PONE-D-23-38296Prevalence of HTN and its risk factors among tribal population in Chhattisgarh, India as per the fifth round of the National Family Health SurveyPLOS 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: Yes

Reviewer #2: Yes

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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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: Yes

Reviewer #2: No

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: This study examines the prevalence of hypertension (HTN) and its risk factors among the tribal population in Chhattisgarh state using data from NFHS 5. I recommend several recommendations to improve the study's clarity and significance:

1. A paragraph explaining why the focus is specifically on Chhattisgarh state. This will help contextualize the study's geographic scope.

2. Given that numerous studies have already utilized NFHS 5 data to examine hypertension and its risk factors, add a paragraph that outlines the unique contributions of this research.

3. In the data analysis section, it is reported that no chi-square, mean, or standard deviation (SD) values were found using the respective statistical tests for categorical and continuous data. This needs verification and correction if necessary.

4. The study's title and objectives are centered on the tribal population of Chhattisgarh state. However, Tables 1 and 4 focus on tribal groups, whereas Tables 2 and 3 make comparisons with the general population. It is unclear why these comparisons are made. Consider revising the study’s objectives and title to reflect a comparative analysis between tribal and non-tribal populations of Chhattisgarh state, or alternatively, focus solely on tribal data from NFHS 4.

5. While Table 2 addresses the prevalence of prehypertension and Table 3 deals with hypertension, Table 4 only discusses hypertension without presenting an adjusted odds ratio for prehypertension. Given the high prevalence of prehypertension noted in the results, it would be beneficial to include a multivariate analysis for prehypertension in both sexes separately.

These suggestions aim to enhance the study’s coherence and depth, ensuring it makes a clear, valuable contribution to the existing body of knowledge.

Reviewer #2: The study reports on the prevalence of hypertension and its risk factors in tribal populations of Chhattisgarh state of India. Study can provide valuable information on Hypertension and its risk factors for state of Chhattisgarh. However manuscript have lots of deficiencies which confuses any reader. To draw your attention following are the observations: -

(1) In abstract, high-altitude has been associated with HTN, but manuscript does not support any data on altitude of study population/participants

(2) Key words - "Hypertension" and "HTN" both have been written

(3) In "Introduction" part of manuscript few sentences have written even without citing references. e.g. As such ........developing countries. in line 65-67 on page 4

(4) NO citation for "Existing...........................................Chhattisgarh." in line No. 70 - 72 on page 4.

(5) NO citation for "Currently ........................................tribal people." in line No. 72-73 on page 4.

(6) Reference 11 is about 42 years old, which is not relevant in current time

(7) Statement of undiagnosed HTN is provided in Line No. 82 - 83 on page 5. I wonder, whether undiagnosed HTN was research question of this study.

(8) Heading "Study population" on page 6 is includes many information about the data and methodology, which should not be included i defining the study population.

(9) A systolic BP has been wrongly defined as 121 - 90 mm Hg on line 128 on page 7

(10) Independent variables: Age groups are wrong

(11) Results: Line 154 page 8 - Of these 72010,27760 is confusing

(12) Table-1: Numbers of the categories of Age, Residence etc do not sum up to the size of participants depicted in column heading

(13) Table-2: Lots of data missing from the table. Total ST from urban and rural areas were 41.23% and 42.84% respectively - Data of 15.93% STs are not known. Similarly as per categories of Marital status i.e. "never married 40.91%; Currently married 44.6%; widowed 38.1% sup up to 123.61%, confusing.

(14) Table-3: Weighted % has been provided for STs and General population - Reason of taking weighted % not given in text

(15) Table-4: Many aORs having 1 in their 95% CI limits have been shown with asterix symbol, typically used to show significance level, are Not significant

(16) Line No. 214 - 217 on page 14 - " Another study by Kusuma et a...............prevalence of HTN. [15] - There was not such study in reference list authored by Kusuma

(17) Wrong citation method in line No. 256 on page 16

(18) Fig 1 provided in manuscript does not add value with respect to its various parts shown in map. Method of showing map of state may not be comprehensible to readers from world beside India

Reviewer #3: 1. The title should not include short forms

2. The study lacks clarity on distribution of sample population as indicated in various tables. There is also mismatch with the open data source in NFHS site, so there is need to spell clear reason for the same in methodology section.

3. source of core data should be mentioned in methodology

4. In table 3 Data, for better comparison data of tribal population should be compared with non tribal population (segregating tribal population for total population)

4. study results should be compared from similar literature regarding prevalence of hypertension among tribal vs non tribal population of central India

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Reviewer #1: Yes:  Nirmalya Mukherjee

Reviewer #2: No

Reviewer #3: Yes:  Suyesh Shrivastava

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Prevalence of Hypertension and its risk factors among tribal population in Chhattisgarh (India): Insights from the fifth round of the National Family Health Survey (2019-21)

PONE-D-23-38296R1

Dear Dr. Goel,

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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Kind regards,

Pijush Kanti Khan, Ph.D.

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 #4: 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 #4: Yes

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

Reviewer #1: 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 #1: Yes

Reviewer #4: 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 #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 #1: (No Response)

Reviewer #4: Authors have addressed all the comments highlighted by the previous reviewers. Article may be accepted for publication.

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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: No

Reviewer #4: Yes:  Dr Pankaj Prasad

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