Dear Dr. Khandaker,

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 Sep 27 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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We look forward to receiving your revised manuscript.

Kind regards,

Mohammad Shafiqul Islam

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. Thank you for stating the following financial disclosure: This trial was funded by the Research Foundation of Cerebral Palsy Alliance (PG02218—Support CP Trial) and international funding from CSF Global Bangladesh and awarded to Prof Gulam Khandaker.   

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.

3. Thank you for stating the following in the Acknowledgments Section of your manuscript: We extend sincere gratitude to primary caregivers and children with CP for their valuable time and voluntary involvement in the SUPPORT CP trial. Additionally, we express heartfelt appreciation to the dedicated CSF global team in Bangladesh for their diligent efforts and support. This trial was funded by the Research Foundation of Cerebral Palsy Alliance (PG02218—Support CP Trial) and international funding from CSF Global Bangladesh. The authors declare that there is no conflict of interest. Research data can be accessed by contacting the corresponding author.

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. 

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: This trial was funded by the Research Foundation of Cerebral Palsy Alliance (PG02218—Support CP Trial) and international funding from CSF Global Bangladesh and awarded to Prof Gulam Khandaker.  

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

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Additional Editor Comments:

Please see attached file

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[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.]

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Dear Dr. Khandaker,

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 May 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.

• 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,

Najmul Hasan, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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

Reviewer #1: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: N/A

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: This is a very interesting study about children with cerebral palsy. However, there are the following issues that need further clarification:

1. The severity of CP patients, whether they can live independently, and the basic expenses for treatment and rehabilitation.

2.How many family members were needed to take care of in their daily lives?

3. What are the urgent problems that these patients and families need to solve?

Reviewer #2: Thank you for the editor's invitation. The authors present in this manuscript the differential outcomes of various support modalities for families of children with cerebral palsy. This study demonstrates innovative elements and could provide valuable insights for developing countries and impoverished regions. However, prior to publication, I have the following suggestions to offer.

1. In lines 76-80, it is recommended that the authors first provide a comprehensive introduction to the clinical characteristics of cerebral palsy, followed by an in-depth discussion on how this condition exacerbates the socioeconomic burden on families from low-income backgrounds.

2. More detailed inclusion and exclusion criteria for the study samples should be added.

3. In lines 143-144, "After distributing the livelihood assets, relevant training sessions were organized to develop participants' skills and knowledge." Please provide more detailed information about these training sessions, such as whether the proficiency levels of each participant are comparable.

4. Please supplement the methodology section with the methodology for sensitivity analysis.

5. How is the total return obtained by participants during the investment period determined, and how reliable is it? The authors need to offer a more comprehensive methodological explanation to enhance readers' confidence in the accuracy of the results.

6. Does the educational level and occupation of parents in different families indirectly affect the rate of return on investment?

7. The credibility of results obtained solely based on differences in the rate of return on investment is relatively low, it is necessary to employ more statistical methods, such as linear regression, to determine whether there is significance.

8. Conducting subgroup analyses based on participants' backgrounds is indeed necessary.

9. The line numbers disappeared after the tenth page.

10. In the section "Lessons learned about different livelihood activities and the key to success," the conclusions are partially subjective and should be supported by an appropriate amount of references.

11. In the discussion section, "To the best of our knowledge, this study compares the efficacy of various livelihood support interventions to determine the most effective approach, is a pioneering effort within LMIC settings." Please explicitly state that this is the most effective approach for improving the well-being of families with children affected by cerebral palsy.

12. The study primarily focuses on the livelihoods of families with children affected by cerebral palsy. However, in the discussion section, there is insufficient analysis and discussion regarding this specific population group.

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Reviewer #1: Yes:  Xiuyu Du

Reviewer #2: Yes:  Xuanjie Chen

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[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.

Cost-effectiveness of livelihood interventions for families of children with cerebral palsy in rural Bangladesh

PONE-D-24-27317R2

Dear Dr. Khandaker,

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.

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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,

Najmul Hasan, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Following a comprehensive review, your paper has been acknowledged for its substantial contribution to the field of health sciences. The study offers valuable insights into the cost-effectiveness of livelihood interventions, and I am confident with this current version that it will have a significant impact on policy discussions, as well as practical applications aimed at improving the lives of children with cerebral palsy and their families in rural Bangladesh

Reviewers' comments: