-->PONE-D-25-27325-->-->Spatial Distribution and Associated Factors Influencing 2024 Measles-Rubella Vaccination Campaign Coverage among Children Aged 9–59 Months in Mainland Tanzania-->-->PLOS ONE

Dear Dr. Msuya,

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.-->--> -->-->Specificaly please provide all the information about the statistical analysis you did as resquested by the reviewer.

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PLOS ONE

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Additional Editor Comments:

Reviewer #1: This is a good attempt in spatial exploration of the 2024 MR vaccination campaign coverage in Tanzania. There are a few concerns that can improve the readability and the uptake of vaccines in Tanzania.

1. The necessary information on Moran's I estimation for autocorrelation analysis are missing.

2. What was the scale or level of aggregation for which autocorrelation was attempted, was it at the regional, district, ward or any other sub-regional levels?

3. How many sub-regions were there?

4. How were the neighbours defined, by contiguity, distance bands or k-nearest?

5. What type of weight matrix was defined for the analysis?

6. Further in the discussion the Moran's I value of 0.34 for such/similar health situations needs to be compared and contrasted.

7. After global Moran's I estimation, we would naturally expect the authors to provide Mora's local estimation (LISA) to point out the outliers (the high-low and low-high regions, which are important input for health intervention.

8.. In case of hot spot analysis, the Gets-Ord Gi* analysis, too in addition to the z values, we would expect to see the confidence limits.

9. Fig.2 in the manuscript indicates that clustering was explored at different geographic scales. If the results varied across these scales, it would be important to report them explicitly, as such differences illustrate the Modifiable Areal Unit Problem (MAUP). Including this discussion would improve methodological transparency.

10. One major purpose of testing for spatial autocorrelation is to guide subsequent analyses that account for spatial dependence, like spatial lag or spatial error models, conditional autoregressive models, or geographically weighted regression, etc. I am curious to know if authors have attempted any of those, and if not, if the reasons for not doing.

11. There is a mention on Geospatial Artificial Intelligence, in the conclusion and even in the abstract. But I could not see any relationship to this article. It would be helpful, if the authors explain it or remove the mention.

12. It would be good to state the specific packages and the version of R software that they have used for specific analyses.

13. In general, the language is of acceptable quality, but there is still a scope for improvements, for example "The majority of the surveyed caregiver’s were married/cohabited. In term of wealth, 5621 (41.3%) of the vaccinated

children during the campaign came from the middle (Table 1)"

Thank you

[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

**********

-->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 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: 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: No

**********

-->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 a good attempt in spatial exploration of the 2024 MR vaccination campaign coverage in Tanzania. There are a few concerns that can improve the readability and the uptake of vaccines in Tanzania.

1. The necessary information on Moran's I estimation for autocorrelation analysis are missing.

2. What was the scale or level of aggregation for which autocorrelation was attempted, was it at the regional, district, ward or any other sub-regional levels?

3. How many sub-regions were there?

4. How were the neighbours defined, by contiguity, distance bands or k-nearest?

5. What type of weight matrix was defined for the analysis?

6. Further in the discussion the Moran's I value of 0.34 for such/similar health situations needs to be compared and contrasted.

7. After global Moran's I estimation, we would naturally expect the authors to provide Mora's local estimation (LISA) to point out the outliers (the high-low and low-high regions, which are important input for health intervention.

8.. In case of hot spot analysis, the Gets-Ord Gi* analysis, too in addition to the z values, we would expect to see the confidence limits.

9. Fig.2 in the manuscript indicates that clustering was explored at different geographic scales. If the results varied across these scales, it would be important to report them explicitly, as such differences illustrate the Modifiable Areal Unit Problem (MAUP). Including this discussion would improve methodological transparency.

10. One major purpose of testing for spatial autocorrelation is to guide subsequent analyses that account for spatial dependence, like spatial lag or spatial error models, conditional autoregressive models, or geographically weighted regression, etc. I am curious to know if authors have attempted any of those, and if not, if the reasons for not doing.

11. There is a mention on Geospatial Artificial Intelligence, in the conclusion and even in the abstract. But I could not see any relationship to this article. It would be helpful, if the authors explain it or remove the mention.

12. It would be good to state the specific packages and the version of R software that they have used for specific analyses.

13. In general, the language is of acceptable quality, but there is still a scope for improvements, for example "The majority of the surveyed caregiver’s were married/cohabited. In term of wealth, 5621 (41.3%) of the vaccinated

children during the campaign came from the middle (Table 1)"

Thank you

**********

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Reviewer #1: Yes: Biju Soman

**********

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-->PONE-D-25-27325R1-->-->Spatial Distribution and Associated Factors Influencing 2024 Measles-Rubella Vaccination Campaign Coverage among Children Aged 9–59 Months in Mainland Tanzania-->-->PLOS One

Dear Dr. Msuya,

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.

==============================-->-->

As noted by the reviewer, the statistical analysis seems to be overinterpreted, there is no need for comparison of multiple CI values, a single statisticaly significant value as 95% is sufficient. As noted there are some standar color for maps and stats that may help.

Perhaps the color should be not significant (pale cream), high (red), low-low (blue), low-high (green) and high-low (light blue). To note there is some questions about the significance of some statistical indicators like the local Moran and Geary indicator within the LISA (Local indicator of spatial association) system (see Y Chen PlosOne 2024 May 22;19(5):e0303456. doi: 10.1371/journal.pone.0303456).

In addition in my mind the hotspot in LISA are the are where are high values near high values and Cold spots (low values near low values) while the others are outliers (areas that differ from their neighbors.

probably a new rewording may help to take that comments in acount

==============================

Please submit your revised manuscript by May 07 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Pierre Roques, Ph.D.

Academic Editor

PLOS One

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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

[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 #1: All comments have been addressed

**********

-->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 #1: Partly

**********

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

Reviewer #1: No

**********

-->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 #1: 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 #1: 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 #1: I thank the authors for the revised manuscript; it is much better than the earlier version. Still, it seems the manuscript will benefit from a thorough scrutiny by an expert in geostatistical analysis. The interpretation of LISA estimates and their statistics need correction. Why you go for 90% 95% and 99% CI values? I feel one CI at 95% level would be sufficient. There are a few factual errors in the manuscript in a couple of instances (eg: Line 362-365; the explanation of cod spots is wrong). The LISA maps should use the standard colour schema and standard pattern for depicting hotspots and cold stops, and significance levels.

**********

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Reviewer #1: Yes: Biju Soman

**********

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-->PONE-D-25-27325R2-->-->Spatial Distribution and Associated Factors Influencing 2024 Measles-Rubella Vaccination Campaign Coverage among Children Aged 9–59 Months in Mainland Tanzania-->-->PLOS One

Dear Dr. Msuya,

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 take in account the last suggestion from the reviewer specifically about the reference population used in the statistical analysis and perhaps the color used in the map (but this is really minor, just take care that it is explained in each of the figure legend; In addition, take care about the wording and cesure within the text as there are very few correction in the final step for publication,-->-->==============================

Please submit your revised manuscript by Jun 14 2026 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 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Pierre Roques, Ph.D.

Academic Editor

PLOS One

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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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 #1: All comments have been addressed

**********

-->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 #1: Yes

**********

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

Reviewer #1: 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 #1: No

**********

-->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 #1: 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 #1: Thank you for addressing the concerns raised earlier. Still there are a couple of things that will improve the manuscript.

1. In Table 2, the 'overall' estimates could be placed as the last row.

2. You are plotting MR vaccination coverage, so the colour schema of the maps should be reversed, high coverage (favourable outcome) should be given green and unfavorable outcome should be given 'red'. This should be adapted in all maps.

3. The groups of marital status should be collapsed to 'married/co-habitated' and 'others' (it does not make sense to keep too many groups, with very low proportions) in the multivariate analysis. Similarly, the sex of the respondent can be omitted, as the vast majority (97.5%) belongs to one sex.

4. Reconsider the inclusion of regions in the multivariate analysis. Why is 'Arusha' province taken as the comparator? If you still wish you keep it, use "Dar Es Salaam", and justify that being the capital city, it is used as the comparator.

5. The following two sentence on page 9 could be modified,

"In this study, the spatial regression models (e.g., spatial lag, spatial error, conditional autoregressive,

or geographically weighted regression) were not applied due to limited district- and ward-level

covariate data. Spatial autocorrelation analyses were performed at both regional and sub-region

levels to capture fine-scale variations in vaccination coverage and reduce aggregation bias from the

Modifiable Areal Unit Problem (MAUP) [32-34]," as

"In this study, inferential spatial regression models were not fitted because adequate district- and ward-level covariate data were not available. Instead, spatial autocorrelation analyses were conducted at both regional and sub-regional administrative levels to examine spatial clustering in vaccination coverage and to explore potential scale-related effects, including those related to the Modifiable Areal Unit Problem (MAUP) [32–34]."

**********

-->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 #1: Yes: Biju Soman

**********

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

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Spatial Distribution and Associated Factors Influencing 2024 Measles-Rubella Vaccination Campaign Coverage among Children Aged 9–59 Months in Mainland Tanzania: A multi-level mixed-effect analysis

PONE-D-25-27325R3

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