Effect of forest cover change on the prevalence of acute respiratory tract infections, diarrhoea, and fever among children under five: Using an ecosystem approach to child health

Amit Timilsina; Binaya Chalise; Kedir Y. Ahmed; Subash Thapa

doi:10.1371/journal.pone.0330101

Peer Review History

Original SubmissionSeptember 8, 2024
6 Dec 2024 Decision Letter - Andrew Wu, Editor PONE-D-24-38792Effect of Forest Cover on Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever among Children under 5 years in NepalPLOS ONE Dear Dr. Timilsina, 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. ==============================Academic Editor Notes:Please address the reviewers' comments below, especially the line about editing the manuscript for more proper English. The grammatical and spelling errors were very distracting on my own reading and make the manuscript look unprofessional to the reader, though I'm sure this does not reflect the authors' efforts. I also want to highlight Reviewer 2's comments about Tables 2 and 3 - I agree that these are difficult to understand and require explanations; new organization of the tables; or both. ============================== Please submit your revised manuscript by Jan 20 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 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, Andrew G Wu 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 [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? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This is an interesting study, providing a assessment of association between forest cover and infectious diseases in Nepal. Although the scale of the study is small, they provided a reasonable analysis and discussed their results well. I only have minor revision. 1. The line number should be provided in the article thoroughly. 2. The results in Table 3 should be provided as “estimate (95% CI)”. 3. What’s the criteria of covariates selection? It should be provided in method section. 4. Reference should be provided in the last paragraph in page 13. 5. Reference should be provided in the last paragraph in page 14. 6. For my consideration, it’s a cross-sectional study rather than ecological analysis. 7. I recommend authors to do stratify analysis according to different hygiene conditions, residential locations (urban/rural), and household income levels to identify effect modifiers and seek populations that could be more beneficial from forest cover. Reviewer #2: Reviewer report PONE-D-24-38792 This is a very interesting ecological study analysing the impact of forest canopy area on the prevalence of acute respiratory infections, fever and diarrhoea using country wide population health data (census) in Nepal. The sampling framework enabled random samples of households to be recruited that are representative of the diverse topography and geography in this country. I have a few questions for the authors to improve clarity and my understanding of their methods and findings. Introduction I would like to know more about the physiological or biological link between levels of forestation and its impact on childhood fever, ARI and diarrhoea so that the research question is more easily understood. Methods Were all the covariates named in Table 1 used in the logit models as potential confounders? Can the authors please explain how ethnicity was used as a measure of “advantage/disadvantage” (Page 8) – this might be obvious to the authors but I do not relate to ethnicity being analysed in this way. Why did the authors select a “logit” (logistic regression) model rather than a “generalized linear mixed model” Table 2: Only mean and standard error for each variable are reported – it is hard to understand the distribution of the variables. I would like to see more detailed summary statistics. Table 3: The lay out of Table 3 is difficult to follow – what are the numbers in the brackets for the “Forest Cover” row? Are these p-values? The p<0.01 – is this correctly reported in Table 3, if the numbers in the brackets are p-values? Please clarify this. Why not report the 95%CI in the Table 3 – it would be helpful see the range? Why are there rows for covariates and what does “yes” mean? The probability of lower levels of reported fever in 2016 is remarkably larger than in 2011 – am I reading the results correctly? How was the change in probability from 2011 to 2016 calculated? I can see the formula but cannot see how the calculation was conducted. Minor issues There are numerous grammatical and spelling errors throughout the manuscript, although they do not detract from the meaning of the manuscript, they will need to be addressed to improve readability. ******** 6. PLOS authors have the option to publish the peer review history of their article (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: Comments.docx https://doi.org/10.1371/journal.pone.0330101.r001
Revision 1
23 Dec 2024 Author Response 22/12/2024 Dr Andrew G Wu Academic Editor PLOS ONE RE: Submission of the revised manuscript, PONE-D-24-38792 Thank you for your time and feedback on our manuscript titled, Effect of Forest Cover Change on the Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever Among Children Under Five: Using an Ecosystem Approach to Child Health. We have carefully revised our manuscript and hope that the manuscript has improved substantially. Should you require any additional information, please do not hesitate to contact me. Thank you for your time and consideration. Sincerely, Mr. Amit Timilsina, MPH E-mail: timilsinaamit@gmail.com Reviewers' comments Reviewer #1 This is an interesting study, providing a assessment of association between forest cover and infectious diseases in Nepal. Although the scale of the study is small, they provided a reasonable analysis and discussed their results well. I only have minor revision. 1. The line number should be provided in the article thoroughly. RESPONSE: Amendment made. 2. The results in Table 3 should be provided as “estimate (95% CI)”. RESPONSE: The format of Table 3 is revised to include results as “estimate (95% CI)”. 3. What’s the criteria of covariates selection? It should be provided in method section. RESPONSE: Covariates included in the analysis were selected based on theoretical relevance, evidence from prior literature, and data availability. This information has been included in the methods section. 4. Reference should be provided in the last paragraph in page 13. RESPONSE: References have been added. 5. Reference should be provided in the last paragraph in page 14. RESPONSE: References have been added. 6. For my consideration, it’s a cross-sectional study rather than ecological analysis. RESPONSE: Thank you, the amendment has been made. 7. I recommend authors to do stratify analysis according to different hygiene conditions, residential locations (urban/rural), and household income levels to identify effect modifiers and seek populations that could be more beneficial from forest cover. RESPONSE: We appreciate the reviewer’s suggestion to conduct stratified analyses. However, we opted not to pursue these analyses as stratification would reduce statistical power due to smaller sample sizes within subgroups. We acknowledge the value of this approach and suggest it as a direction for future research. Reviewer #2: Reviewer report PONE-D-24-38792 This is a very interesting ecological study analysing the impact of forest canopy area on the prevalence of acute respiratory infections, fever and diarrhoea using country wide population health data (census) in Nepal. The sampling framework enabled random samples of households to be recruited that are representative of the diverse topography and geography in this country. I have a few questions for the authors to improve clarity and my understanding of their methods and findings. Introduction 1. I would like to know more about the physiological or biological link between levels of forestation and its impact on childhood fever, ARI and diarrhoea so that the research question is more easily understood. RESPONSE: Thank you for your feedback. Explanations about the physiological and ecological mechanisms linking forest cover to childhood infections have been added to the Introduction section with references. Methods 2. Were all the covariates named in Table 1 used in the logit models as potential confounders? RESPONSE: All covariates listed in Table 1 were included as potential confounders in the logit models. This has been mentioned in the statistical analysis section. 3. Can the authors please explain how ethnicity was used as a measure of “advantage/disadvantage” (Page 8) – this might be obvious to the authors but I do not relate to ethnicity being analysed in this way. RESPONSE: The categorization of caste/ethnicity in DHS data for Nepal is based on the caste system, which includes more than 125 groups. Due to the socioeconomic status and cultural hierarchy of these castes and ethnicities in Nepalese society, the DHS classifies them into six groups: upper caste groups, relatively advantaged janajati, religious minorities, disadvantaged non-Dalit Terai castes, disadvantaged janajati, and Dalits. For the purpose of this study, we further divide these into two broad categories: advantaged ethnic groups (comprising upper caste groups and relatively advantaged janajati) and disadvantaged groups (encompassing all others). 4. Why did the authors select a “logit” (logistic regression) model rather than a “generalized linear mixed model” RESPONSE: We used logistic regression with clustered standard errors at the village level because it is well-suited to the structure of our data, which comes from repeated cross-sectional surveys where households are not repeated across DHS waves. While households are nested within villages, the clustering in our data was appropriately accounted for by adjusting standard errors at the village (i.e. the DHS cluster) level, addressing intra-cluster correlation and ensuring valid inference. GLMMs are typically advantageous when analyzing hierarchical data with repeated measures or when random effects can capture substantial within-cluster variability. However, in this case, the absence of repeated measures for households and the cross-sectional nature of the data makes random effects unnecessary. Logistic regression with clustered standard errors provides a parsimonious and interpretable approach, aligning with our objective to assess population-level relationships while appropriately accounting for the data structure. 5. Table 2: Only mean and standard error for each variable are reported – it is hard to understand the distribution of the variables. I would like to see more detailed summary statistics. RESPONSE: Thank you. We acknowledge the value of additional statistics however, we opted to present the means and standard errors as they align with the primary objectives of our analysis, which focus on comparative trends over time rather than detailed distributional characteristics, which are in fact available in Demographic Survey reports. Table 3: 6. The lay out of Table 3 is difficult to follow – what are the numbers in the brackets for the “Forest Cover” row? Are these p-values? RESPONSE: Table 3 has been revised for clarity. 7. The ** p<0.01 – is this correctly reported in Table 3, if the numbers in the brackets are p-values? Please clarify this. RESPONSE: Amendment made. 8. Why not report the 95%CI in the Table 3 – it would be helpful see the range? RESPONSE: The 95% confidence intervals of the predicted probabilities are added to Table 3 for all estimates. 9. Why are there rows for covariates and what does “yes” mean? RESPONSE: Clarified in Table 3. 10. The probability of lower levels of reported fever in 2016 is remarkably larger than in 2011 – am I reading the results correctly? RESPONSE: Yes you are correct. 11. How was the change in probability from 2011 to 2016 calculated? I can see the formula but cannot see how the calculation was conducted. RESPONSE: The differences in average infection probabilities between the years 2011 and 2016 were calculated by including a dummy variable for the year 2016 in the regression model. This dummy variable takes the value of "1" for observations from the 2016 DHS wave and "0" for the 2011 wave. The coefficient of this dummy variable captures the change in the average probability of infection in 2016 relative to 2011, holding all other covariates constant. Specifically, the regression equation in page 7 can be expressed as: P(infection=1│X)= Φ(β_0+β_1 fcover+β_2 DHS2016+⋯) Here, β_2 DHS2016 quantifies the difference in the baseline log-odds of infection between 2016 and 2011, controlling for forest cover, household socio-demographic characteristics, maternal and child health characteristics, and household environmental characteristics. The corresponding probability difference can be computed by transforming the predicted log-odds into probabilities using the inverse of the link function (in this case, the cumulative normal distribution, Φ). Minor issues 12. There are numerous grammatical and spelling errors throughout the manuscript, although they do not detract from the meaning of the manuscript, they will need to be addressed to improve readability. RESPONSE: The manuscript has undergone a thorough proofreading process to address grammatical and spelling errors. Attachments Attachment Submitted filename: Response letter.docx https://doi.org/10.1371/journal.pone.0330101.r002
7 Mar 2025 Decision Letter - Furqan Kabir, Editor PONE-D-24-38792R1Effect of Forest Cover Change on the Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever Among Children Under Five: Using an Ecosystem Approach to Child HealthPLOS ONE Dear Dr. Timilsina, 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 go through the Reviewers comments in detail and respond to them accordingly. Please submit your revised manuscript by Apr 21 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 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, Furqan Kabir Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: (No Response) Reviewer #3: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. 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 requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: I thank the authors for responding to the reviewers’ comments and questions. Aside from some minor grammar edits, I recommend this manuscript be accepted for publication. I look forward to future research which tracks the trends identified in these analyses. Grammar/edits Line 95: ‘sub-region’ should be ‘sub-regions’ Line 96: ‘province’ should be ‘provinces’ Line 141: please add a comma after ‘dwelling’ Line 111: ArcGIS Pro requires some reference with the version number and manufacturer. Line 180: Please consider adding “decreased” after “(5% to 3%) as the sentence is incomplete. Line 180: Please edit the last sentence to “For detailed information, please refer to Table 2”. Reviewer #3: Thank you for the revised manuscript. Most of the comments from the first review were addressed. however- I still feel the following points still need to be addressed. Page 3 line 50 – Are these global statistics? Please specify PAGE 8 LINES 178- 180 The second part of the sentence seems incomplete Page 11 lines 244-245 While I understand this reasoning, I do not think that forest cover is directly related to diarrhoea either. One of the challenges in understanding the results is the lack of sample statistics (n +%). This helps us understand the prevalence of the different conditions and could also help us understand the non-significant results. Although the authors provide reasons for presenting means and standard errors only in their response- including sample distribution could still enhance the interpretation of the results. ****** 7. PLOS authors have the option to publish the peer review history of their article (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: No 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 . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0330101.r003
Revision 2
19 Mar 2025 Author Response 13/03/2025 Dr Furqan Kabir Academic Editor PLOS ONE RE: Submission of the revision 2 of the manuscript, PONE-D-24-38792 Thank you for your time and feedback on our manuscript titled, Effect of Forest Cover Change on the Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever Among Children Under Five: Using an Ecosystem Approach to Child Health. We have carefully revised our manuscript based on the feedback. Should you require any additional information, please do not hesitate to contact me. Thank you for your time and consideration. Sincerely, Mr. Amit Timilsina, MPH E-mail: timilsinaamit@gmail.com Reviewers' comments Reviewer #2 I thank the authors for responding to the reviewers’ comments and questions. Aside from some minor grammar edits, I recommend this manuscript be accepted for publication. I look forward to future research which tracks the trends identified in these analyses. Grammar/edits Line 95: ‘sub-region’ should be ‘sub-regions’ Line 96: ‘province’ should be ‘provinces’ Line 141: please add a comma after ‘dwelling’ Line 111: ArcGIS Pro requires some reference with the version number and manufacturer. Line 180: Please consider adding “decreased” after “(5% to 3%) as the sentence is incomplete. Line 180: Please edit the last sentence to “For detailed information, please refer to Table 2”. RESPONSE: Thank you. All the suggested amendments have been made. Reviewer #3 Thank you for the revised manuscript. Most of the comments from the first review were addressed. however- I still feel the following points still need to be addressed. Page 3 line 50 – Are these global statistics? Please specify RESPONSE: Amendment made. PAGE 8 LINES 178- 180 The second part of the sentence seems incomplete RESPONSE: Amendment made. Page 11 lines 244-245 While I understand this reasoning, I do not think that forest cover is directly related to diarrhoea either. RESPONSE: Thank you. The paragraph has been revised for clarity. One of the challenges in understanding the results is the lack of sample statistics (n +%). This helps us understand the prevalence of the different conditions and could also help us understand the non-significant results. Although the authors provide reasons for presenting means and standard errors only in their response- including sample distribution could still enhance the interpretation of the results. RESPONSE: Thank you for your comment. We truly appreciate your time and feedback. However, we prefer to maintain a focused presentation in this paper on the primary trends and the implications of forest cover changes on childhood infections. As you know, there have been published numerous papers over the past two decades on childhood fever, ARI, and diarrhoea using DHS data, focusing on the detailed demographic and distributional context. We hope you will agree with our rationale and decision. Thank you once again. Attachments Attachment Submitted filename: Response_letter_auresp_2.docx https://doi.org/10.1371/journal.pone.0330101.r004
21 Mar 2025 Decision Letter - Furqan Kabir, Editor PONE-D-24-38792R2Effect of Forest Cover Change on the Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever Among Children Under Five: Using an Ecosystem Approach to Child HealthPLOS ONE Dear Dr. Timilsina, 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. There are few minor comments that really need your attention, please review and respond accordingly. Please submit your revised manuscript by May 05 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 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, Furqan Kabir 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.] [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. https://doi.org/10.1371/journal.pone.0330101.r005
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11 Apr 2025 Author Response 11/04/2025 Dr Furqan Kabir Academic Editor PLOS ONE RE: Submission of the revision 3 of the manuscript, PONE-D-24-38792 Thank you for your feedback on our manuscript titled, Effect of Forest Cover Change on the Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever Among Children Under Five: Using an Ecosystem Approach to Child Health. We have revised the reference list based on your comment. Thank you for your time and consideration. Sincerely, Mr. Amit Timilsina, MPH E-mail: timilsinaamit@gmail.com Journal Requirements: 1. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. RESPONSE: Thank you. Ethics statement included. 2. 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. We have carefully checked all the references. References 1, 2, 4, 17, 23, and 24 have been corrected. Attachments Attachment Submitted filename: Response letter_R4.docx https://doi.org/10.1371/journal.pone.0330101.r006
15 Apr 2025 Decision Letter - Furqan Kabir, Editor PONE-D-24-38792R3Effect of Forest Cover Change on the Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever Among Children Under Five: Using an Ecosystem Approach to Child HealthPLOS ONE Dear Dr. Timilsina, 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 go through the Reviewers comments and draft your responses accordingly. Please submit your revised manuscript by May 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. Please include the following items when submitting your revised manuscript: 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, Furqan Kabir Academic Editor PLOS ONE [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 . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0330101.r007
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10 May 2025 Author Response 24/04/2025 Maidelyn R. Peregrin PLOS ONE RE: Submission of the revision 6 of the manuscript, PONE-D-24-38792 Thank you for your feedback regarding the use of figures containing map-based data. After careful consideration, we have decided to remove Figures 1 and 2 from the manuscript. Thank you for your time and consideration. Sincerely, Mr. Amit Timilsina, MPH E-mail: timilsinaamit@gmail.com Journal Requirements: 1. 1. We note that Figures 1,2 and 3 in your submission contain [map/satellite] images which may be copyrighted. All PLOS content is published under the Creative Commons Attribution License (CC BY 4.0), which means that the manuscript, images, and Supporting Information files will be freely available online, and any third party is permitted to access, download, copy, distribute, and use these materials in any way, even commercially, with proper attribution. For these reasons, we cannot publish previously copyrighted maps or satellite images created using proprietary data, such as Google software (Google Maps, Street View, and Earth). For more information, see our copyright guidelines: http://journals.plos.org/plosone/s/licenses-and-copyright. We require you to either (1) present written permission from the copyright holder to publish these figures specifically under the CC BY 4.0 license, or (2) remove the figures from your submission: 1. You may seek permission from the original copyright holder of Figures 1,2 and 3 to publish the content specifically under the CC BY 4.0 license. We recommend that you contact the original copyright holder with the Content Permission Form (http://journals.plos.org/plosone/s/file?id=7c09/content-permission-form.pdf) and the following text: “I request permission for the open-access journal PLOS ONE to publish XXX under the Creative Commons Attribution License (CCAL) CC BY 4.0 (http://creativecommons.org/licenses/by/4.0/). Please be aware that this license allows unrestricted use and distribution, even commercially, by third parties. Please reply and provide explicit written permission to publish XXX under a CC BY license and complete the attached form.” Please upload the completed Content Permission Form or other proof of granted permissions as an ""Other"" file with your submission. In the figure caption of the copyrighted figure, please include the following text: “Reprinted from [ref] under a CC BY license, with permission from [name of publisher], original copyright [original copyright year].” 2. If you are unable to obtain permission from the original copyright holder to publish these figures under the CC BY 4.0 license or if the copyright holder’s requirements are incompatible with the CC BY 4.0 license, please either i) remove the figure or ii) supply a replacement figure that complies with the CC BY 4.0 license. Please check copyright information on all replacement figures and update the figure caption with source information. If applicable, please specify in the figure caption text when a figure is similar but not identical to the original image and is therefore for illustrative purposes only. The following resources for replacing copyrighted map figures may be helpful: USGS National Map Viewer (public domain): http://viewer.nationalmap.gov/viewer/ The Gateway to Astronaut Photography of Earth (public domain): http://eol.jsc.nasa.gov/sseop/clickmap/ Maps at the CIA (public domain): https://www.cia.gov/library/publications/the-world-factbook/index.html and https://www.cia.gov/library/publications/cia-maps-publications/index.html NASA Earth Observatory (public domain): http://earthobservatory.nasa.gov/ Landsat: http://landsat.visibleearth.nasa.gov/ USGS EROS (Earth Resources Observatory and Science (EROS) Center) (public domain): http://eros.usgs.gov/# Natural Earth (public domain): http://www.naturalearthdata.com/" RESPONSE: Thank you for your feedback regarding the use of figures containing map-based data. After careful consideration, we have decided to remove Figures 1 and 2 from the manuscript. Our study primarily aims to examine the relationship between forest cover change and the risk of common childhood infections among children under five in Nepal. While spatial representation of forest cover was initially included for context, it is not central to our research objectives or analyses. We believe that removing these figures will not affect the clarity or scientific contribution of the study. We appreciate your guidance and hope this revised version aligns better with the journal’s licensing requirements. Attachments Attachment Submitted filename: Response letter_R6.docx https://doi.org/10.1371/journal.pone.0330101.r008
28 Jul 2025 Decision Letter - Keiko Nakamura, Editor Effect of Forest Cover Change on the Prevalence of Acute Respiratory Tract Infections, Diarrhoea, and Fever Among Children Under Five: Using an Ecosystem Approach to Child Health PONE-D-24-38792R4 Dear Dr. Timilsina, 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. For questions related to billing, please contact billing support . 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, Keiko Nakamura Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0330101.r009

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