PONE-D-24-31683Knowledge, attitude, practice, and adherence toward antimicrobials among women living in two urban municipalities in Lalitpur district, NepalPLOS ONE

Dear Dr. Jha,

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Kshitij Karki, MPH, MA

Academic Editor

PLOS ONE

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“University Grants Commission collaborative research grant. Grant number CRG-79/80-HS-01.”

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4. Thank you for stating the following in the Acknowledgments Section of your manuscript:

“Authors would like to thank all the participants from both the municipalities. We also like to thank the ward chairs of the Godavari and Mahalaxmi municipalities for allowing us to conduct the research in their areas. We also thank the University Grants Commission for grants us with the collaborative research grant with the grant number CRG-79/80-HS-01.”

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Additional Editor Comments:

The intervention study is very timely and needed. Please do following revision and also go through all the comments from reviewers.

- Check the spelling of Godawari Municipality

- Introduction part - no need to write the methodology but add the importance of the study

- Write details of data analysis in methodology part

- Check the table percentage (whether row or column %) as you are comparing two municipalities

- Revisit the table and try to make it more efficient

Thank you so much.

[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: Partly

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1. General

Jha et al assessed KAPs on antimicrobial use in Nepal. The manuscript is potentially relevant but would require major revision to make it fit for publication. It has a lot of information but poorly organized.

2. Introduction

a. Authors described the burden and public health importance of AMR but without statistics. Kindly include statistics at global, regional, and national levels to give weight to the problem

b. What did previous studies find about AMR, knowledge, attitude, and use of antibiotics among community members? What were the gaps? Which gap(s) is the current study seeking to address?

c. Merge lines 79-81 with 97-98

3. Methods

a. How were the study areas classified? What differentiates the study areas as intervention and control?

b. How was the data analyzed? It is important to include a brief on data analysis in this section.

c. More respondents were selected in Godawari municipality compared with Mahalaxmi. Why the unequal sample size?

d. Why was Lalitpur district selected for the study and not any other district in the province or country?

e. Background information on the study site is inadequate. Authors should provide additional information on the health profile of the study area including access to healthcare, disease burden etc

4. Results

a. In lines 154-156 authors reported that presence of respiratory disease was found not to be different among the two municipalities. However, in line 156-158, presence of respiratory disease was found to differ among the two locations. Kindly clarify

b. The results in table 1 have not been adequately described. Authors should give a succinct description of the outputs in the table

5. Discussion

a. The discussion section appears to be an extension or repetition of the results. Authors should reorganize, explain the meaning of the results, relate them to studies done elsewhere, and reasons for any differences observed

b. Lines 313-325 are better placed under introduction

6. Conclusion

a. A paragraph on the key findings should precede the recommendations

Reviewer #2: This study describes the results of a survey conducted in two districts of Nepal. The survey collected information about the awareness regarding antibiotics and antimicrobial resistance, attitude towards the use of antibiotics and adherence to treatment with antibiotics among woman in these two districts, using a structured questionnaire.

Below, please find my comments:

1. Page 4 – Please, define the abbreviation FCHV when you first mention it in the main text of the manuscript.

2. How big is the problem of AMR in Nepal? Are there any data about the resistance of specific bacterial pathogens to specific antibiotics? Please describe the situation in the country in this regard.

3. How similar the selected two districts - Mahalaxmi and Godawari - are in terms of urban vs rural areas, population demographics, prevalence of infectious disease, etc. Please, provide some information about this.

4. Page 5, Methods – I would not characterize this study as quasi-experimental. This is a population survey and would recommend referring to it as such.

5. Page 5 – Sampling techniques: You indicate: “All women belonging to the mother’s group of FCHVs of intervention and comparison areas were included in the baseline survey” – in your assessment, how much are these participants representative of the general population of the two districts you studied?

6. Page 24 – In the limitations section: “No intervention for the community pharmacies in this research project is another limitation.” – since this is a population survey, it was not required to have pharmacies participating in the study. I would not consider it as a limitation.

Reviewer #3: Would like to request a clarification in table 1 regarding the variable 'No disease present in the household' followed by yes and no requires some clarity whether yes means that there is disease or there is no disease. Also if a future study is planned as an intervention clarification regarding why respiratory illness was included as a separate illness along with other communicable diseases.

Would also like to request the authors to add something in the title to indicate that this study is the first part of a larger study which to be done as a quasi-experimental study which would give some more clarity to the title as to why this is being done is as an initial step towards the intervention study being done at a later date.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Attachments

Attachment

Submitted filename: REVIEWER COMMENTS.docx

Baseline assessment of knowledge, attitude, practice, and adherence toward antimicrobials among women living in two urban municipalities in Lalitpur district, Nepal

PONE-D-24-31683R1

Dear Dr. Nisha Jha,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Kshitij Karki, MPH, MA

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you. Please check the the spelling of Godawari Municipality (You have written different (Godavari) in the manuscript).

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 #3: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: Yes

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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 #3: Yes

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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 #3: Yes

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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: I have no further comments. Authors have answered all my comments and made corresponding changes in the manuscript. Thank you.

Reviewer #3: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

Reviewer #3: No

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