listed in descending order of importance? When reading the objectives, I interpret that the main objective of the study is to answer objective 1, whereas the title, Abstract, and Introduction have been directed towards objective 2 and objective 1 has not been referenced. Consider adjusting the title to reflect the key role of the referred socioecological factors, or conversely, reordering the objectives to highlight objective 2. Line 174 (Outcome Assessment): Kindly correct typo “24 to 59 years”. Lines 202-203 (Exposure Assessment): Can you confirm that FIES scores were calculated only through the simple sum of affirmative responses, and that the complex assessment criteria recommended in ideal circumstances by the FAO with calculation of infit/outfit/etc. were not applied? Just confirming understanding. Line 232 (Multilevel Model Building Strategy): Can you please define “community”, according to the MICS? Exosystem variables mentioned above include area type (urban/rural) and region, but I haven’t found a clarification of whether “communities” according to MICS correspond to one of these, or other admin boundaries, or MICS-defined clusters, or something else. Also to note for lines 423-425. Line 271: Slightly more than one half of who? Line 290: To clarify: severe FI only, or the exposure variable of mod-sev FI? Related in Table 2, I’m surprised to not see the aggregate numbers for mod-sev FI since this category is the key independent variable. If it’s a lot of trouble to add then no need, but at minimum a reference in the texts seems appropriate. Line 392-394: To consider for the discussion – overlap is high in the variables being measured by “functional difficulty” and “developmentally off-track” given the components of the ECDI2030 Health section which directly enquire about motor skills. Not a problem, but something to acknowledge. Lines 402-408: Please revise for typos which obscure the meaning of the results. Lines 500-518: Well-said! Lines 635-645 (Conclusion): Considering the title of the manuscript and objectives, it is surprising to not see FI mentioned at all in the conclusions. Kindly wrap up by tying all three objectives to their conclusion. ****** 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: Yes: Addae Yaw Hammond 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.0316381.r003
Revision 2
6 Dec 2024 Author Response Thank you for your review and comments which have helped to improve the quality and rigor of the work undertaken to produce this manuscript. Below, we provide a point-by-point response to the observations raised. We hope your find these useful. Overall, this manuscript would benefit from a final review by an English-speaking editor. There are minor spelling/grammatical errors, most often in missing words and inconsistency in capitalization and spelling of words used multiple times (e.g., socioecological). But, more notably, copyediting would be useful to ensure that ideas and connecting words are clear. In a number of sentences throughout, and quite notably in the Abstract (e.g., lines 14-15, 29-31, 36), the language used is not effective in communicating the idea. Author’s response: Done Line 21 (Abstract): Could you consider replacing the unweighted N with the weighted N, as the latter is reported in the Analytic Sample section and tables and is perhaps more useful to readers? Author’s response: Done Throughout: Please consider adding commas in numbers >3 digits long. Tiny thing, but helps avoid errors and misinterpretations. Author’s response: Done Lines 47-50 (Introduction): These two sentences seem not to support, but to contradict each other. Revisit to verify that “very low FI” does correspond with “lower odds” as mentioned (line 49). Author’s response: Thank you for this observation. We have now corrected this in the revised manuscript. Lines 81-96 (Objectives): Are these objectives listed in descending order of importance? When reading the objectives, I interpret that the main objective of the study is to answer objective 1, whereas the title, Abstract, and Introduction have been directed towards objective 2 and objective 1 has not been referenced. Consider adjusting the title to reflect the key role of the referred socioecological factors, or conversely, reordering the objectives to highlight objective 2. Author’s response: We have reordered the objectives to highlight objective 2. Line 174 (Outcome Assessment): Kindly correct typo “24 to 59 years”. Author’s response: Done Lines 202-203 (Exposure Assessment): Can you confirm that FIES scores were calculated only through the simple sum of affirmative responses, and that the complex assessment criteria recommended in ideal circumstances by the FAO with calculation of infit/outfit/etc. were not applied? Just confirming understanding. Author’s response: Yes, FIES scores were calculated through the simple sum of affirmative responses. Line 232 (Multilevel Model Building Strategy): Can you please define “community”, according to the MICS? Exosystem variables mentioned above include area type (urban/rural) and region, but I haven’t found a clarification of whether “communities” according to MICS correspond to one of these, or other admin boundaries, or MICS-defined clusters, or something else. Also to note for lines 423-425. Author’s response: In the context of the MICS dataset, 'community' refers to survey clusters, which represent geographically defined enumeration areas (EAs) sampled for data collection. These clusters form the primary sampling units within the hierarchical data structure. In the revised manuscript, we have changed this to “clusters” Line 271: Slightly more than one half of who? Author’s response: Mothers of children included in the study. Line 290: To clarify: severe FI only, or the exposure variable of mod-sev FI? Related in Table 2, I’m surprised to not see the aggregate numbers for mod-sev FI since this category is the key independent variable. If it’s a lot of trouble to add then no need, but at minimum a reference in the texts seems appropriate. Author’s response: The primary independent variable in this study is food insecurity (FI) status, which is categorized into three groups: none/mild, moderate, and severe FI. We have maintained this classification throughout the text and in the Tables to distinguish between moderate and severe FI, rather than aggregating both categories into a single "food insecurity" category. Line 392-394: To consider for the discussion – overlap is high in the variables being measured by “functional difficulty” and “developmentally off-track” given the components of the ECDI2030 Health section which directly enquire about motor skills. Not a problem, but something to acknowledge. Author’s response: Thank you for the suggestion. We have included this in the discussion (Line 525-528) Lines 402-408: Please revise for typos which obscure the meaning of the results. Author’s response: Thank you. We have corrected the typos. Lines 500-518: Well-said! Author’s response: Thank you. Lines 635-645 (Conclusion): Considering the title of the manuscript and objectives, it is surprising to not see FI mentioned at all in the conclusions. Kindly wrap up by tying all three objectives to their conclusion. Author’s response: Done https://doi.org/10.1371/journal.pone.0316381.r004
11 Dec 2024 Decision Letter - Vinay Kumar, Editor Food Insecurity and Early Childhood Development among Children 24-59 months in Nigeria: A Multilevel Mixed Effects Modelling of the Social Determinants of Health Inequities PONE-D-24-13325R2 Dear Dr. Ujah, 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, Vinay Kumar, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0316381.r005
Formally Accepted
2 Jan 2025 Acceptance Letter - Vinay Kumar, Editor PONE-D-24-13325R2 PLOS ONE Dear Dr. Ujah, 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. Vinay Kumar Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0316381.r006

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