Benefits of psychosocial support for adolescent mothers on infant development and maternal mental wellbeing in Rakai and Kyotera, Uganda: Quasi-experimental study

Esther Nakyaze; Mark Pesner; Marc Sklar; Eleanor Nakintu; Elizabeth B. Magill; Jolly Nankunda; Richard Kimaka; Daniel Murokora

doi:10.1371/journal.pone.0325463

Peer Review History

Original SubmissionNovember 12, 2023
17 Mar 2024 Decision Letter - Forough Mortazavi, Editor Dear Dr. Nakyaze, 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. Specifically these areas are in need of revision and improvement: incomplete sentences description of the instruments limitations and weak points of the study Please submit your revised manuscript by May 01 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. 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 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, Forough Mortazavi Academic Editor PLOS ONE Journal Requirements: 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 note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. 3. Thank you for stating the following financial disclosure: "Funding was provided by Grand Challenges Canada’s Saving Brains Program with additional funding from Brick by Brick Partners supported the project" Please state what role the funders took in the study. If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. 4. In the online submission form, you indicated that [Data will be available upon formal request for the first Author through email: esther.nakyaze@gmail.com for researchers who meet the criteria for access to confidential data.]. 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. 5. Please ensure that you include a title page within your main document. You should list all authors and all affiliations as per our author instructions and clearly indicate the corresponding author. 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. 7. 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. Additional Editor Comments: Dear authors, Thank you for addressing Adolescent Mothers’ Mental well-being and Infant Developmental Outcomes. I have some comments that I hope will help in improving the manuscript. Introduction: In the introduction section, the authors should state the rate of unplanned and unwanted pregnancies among teenagers in Uganda. Also, they should report those rates among their participants in the methods section. Methods: Further description of the SRQ-20 is needed. Please state the scale’s total score, its cut-off point (if there is one), and the meaning of the total score. Results: Two groups should have been compared in terms of the family support they had already received. This can be stated as a weak point of the study. The sentence in lines 192-3 is incomplete and needs revision. Discussion: In the first paragraph, the authors state, “Our results also show statistically significant reductions in maternal symptoms of mental illness at term and 6-months postpartum.” However, in Table 3, no significant reduction is found in the scores of the control group. [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? Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: The authors should follow appropriate labelling of the title of each table in the manuscripts according to the journal’s guidelines. While the study appears to be sound, the language is unclear, making difficult to follow. Thus, the authors should work with a writing editor to improve readability of the text. ****** 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: Zalikha Al-Marzouqi ******** [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 https://doi.org/10.1371/journal.pone.0325463.r001
Revision 1
5 May 2024 Author Response Response to Reviewers comments Journal Requirements: 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 Response: Documents have been formatted using the PLOS ONE’s style reequipments. See Revised Manuscript with Track Changes and Manuscript We note that the grant information you provided in the ‘Funding Information’ and ‘Financial Disclosure’ sections do not match. When you resubmit, please ensure that you provide the correct grant numbers for the awards you received for your study in the ‘Funding Information’ section. Response: This has been modified in the system, 3. Please state what role the funders took in the study. If the funders had no role, please state: ""The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript."" If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf. Response: Funding was provided by; Grand Challenges Canada’s Saving Brains Program. This was received by DM, https://www.grandchallenges.ca/, Grant number: SB-1810-20437 Additional funding from Brick by Brick Partners, received by MS, https://togetherwomenrise.org/programfactsheets/brick-by-brick-partners/, No grant number Staff paid by the grants include; DM, EN, EN, MP, RK The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 4. In the online submission form, you indicated that [Data will be available upon formal request for the first Author through email: esther.nakyaze@gmail.com for researchers who meet the criteria for access to confidential data.]. 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. Response: Data will be uploaded as supplementary information in the system; S2 Dataset. Ages and Stages data, S3 Dataset. Self-Reported Questionnaire, S4 Dataset. Demographic data 5. Please ensure that you include a title page within your main document. You should list all authors and all affiliations as per our author instructions and clearly indicate the corresponding author. Response: Title page included in the main document (see page 1 of the Manuscript ) 6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Response: Supporting documents uploaded accordingly following the guidelines. 7. 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 include a citation and full reference for the retraction notice. Response: Reference list updated Removed reference; Lesser J, Escoto-Lloyd S. Health-related problems in a vulnerable population: pregnant teens and adolescent mothers. Nurs Clin North Am. 1999;34(2):289-299. New reference added: Okalo, P., Arach, A. A., Apili, B., Oyat, J., Halima, N., & Kabunga, A. (2023). Predictors of Unintended Pregnancy Among Adolescent Girls During the Second Wave of COVID-19 Pandemic in Oyam District in Northern Uganda. Open access journal of contraception, 14, 15–21. https://doi.org/10.2147/OAJC.S399973 Additional Editor Comments: Dear authors, Thank you for addressing Adolescent Mothers’ Mental well-being and Infant Developmental Outcomes. I have some comments that I hope will help in improving the manuscript. Introduction: In the introduction section, the authors should state the rate of unplanned and unwanted pregnancies among teenagers in Uganda. Also, they should report those rates among their participants in the methods section. Response: Rate of unplanned and unwanted pregnancies among teenagers in Uganda and rates among their participants in the methods section stated (see page 2 line 51-52). Methods: Further description of the SRQ-20 is needed. Please state the scale’s total score, its cut-off point (if there is one), and the meaning of the total score. Response: The SRQ -20 is described on page 10. The tool caries a total score range of 0-20. A “Yes” response to experience of a mental health symptom was transcribed to carry 1 score while “No” was transcribed caries carry 0 score. Based on the context, some studies and programs have created cut offs, however this study focused on using the tool to assess maternal mental wellbeing at different assessment points. Results: Two groups should have been compared in terms of the family support they had already received. This can be stated as a weak point of the study. Response: Results on family support received during the study period is available, although not presented in this paper, this will be present in a separate paper. The sentence in lines 192-3 is incomplete and needs revision. Response: modifications made. In the first paragraph, the authors state, “Our results also show statistically significant reductions in maternal symptoms of mental illness at term and 6-months postpartum.” However, in Table 3, no significant reduction is found in the scores of the control group. Response: The scores were significant, results in the table as well. See table 3 column 11, 12 and 13. Attachments Attachment Submitted filename: Response to Reviewers.pdf https://doi.org/10.1371/journal.pone.0325463.r002
14 May 2024 Decision Letter - Forough Mortazavi, Editor Dear Dr. Nakyaze, 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 Jun 28 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. 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 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, Forough Mortazavi 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. Additional Editor Comments: Dear authors, Thank you for revising the manuscript. In the results section, two groups should have been compared in terms of the family support they had already received. It is important to report those results. The sentence in lines 211-13 is still incomplete and needs revision. [Note: HTML markup is below. Please do not edit.] [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 https://doi.org/10.1371/journal.pone.0325463.r003
Revision 2
27 Jun 2024 Author Response Additional Editor Comments: In the results section, two groups should have been compared in terms of the family support they had already received. It is important to report those results. Response: the study didn’t assess family support received by the adolescent mothers before the study. This has been included as a study limitation-See page 20, line 418-420. Note: The study assessed family support at 6 months post-delivery using Multidimensional Scale of Perceived Social Support (MSPSS)-See page 09, line 211-215. These results have been submitted as S5_Family support during the study. The sentence in lines 211-13 is still incomplete and needs revision. Response: the sentences have been modified. Attachments Attachment Submitted filename: Response to Reviewers_EN_23.06.2024.docx https://doi.org/10.1371/journal.pone.0325463.r004
18 Sep 2024 Decision Letter - Poshan Thapa, Editor Dear Dr. Nakyaze, 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. As the previous reviewers were unavailable, we sent the revised manuscript to new reviewers, both of whom have provided additional comments that need to be addressed. Therefore, we invite you to submit a revised version of the manuscript that responds to the points raised during the review process. Please submit your revised manuscript by Nov 02 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. 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 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, Poshan Thapa, PhD 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. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: (No Response) Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> 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 Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes Reviewer #3: Yes ****** Reviewer #2: The manuscript presents findings in a relatively important area of interest, esepcially in LMICs. I have attached my comments as a separate file. Reviewer #3: Thank you for addressing the previous comments satisfactorily. I have minor remarks, recommended to change during publication process Abstract- remove reference no 4 from abstract at the end of second sentence. Don't start sentence with number such as 789 adolescent Since, intervention and curriculum development is a part of the methods of the experimental study, it is highly recommended moving those sections to the methods part than keeping as introduction. In study diagram fig 1, loss to follow up has separated with the number and lost babies. I assume lost babies is reason of loss to follow up, not separate number as study population is mother not the babies. So it is recommended to keep total loss to follow up as total number 85 and reason as lost babies - .. , maternal death .. and other reason. ****** 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: Yes: Valerian Mwenda 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 Attachments Attachment Submitted filename: Reviewer comments_300724.docx https://doi.org/10.1371/journal.pone.0325463.r005
Revision 3
29 Oct 2024 Author Response Dear Academic Editor, Thank you for giving us the opportunity to submit a revised draft of my manuscript titled “Benefits of psychosocial support for adolescent mothers on infant development and maternal mental wellbeing in Rakai and Kyotera, Uganda: quasi-experimental study” to Plos one Journal. We appreciate the time and effort that you and other reviewers have dedicated to providing your valuable feedback on my manuscript. We are grateful for the insightful comments on my paper. We have been able to incorporate changes to reflect most of the suggestions provided. We have highlighted the changes within the manuscript. Here is a point-by-point response to the reviewers’ comments and concerns. Reviewer comments Reviewer #3: Thank you for addressing the previous comments satisfactorily. I have minor remarks, recommended to change during publication process Abstract- remove reference no 4 from abstract at the end of second sentence. Response: Reference has been removed (see page one, line 26 of the tracked manuscript). Don't start sentence with number such as 789 adolescent Response: This has been modified (see page two, line 43 of the tracked manuscript). Since, intervention and curriculum development is a part of the methods of the experimental study, it is highly recommended moving those sections to the methods part than keeping as introduction. Response: Description of the study moved to the methods section as per the reviewer recommendation (See page 9-12 of the tracked manuscript). In study diagram fig 1, loss to follow up has separated with the number and lost babies. I assume lost babies is reason of loss to follow up, not separate number as study population is mother not the babies. So it is recommended to keep total loss to follow up as total number 85 and reason as lost babies - .. , maternal death .. and other reason. Response: This has been modified, see figure 1, page 16. Reviewer#2 Abstract Line 34: ‘Usual care’ can be briefly described. Response: Modification made. See page 2 of the tracked manuscript. Care as usual has been further described on page 12 and 13 of the methods section Line 34: For the abstract to be stand-alone, even the ‘psychosocial support programming’ can be briefly described (what exactly did it entail?) Its possible to do this without a major increase in the word count. Response: Modification made. See page 2 of the tracked manuscript. Line 39: not advisable to start a sentence with a number. Response: Modification made. See page 2 of the tracked manuscript. Lines 40-45: it is always advisable to include the effect size; what was the score in each group? This is important in enabling the reader to interpret the findings, something which is not possible with p-value alone. Response: These have been included, see page 2 of the tracked manuscript. Methods Line 105: the standard care needs to be described. What does the usual care for such mothers’ entail, in the study setting? This is important in delineating the incremental value of the intervention. Response: Standard ANC and PNC described on page 12 of the tracked manuscript. Lines 109-117: who participated in the development of the curriculum? Was it validated? How was the validation process? Creation of curriculums have specific steps, which may be different from development of training packages, for instance. Response: The curriculum was developed by program staff with expertise in public health, adolescent health, maternal and child health, clinical psychology, and monitoring and evaluation, with technical guidance from two consultants—a pediatrician and a psychologist. To ensure the curriculum was relevant to the Ugandan context, development sessions included contributions from facility and community health workers, as well as mothers of adolescents in the Rakai and Kyotera Districts. The MAP curriculum was primarily based on the World Health Organization’s Care for Child Development Manual, Northwestern University’s Mothers and Babies curriculum, and Uganda's Infant and Young Child Feeding Guidelines (IYCF). Additional literature on infant and maternal development was also incorporated, with all materials consolidated and adapted to fit the local context and adolescent target population. After development, the curriculum was validated through a pilot implementation in a controlled setting to assess its effectiveness. Feedback was collected and analyzed, which informed the creation of the final version. Following validation, we implemented the curriculum and conducted bimonthly meetings with users to evaluate its effectiveness and make necessary updates. 134: A reference for the Care for Child Development Curriculum is necessary here. Response: care of child development reference included (see page 9-10 of the manuscript). Lines 165: Study setting: how far are the two districts from each other? Any possibility of contamination during the interventions? Response: The districts are approximately 30kms from each other and thus minimal possibility of contamination. This information has been included under study setting. Sample size calculation: usually in scientific publications, this section is worded differently from the study protocol. I would advise instead of showing the formula, the authors reword it as follows: In order to have power of 80% to detect a difference in developmental milestones between the two groups of at least 10%, with an alpha level of .05, and proportion of xxx among the control of 50%, we required a minimum sample size of 389. The authors can improve on that. Response: Rewording has been done, see page 8 of the tracked manuscript. Ethical consideration: how did you deal with the issue of informed consent, since a substantial proportion of your participants were expected to be minors? We followed the guidance form the Uganda National Council of Science and Technology (UNCST)regarding “emancipated minors.” According to the UNCST, emancipated minors are individuals under the age of 18 who have been legally granted independence from their parents or guardians. This status allows them to make decisions regarding their health, education, and other personal matters without parental consent. Emancipated minors can consent to medical treatment, enter contracts, and make independent decisions regarding their lives. The criteria for emancipation can vary, but it often requires demonstrating maturity, financial independence, and the ability to live independently. In the context of research, emancipated minors may have the authority to provide informed consent, impacting ethical guidelines and approval processes. Results and discussion The control group had a higher proportion of mothers with no children. Any impact the authors postulate this could have had on the findings of the interventions? Response: There are likely no effects of this on the findings. We controlled any covariates during data analysis. Data were analyzed using the difference-in-difference method. We ran a regression for the entire sample and then separately for observations at 2 months, 6 months, and 12 months: y_it=β_0+β_1 Post_6+β_2 Post_12+β_3 Treat_i+β_4 Post_6×Treat_i+β_5 Post_12×Treat_i+e_it Standard errors were clustered at the mother-level and maternal mental wellbeing at enrolment, towards birth and 6-months. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_3.pdf https://doi.org/10.1371/journal.pone.0325463.r006
20 Nov 2024 Decision Letter - Poshan Thapa, Editor Dear Dr. Esther, Thank you for submitting your manuscript to PLOS ONE. We appreciate your diligence in thoroughly addressing the reviewers' comments, and we are pleased with the revisions made so far. However, before we can proceed with accepting the manuscript for publication, we kindly request that you conduct a final, thorough proofreading of the manuscript to ensure clarity and adherence to the journal's standards. In particular, we recommend focusing on the following: Sentence Structure : Simplify and refine sentences for better coherence and readability. Grammatical Accuracy: Correct any typographical and grammatical errors. Punctuation : Ensure appropriate use of full stops, commas, and other punctuation marks. Please submit your revised manuscript by Jan 04 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 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'. Kind regards, Dr Poshan Thapa, PhD Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0325463.r007
Revision 4
31 Dec 2024 Author Response Comment-Sentence Structure: Simplify and refine sentences for better coherence and readability. Response to academic editor: This has been adressed Grammatical Accuracy: Correct any typographical and grammatical errors. Response to academic editor: This has been adressed Punctuation: Ensure appropriate use of full stops, commas, and other punctuation marks. Response to academic editor: This has been adressed Attachments Attachment Submitted filename: Response to Reviewers_EN_4.12. 2024.pdf https://doi.org/10.1371/journal.pone.0325463.r008
10 Mar 2025 Decision Letter - Rehana Salam, Editor Dear Dr. Nakyaze, 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. ============================== I would like to thank the authors for making edits to the manuscript in reponse to the previous editorial and peer-reviewed comments. The study findings are very relevant and interetsing. Since, I have just stepped in as the Academic Editor, I would suggest some further edits to the draft which are detailed as follows to improve the quality of the manuscript further. ============================== Please submit your revised manuscript by Apr 24 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. 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 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, Rehana Abdus Salam 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. Additional Editor Comments: I would like to thank the authors for making edits to the manuscript in reponse to the previous editorial and peer-reviewed comments. The study findings are very relevant and interetsing. Since, I have just stepped in as the Academic Editor, I would suggest some further edits to the draft which are as follows: Abstract: 1. Abstract in its current form is too lengthy and needs to be more succint. 2. Spell out WHO in the abstract when used first time. 3. Specify that the estimates reported for the ASQ infant development domains are Mean difference (MD) and not means. Also specify the time point (for e.g. "The difference-in-difference estimations reveal that the intervention group outperformed the control group in all five ASQ infant development domains, with statistically significant results (p<0.01) across 2-12 months: " Introduction: 1. Please add a reference here : "Beyond these contributing factors, adolescent pregnant mothers also have low antenatal care (ANC) attendance and limited knowledge of child development and care as compared to older pregnant mothers." 2. Spell out "BAMA" when used in the manuscript for the first time. 3. I would suggest if the authors could update the references in the introductiuon section to more recent ones, if available. Methods: 1. Under 'Study design and setting', please specify that Rakai Hospita was chosen as the intervention and Kalisizo Hospital was chosen as the control group. Statistical analysis: 1. Doe sthis statement "Pearson’s chi squared tests were used to compare categorical variables greater than 5 cells and Fishers exact tests for variables less five cells" mean that Pearsons chi-square test was used for variables with a cell-count of > 5 and fishers exact test was used for cell counts < 5 ? if this is the case, please make this sentence more clearer. Results: 1. In figure 1 (study diagram), please add the numbers followed up at 2 months, 6 months and 12 months Disucssion: 1. I would suggest that if the authors could add some discussion around the sustainability and integration of this intervention at a larger scale for longer run. 2. I would suggest the authors to add some insight on how the baseline difference in number of children at enrolment, education level, religion, and family size between the intervention and control groups could impact the results, if at all, in the 'Limitations' section. Overall, please make sure that the acronyms are spelled out once when these are used for the first time in the draft and then can be used as acronyms throughout the text. For e.g. acronyms of WHO, MAP, LMICs etc have been spelled out multiple times throughout the manuscript. [Note: HTML markup is below. Please do not edit.] [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 https://doi.org/10.1371/journal.pone.0325463.r009
Revision 5
12 May 2025 Author Response Dear Academic Editor, Thank you for giving us the opportunity to submit a revised draft of my manuscript titled “Benefits of psychosocial support for adolescent mothers on infant development and maternal mental wellbeing in Rakai and Kyotera, Uganda: quasi-experimental study” to Plos one Journal. We appreciate the time and effort that you and other reviewers have dedicated to providing your valuable feedback on my manuscript. We are grateful for the insightful comments in my paper. We have been able to incorporate changes to reflect most of the suggestions provided. We have highlighted the changes within the manuscript. Here is a point-by-point response to the reviewers’ comments and concerns. 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 include a citation and full reference for the retraction notice. Response: The reference list has been reviewed and updated, no retracted articles. Four references have been updated to provide the latest updated references. (see reference list in the tracked manuscript) 1. Removed reference: Gideon R. Factors Associated with Adolescent Pregnancy and Fertility in Uganda: Analysis of the 2011 Demographic and Health Survey Data. American Journal of Sociological Research 2013. 2013;3(2):30-35. And replaced with: Chemutai V, Musaba MW, Amongin D, Wandabwa JN. Prevalence and factors associated with teenage pregnancy among parturients in Mbale Regional Referral Hospital: a cross-sectional study. Afr Health Sci. 2022 Jun;22(2):451-458. doi: 10.4314/has.v22i2.52. PMID: 36407378; PMCID: PMC9652643. This is mainly to provide an updated reference 2. Removed reference: Nabukhonzo P. Uganda Demographic and Health Survey (UDHS). In:2012:1-10 and123. Okalo, P., Arach, A. A., Apili, B., Oyat, J., Halima, N., & Kabunga, A. (2023). Replaced with: Amongin, D., Benova, L., Nakimuli, A. et al. Trends and determinants of adolescent childbirth in Uganda- analysis of rural and urban women using six demographic and health surveys, 1988–2016. Reprod Health 17, 74 (2020). https://doi.org/10.1186/s12978-020-00925-8 This is mainly to provide an updated reference 3. Removed reference: Kwon MK. Parenting stress and related factors of employed and non-employed mothers with infants. Korean Journal of Childcare and Education. 2011;7(2):19-41 Replaced with Flaherty SC, Sadler LS. Parenting Stress Among Adolescent Mothers: An Integrative Literature Review. Western Journal of Nursing Research. 2022;44(7):701-719. doi:10.1177/01939459211014241 This is mainly to provide an updated references 4. Reference Removed reference: http://www.brickbybrick.org/ Replaced with Babies and Mothers Alive Foundation Website https://www.babiesandmothersalive.org/ This is mainly to provide an updated reference Additional Editor Comments: I would like to thank the authors for making edits to the manuscript in reponse to the previous editorial and peer-reviewed comments. The study findings are very relevant and interesting. Since, I have just stepped in as the Academic Editor, I would suggest some further edits to the draft which are as follows: Abstract: 1. Abstract in its current form is too lengthy and needs to be more succinct. Response: This has been edited. See page 1 and 2 of the manuscript 2. Spell out WHO in the abstract when used first time. Response: This has been modified- (see page 2) 3. Specify that the estimates reported for the ASQ infant development domains are Mean difference (MD) and not means. Also specify the time point (for e.g. "The difference-in-difference estimations reveal that the intervention group outperformed the control group in all five ASQ infant development domains, with statistically significant results (p<0.01) across 2-12 months: " Response: This has been included Introduction: 1. Please add a reference here: "Beyond these contributing factors, adolescent pregnant mothers also have low antenatal care (ANC) attendance and limited knowledge of child development and care as compared to older pregnant mothers." Response: Reference has been included (see page 4 line 80) 2. Spell out "BAMA" when used in the manuscript for the first time. Response: This has been included (see page 4 line 98) 3. I would suggest if the authors could update the references in the introduction section to more recent ones, if available. Response: These have been updated (all references in the entire article have been updated Methods: 1. Under 'Study design and setting', please specify that Rakai Hospital was chosen as the intervention and Kalisizo Hospital was chosen as the control group. Response: This has been included (see page 5 of the tracked manuscript) Statistical analysis: 1. Does this statement "Pearson’s chi squared tests were used to compare categorical variables greater than 5 cells and Fishers exact tests for variables less five cells" mean that Pearsons chi-square test was used for variables with a cell-count of > 5 and fishers exact test was used for cell counts < 5 ? if this is the case, please make this sentence more clearer. Response: This has been included (see page 12 of the tracked manuscript) Results: 1. In figure 1 (study diagram), please add the numbers followed up at 2 months, 6 months and 12 months Response: this has been included, see page 22 of the tracked manuscript Discussion: 1. I would suggest that if the authors could add some discussion around the sustainability and integration of this intervention at a larger scale for longer run. Response: this has been included, see page 22 of the tracked manuscript 2. I would suggest the authors to add some insight on how the baseline difference in number of children at enrolment, education level, religion, and family size between the intervention and control groups could impact the results, if at all, in the 'Limitations' section. Response: Although the differences heighted were available, we used a regress equation for the entire sample and then separately for observations at 2 months, 6 months, and 12 months: 𝑦𝑖𝑡=𝛽0+𝛽1𝑃𝑜𝑠𝑡6+𝛽2𝑃𝑜𝑠𝑡12+𝛽3𝑇𝑟𝑒𝑎𝑡𝑖+𝛽4𝑃𝑜𝑠𝑡6×𝑇𝑟𝑒𝑎𝑡𝑖+𝛽5𝑃𝑜𝑠𝑡12×𝑇𝑟𝑒𝑎𝑡𝑖+𝑒𝑖𝑡 The outcome ( 𝑦𝑖𝑡) is the sum of the questions across each domain of communication, gross motor, fine motor, problem solving, and personal-social. 𝑃𝑜𝑠𝑡6=1 if the observation is in the 6th month, 𝑃𝑜𝑠𝑡12=1 if the observation is in the 12th month, and 𝑇𝑟𝑒𝑎𝑡𝑖=1 if the mother was in the intervention group. An F-test was conducted to test the null hypothesis of equality across groups. This catered for all the confounders. Response: This is described under page 13 of the tracked manuscript) Overall, please make sure that the acronyms are spelled out once when these are used for the first time in the draft and then can be used as acronyms throughout the text. For e.g. acronyms of WHO, MAP, LMICs etc. have been spelled out multiple times throughout the manuscript. Response: These have been spelt out across all the document We look forward to hearing from you in due course regarding our submission and to responding to any further questions and comments you may have. Sincerely Esther Nakyaze First Author Attachments Attachment Submitted filename: Response to Reviewers_EN_29.04. 2025.pdf https://doi.org/10.1371/journal.pone.0325463.r010
14 May 2025 Decision Letter - Rehana Salam, Editor <p>Benefits of psychosocial support for adolescent mothers on infant development and maternal mental wellbeing in Rakai and Kyotera, Uganda: quasi-experimental study PONE-D-23-35096R5 Dear Dr. Nakyaze, 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, Rehana Abdus Salam Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0325463.r011
Formally Accepted
Acceptance Letter - Rehana Salam, Editor PONE-D-23-35096R5 PLOS ONE Dear Dr. Nakyaze, 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 You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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. Rehana Abdus Salam Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0325463.r012

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