PONE-D-24-13694Trends and Socioeconomic Inequality in Recommended Antenatal Care (ANC) Service Utilization in Ethiopia:  A Decomposition Analysis Using Ethiopian Nationwide Demographic Health Survey Data from 2011-2019PLOS ONE

Dear Dr. Tsega,

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Reviewers' comments:

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Comments to the Author

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

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Reviewer #1: Yes

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

Reviewer #1: Yes

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

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: This manuscript analyzed the patterns and socioeconomic disparities in the utilization of recommended antenatal care (ANC) services in Ethiopia. It used nationwide demographic health survey data from 2011 to 2019. In general, the research is solid, carefully designed, and the paper is skillfully written and well-structured. Having said that, I strongly urge the authors to focus on the following few issues:

1. Some attention is needed for lines 207-208 by the authors.

2. Line 232: The authors wroye: (Error! Reference source not found.). What is the meaning of this statement?

3. Unlike the Tables, all Figures clearly require significant revisions to enhance their quality.

4. Editing is needed for the cell in Table 6, specifically in column 3 and row 4.

5. While the discussion is acceptable, it could be enhanced by including more comparisons with other studies conducted in Ethiopia or the surrounding region that share similar conditions.

6. While the discussion is acceptable, it could be enhanced by including more comparisons with other studies conducted in Ethiopia or the surrounding region that share similar conditions.

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Reviewer #1: No

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PONE-D-24-13694R1Trends and socioeconomic inequality in recommended Antenatal Care Service utilization in Ethiopia: A Decomposition Analysis using Ethiopian Nationwide Demographic Health Surveys from 2011-2019PLOS ONE

Dear Dr. Tsega,

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 19 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,

Ranjan Kumar Prusty, Ph.D.

Academic Editor

PLOS ONE

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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 #2: (No Response)

Reviewer #3: (No Response)

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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: No

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

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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: No

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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: No

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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 few comments

1. In the methodology, The authors have kept individual level socioeconomic status and community or macro indicators such as HDI together, it will be good if they present it with separate subtitle.

2. Further, Mother’s current marital status is described as currently unmarried, currently married. It will be good if Currently unmarried presented as widowed/separated

3. In table 3, for the Family size, in the COR the authors have kept ≥7 as reference and in the adjusted model, the authors have kept 1-4 as reference, why?. Its better to follow same

Reviewer #3: Reviewer’s report:

Manuscript Number: PONE-D-24-13694R1

Article Title: Trends and socioeconomic inequality in recommended Antenatal Care Service utilization in Ethiopia: A Decomposition Analysis using Ethiopian Nationwide Demographic Health Surveys from 2011-2019

Overview:

This paper, submitted to PLOS ONE, has focussed on an important public health issue in LICs, socioeconomic inequality in utilization of antenatal care services among women. The study used data from three waves of Ethiopian DHS conducted in years 2011, 2016, and 2019. Bivariate and multivariate logistic regression models were applied to find out the determinants of recommended ANC services utilization among Ethiopian mothers. Further, decomposition of concentration index was carried out to measure contributions of studied variables in socioeconomic inequalities.

Finding highlights that coverage of recommended ANC services increased from 29.96% in 2011 to 44.70% in 2019. Several socio-demographic factors such as mother’s age and education, household wealth status, distance of mothers’, place to the nearest health facility, among others were significantly associated with utilization of recommended ANC services. The decomposition of concentration indices revealed household wealth status as the largest contributor (~67%) to the socioeconomic inequality that exist in utilization of antenatal care services among Ethiopian women.

The current version of the paper does not meet the publication quality. The manuscript should be thoroughly revised by carefully addressing a number of shortcomings, ranging from its grammatical errors to statistical analyses. Authors may consider my comments below while revising the manuscript.

I appreciate the opportunity to review this work and hope that authors would find my comments useful.

Observations:

— The information presented in the ‘Introduction’ section is very generic. The research problem to be addressed (in this study) should be described adequately and with an appropriate background, which is missing.

— Where is the literature review? Authors should add at least one paragraph on review of relevant literature to the ‘Introduction’ section.

— Next is research gap. Authors should describe whether there were any research gaps in the existing literature and thereafter, the need for this study should be mentioned.

— The methodology used in the study should be introduced to the readers in the ‘Introduction’ section only.

— Line 80: Authors may consider renaming of the heading ‘Data and Methods’.

— Line 89: What is ‘source population’?.

— Line 90-91: It should be mentioned clearly about who were the study population (e.g., pregnant women or women of reproductive age).

— How do you define ‘Recommended ANC Services’? Please disclose it to readers while defining outcome variables.

— Line 115: Remove the statement “and it is also more practical to implement”

— Line 199-201, 202-203: Not clear, what authors want to state.

— Line 218: What does it mean by ‘candidates’?

— Line 401-403: Not clear, what authors want to state.

— The study should be organised appropriately ensuring that it is not taxing the readers’ attention.

— Finally, this manuscript needs thorough English language editing to make it understandable to the readers.

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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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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.

Trends and socioeconomic inequalities of recommended antenatal care services utilization in Ethiopia: A Decomposition analysis using Ethiopian nationwide Demographic Health Surveys 2011-2019

PONE-D-24-13694R2

Dear Dr. Tsega,

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,

Ranjan Kumar Prusty, Ph.D.

Academic Editor

PLOS ONE

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