PONE-D-24-42057Prevalence and determinants of unhealthy feeding practices among young children aged 6–23 months in five sub-Saharan African countriesPLOS ONE

Dear Dr. Tekeba,

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 Dec 26 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'.
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• 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,

António Raposo

Academic Editor

PLOS ONE

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When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0305810

https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-024-05027-z

In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

3. In the online submission form, you indicated that “data will be available upon request”. All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either 1. In a public repository, 2. Within the manuscript itself, or 3. Uploaded as supplementary information. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval.

4. Please ensure that you refer to Figures 3 and 4 in your text as, if accepted, production will need this reference to link the reader to the figure.

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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: Yes

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: No

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: Yes

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: The manuscript addresses a pertinent research question within the journal's scope and investigates a significant issue concerning the pooled prevalence of unhealthy feeding practices and determinants among children aged 6–23 months in five subSaharan African countries.

To improve the structure and flow of the manuscript, I would like to offer some comments, questions, and suggestions.

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

Abstract:

- Reduce the abstract to 300 words, as recommended by the author guidelines.

- Ensure ethics committee registration is indicated.

- In the conclusion, include descriptions of the five countries analyzed.

- Define the abbreviations for "ANC" and "AOR" at their first occurrence.

- Change “key words” to “keywords.”

Ethics Statement:

- Although secondary data is used, mention this detail in the abstract.

Introduction:

- Abbreviations should only be defined once, at their first mention; review and avoid repeated definitions, using only the abbreviation thereafter.

Methods:

- If abbreviating “sub-Saharan African nations (SSA),” do so upon first mention and use the abbreviation consistently.

- Define “EAs” in Data source and sampling procedure, “ANC visit” and “EDHS” in Independent variables at first mention.

- Ensure the formula in Data management and model selection matches the text’s black font color.

- Clarify if ethical approvals, committee registration, informed consent, and primary database details are included, and provide a relevant link.

Results:

- Use consistent font size throughout, especially line 246.

- Add a legend in Table 2 for “ANC.”

- Define “ICC” in Random effect and model fit statistics at its first mention.

- In Table 3, provide a legend for “ICC,” “MOR,” “PCV,” and “LLR”; ensure table legends list all abbreviations, even if previously defined in the text.

- In Table 4, add a legend next to “ANC” explaining “AOR.”

Strengths and Limitations:

- Consider splitting this section, using separate paragraphs for strengths and limitations.

Conclusion:

- List the names of the countries studied.

- Summarize the key findings in brief.

References:

- Use brackets instead of parentheses for citations.

- Ensure the reference font is consistent with the main text.

- Format references in the “Vancouver” style.

Reviewer #2: Abstract

The abstract is informative and well-structured, providing a solid foundation for understanding the study's context, methods, findings, and implications.

Introduction

The introduction provides a comprehensive overview of the importance of infant feeding practices and the impact of unhealthy diets on young children, particularly in low- and middle-income countries. The relevance of focusing on sub-Saharan Africa is well-justified, though further emphasis on the unique challenges of this region could strengthen the rationale. Additionally, a clearer definition of terms like "sentinel foods" and a more sequential flow of ideas would improve clarity.

Methods

The Methods section is comprehensive, detailing the study design, sampling, and statistical methods used effectively. The multi-level logistic regression approach is appropriate, given the hierarchical data structure, and variables are clearly defined. To enhance clarity, I suggest briefly explaining "EAs" (enumeration areas) in the sampling procedure and summarizing the definition of "unhealthy feeding practices" after listing criteria.

Results

The results section presents a well-structured and comprehensive analysis of unhealthy feeding practices among children across five African nations. The findings are clearly articulated, highlighting the variations in prevalence rates and key demographic factors associated with these practices.

Discussion

The discussion section effectively contextualizes the findings on unhealthy feeding practices within the broader trends observed in low- and middle-income countries. The comparison of prevalence rates with studies from higher-income nations and previous sub-Saharan African research provides valuable insights, though the rationale for differences could be articulated more clearly. The exploration of demographic factors such as age, economic status, and urban versus rural residence in relation to feeding practices is well-supported by existing literature, which strengthens the analysis.

However, the discussion could benefit from a more concise presentation of key findings to enhance clarity. Some sections feel repetitive, particularly when reiterating known associations without adding new insights.

Conclusion

The conclusion succinctly summarizes the key findings of the study regarding the high prevalence of unhealthy feeding practices in five sub-Saharan African countries. It effectively highlights the need for targeted interventions by policymakers and relevant authorities to address these issues. However, the conclusion could be strengthened by briefly reiterating specific statistics or findings from the study to reinforce the severity of the problem. Additionally, it would be beneficial to explicitly mention the potential long-term impacts of unhealthy feeding practices on child health and development, as this would underscore the urgency of the recommended actions.

Reviewer #3: Overall, an interesting read. The subject matter is highly relevant, given the nutritional transition in low- and middle-income countries. Congratulations to the authors for their work!

Some specific comments follow:

1. In the abstract, perhaps authors should specifically mention the use of multilevel logistic regression, as this is a strength of the paper;

2. In the introduction, the authors mention a “paucity of recent updated information,” which justifies the study. Identifying specific gaps in existing literature (e.g., lack of multi-country data or limited insight into socio-economic determinants) would better underscore the study’s novelty;

3. In sample selection, authors include a description of the sampling procedure from DHS. This is welcomed, but a more explicit mention of any exclusions or limitations due to the DHS sampling framework would improve transparency;

4. Regarding the outcome variable, was the assessment of intake made according to a food frequency questionnaire? Or to the intake in the day (or previous day) of data collection? Please clarify. I understood better after reading the complete paper, but it could be clearer up to this point in the paper.

5. The manuscript is well-referenced, with appropriate citations to support the discussion and methodology, but there is a lack of more recent publications (past five years) on dietary transitions in Sub-Saharan Africa... Was this topic not addressed recently in the scientific literature?

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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: Marcela Gomes Reis

Reviewer #2: Yes: Leandro Oliveira

Reviewer #3: No

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PONE-D-24-42057R1Prevalence and determinants of unhealthy feeding practices among young children aged 6–23 months in five sub-Saharan African countriesPLOS ONE

Dear Dr. Tekeba,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jan 30 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,

António Raposo

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.

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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: (No Response)

Reviewer #2: (No Response)

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 #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

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: Abstract

- The abstract currently has 410 words; I maintain the recommendation to reduce it to 300 words, as specified in the author guidelines.

- To aid in reducing the word count, I suggest that after defining the acronyms, you use them consistently instead of repeating the terms in full, as seen with the acronym SSA referring to sub-Saharan Africa.

- In the Keywords section, I recommend starting each keyword with a capital letter for consistency.

Introduction

- Even though some abbreviations are defined in the abstract, they should also be defined upon their first mention in the main text. For example, in the sentence: “Nevertheless, diets in many low- and middle-income nations including SSA are changing [...]”, the acronym SSA (sub-Saharan Africa) should be explicitly described.

- When abbreviations are used, ensure they are defined at first mention. If you opt to use abbreviations throughout the text, ensure consistency by using either the abbreviation or the full term exclusively.

Figure 1

- After the description of Figure 1, ensure the subsequent text begins with a capital letter.

Figures

- Standardize the titles of all figures. For instance, ensure they follow the format used in Figure 1: The overall pooled prevalence of unhealthy feeding [...], which includes a colon (:). Other figures currently lack this formatting.

- Decide on a consistent placement for figure titles (either above or below the figures) to avoid confusion for the reader.

References

- Format the references according to the Vancouver style. Note that there is a specific way to format website citations, which is currently not being followed. Ensure all references adhere to this standardized formatting.

Reviewer #2: The authors have successfully addressed all my comments and suggestions. The abstract remains clear and informative, while the introduction, methods, discussion, and conclusion sections have been revised to enhance clarity, depth, and relevance. The improvements, including clearer definitions, streamlined discussions, and strengthened conclusions with relevant statistics, significantly elevate the manuscript's quality.

I recommend the manuscript for acceptance.

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 #1: Yes: Marcela Gomes Reis

Reviewer #2: Yes: Leandro Oliveira

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.

PONE-D-24-42057R2Prevalence and determinants of unhealthy feeding practices among young children aged 6–23 months in five sub-Saharan African countriesPLOS ONE

Dear Dr. Tekeba,

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 Feb 01 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

António Raposo

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: (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

**********

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

Reviewer #1: 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

**********

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

**********

6. Review Comments to the Author

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

Reviewer #1: The authors addressed all the comments; however, the absence of the description for the first mention of the abbreviations SSA and USAID was still observed. I suggest including the full description upon first mention and using only the abbreviations throughout the remainder of the text, which poses no issue.

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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: Marcela Gomes Reis

**********

[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.

Prevalence and determinants of unhealthy feeding practices among young children aged 6–23 months in five sub-Saharan African countries

PONE-D-24-42057R3

Dear Dr. Tekeba,

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,

António Raposo

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: