Level and determinants of pentavalent vaccine dropout during infancy: A hierarchical analysis of community-level longitudinal study

Tariku Tesfaye Bekuma; Assefa Seme; Saifuddin Ahmed; Muluemebet Abera

doi:10.1371/journal.pone.0326684

Peer Review History

Original SubmissionFebruary 10, 2025
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If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references.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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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 Reviewer #2: No ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: No Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: No ****** Reviewer #1: 1. Add objective to introduction section than a sub-section in abstract? 2. There are a plenty of research o vaccination drop out in Ethiopia with even with spatial and weighted regression analysis, what you adds? 3. Why you don’t use other random effect statistics, median odds ratio, proportional change in variance 4. I am not sure with your community level variables? What are your references cite it? 5. What is the your rational to do spatial analysis, do you think there is a variation across regions? If so how do you know? Have you done auto-correlation? 6. Don’t compare apple to orange, compare apple to apple in your discussion, why your pocket study compared with sub-Saharan African study? 7. Improve the language, consistency and grammar of your entire text? Reviewer #2: Reviewer concern General comments Throughout the paper there are major editorial and structural issue which requires rearticulating and correction. This study is not appropriable titled since the the objective of the study is not addressed The title The tittle is not related to your research it is not a spatial study since it does not show spatial related methods and findings Abstract The background section of the abstract is just copy from your background section as a result please paraphrasing On conclusion you state higher pentavalent dropouts; what is your baseline to state high? Your recommendation is not in line with your finding; does you assess whether or not outreach programs gap for the finding? Background The first paragraph is just one sentence there for merge with succeeding paragraph Please maintain the chorological order of information I recommended you to construct from global to local We are now on 2025; what is this study contribution for Ethiopia National Expanded Program on Immunization Comprehensive Multi-Year Plan (2021-2025); rather find other targets that your study will have a contribution. The background section generally not informative; and it does not clearly show the known and the gap you want to find out; therefore please clearly show the gap as well as known contributing factors. Method Why you used three regions, why not you consider all regions considered in data collection since you want to show spatial distribution; it is recommended to consider all. If you consider mothers who were lost to follow-up as exclusion criteria; this may underestimate the finding since the mother lost follow up the infant may become defaulter The details of the sample size is not essential just take the total infants based on your inclusions criteria Please merge data collection tool and measurement Please state dependent variable and its operational definition Please rearticulate data quality section as one paragraph The first and last paragraph of data processing and analysis is not part of data analysis remove and use for data measurement and operational definition section respectively Ethics approval and consent to participate; I think it is not applicable since you used secondary data The method section has not single information about spatial autocorrelation analysis, hot spot analysis, and spatial interpolation; so please clearly right about these issues otherwise it is not a spatial study. Result This section is not well articulating please rearticulate all the result section Related to infant related characteristics which table has the detail of this section What does mean vaccination dropouts by background characteristics? Please rearticulating appropriately As I stated in the method section also here in the result section there is no enough analysis done to show spatial distribution. It is not a spatial study else work on autocorrelation analysis, hot spot analysis, and spatial interpolation Discussion The discussion is not well articulated and it does not clearly compare with other studies and does not use appropriate justification for discrepancies Please show the implication for each contributing factors ****** 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: No 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 Attachments Attachment Submitted filename: Comment_plos.docx https://doi.org/10.1371/journal.pone.0326684.r001
Revision 1
13 May 2025 Author Response Point by point responses to reviewers ‘comments We appreciated all the points raised by the reviewers and addressed as described below. Reviewer 1 comments 1: Add objective to introduction section than a sub-section in abstract? • Response: Thanks for the comment. Objective is merged into introduction section now. 2: There are a plenty of research o vaccination drop out in Ethiopia with even with spatial and weighted regression analysis, what you adds? • Response: Indeed, a lot of researches have been done in Ethiopia on vaccine dropout. This study also employed longitudinal data, asking a cohort of mothers about their infants'vaccinations at six weeks, six months, and a year. Because it encompassed the three major regions, it also provided a broader view. Other surveys like EDHS ask retrospectively about vaccination status over the previous two years of the study whereas others are small in scales which are limited within one zone/woreda of the country. 3. Why you don’t use other random effect statistics, median odds ratio, proportional change in variance • Response: Accepted! Thanks so much for the informative comments. Though we checked it initially, we did present the ICC only. Now, we learnt that it is important to add the median odds ratio and proportional change in variance measures too. They are both added now. Thanks so much, again. 4. I am not sure with your community level variables? What are your references cite it? • Response: We fully revised the community level variables and we used three references (Michael 2020, Hailay 2024, Kasiye 2021) which are cited as in the document. 5. What is the your rational to do spatial analysis, do you think there is a variation across regions? If so how do you know? Have you done auto-correlation? • Response: A valid point and we appreciated the comment. Yes, there is significant regional difference and we initially did not intend to show the detailed spatial analysis in this paper as it was not objective of this paper. As a result, we have omitted spatial related statements both from the title and the document. Thanks again for the concern. 6. Don’t compare apple to orange, compare apple to apple in your discussion, why your pocket study compared with sub-Saharan African study? • Response: Thanks so much for the important feedback. Now, discussion is fully revised as per your kind comments and the changed sessions are shown in TRACKED changes. 7. Improve the language, consistency and grammar of your entire text? • Response: The document is fully revised from the beginning and all language related issues are well addressed. Thanks so much, for the comment. Reviewer 2 comments General comment: • Throughout the paper there are major editorial and structural issue which requires rearticulating and correction. This study is not appropriable titled since the objective of the study is not addressed Response: The paper is now thoroughly revised and language related issues are well addressed. The title is modified in a way it better fits to the document. Thanks, Title • The tittle is not related to your research it is not a spatial study since it does not show spatial related methods and findings Response: Yes, we accepted the kind comments. We are using a multilevel analysis with odds ratio and we did not intend to do the detailed spatial analysis. As a result, we removed it both from the title and the content now. Thanks! Abstract: • The background section of the abstract is just copy from your background section as a result please paraphrasing. Conclusion you state higher pentavalent dropouts; what is your baseline to state high? Recommendation is not in line with your finding; does you assess whether or not outreach programs gap for the finding? Responses: • Background and recommendations are both revised/paraphrased as per the kind comments (shown in tracked changes). • In conclusion, “Higher” is used to describe the difference among different population sub-groups/a category of explanatory variables included in this study (the variables those significantly affected the dropout). It was not about comparison with other studies’ findings. Thank you for raising the concern. • Recommendation is revised accordingly. The point is well addressed now. Introduction: • The first paragraph is just one sentence there for merge with succeeding paragraph Response: The 1st and 2nd paragraphs are now merged • Please maintain the chorological order of information I recommended you to construct from global to local. Response: Misplaced statements/passages are now re-arranged from global to local. Thanks so much for the constructive feedback. • We are now on 2025; what is this study contribution for Ethiopia National Expanded Program on Immunization Comprehensive Multi-Year Plan (2021-2025); rather find other targets that your study will have a contribution. Response: The comment is very important and relevant. Yes, we are already in the target year and the context needs to be changed as a result. Accordingly, we have rephrased the statement to fit the current context and added another target too (the new initiative that Ethiopia recently launched in 2025, Re-Ignition of the Big Catch-Up (BCU)). Thanks, • The background section generally not informative; and it does not clearly show the known and the gap you want to find out; therefore please clearly show the gap as well as known contributing factors. Response: The background section is revised all in a way it shows gaps and contributing factors as per the kind suggestion. Thanks, Methods section • Why you used three regions, why not you consider all regions considered in data collection since you want to show spatial distribution; it is recommended to consider all. Response: We used only the three regions. Because, the panel survey was not conducted across all regions; Addis Ababa is fully urban, Afar is dominantly pastoral whereas panel data collection at Tigray region was interrupted for security reasons. The spatial component is now omitted as it was not the main aim of the study as already stated in the abstract (Objective statement). • If you consider mothers who were lost to follow-up as exclusion criteria; this may underestimate the finding since the mother lost follow up the infant may become defaulter Response: Yes, as stated exclusion of those lost to follow up from the data may either over-or-under-estimate the results. To adjust for this, we used a one-year follow-up weight. • The details of the sample size is not essential just take the total infants based on your inclusions criteria Response: The details of sample size are now removed as per the kind suggestion. • Please merge data collection tool and measurement Response: By measurement, we intended to present the operational measurement of outcome variable, which was generated specifically for this study rather than being initially collected. We have subtitled it now to reflect its true nature. • Please state dependent variable and its operational definition Response: This one is addressed in the response to the above comment (data collection tool and measurement). Sorry, it was confusing as it initially stands. Thanks for the constructive comment. • Please rearticulate data quality section as one paragraph Response: Thanks so much, for the comment. Data quality section is merged as a single passage now. • The first and last paragraph of data processing and analysis is not part of data analysis remove and use for data measurement and operational definition section respectively Response: Thanks! This is addressed accordingly and can be checked in the tracked changes. • Ethics approval and consent to participate; I think it is not applicable since you used secondary data Response: Ethics approval and consent to participate, which was stated in the paper refers to the original PMA Ethiopia survey. We wanted to provide evidence showing that the original survey was ethically cleared (as used in many studies). It was also separately requested during the online manuscript submission to the journal. Thanks again! • The method section has no single information about spatial autocorrelation analysis, hot spot analysis, and spatial interpolation; so please clearly right about these issues otherwise it is not a spatial study. Response: Thanks so much! We accepted your kind comments. Yes, it’s not a spatial study. As already stated in the abstract section, the study aimed to examine the level of pentavalent vaccine dropouts and determinants during infancy. Spatial analysis is already underway in another paper and we removed spatial statements both from the title and the content. Thanks again, Results Section • This section is not well articulating please rearticulate all the result section Related to infant related characteristics which table has the detail of this section What does mean vaccination dropouts by background characteristics? Please rearticulating appropriately Response: Result section is thoroughly revised and all the necessary changes are made. Infant related characteristics are now merged as study participants ‘characteristics which was originally stated only in a passage. Background characteristics were to mean maternal different characteristics. It’s now modified accordingly. Thanks, • As I stated in the method section also here in the result section there is no enough analysis done to show spatial distribution. It is not a spatial study else work on autocorrelation analysis, hot spot analysis, and spatial interpolation Response: Well appreciated! As responded above in methods session, the study aimed to examine the level of pentavalent vaccine dropouts and determinants during infancy. As a result, the spatial related statements are omitted for the stated reason. Discussions session • The discussion is not well articulated and it does not clearly compare with other studies and does not use appropriate justification for discrepancies Please show the implication for each contributing factors Response: Discussion is now thoroughly revised and sufficient justifications are added for the discrepancies. The implications for each factor are also explained well. Thanks so much for the informative comments! Attachments Attachment Submitted filename: Point by point responses to reviewers comments.docx https://doi.org/10.1371/journal.pone.0326684.r002
Decision Letter - Mohammed Hasen Badeso, Editor Level and determinants of pentavalent vaccine dropout during infancy: a hierarchical analysis of community-level longitudinal study PONE-D-25-04328R1 Dear Dr. Bekuma, 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, Mohammed Hasen Badeso, Epidemiologist Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0326684.r003
Formally Accepted
Acceptance Letter - Mohammed Hasen Badeso, Editor PONE-D-25-04328R1 PLOS ONE Dear Dr. Bekuma, 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. 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 Mr Mohammed Hasen Badeso Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0326684.r004

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