Prevalence and associated factors of anemia during pregnancy at a tertiary hospital in Zambia

Lukundo Siame; Francis Lwito Chishimba; Collins Mukubesa; Musonda Musonda; Fred Kabati; Michelo H. Miyoba; Kingsley Kamvuma; Sepiso K. Masenga; Benson M. Hamooya

doi:10.1371/journal.pone.0327801

Peer Review History

Original SubmissionNovember 4, 2024
Decision Letter - Ochuwa Babah, Editor Dear Dr. Siame, 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 Feb 06 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'. 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We look forward to receiving your revised manuscript. Kind regards, Ochuwa Adiketu Babah, M.Sc.PH (Epidemiology), FWACS, FMCOG 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. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary). 3. 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It is therefore not appropriate to publicly share personally identifiable data on human research participants. The following are examples of data that should not be shared: -Name, initials, physical address -Ages more specific than whole numbers -Internet protocol (IP) address -Specific dates (birth dates, death dates, examination dates, etc.) -Contact information such as phone number or email address -Location data -ID numbers that seem specific (long numbers, include initials, titled “Hospital ID”) rather than random (small numbers in numerical order) Data that are not directly identifying may also be inappropriate to share, as in combination they can become identifying. For example, data collected from a small group of participants, vulnerable populations, or private groups should not be shared if they involve indirect identifiers (such as sex, ethnicity, location, etc.) that may risk the identification of study participants. 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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, Please revise the manuscript in line with the reviewer's comments. Also please ensure that all editorial comments are noted and that the manuscript conforms with the journal style. Thank you. Best regards, Dr Ochuwa A. Babah [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: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: The manuscript addresses a very important and common problem. It is well written. my only comment is related to the demographic data. You included religion, does being protestant or catholic has different diet that could affect the prevalence of anaemia. If not please remove it. The same goes for the residence. Also please add the word complications to the (history of antepartum and history of postpartum) Reviewer #2: There is some grammar mistakes that the authors must correct. The mathematical equations of presented model were not provided. A figure that depicted the anemia in terms of ages were not presented. ****** 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: Nourah Hasan Al Qahtani 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 https://doi.org/10.1371/journal.pone.0327801.r001
Revision 1
26 Dec 2024 Author Response 24th December, 2024 To the reviewers and Editor, Ref: RESPONSES TO REVIEWER COMMENTS We would like to thank the reviewers for taking the time to make suggestions that have improved our manuscript. We have now made revisions to the comments in the manuscript and incorporated all suggestions. We now hope the current manuscript is acceptable for publication. Below are the point-by-point responses to all comments and suggestions Editorial comments 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: thank you. Files named according 2. Please amend your list of authors on the manuscript to ensure that each author is linked to an affiliation. Authors’ affiliations should reflect the institution where the work was done (if authors moved subsequently, you can also list the new affiliation stating “current affiliation:….” as necessary). Response: thank you. all authors have been given an affiliations 3. Please ensure that you refer to Figure 1 in your text as, if accepted, production will need this reference to link the reader to the figure. Response: thank you. Figure have been removed and uploaded as separate figures acceptable to the Journal requirements 4. 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: thank you. Supporting document caption has been updated at the end of the manuscript as per journal guidelines 5. We note that there is identifying data in the Supporting Information file <S2_minimal data set.xlsx>. Due to the inclusion of these potentially identifying data, we have removed this file from your file inventory. Prior to sharing human research participant data, authors should consult with an ethics committee to ensure data are shared in accordance with participant consent and all applicable local laws. Data sharing should never compromise participant privacy. It is therefore not appropriate to publicly share personally identifiable data on human research participants. The following are examples of data that should not be shared: -Name, initials, physical address -Ages more specific than whole numbers -Internet protocol (IP) address -Specific dates (birth dates, death dates, examination dates, etc.) -Contact information such as phone number or email address -Location data -ID numbers that seem specific (long numbers, include initials, titled “Hospital ID”) rather than random (small numbers in numerical order) Data that are not directly identifying may also be inappropriate to share, as in combination they can become identifying. For example, data collected from a small group of participants, vulnerable populations, or private groups should not be shared if they involve indirect identifiers (such as sex, ethnicity, location, etc.) that may risk the identification of study participants. Additional guidance on preparing raw data for publication can be found in our Data Policy (https://journals.plos.org/plosone/s/data-availability#loc-human-research-participant-data-and-other-sensitive-data) and in the following article: http://www.bmj.com/content/340/bmj.c181.long. Please remove or anonymize all personal information (Age in years) ensure that the data shared are in accordance with participant consent, and re-upload a fully anonymized data set. Please note that spreadsheet columns with personal information must be removed and not hidden as all hidden columns will appear in the published file. Response: thank you. All identifying information have been removed from the data set 6. 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. Response: thank you all references have been checked and cited accordingly in the text. Reviewer Comments Reviewer #1: The manuscript addresses a very important and common problem. It is well written. Response: thank you for reviewing of our article My only comment is related to the demographic data. You included religion, does being protestant or catholic has different diet that could affect the prevalence of anaemia. If not please remove it. The same goes for the residence. Response: Thank you very much. We included religion because, in our setting, certain Protestant religious groups (for example, Seventh-day Adventists, who make up 7.1%) advocate for vegetarianism. Regarding residence, we aimed to explore whether differences exist, as rural-based individuals tend to have a predominantly vegetable-based diet when compared to the urban based individuals. Also please add the word complications to the (history of antepartum and history of postpartum) Response: thank you for the suggestion. We have added the word complication Reviewer #2: There is some grammar mistakes that the authors must correct. Response: thank you for the observation. We have made effort to revise grammar. The mathematical equations of presented model were not provided. Response: Thank you. To arrive at the final model, we used variables with p-values less than 0.20 and those supported by the literature. These were included in the multivariable analysis, as explained in the methods section. A figure that depicted the anemia in terms of ages were not presented. Response: Thank you. A figure depicting anemia in terms of age has now been presented as Figure 2. We have revised the manuscript and addressed all concerns raised by the reviewers. We want to thank you all again for the tremendous work and time that you committed in editing our work. Our manuscript is much improved, and we are very grateful. Yours sincerely, Dr. Lukundo Siame, Bsc., MBcHB. Junior Residence Medical officer Livingstone University Teaching Hospital, Zambia Attachments Attachment Submitted filename: responses to the reviewers.docx https://doi.org/10.1371/journal.pone.0327801.r002
Decision Letter - Jennifer Yourkavitch, Editor Dear Dr. Siame, 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 Jul 30 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, Jennifer Yourkavitch 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: Thank you for this revision. I am a new editor recently assigned to this manuscript. I have just one last editing note: In the Results section, please do not begin sentences with a number, e.g., 8.2% of women xxx etc. You can begin those sentences with the spelling of the number, e.g., Eight percent of women xxx etc. or reconstruct those sentences, e.g., Few women (8.2.%) were xxx etc. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #2: Yes ****** Reviewer #2: The answers to the all comments were presented and prepared. There are no any reminded comments to be answered. ****** 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: Solaiman Afroughi ******** [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.0327801.r003
Revision 2
17 Jun 2025 Author Response We would like to thank the reviewers for taking the time to make suggestions that have improved our manuscript. We have revised the manuscript and addressed all concerns and suggestions. We now hope the current manuscript is acceptable for publication. Below are the point-by-point responses to all comments and suggestions. Response to the reviewer: Academic editor’s comment: Thank you for this revision. I am a new editor recently assigned to this manuscript. I have just one last editing note: In the Results section, please do not begin sentences with a number, e.g., 8.2% of women xxx etc. You can begin those sentences with the spelling of the number, e.g., Eight percent of women xxx etc. or reconstruct those sentences, e.g., Few women (8.2.%) were xxx etc. Response: Thank you very much for the suggestion: we have revised the manuscript the manuscript as suggested. Reviewer comments: Reviewer #2: The answers to all comments were presented and prepared. There are no any reminded comments to be answered. Response: thank you. We have revised the manuscript and addressed all concerns raised. We want to thank you all again for the tremendous work and time that you committed to reviewing and correcting our work. Our manuscript is much improved, and we are very grateful. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0327801.r004
Decision Letter - Jennifer Yourkavitch, Editor Prevalence and associated factors of anemia during pregnancy at a tertiary hospital in Zambia PONE-D-24-48610R2 Dear Dr. Siame, 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, Jennifer Yourkavitch Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0327801.r005
Formally Accepted
Acceptance Letter - Jennifer Yourkavitch, Editor PONE-D-24-48610R2 PLOS ONE Dear Dr. Siame, 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 Dr. Jennifer Yourkavitch Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0327801.r006

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