Factors associated with weighing a child at birth: Evidence from 16 sub-Saharan African countries

Alex Bawuah; Samuel Ampaw; Edward Nketiah-Amponsah

doi:10.1371/journal.pone.0328463

Peer Review History

Original SubmissionJanuary 27, 2024
Decision Letter - George Kuryan, Editor Dear Dr. Nketiah-Amponsah, 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 18 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'. 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We strongly recommend all authors decide on a data sharing plan before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire data will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption. Please be assured that, once you have provided your new statement, the assessment of your exemption will not hold up the peer review process. [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: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes ****** Reviewer #1: I appreciate the authors highlighting health disparities by emphasizing the importance of weighing newborn babies, and how it will help health organizations and policy administrations address neonatal complications and mortalities. Introduction: No changes required Methods: • The study conducted both unadjusted and adjusted analyses. In the adjusted analysis, did the authors explore whether there were any interaction effects? • Additionally, did the authors identify any high correlations between independent variables? For example, are women who are wealthy more likely to live in urban areas and also be well-educated? Results and Discussion: • Page 5, line 21 to 27: I see which African country has the highest and lowest percentage of children weighted at birth. However, I don’t see authors mentioning why that is the case. • This also raises the question of why the authors did not include the country as an independent variable in the adjusted analysis. Despite the similarities within sub-Saharan countries, health policy and care delivery might differ among these countries, potentially affecting the final response variable, i.e., recording infant weight after birth. • Table 1 – consider removing the column ‘% of children not weighted at birth’ as it seems redundant. • The numbers in Table 2 don’t add up to 100%. There is a small margin of error for some categories. For example, when adding the percentages for 'weighed' and 'not weighed' for both male and female genders, it does not exactly equal the pooled sample total. The same issue arises for birth type. I encourage the authors to double-check the numbers." Conclusion: no changes required. ****** 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 ******** [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". 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Revision 1
14 May 2024 Author Response Dear Editor, Thank you sincerely for the positive feedback and the meticulous review and constructive comments on our manuscript. The comments have been invaluable in improving the quality of our manuscript. In response to the reviewer comments, we have diligently implemented the necessary corrections throughout the manuscript. It is important to note that these revisions may have resulted in changes to line and page numbers. Our commitment to enhancing the clarity and precision of our submission has been paramount in making these adjustments. Please find below our responses to the reviewers’ comments; the comments are italicized while the responses are highlighted in read. Moreover, the ensuing corrections or changes in the manuscript are tracked for easy recognition. Reviewer #1: Comment I appreciate the authors highlighting health disparities by emphasizing the importance of weighing newborn babies, and how it will help health organizations and policy administrations address neonatal complications and mortalities. Response No changes required. Many thanks for the compliment. Comment Methods: The study conducted both unadjusted and adjusted analyses. In the adjusted analysis, did the authors explore whether there were any interaction effects? Response Many thanks for this insightful suggestion. Accordingly, we have included interactions in the adjusted analysis. We interacted place of residence and birthplace, using ANC and birthplace and education and place of residence (see the revised estimates in Table 3 for the results on pages 9 and 10). Comments Additionally, did the authors identify any high correlations between independent variables? For example, are women who are wealthy more likely to live in urban areas and also be well-educated? Response Thank you for drawing our attention to the need to provide evidence on the extent of collinearity between the independent variables. We performed a diagnostic test for collinearity between the independent variables by looking at the variance inflation factor (VIF) and tolerance indices (TI) of the independent variables (see page 5 lines 20 to 26). Comment Results and Discussion: • Page 5, line 21 to 27: I see which African country has the highest and lowest percentage of children weighted at birth. However, I don’t see authors mentioning why that is the case. • This also raises the question of why the authors did not include the country as an independent variable in the adjusted analysis. Despite the similarities within sub-Saharan countries, health policy and care delivery might differ among these countries, potentially affecting the final response variable, i.e., recording infant weight after birth. Response We have addressed this concern by including the country as an independent variable in the adjusted analysis. See table 3 for the results on pages 9 and 10 and page 12 line 20 to 26 for possible explanation for the differences in the percentages of children weighed at birth across the sampled countries. For instance, in 2006, Rwanda launched a national Facility-Based Childbirth Policy (FBCP), which provides free antenatal care and facility-based delivery services. The policy led to an increase in intuitional delivery and other maternal healthcare services. Perhaps, the reason why children in Rwanda are more likely to be weighed compared to children from other countries. Comment Table 1 – consider removing the column ‘% of children not weighted at birth’ as it seems redundant. Response Many thanks. This has been duly deleted. Comment The numbers in Table 2 don’t add up to 100%. There is a small margin of error for some categories. For example, when adding the percentages for 'weighed' and 'not weighed' for both male and female genders, it does not exactly equal the pooled sample total. The same issue arises for birth type. I encourage the authors to double-check the numbers." Response Thanks for drawing our attention to this anomaly. We have made the requisite changes. We hope our revision will meet your expectations. Yours faithfully Edward Nketiah-Amponsah (On behalf of co-authors) Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0328463.r002
Decision Letter - Gbenga Kayode, Editor Dear Dr. Nketiah-Amponsah, 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 Mar 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, Gbenga Kayode Academic Editor PLOS ONE Additional Editor Comments: Although both reviewers recommended the manuscript for acceptance, I would like the authors to address the following comments before we consider publication. 1) The authors should explain why the year of data collection was not included in the analysis. 2) Given the hierarchical nature of the data, the authors should clarify why a hierarchical or multilevel model was not used to analyze the data. 3) The authors should clarify why health indicators from previous births were not considered. 4) For each variable in Table 2, the authors should present the percentages of missing data. 5) The authors should clarify why they did not consider the weight of the data in their analysis. 6) The authors should clarify why significant factors like employment status and birth order were excluded from the analysis. 7) The authors should clarify how they handled missing data. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Page 12 line 21, there is a typo, change it to “countries”. Otherwise, the current manuscript draft reads well, and I acknowledge that all my comments have been addressed. I wish authors good luck for their future research works. Thanks! Reviewer #2: The manuscript have addressed all the reviewer's comments. The write up is concise and comprehensive . However, i will recommend the word"lilkelier be replaced with "most likely', otherwise, the manuscript was well written. The introduction, objectives, methodology, results and discussion were all well captured. ****** 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 . Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-24-00704_R1_reviewer.pdf https://doi.org/10.1371/journal.pone.0328463.r003
Revision 2
22 Feb 2025 Author Response Response to Editor's Comments We wish to thank you and the reviewers sincerely for your constructive comments on our manuscript titled ‘Factors associated with weighing a child at birth: evidence from 16 sub-Saharan African countries’ submitted to PLOS ONE for publication consideration. The comments have been invaluable in improving the quality of our manuscript. In response to the reviewer comments, we have diligently implemented the necessary corrections throughout the manuscript. We have addressed the comments point-by-point as far as feasible. Please find below our responses to the reviewers’ comments; the comments are boldened while the responses are italicized. Moreover, the ensuing corrections or changes in the manuscript are identified by page numbers for easy recognition whenever applicable. 1. The authors should explain why the year of data collection was not included in the analysis. Response: The model initially included the year variable to account for potential temporal effects. However, it (year) was perfectly collinear with the country variable. Given this collinearity, the year variable was omitted from the final model. We can still show the results with the year variable if deemed necessary. 2. Given the hierarchical nature of the data, the authors should clarify why a hierarchical or multilevel model was not used to analyse the data. Response: We acknowledge the hierarchical nature of the data, where individuals are nested within countries. To address this, we accounted for clustering and country-level heterogeneity in the following ways; i. Clustering at the Country Level: We used clustered standard errors at the country level (vce(cluster Country)) to adjust for within-country correlation. This ensures that our standard errors are robust to potential intra-country dependencies. ii. Country-Fixed Effects: We included country-fixed effects (i.Country) in our regression model to control for unobserved country-level characteristics that might influence the outcome variable. This approach allows us to isolate within-country variation while accounting for systematic differences across countries. 3. The authors should clarify why health indicators from previous births were not considered. Response: Health indicators from previous births are only available for women who have had more than one birth. Including these variables would exclude women with only one birth from the analysis. Since our study is not limited to women with multiple births, we chose not to incorporate these indicators to maintain a broader and more representative and consistent sample. 4. For each variable in Table 2, the authors should present the percentages of missing data. Response: This has been duly provided in the revised version of the manuscript. See Table 2 (pages 7 and 8) 5. The authors should clarify why they did not consider the weight of the data in their analysis. Response: Our analysis accounted for survey sampling weights by specifying the probability weights (pweight=v005) in our regression model. See page 5, line 24. 6. The authors should clarify why significant factors like employment status and birth order were excluded from the analysis. Response: We have included employment status (currently working variable) in the revised version of the manuscript. The model did not include birth order due to collinearity with the parity variable. We are happy to include it regardless, if deemed necessary. 7. The authors should clarify how they handled missing data. Response: We handled missing data using listwise deletion. Thus, observations with missing values in any of the variables included in the regression model were excluded from the analysis. This approach ensures consistency across all model estimates. See page 5, lines 24 to 27. We hope our revisions will meet your kind expectations. Yours faithfully, Prof. Edward Nketiah-Amponsah, PhD (on behalf of all co-authors) Attachments Attachment Submitted filename: Response Memo to Reviewers Comments_Birthweight Manuscript.docx https://doi.org/10.1371/journal.pone.0328463.r004
Decision Letter - Alfredo Fort, Editor Dear Dr. Nketiah-Amponsah, 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 11 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, Alfredo Luis Fort, M.D., M.Sc., Ph.D. 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. [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: I have reviewed the revised manuscript and confirm that the author has satisfactorily addressed all the concerns and suggestions raised during the review process. The revisions have strengthened the clarity, scientific rigor, and relevance of the study. The responses to comments were clear, and the updated manuscript reflects the necessary improvements in content and structure. I find no further issues requiring revision and recommend the manuscript for acceptance in its current form. ****** 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: Fatima Abubakar Ishaq ******** [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: PONE-D-24-00704_R2 (3).pdf Attachment Submitted filename: PONE-D-24-00704_R2-AF.pdf https://doi.org/10.1371/journal.pone.0328463.r005
Revision 3
12 Jun 2025 Author Response We sincerely thank you for your constructive editorial comments on our manuscript titled ‘Factors associated with weighing a child at birth: evidence from 16 sub-Saharan African countries’ submitted to PLOS ONE for publication consideration. The comments have been invaluable in improving the quality of our manuscript. In particular, we requested a colleague who is more proficient in the English language to proofread the manuscript. We have also diligently addressed all the minor but essential errors, such as omitting the percent (%) sign in some figures. Besides, we have accepted your suggested corrections in tracked changes across the manuscript. For ease of reference, we have provided the clean and tracked changes versions of the manuscript for your review. We hope our revisions will meet your kind expectations. https://doi.org/10.1371/journal.pone.0328463.r006
Decision Letter - Alfredo Fort, Editor Factors associated with weighing a child at birth: evidence from 16 sub-Saharan African countries PONE-D-24-00704R3 Dear Dr. Nketiah-Amponsah, 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, Alfredo Luis Fort, M.D., M.Sc., Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): I have added a copy of the latest version with a few suggested additions and edits to make the manuscript more understandable to general readers. Please see them in the attached file. Attachments Attachment Submitted filename: PONE-D-24-00704_R3-AF.pdf https://doi.org/10.1371/journal.pone.0328463.r007
Formally Accepted
Acceptance Letter - Alfredo Fort, Editor PONE-D-24-00704R3 PLOS ONE Dear Dr. Nketiah-Amponsah, 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. Alfredo Luis Fort Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0328463.r008

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