Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: A multilevel analysis of multination population survey data

Kusse Urmale Mare; Gashaye Gobena Andargie; Abdulkerim Hassen Moloro; Ahmed Adem Mohammed; Osman Ahmed Mohammed; Beriso Furo Wengoro; Begetayinoral Kussia Lahole; Tesfahun Simon Hadaro; Simeon Meskele Leyto; Petros Orkaido Mamo; Abdulhakim Hora Hedato; Beminate Lemma Seifu; Temesgen Gebeyehu Wondmeneh; Oumer Abdulkadir Ebrahim; Kebede Gemeda Sabo

doi:10.1371/journal.pone.0316671

Peer Review History

Original SubmissionMay 29, 2024
10 Jul 2024 Decision Letter - Hassen Mosa, Editor PONE-D-24-21779Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey data PLOS ONE Dear Dr. Mare, 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 24 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, Hassen Mosa, Msc Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements. 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. Thank you for uploading your study's underlying data set. Unfortunately, the repository you have noted in your Data Availability statement does not qualify as an acceptable data repository according to PLOS's standards. At this time, please upload the minimal data set necessary to replicate your study's findings to a stable, public repository (such as figshare or Dryad) and provide us with the relevant URLs, DOIs, or accession numbers that may be used to access these data. For a list of recommended repositories and additional information on PLOS standards for data deposition, please see https://journals.plos.org/plosone/s/recommended-repositories. 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: 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: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: • Line 78-80: “Furthermore, comprehensive health system and community-level interventions have been implemented to bolster the quality and accessibility of ANC services and community awareness about the importance of timely ANC initiation, respectively” The authors should provide citations and references to back this statement • Results: I will suggest the author report the proportion or the percentages only without quoting the numbers of participants • Where are the tables the authors are referring to in their results? • Tables should be placed directly after the next reporting result from the table • Table 1 should be quoted in the text where the results are reported • Discussion: Though the authors make a comparison between their findings and those of previous studies, it will be important they provide the public health implication of their findings • The tables on multilevel analysis results provided by the authors are difficult to understand, I will suggest the authors make their tables as concise as possible showing all the three models of the multilevel regression carried out Reviewer #2: This is an insightful study that addresses the hurdle of maternal health, which is late initiation of ANC by using the latest model. The manuscript is readable, however the conclusion is too general and I would suggest authors get it edited. ****** 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: Robert Kokou Dowou 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.0316671.r001
Revision 1
13 Jul 2024 Author Response Dear Academic Editor, Thank you for the opportunity to revise our manuscript “Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey data (ID: PONE-D-24-21779)”. We have addressed the concerns raised by the reviewers using a point-by-point response as stated below. The amendments made to the manuscript have been presented using track change in the attachment titled “Revised Manuscript with Track Changes”. Journal Requirements Comment 1: When submitting your revision, we need you to address these additional requirements. 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. Response 1: Thank you. We have amended the manuscript as per the PLOS ONE style requirements. Comment 2: Thank you for uploading your study's underlying data set. Unfortunately, the repository you have noted in your Data Availability statement does not qualify as an acceptable data repository according to PLOS's standards. At this time, please upload the minimal data set necessary to replicate your study's findings to a stable, public repository (such as Figshare or Dryad) and provide us with the relevant URLs, DOIs, or accession numbers that may be used to access these data. For a list of recommended repositories and additional information on PLOS standards for data deposition, please see https://journals.plos.org/plosone/s/recommended-repositories. Response 2: Thank you very much for your recommendation. We have provided the relevant URL for the data used in the study and uploaded the minimal dataset used for the analysis. Comment 3: 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. Response 3: Thank you very much. We have checked the reference list and ensured that the list does not contain a retracted paper. Responses to Reviewer #1 Comments Comment 1: Line 78-80: “Furthermore, comprehensive health system and community-level interventions have been implemented to bolster the quality and accessibility of ANC services and community awareness about the importance of timely ANC initiation, respectively” The authors should provide citations and references to back this statement. Response 1: Thank you very much for your important recommendation. We have provided citations and references for the stated statement as suggested. Comment 2: Results: I will suggest the author report the proportion or the percentages only without quoting the number of participants. Response 2: Thank you for your suggestion. We have incorporated this suggestion into the descriptive results of the revised manuscript. Comment 3: Where are the tables the authors are referring to in their results? Tables should be placed directly after the next reporting result from the table. Table 1 should be quoted in the text where the results are reported. Response 3: Thank you for your concern. We agree that tables should be placed right after their respective descriptive results, however, as per the journal requirements, tables are placed at the end of the main body of the manuscript just following the reference list. Thus, details of the tables quoted in the main body are available at the end of the manuscript. Comment 4: Discussion-though the authors make a comparison between their findings and those of previous studies, it will be important they provide the public health implication of their findings. Response 4: Thank you very much. We have provided the public health implication of the study findings under the conclusion section of the revised manuscript. Comment 5: The tables on multilevel analysis results provided by the authors are difficult to understand, I will suggest the authors make their tables as concise as possible showing all the three models of the multilevel regression carried out. Response 5: Thank you very much for your important recommendation. We have presented the results of multilevel regression analysis for the three models as suggested in the revised manuscript. Responses to Reviewer #2 Comments This is an insightful study that addresses the hurdle of maternal health, which is late initiation of ANC by using the latest model. Comment: The manuscript is readable, however, the conclusion is too general and I would suggest authors get it edited. Response: Thank you for your interesting suggestion. We have revised the conclusion section as suggested. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0316671.r002
16 Oct 2024 Decision Letter - Marianne Clemence, Editor PONE-D-24-21779R1Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey dataPLOS ONE Dear Dr. Mare, 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. To ensure a thorough evaluation of your methodological approach, an additional reviewer was consulted in this round. The reviewer has expressed a number of major concerns about the quality of the reporting and analysis, particularly with respect to your statistical approach. Please ensure you carefully revise the manuscript to address all of the concerns raised. Please submit your revised manuscript by Nov 29 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, Marianne Clemence Staff 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: All comments have been addressed Reviewer #2: All comments have been addressed Reviewer #3: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: No ****** 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 Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Data source: The authors should provide the accession number or the direct web link in the Availability of Data and Materials section of your manuscript. Reviewer #2: The authors have addressed all the comments given in the revision one of the manuscript. I have no further comment. Reviewer #3: The paper addresses an important topic. However, it has some major technical weaknesses. In particular, some crucial details on methodology are missing, making it impossible to assess appropriateness of the analysis presented. 1. It is stated that the analysis is based on multilevel analysis, yet it is unclear what the different levels are. For instance, is the multilevel analysis based on two-levels or 3-level logistic regression, and what are the levels (community, country, etc)? The results presented only show fixed effects without any random effects, so it is unclear whether there were any significant variations across the different levels of analysis. It is impossible to ascertain what multilevel models were fitted, or results based on single-level logistic regression. 2. It is stated that weighting was undertaken for pooled data, but unclear how this was done. Was weighting based of DHS-derived country-specific weights, or were pooled weights derived, taking into consideration different sampling fractions used by DHS in different countries? The DHS-derived weights are useful for country-specific analysis to achieve national representativeness, but would not be appropriate for pooled data across different countries in sub-Saharan Africa. Other points for consideration: - Need to correct errors in some factual statements – e,g. first paragraph of introduction ‘…the services received after first trimester are considered late’ . Do you mean to say initiation/booking of ANC after first semester is considered late? - It is suggested that ‘…evidence on the level of late antenatal care booking and its determinants in SSA following the implementation of the 2016 new antenatal care model is limited’, but it is unclear how the new ANC model deviates from previous guidelines in relation to initiation/timing of ANC. - Table 6 presents ‘multilevel fixed-effects’ analysis –significance for some of the factors where ORs suggest significance are not marked so, e.g rural residence and decision on healthcare. Are these omissions or intended? Clarification needed if the latter. - Reference to table 3 in results section, yet there is no Table 3 among the list of tables provided at the end of the paper. Is this the same as table 6? - Aspects of discussion could be better thought through. For instance, the lower prevalence of late ANC compared to other studies in this paper has been attributed to differences in sample size and scope of study, the current study having a much larger sample covering a wider geographic area. It is important to note that a larger sample size in itself is unlikely to lead to lower prevalence. Potential explanations may include use of different definition for late ANC – other studies (e.g. [14] defined late ANC as 2nd or 3rd trimester (after 1st trimester – i.e 3 months) rather than after 4 months used in the study. - Reporting of results could be better thought through. Eg it is stated that the analysis ‘revealed that health insurance coverage [AOR (95% CI) = 1.84 (1.68, 2.01)] and higher birth order 184 [AOR (95% CI) = 1.40 (1.34, 1.47)] were associated with higher odds of late antenatal care booking’ without clarifying what is being compared or what the Odds ratios refer to. ****** 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: Robert Kokou Dowou Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0316671.r003
Revision 2
11 Nov 2024 Author Response Dear Academic Editor, Thank you for the opportunity to revise our manuscript. “Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey data (ID: PONE-D-24-21779R1)”. We have addressed the concerns raised by the reviewers using a point-by-point response as stated below. The amendments made to the manuscript have been presented using track change in the attachment titled “Revised Manuscript with Track Changes”. Response to Reviewer #1 Comment Comment 1: Data source: The authors should provide the accession number or the direct web link in the Availability of Data and Materials section of your manuscript. Response 1: Thank you very much for your suggestion. We have provided the web link and a reference number of an authorization latter to access the data used in our analysis. Response to Reviewer #2 Comment Comment: The authors have addressed all the comments given in the revision one of the manuscript. I have no further comment. Response: Thank you very much for accepting our manuscript in its current form. Response to Reviewer #3 Comments: The paper addresses an important topic. However, it has some major technical weaknesses. In particular, some crucial details on methodology are missing, making it impossible to assess appropriateness of the analysis presented. Comment 1: It is stated that the analysis is based on multilevel analysis, yet it is unclear what the different levels are. For instance, is the multilevel analysis based on two-levels or 3-level logistic regression, and what are the levels (community, country, etc)? The results presented only show fixed effects without any random effects, so it is unclear whether there were any significant variations across the different levels of analysis. It is impossible to ascertain what multilevel models were fitted, or results based on single-level logistic regression. Response 1: Thank you very much for your important concern. We have presented the random effect analysis result in the revised manuscript (i.e. we have revised the method and result section based on the suggestion). Comment 2: It is stated that weighting was undertaken for pooled data, but unclear how this was done. Was weighting based of DHS-derived country-specific weights, or were pooled weights derived, taking into consideration different sampling fractions used by DHS in different countries? The DHS-derived weights are useful for country-specific analysis to achieve national representativeness, but would not be appropriate for pooled data across different countries in sub-Saharan Africa. Response 2: Thank you again for your interesting comment. We have generated a pooled weight and used it throughout our analysis and we have indicated this issue as per your recommendation in the revised manuscript. Other points for consideration: Comment 3: Need to correct errors in some factual statements – e,g. first paragraph of introduction ‘…the services received after first trimester are considered late’ . Do you mean to say initiation/booking of ANC after first semester is considered late? Response 3: Thank you and sorry for the grammatical error. We have replaced it with the suggested phrase. Comment 4: It is suggested that ‘…evidence on the level of late antenatal care booking and its determinants in SSA following the implementation of the 2016 new antenatal care model is limited’, but it is unclear how the new ANC model deviates from previous guidelines in relation to initiation/timing of ANC. Response 4: Thank you for your important comment. As stated in paragraph 5 of an “Introduction” section, the new recommendation deviates from the former one by the minimum number of ANC visits that a pregnant woman should attend during pregnancy. For instance, while the former model recommends a minimum of four visits, the new guideline suggests a minimum of eight visits. Comment 5: Table 6 presents ‘multilevel fixed-effects’ analysis –significance for some of the factors where ORs suggest significance are not marked so, e.g rural residence and decision on healthcare. Are these omissions or intended? Clarification needed if the latter. Response 5: Thank you very much for your important comment. It is an editorial error and we have marked them in the revision. Comment 6: Reference to table 3 in results section, yet there is no Table 3 among the list of tables provided at the end of the paper. Is this the same as table 6? Response 6: Thank you for your concern. Yes, it is the same as table 6 and we have corrected this issue in the revised manuscript. Comment 7: Aspects of discussion could be better thought through. For instance, the lower prevalence of late ANC compared to other studies in this paper has been attributed to differences in sample size and scope of study, the current study having a much larger sample covering a wider geographic area. It is important to note that a larger sample size in itself is unlikely to lead to lower prevalence. Potential explanations may include use of different definition for late ANC – other studies (e.g. [14] defined late ANC as 2nd or 3rd trimester (after 1st trimester – i.e. 3 months) rather than after 4 months used in the study. Response 7: Thank you for your important recommendation. We have considered the suggested explanation/justification for the observed discrepancy in the revision. Comment 8: Reporting of results could be better thought through. Eg it is stated that the analysis ‘revealed that health insurance coverage [AOR (95% CI) = 1.84 (1.68, 2.01)] and higher birth order 184 [AOR (95% CI) = 1.40 (1.34, 1.47)] were associated with higher odds of late antenatal care booking’ without clarifying what is being compared or what the Odds ratios refer to. Response 8: Thank you very much. We have revised this concern and provided the reference category (comparison group) for the stated factors. Attachments Attachment Submitted filename: Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0316671.r004
5 Dec 2024 Decision Letter - Muhammad Haroon Stanikzai, Editor PONE-D-24-21779R2Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey dataPLOS ONE Dear Dr. Mare, 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. ============================== Thank you for addressing the initial comments provided by the reviewers. Based on the revised manuscript, the reviewers and I have requested that some minor comments still need to be addressed. ============================== Please submit your revised manuscript by Jan 19 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, Muhammad Haroon Stanikzai 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: - Definition of the outcome – WHO recommends 1st ANC visit within 3 months (1st trimester). In the manuscript authors defined late ANC after 4 months of gestation. According to the literature, ANC visit within 4 months is also consider late ANC. Additionally, authors compared their results with papers mostly discussing late ANC after 3 months. I ask the authors to revisit WHO recommendations for ANC timing and revised their results accordingly. I also suggest the authors can consult and add the following citations which details late ANC in another low-income country. --https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0309300 --https://www.dovepress.com/sociodemographic-predictors-of-initiating-antenatal-care-visits-by-pre-peer-reviewed-fulltext-article-IJWH - In Abstract add the abbreviation SSA from the first paragraph (line 25). - In Abstract add the full form (DHS) from the first paragraph (line 27). - Methods described aren't the ones opted by the author. They were done part of the National Surveys. These methods should be supported be relevant citations (lines 94-100). - Dependent variable: Add citation considering my earlier comment. [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 #2: All comments have been addressed Reviewer #4: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes Reviewer #4: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes Reviewer #4: 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 Reviewer #4: 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 Reviewer #4: 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: The authors addressed all comments given in the revised version of the manuscript. Therefore, I have no further comments. Reviewer #4: Dear Editors and Authors, Thank you for giving me the opportunity to review the manuscript, titled “Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey data”. The authors of the study chose a very important topic related to maternal health in Africa. This study aimed to determine the pooled prevalence of late ANC visit and its determinants among women in Sub-Saharan Africa (SSA) using DHS conducted after the implementation of new guidelines in 2016. The authors used from 16 SSA between 2018 and 2022, with a weighted sample of 101,983 women who had ANC visits during their pregnancy. The authors applied logistic regression models for multivariate results and found the pooled prevalence of late ANC visits to be 32.0% (min 13.3% in Liberia to max 50.0% in Nigeria). The determinants of late ANC visit were women’s age and education, partner’s education, health insurance coverage, birth order, household wealth, age at marriage, decision on health care, residence, and community-level women’s illiteracy. My assessment of the manuscript is that it is well written and is well organized. I also see that this is the second reviewer of the manuscript which has improved after the authors addressed the previous reviewers’ comments. The findings from this study have the potential to impact health interventions and policy to improve initiation of timely ANC visit and maternal health services in developing countries. Apart from few grammatical errors, which I have mentioned below and the authors need to address them, the manuscript can be considered for publication. The authors may opt to use ANC visit instead of ANC booking, as currently they have used the two terms interchangeably, which can be confusing. Further, the women reported their ANC visit(s) rather than their booking of ANC visit(s). The word “bias” is usually used as uncountable; therefore, in line 300 “may be recall bias” instead of “may be a recall bias” should be used. In line 295 “This data was collected” to be changed to “The data were collected”. The above are few errors I have noticed; the authors should check the English language and grammar for their work in this study. ****** 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: No Reviewer #4: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: reviewers comments.pdf https://doi.org/10.1371/journal.pone.0316671.r005
Revision 3
13 Dec 2024 Author Response Dear Academic Editor, Thank you again for the opportunity to revise our manuscript “Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey data (ID: PONE-D-24-21779R2)”. We have addressed the concerns raised by the reviewers using a point-by-point response as stated below. The amendments made to the manuscript have been presented using track change in the attachment titled “Revised Manuscript with Track Changes”. Response to Editor’s comments Journal Requirements: Comment 1: 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. Response 1: Thank you. We have checked the reference list, confirmed that all references are complete and correct, and ensured that we have not used a retracted paper in the citation. Additional Editor Comments: Comment 1: Definition of the outcome – WHO recommends 1st ANC visit within 3 months (1st trimester). In the manuscript, the authors defined late ANC after 4 months of gestation. According to the literature, ANC visit within 4 months is also considered late ANC. Additionally, authors compared their results with papers mostly discussing late ANC after 3 months. I ask the authors to revisit WHO recommendations for ANC timing and revise their results accordingly. I also suggest the authors can consult and add the following citations which detail late ANC in another low-income country • https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0309300 • https://www.dovepress.com/sociodemographic-predictors-of-initiating-antenatal-care-visits-by-pre-peer-reviewed-fulltext-article-IJWH Response 1: Thank you very much for your important and interesting recommendation. We have changed the definition for ANC timing, did a reanalysis, and revised the result section as per your suggestion. In addition, we have provided the suggested citations for the definition of late ANC visit. Comment 2: In the Abstract add the abbreviation SSA from the first paragraph (line 25). Response 2: Thank you. We have added the abbreviation for sub-Saharan Africa in line 25 of the abstract section. Comment 3: In Abstract add the full form (DHS) from the first paragraph (line 27). Response 3: Thank you have added the extended form of DHS in line 27 of the revised manuscript. Comment 4: Methods described aren't the ones opted by the author. They were done part of the National Surveys. These methods should be supported be relevant citations (lines 94-100). Response 4: Thank you very much. We have provided citation for DHS methodology as suggested in the revised manuscript. Comment 5: Dependent variable: Add citation considering my earlier comment. Response 5: Thank you. We have added the citations suggested in comment 1 for the dependent variable. Response to Reviewer #4 Comments Comment 1: My assessment of the manuscript is that it is well-written and is well organized. I also see that this is the second reviewer of the manuscript which has improved after the authors addressed the previous reviewers’ comments. The findings from this study have the potential to impact health interventions and policy to improve the initiation of timely ANC visits and maternal health services in developing countries. Apart from a few grammatical errors, which I have mentioned below and the authors need to address them, the manuscript can be considered for publication. Response 1: Thank you for your appreciation and important concern. We have thoroughly checked and fixed the manuscript for grammatical and typos errors. Comment 2: The authors may opt to use ANC visit instead of ANC booking, as currently, they have used the two terms interchangeably, which can be confusing. Further, the women reported their ANC visit(s) rather than their booking of ANC visit(s). Response 2: Thank you for your suggestion. We have replaced “ANC booking” with “ANC visit” throughout the revised manuscript. Comment 3: The word “bias” is usually used as uncountable; therefore, in line 300 “may be recall bias” instead of “may be a recall bias” should be used. Response 3: Thank you for your concern. We have changed “may be a recall bias” to “may be recall bias” in the revised manuscript. Comment 4: In line 295 “This data was collected” to be changed to “The data were collected”. Response: Thank you very much. We have replaced “This data was collected” with “The data were collected” as suggested in the revised manuscript. Comment 5: The above are a few errors I have noticed; the authors should check the English language and grammar for their work in this study. Response 5: Thank you for your recommendation. We have checked and fixed grammatical and editorial errors throughout the revised manuscript. Attachments Attachment Submitted filename: Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0316671.r006
16 Dec 2024 Decision Letter - Muhammad Haroon Stanikzai, Editor Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: a multilevel analysis of multination population survey data PONE-D-24-21779R3 Dear Dr. Mare, 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, Muhammad Haroon Stanikzai Academic Editor PLOS ONE Additional Editor Comments (optional): Thank you for addressing the reviewer comments. - Line 83: Please spell out SSA. Abbreviations should be spell out at their first use. You have spelled out in the abstract. You all also need to spell it out in the body of manuscript. - Line 90: Please spell out DHS. - Tables 1 and 4: Please correct Partner Education to Partner education. Reviewers' comments: https://doi.org/10.1371/journal.pone.0316671.r007
Formally Accepted
20 Dec 2024 Acceptance Letter - Muhammad Haroon Stanikzai, Editor PONE-D-24-21779R3 PLOS ONE Dear Dr. Mare, 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. Muhammad Haroon Stanikzai Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0316671.r008

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