PONE-D-24-27306“Everything had stopped, no meeting, no gathering”: social interactions during the COVID-19 pandemic in the Central African Republic, the Democratic Republic of Congo, and Bangladesh.PLOS ONE

Dear Dr. Altare,

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Sk Md Mamunur Rahman Malik

Academic Editor

PLOS ONE

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This work was supported by the Bureau for Humanitarian Assistance, US Agency for International Development (https://www.usaid.gov/) under Grant Number 720FDA20GR00228. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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We would like to thank the United States Bureau for Humanitarian Assistance (USAID/BHA) for funding this work; Marissa Smith, Madison Bates, Natalia Hernandez Morfin, and Sharon Leslie helped analyze the data and draft the case study reports. 

Group authorships are as follows: 

IMPACT CAR Team: Ugo Semat, Melissa Pointet,  Sarah McArthur, Samuel Carcanague, Ana Tolosa, Rodrigue Biguioh

IMPACT DRC Team: Roxana Mullafiroze, Jasper Linke, Olivier Cecchi, Nayana Das, Katie Rickard; Jean-Paul Mushamalirwa, Destin Ruhinda, Nadia Lehmann, Marie Amandine, Eliora Henzler, Audrey Gallecier, Benoit Besnardeau, Noortje Gerritsma

IMPACT Bangladesh Team: Roxana Mullafiroze, Jasper Linke, Olivier Cecchi, Nayana Das, Katie Rickard, Rosie Witton, Sara Chowdhury, Zia Foisal, Teresa Schwarz, Glenn Poresh.

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This work was supported by the Bureau for Humanitarian Assistance, US Agency for International Development (https://www.usaid.gov/) under Grant Number 720FDA20GR00228. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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6. One of the noted authors is a group or consortium "IMPACT CAR Team; IMPACT DRC Team; IMPACT Bangladesh Team". In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address.

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1:  The paper presents a valuable investigation into how social interactions in three humanitarian settings (Democratic Republic of the Congo, Central African Republic, and Cox’s Bazar, Bangladesh) changed during the first year of the COVID-19 pandemic. This is a significant contribution given the unique challenges and vulnerabilities these settings face.

One of the novel aspects is the comparative mixed-methods approach, combining representative household surveys with qualitative data from focus group discussions and key informant interviews. This methodology provides a comprehensive understanding of social dynamics and preventive behaviors during an epidemic.

The paper highlights the discrepancy between knowledge about and practice of preventive behaviors and identifies factors associated with non-compliant behaviors, such as reluctance towards COVID-19 vaccination and living conditions in IDP communities.

Strengths:

The study addresses a critical gap in understanding social interactions in humanitarian settings during a pandemic, which has been underexplored in existing literature.

The methodology is robust, with a clear explanation of the mixed-methods approach and the rationale for selecting the study sites. The use of both quantitative and qualitative data enriches the analysis.

The findings are relevant and timely, providing insights that could inform future public health interventions in similar settings. For example, the identification of trust in authorities and socio-economic factors as drivers of behavior is crucial for designing effective public health strategies.

The paper is well-organized, with a clear structure that guides the reader through the background, methodology, results, and discussion.

Weaknesses:

The study's reliance on self-reported data could introduce bias, particularly in sensitive topics such as compliance with preventive measures and vaccination attitudes. The paper does not adequately address how this potential bias was mitigated.

The paper could benefit from a more in-depth discussion of the limitations of the study. For example, the authors should discuss the potential impact of the non-reachable settlements in DRC on the representativeness of the data.

Some of the statistical analyses, such as the multivariate logistic regression, are presented without sufficient detail on the assumptions and checks performed to validate the models.

Suggestions for Improvement:

Address the potential biases introduced by self-reported data by discussing any steps taken to validate the responses or by including a section on the limitations of self-reported data. For example, cross-referencing self-reported behaviors with observed behaviors or using triangulation methods could strengthen the validity of the findings.

Expand the discussion on the limitations of the study, particularly regarding the non-reachable settlements in DRC and any other logistical challenges encountered. This transparency will help readers critically assess the robustness of the study.

Provide more detail on the statistical analysis methods, including the assumptions of the logistic regression models and how these were checked. This could include information on multicollinearity tests, goodness-of-fit measures, and any sensitivity analyses performed.

Enhance the discussion on the implications of the findings for public health policy and practice. For example, the paper could suggest specific interventions to increase trust in authorities or address the socio-economic factors influencing preventive behaviors.

Reviewer #2:  The study is very important and touches a very critical aspect of population health during pandemic. Please consider the following:

1- Adjust the article and use the past tense

2- Add to the keywords list: pandemic; population health

3- Shed light on the impact of pandemic and borders closure on health system and supply chains

4- Identify the impact of humanitarian aids supported underserved and vulnerable population

5- What are the common characteristics and differences between the three countries? and define the rationale of selecting those countries.

6- Shed light on the interaction between pandemic related psychological dilemma and population dynamic

7- Qualitative analysis is inadequate.

8- In contrary to other population, explain the reasons for higher rates of covid-19 vaccination acceptance.

9- Add a section for limitation and recommendations

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Reviewer #1: Yes:  Olivier Mukuku

Reviewer #2: Yes:  WEAM BANJAR

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PONE-D-24-27306R1“Everything had stopped, no meeting, no gathering”: social interactions during the COVID-19 pandemic in the Central African Republic, the Democratic Republic of Congo, and Bangladesh.PLOS ONE

Dear Dr. Altare,

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 following minor points raised during the final review process.

1. This article, according to the authors, attempted to understand the spread of COVID-19 in humanitarian settings. However, it was not clear on what considerations the Cox's Bazar area of Bangladesh was selected as a site or an area with a humanitarian context! . The Cox's Bazar area of Bangladesh does not meet the criteria to be called an area with a humanitarian crisis just because it is hosting Rohingya refugees. According to the authors, the site was selected for this study as it is the location of the IMPACT project and possibly the site of a larger multi-country project. It is important, therefore, to provide adequate justifications under the methodology section on the selection of Cox's Bazar as a site that is comparable to CAR and the DRC in terms of demographic, socio-economic, and humanitarian characteristics.

2. In the analysis section, it has been mentioned that "thematic analysis was applied to summarize relevant themes across study participants as well as to identify differences across study sites.". In the result section of the qualitative data, no such analysis by thematic areas and comparison by different sites were noted. It is important that the analyzed qualitative data are presented by the main thematic areas of the study, and a summary of the main findings is presented in a way that shows comparison or commonalities between the sites.

3. More description should be provided on how the qualitative data were analyzed. Such as how the data were transcribed, which software was used to record, and code and for transcription of the data. How the consistency and accuracy were checked as the interviews and FGDs were done in three sites in the local language. 

4. It is also important to highlight in the section on strength and limitation if the translation of the KII and FGD into English from the local language introduced any inconsistencies and how they were checked and prevented.

5. For sample size selection, a "prevalence of 50%" was used to select the household number for Cox's Bazar and CAR. It is not clear what this "50% prevalence" refers to. What is the source of such an assumption? The pandemic was a new event. Therefore, what was the reference underlying the author's decision to use a "50% prevalence" for what variable in order to select the right sample? Please provide some clarity in the text to make the readers understand the rationale behind such an assumption.

6. In Table 2, please provide the mean age (SD) or median (IR) age of the respondents by three study sites. It is also important to present the  gender characteristics of the respondents though these are availabel in the supplementary table. 

7. In Tables 3 and 4, we understand that the data are analyzed using a multivariate logistic regression analysis. As such, the Odds Ratios presented in these tables should be named as adjusted Odds Ratios (aOR) unless the authors have other justifications for not naming these ratios as "aOR".

8. It is not clear why (in Table 3) the columns for "Displacement" for Bangladesh and CAR are empty. No displaced people from either of these two countries were included in the sample.? Please provide a justification in the footnote of the table.

9. The author's findings that "IDPs were at higher risk and increased and faced increased barriers to protecting themselves from COVID-19" is not substantiated by data presented in Table 4 (P value not significant). Any clarity will be helpful. 

Please submit your revised manuscript by Apr 07 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.

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• 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,

Sk Md Mamunur Rahman Malik

Academic Editor

PLOS ONE

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“Everything had stopped, no meeting, no gathering”: social interactions during the COVID-19 pandemic in the Central African Republic, the Democratic Republic of Congo, and Bangladesh.

PONE-D-24-27306R2

Dear Dr. Altare,

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,

Sk Md Mamunur Rahman Malik

Academic Editor

PLOS ONE

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