PONE-D-24-23199Household food insecurity, living conditions, and individual sense of security: a cross-sectional survey among Burkina Faso refugees in GhanaPLOS ONE

Dear Dr. Head,

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

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

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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

Reviewer #4: Yes

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

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: 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: This study provides interesting insights into the significant food insecurity challenges facing Burkina Faso refugees in Ghana’s Upper East region.

As a one-off cross-sectional survey, the study captures food insecurity at a single point in time, which may not accurately reflect fluctuations in food access or conditions over time. A longitudinal approach would be more appropriate for tracking how food insecurity levels change, particularly given the volatile nature of refugee populations and their reliance on aid.

Although 498 households were surveyed, the study does not specify how representative this sample is of the overall Burkina Faso refugee population in northern Ghana. More information on sampling techniques would help clarify whether these results can be generalized across different refugee populations or other regions.

The study relied on community-focal persons to contact registered refugee households, which may introduce selection bias. Refugees more integrated into the community or more familiar with focal persons may have been overrepresented, potentially skewing the results on food insecurity, social integration, and perceptions of safety.

While the Rasch model is a reliable method for scaling responses, it would be helpful to see more justification for its use in this context. Additionally, further explanation of how Rasch scores were interpreted in assessing food insecurity levels would improve clarity. Complementary methods, such as factor analysis or other model checks, could strengthen the robustness of findings.

While the study highlights key factors (e.g., urban vs. rural origin, camp vs. community living), it lacks consideration of potentially confounding variables, such as employment opportunities, family size, and health conditions. Controlling for these variables would provide a clearer understanding of the specific drivers of food insecurity within this population.

The link between accommodation dissatisfaction and food insecurity was marginally significant (p = .060), suggesting only a weak association. This should be interpreted cautiously. Additional qualitative insights, such as interviews, could shed light on how living conditions contribute to the experience of food insecurity and whether dissatisfaction stems from factors like overcrowding, location, or infrastructure inadequacies.

Although the study calls for improved food distribution logistics, accommodation facilities, and healthcare access, these recommendations lack specificity. For instance, outlining what logistical improvements are necessary (e.g., increased food delivery frequency, local partnerships) or how accommodation can be sustainably expanded would enhance the applicability of these findings for stakeholders like governments, UNHCR, and UNICEF.

Finding that 73.5% of refugees feel safe and welcomed is encouraging, but it would benefit from further investigation into what factors influence these perceptions, particularly as food insecurity often increases vulnerability. A more nuanced analysis might also explore how safety perceptions differ between camps and community-integrated refugees.

Reviewer #2: I commend the authors on a capably conducted and important study of food insecurity in a refugee context. I recommend the following revisions.

1. The paper would be enhanced with some theoretical context and consideration of possible theoretical implications. I recommend food and nutrition security theory, which can be accessed at the following link: https://journals.sagepub.com/doi/10.1177/0379572120925341#:~:text=Food%20and%20nutrition%20insecurity%20continue,but%20not%20acceptable%20or%20sustainable. This theory can provide greater analytical precision. Perhaps most importantly, the authors’ empirical investigation could be used to advance and refine the theory given the refugee context they are studying. That could be done in the Discussion.

2. I appreciate the authors’ attention to methodological detail. Were power analyses needed or employed to arrive at the sufficient sample size number identified in the manuscript? They have addressed sample size considerations using a single population proportion formula. I’d welcome another couple of sentences on this front for additional clarity.

3. There were two stages of sampling used here. First, purposive sampling was used for community selection, which is completely understandable. Second, individuals were sampled prior to survey administration. Should we be concerned about selectivity bias in this second stage of sampling? Could reliance on the community refugee focal person lead to sampling bias due to the manner in which this work is done? More notably, could some refugees decline or opt out in a nonrandom fashion? Please address these possibilities if they are reasonable threats. They do not undermine the study but could be limitations.

4. I like that religion (faith tradition) was examined as a control. Please expound briefly on traditional religion, though I’m pretty sure I understand that. Also, was level of religious activity gauged? If so, I’d say to test for that.

5. Some proofing for spacing would be welcome. See, e.g., the first sentence of the second Discussion paragraph. I saw this in several spaces.

Generally, this is an impressive study with important findings. Well done.

Reviewer #3: Comments:

The manuscript addresses a relevant research question within the journal's scope, examining household food insecurity, living conditions, and perceptions of security among Burkina Faso refugees residing in the Upper East region of Ghana.

To enhance the manuscript's structure and flow, I have provided some comments, questions, and suggestions below.

The title effectively captures the manuscript's focus and is concise. The abstract accurately summarizes the objectives, methods, results, and conclusions, though some revisions are needed for clarity.

Throughout the text:

- I recommend using justified alignment for uniform spacing.

- Maintain a consistent font throughout the text, including in the references.

- Standardize references to supplementary materials to avoid variations, for instance, using either “(supplementary S1),” “supplementary information (S2),” or “(Supplementary, S3).”

Abstract:

- Replace “key words” with “keywords.”

Introduction:

- I suggest adding a paragraph after “Refugees often flee from armed conflict [...].”

- Provide the full name of UNICEF at its first mention. Abbreviations should be introduced only upon their first use.

Methods:

- Sampling technique and procedures: Include a separate paragraph describing inclusion and exclusion criteria, beginning with “Inclusion criteria were adults [...].”

- Study variables: If describing subsections, avoid using bold on the same line as text; consider adding a paragraph before each subsection.

- Sense of security: In “1 = strongly disagree; 5 = strongly agree,” consider removing italics.

- Data collection procedure and quality control: Add a paragraph after “Ten community health workers participated [...].”

- Briefly outline FIES 1-8 variables in the Data analysis techniques section.

Results:

- Tables 1 and 3: Replace “yrs” with “years.”

- Provide the full name of FAO upon its first mention, as abbreviations should be introduced only once.

- Tables 2 and 3: Match the format of these tables with Table 1 regarding borders and lines.

- Table 5: Insert a line before explaining the asterisk referring to the average to clarify that it belongs to the legend.

- Ensure consistency in table legends, using either italics or plain text.

Discussion:

- Add references to support or contrast with the findings in the paragraph discussing Figure 5: “The conceptual framework in Figure 5 is adapted from adapted [...].”

- Consider adding references in the paragraph, “Around half of the participants in this study resided in refugee camps set up by UNHCR and the local authorities [...].”

- Add references to support the paragraph: “Refugees are entitled to receive welfare support from local authorities [...].”

- Add a paragraph after “In this study, refugees presently residing with an acquaintance within the host community [...].”

- Add references for the paragraph: “The displacement of Burkina Faso populations is on a much smaller scale than the situation with Ukraine [...].”

Strengths and Limitations:

- Add a paragraph after “However, the study contains limitations [...].”

Conclusion:

- Add a paragraph following “The short-term measures could include improved logistics [...].”

References:

- Use brackets instead of parentheses for in-text citations.

- Consistently place references in brackets after the period at the end of the sentence; some currently appear before the period.

- Ensure the font and size of references match the rest of the text.

- Format references in Vancouver style, per the author guidelines.

Figures:

- Improve the quality of images.

- Figure 4: Explain the abbreviation CSOs in the caption.

Supplementary Material:

- S1: Format the supplementary material to use the same font, color, and size as the main text, with bold and italics consistent across all items. Some items currently appear in different fonts, colors, sizes, and styles.

Reviewer #4: The study is highly relevant and was conducted in a robust and appropriate manner. The results obtained by the authors represent a significant contribution. However, the discussion falls short of the quality presented in the rest of the manuscript. After reading the results, it is natural for readers to expect a discussion on the determinants that contributed to the food security observed among Burkinabe refugees in Ghana. Yet, the authors address these determinants only briefly. Numerous comparisons are made with refugees in various other countries, which have socioeconomic conditions and refugee support systems quite different from those in Ghana. By relying on multiple isolated citations, the authors miss an opportunity to focus on the key determinants of food insecurity, which would allow readers a deeper understanding of the complex situation faced by refugees in Ghana.

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Reviewer #1: Yes: M. João Reis Lima

Reviewer #2: No

Reviewer #3: Yes: Marcela Gomes Reis

Reviewer #4: No

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Household food insecurity, living conditions, and individual sense of security: a cross-sectional survey among Burkina Faso refugees in Ghana

PONE-D-24-23199R1

Dear Dr. Head,

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.

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António Raposo

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: (No Response)

Reviewer #2: 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 #1: Yes

Reviewer #2: 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 #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: Considering the answers and the modifications made in the manuscript by the authors, I believe it can now be published.

Reviewer #2: I commend the authors on a sound and thorough revision. In my view, this paper is ready to move forward.

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

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

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

Reviewer #1: Yes: M. João Reis Lima

Reviewer #2: No

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