The impact of civil unrest on child health care: Evidenced by acute medical complications at presentation – A retrospective comparative study

Tesfaye Taye Gelaw; Mensur Azeze Getahun; Assefa Mitiku Bayih; Kassahun Gedefie Hailu; Gasha Amsalu Tadesse; Gebeyaw Lulie Adamu; Mastewal Addisu Legesse

doi:10.1371/journal.pone.0320902

Peer Review History

Original SubmissionJuly 1, 2024
1 Jul 2024 Author Response https://doi.org/10.1371/journal.pone.0320902.r001
4 Nov 2024 Decision Letter - Sk Md Mamunur Rahman Malik, Editor PONE-D-24-26693The Impact of civil unrest on child health care: evidenced by acute medical complications at presentation – a retrospective comparative study.PLOS ONE Dear Dr. Gelaw, 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 18 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. 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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://unesdoc.unesco.org/ark:/48223/pf0000190712 https://pubmed.ncbi.nlm.nih.gov/30621338/ 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. [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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes ****** 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 ****** 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 ****** 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: Thank you for your manuscript. Please see the attached document for detailed comments and suggestions. Reviewer #2: The authors have presented a paper on the topic ‘The Impact of civil unrest on child health care: evidenced by acute medical complications at presentation – a retrospective comparative study.’ Generally, the paper is clearly written and makes good contribution to research on children’s wellbeing. However, minor issues have been identified and it is recommended that these be addressed before publication of the manuscript. Please see below comments: The new sentence on the second line under the Introduction should start with a capital C, that is ‘Children…’ In-text citations throughout the paper are written outside the sentences after the punctuation mark- full stop is written. It will be good to bring citations before the punctuation mark to avoid adding citations to the beginning of new sentences. Referring to these statements ‘Data were collected by trained nurses and pediatric residents. Authors had no access to identify participants of the study’, it appears the authors used secondary data from medical records taken by others. It will be helpful for the authors to clarify the type of data used in the study, whether the data is considered primary or secondary data to guide future studies and whether any of the authors were involved in the data collection. In text reference to tables and figures should not be placed after the full stop but before. Generally, I believe that the discussion should be improved by providing more information and explanations to the findings. As the findings are very technical, for easy understanding by readers, the discussion is required to explain the findings and implications more clearly but I feel that this is lacking in the discussion section. It is very brief, some sentences appear vague and does not highlight more on all the key findings for example, what types of complications were identified. Indeed, there is a general presentation of trends showing an increase in complications and rural residents been affected more, but as to what types of complications they experienced more than the urban residents or in what ways are they more affected based on the findings are not explained. If there is a lack of awareness/data of the types of acute complications that the patients experienced, then this can be considered as limitation of the study as it will make a big difference in the study if there is a presentation of some of the acute complications identified to affect the groups differently. This will provide guidance for targeted intervention strategies. ****** 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: Beth A Tippett Barr Reviewer #2: 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. Attachments Attachment Submitted filename: PONE_Review_ChildHealthcare_Conflict_Aug2024.docx https://doi.org/10.1371/journal.pone.0320902.r002
Revision 1
13 Nov 2024 Author Response Response to academic editor and reviewers (Rebuttal letter): Journal: PLOS ONE Manuscript number: PONE-D-24-26693 Title: The Impact of civil unrest on child health care: evidenced by acute medical complications at presentation – a retrospective comparative study. Dear academic editor Sk Md Mamunur Rahman Malik and reviewers, Thank you very much for your nourishing comments and feedbacks. All the comments are constructive and lessons for us. Here below are our point-by-point responses and corrections for the constructive feedbacks provided. Response to Academic Editor Feedbacks: 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. a. Response: comment well accepted and revised as per PLOS ONE’s style. 2. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed: a. Response: comment well accepted. The paragraphs are revised and rephrased. Response to review comments of Reviewer #1: 1. Comment 1: Overall: Do a careful reading for grammatical corrections. a. Response: comment accepted and grammatical corrections done throughout the document. 2. Comment 2: Background/Introduction a. Information about what happens to healthcare providers during conflict in your country context : i. Response: comment well accepted and information regarding healthcare providers is included in the background/introduction part. b. Final sentence: ……. The need to inform the government ….. i. Response: Comment well accepted and included. 3. Comment 3: Methods a. Study design – you have included a lot of information in this section about the statistical analysis, which belongs in the statistical analysis section. For the study design section, it’s okay to be brief and define this as a retrospective medical record review. i. Response: comment well accepted and edited accordingly. b. Study design – your ethics statement is in this section, but usually would have its own section or be shown separately in a section after the manuscript. Please review journal requirements and include as advised by the journal. i. Response: comment well accepted and shown separately. c. Definition – acute medical complications: There’s nothing in the definition to indicate this can be a result of delayed care, but I believe this is the premise of your paper; the care is delayed and as a result, children are more likely to have acute medical complications? If correct, please refine your definition to include a reference to delayed care. i. Response: Comment accepted and refined. d. Sample size – I don’t believe you need the full equations included. You can make this section far more concise by using wording only. See other journal articles for how others have done this. i. Response: comment well accepted and made concise by using wording. e. Table 1 – please provide table footnotes on what Beta represents. i. Response: comment well accepted and table footnote provided. 4. Comment 4: Results: a. Table 2. Please remove color stripes from the table. Please add column percentages so that it’s easier to ‘see’ the data distribution between groups i. Response: comment accepted and color stripes are removed from the table. ii. Response: comment accepted and column for percentages is added. b. “table 1” in STATA (?) output – please remove this and create “Table 3”. In the narrative please remove definitions and just describe the findings objectively. i. Response: comment accepted. The output table is removed and Table 3 created. This created table 3 highlights the treatment effect between covariates before and after matching. Definition is removed and findings are described. c. “table 2” in STATA (?) output – please remove this and create “Table 4” – if possible, consider merging these two STATA tables into a single table for the results. Think how best to share your findings in a way that’s both understandable and concise i. Response: STATA output removed and “Table 4” created. This created table 4 the balance test for variables after PSM. Actually we used the font similar to STATA output formats and it seems a copy. Merging may limit someone’s understanding of our work and as the column and row numbers are different for the two tables, it might lead us miss the content. Hence, with due respect, we left it as it is (two tables). d. “Interpretation” – remove this statement and put everything into narrative that describes your findings. i. Response: comment accepted. e. “table 5” in STATA output – remove this as well and describe in the narrative. i. Response: comment accepted and description included in the narration. 5. Comment 5: Discussion a. You need to describe a bit more about how the other research studies have documented negative health effects if not at the individual level – what did they look at that was not as rigorous as your study? i. Response: comment well accepted and the negative health effects of conflict in other studies is narrated as “Up to our knowledge, no research clearly shows the impact of civil unrest on child health care revealing nuanced statistical results on conflict’s effect on children’s health in such a way that enables to compare “children living in the same region of a same country” with different exposure to armed conflict over time and place of residency.” Most of the researches done on this matter are focusing more on demonstrating the prevalence and diseases profiles of children in conflict-hit areas. b. In the third paragraph which starts “the acute medical complications” – please describe a bit more about the differences between rural and urban before and during conflict – it doesn’t come out clearly here i. Response: comment well accepted and description on the difference is included. 6. Comment 6: Limitations a. Remove the word ‘holistically’ – be more concise; you can just say that because the study was done at one tertiary facility, the results may not be generalizable to other conflict settings i. Response: comment well accepted and re-iterated as recommended. 7. Comment 7: Conclusion, Recommendation, Implications a. There are too many sections here. You should have your “Discussion” and “Conclusion” sections. Your implications all need to be incorporated into your discussion section, connected to the key findings that you shared in the results section. Aim to have about 3-4 main points (1 per paragraph) and work the implications into each paragraph so you have a coherent discussion that flows well. Your limitations section should be the final paragraph in your discussion. i. Response: comment well accepted and re-written as recommended. Response to review comments of Reviewer #2: 1. Comment 1: The new sentence on the second line under the Introduction should start with a capital C, that is ‘Children …’ a. Response: comment accepted and edited 2. Comment 2: In-text citations throughout the paper are written outside the sentences after the punctuation mark- full stop is written. It will be good to bring citations before the punctuation mark to avoid adding citations to the beginning of new sentences. a. Response: comment well accepted and edited. 3. Comment 3: Referring to these statements ‘Data were collected by trained nurses and pediatric residents. Authors had no access to identify participants of the study’, it appears the authors used secondary data from medical records taken by others. It will be helpful for the authors to clarify the type of data used in the study, whether the data is considered primary or secondary data to guide future studies and whether any of the authors were involved in the data collection. a. Response: Comment well accepted and re-phrased as ‘Data were collected by properly trained nurses and pediatric residents retrospectively using structured questionnaire from medical records of children admitted to pediatric ward ‘. Our data is primary data collected for this study from medical records of clients admitted to the hospital. 4. Comment 4: In text reference to tables and figures should not be placed after the full stop but before. a. Response: comment well accepted and edited. 5. Comment 5: Discussion a. Response: comment is well accepted. The type of complications are included as a supplement table and narrated in the result section as well as the discussion part. Thank you for all your constructive comments, Corresponding author Dr. Tesfaye Taye Gelaw Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0320902.r003
27 Feb 2025 Decision Letter - Sk Md Mamunur Rahman Malik, Editor The Impact of civil unrest on child health care: evidenced by acute medical complications at presentation – a retrospective comparative study. PONE-D-24-26693R1 Dear Dr. Gelaw, 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, Sk Md Mamunur Rahman Malik Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0320902.r004
Formally Accepted
Acceptance Letter - Sk Md Mamunur Rahman Malik, Editor PONE-D-24-26693R1 PLOS ONE Dear Dr. Gelaw, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Sk Md Mamunur Rahman Malik Academic Editor PLOS ONE Attachments Attachment Submitted filename: pone.0320902.docx https://doi.org/10.1371/journal.pone.0320902.r005

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