Factors associated with Catastrophic Healthcare Expenditure in communities of Lagos Nigeria: A Megacity experience

Kikelomo Ololade Wright; Adeyinka Adeniran; Adedayo Aderibigbe; Olufunsho Akinyemi; Temiloluwa Fagbemi; Omoyeni Ayodeji; Biola Adepase; Emmanuella Zamba; Hussein Abdurrazzaq; Faith Oniyire; Olusegun Ogboye; Akin Abayomi

doi:10.1371/journal.pone.0316814

Peer Review History

Original SubmissionJuly 10, 2024
4 Oct 2024 Decision Letter - Ugochukwu Anthony Eze, Editor PONE-D-24-25551Factors Associated with Catastrophic Healthcare Expenditure in Communities of Lagos Nigeria: A Megacity ExperiencePLOS ONE Dear Dr. Wright, 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 Nov 18 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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: Yes 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: Title – Factors Associated with Catastrophic Healthcare Expenditure in Communities of Lagos Nigeria: A Megacity Experience - Appropriate Abstract – Well presented. Introduction – Statement of problem, magnitude of problem, rationale for the study and study objectives well presented. Methods and analysis – Clearly presented. Study area description, study population, sample size calculation, sampling technique, data collection, variables and data analysis are well presented. Study setting, target population, sampling techniques and data management are well described •There are too many 1 - sentence paragraphs. Avoid 1 - sentence paragraphs Result Table 4 – replace < 0.000 with < 0.001 Discussion – Findings well discussed. Line 231 – The CHE cannot be regarded as similar (Over 50% higher). It is better referred to as "higher" Line 235 – Compare the OOP in Kenya with Nigeria before this statement can be affirmed. Conclusion and Recommendations are appropriate References - Adequate Reviewer #2: 1. The manuscript is technically sound. 2.. The choices of the statistical tools were appropriate for the Questions 3. All data was made available 4.The English language was presented correctly. 5. The article should be accepted. ****** 6. 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If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-24-25551_reviewer1.pdf https://doi.org/10.1371/journal.pone.0316814.r001
Revision 1
9 Oct 2024 Author Response Point-by-point responses to reviewers' comments. Reviewer #1: Title – Factors Associated with Catastrophic Healthcare Expenditure in Communities of Lagos Nigeria: A Megacity Experience - Appropriate Abstract – Well presented. Introduction – Statement of problem, magnitude of problem, rationale for the study and study objectives well presented. Methods and analysis – Clearly presented. Study area description, study population, sample size calculation, sampling technique, data collection, variables and data analysis are well presented. Study setting, target population, sampling techniques and data management are well described. Thank you Response To Comments 1. •There are too many 1 - sentence paragraphs. Avoid 1 - sentence paragraphs Result: Table 4 – replace < 0.000 with < 0.001 This has been done Discussion – Findings well discussed. Thank you 2. Line 231 – The CHE cannot be regarded as similar (Over 50% higher). It is better referred to as "higher." This has been corrected to read ‘’which is slightly higher than figures’’ in line 243 3. Line 235 – Compare the OOP in Kenya with Nigeria before this statement can be affirmed. This has been corrected to read, “Our study shows a higher CHE than another Kenyan study, which indicated a prevalence of 1.55% at a 30% threshold using the WHO model and potentially a lower prevalence of under 1.52% at a 40% threshold. This difference may be explained by the monthly OOP payments of ₦6,221.38 in our study compared to the average OOP health spending of 337.7 Kenyan Shillings (approximately ₦4,269.99) in the Kenyan study. 23” Lines 245-250 Conclusion and Recommendations are appropriate. Thank you References – Adequate. Thank you 4. Data Availability statement The datasets generated and analyzed during the current study are not publicly available because they contain potentially identifying or sensitive respondents’ information, but the Lagos State University Teaching Hospital—Health Research and Ethics Committee (LASUTH-HREC) can facilitate access upon reasonable request. (Email: dcst@lasuth.org) Lines 325-328 5. Role the funders took in the study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Reviewer #2: Thank you 1. The manuscript is technically sound. 2.. The choices of the statistical tools were appropriate for the Questions 3. All data was made available 4. The English language was presented correctly. 5. The article should be accepted. Thank you Attachments Attachment Submitted filename: Response to Reviewers - PLOS ONE.docx https://doi.org/10.1371/journal.pone.0316814.r002
8 Dec 2024 Decision Letter - Ibrahim Jahun, Editor PONE-D-24-25551R1Factors Associated with Catastrophic Healthcare Expenditure in Communities of Lagos Nigeria: A Megacity ExperiencePLOS ONE Dear Dr. Wright, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: Thank you for submitting the revised paper. There are few items to address as stated below. Kindly review and address all the comments. Introduction: Will be appropriate if the authors can provide insight about the status of health insurance in the study state including coverage, distribution and progress made by LASHMA. Methods: Sampling methods: Will be good to provide a table illustrating the numbers at each stage of the selection LGAs, wards, streets e.t.c. Lines 153 – 154: please indicate the year of the conversion rate. Also indicate that it is US Dollars. Data collection: Please indicate the periods when the data was collected, who collected the data and how the data was transmitted into REDCAP. Also highlight how data confidentiality and security was enhanced. Remember, the data was sensitive and was not shared in this submission which implies that it requires protection and security. Results: Figure 1 may not be necessary since it does not add any additional value. The findings presented in the figure have been outlined in the results. Also there are only 2 variables. However, if the authors decided to retain the figure, then clearly present the caption and define the abbreviations. Acknowledgement: Please include this section at the end of the paper. Please submit your revised manuscript by Jan 22 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. We look forward to receiving your revised manuscript. Kind regards, Ibrahim Jahun, MD, MSC, PhD Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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 ******** 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: 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: All the corrections have been effected by the authors. No additional comments to be addressed by the authors Reviewer #2: The Manuscript is intelligently written and technically sound. the Statistical analysis had answered the research questions. ****** 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: Prof. Tanimola Makanjuola Akande Reviewer #2: Yes: Bello Shahir Umar ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-24-25551_R2_reviewer.pdf https://doi.org/10.1371/journal.pone.0316814.r003
Revision 2
14 Dec 2024 Author Response Point-by-point responses to reviewers' comments. Introduction: Will be appropriate if the authors can provide insight about the status of health insurance in the study state including coverage, distribution and progress made by LASHMA. Lines 78-87 Under this scheme, state governments are also permitted to establish state-based health Insurance schemes. In 2007, Lagos State, often described as the commercial capital of Nigeria launched Community Based Health Insurance schemes to provide social health protection coverage for the poor and underserved communities while the Lagos State Health Management Agency (LASHMA) was established to provide quality healthcare and reduce out-of-pocket spending. Subsequently, LASHMA launched the Lagos State Health Insurance Scheme in 2019. A recent study conducted in Lagos revealed that only about 10.9% of respondents have ever been enrolled in any type of health insurance. Among these, private health insurance schemes were the most popular, utilized by 58.5% of participants, while less than one-fifth (15.9%) opted for the Lagos State-owned scheme. 13 Methods: Sampling methods: • Will be good to provide a table illustrating the numbers at each stage of the selection LGAs, wards, streets etc. • Lines 131-132 Stage Selection Criteria Total Available Selected Selection Method Stage 1: LGAs Urban LGAs 16 3 Simple random sampling (balloting) Rural LGAs 4 1 Simple random sampling (balloting) Stage 2: Wards Wards within selected LGAs Variable 1 per LGA Simple random sampling Stage 3: Streets Streets within selected wards Variable At least 10 per ward Systematic random sampling Stage 4: Houses Houses on selected streets Variable Based on sampling interval of 2 Systematic random sampling Stage 5: Individuals Consenting adults in households Variable 1 per household Random selection (balloting) Lines 153 – 154: please indicate the year of the conversion rate. Also indicate that it is US Dollars. DONE Data collection: • Please indicate the periods when the data was collected, who collected the data and how the data was transmitted into REDCAP. Also highlight how data confidentiality and security was enhanced. Remember, the data was sensitive and was not shared in this submission which implies that it requires protection and security. • DONE (Lines 143-148) Results: • Figure 1 may not be necessary since it does not add any additional value. The findings presented in the figure have been outlined in the results. Also there are only 2 variables. However, if the authors decided to retain the figure, then clearly present the caption and define the abbreviations. • FIGURE 1 HAS BEEN REMOVED Acknowledgement: Acknowledgements (Lines 327-329) Please include this section at the end of the paper. Additional reference: 13. Adeniran A, Wright K, Aderibigbe A, Akinyemi O, Fagbemi T, Ayodeji O, Adepase A, Zamba E, Abdur-Razzaq H, Oniyire F, Ogboye O, Abayomi A. Determinants of health insurance adoption among residents of Lagos, Nigeria: A cross-sectional survey. Open Health. 2024;5(1): 20230043. https://doi.org/10.1515/ohe-2023-0043 Attachments Attachment Submitted filename: Response to Reviewers 12.12.2024.docx https://doi.org/10.1371/journal.pone.0316814.r004
17 Dec 2024 Decision Letter - Ibrahim Jahun, Editor Factors Associated with Catastrophic Healthcare Expenditure in Communities of Lagos Nigeria: A Megacity Experience PONE-D-24-25551R2 Dear Dr. Wright, 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, Ibrahim Jahun, MD, MSc, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0316814.r005
Formally Accepted
2 Jan 2025 Acceptance Letter - Ibrahim Jahun, Editor PONE-D-24-25551R2 PLOS ONE Dear Dr. Wright, 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. Ibrahim Jahun Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0316814.r006

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