Dear Dr. Endehabtu,

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.

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ACADEMIC EDITOR:

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Bereket Yakob, Ph.D.

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Dear Endehabtu,

Thanks for submitting your manuscript to PLOS One! We have reviewed your manuscript and found that it has a merit. However, before we make the final decision on it, I kindly ask you to make amendments to the review comments or write a rebuttal letter to each of the points raised by the reviewers.

Below are my comments for your consideration.

General comment:

Please check every line and sentence for language clarity and typos and amend accordingly.

Specific comments:

Move line 115 to 121 (put it under the data sources).

Methods section:

Expand the data source section - who conducted the national immunization survey? When was it conducted? Who was/were the participants? How many? Did the survey use a representative sample? And include any pertinent information about the survey. Cite references for the data source.

Sampling and sample size - It's unclear if this was about the national immunization survey or other steps you took during the analysis or in the methods. Was this about the data source? Clarify this!

Lines 181-184 are unclear. Please check it and rephrase for clarity.

Ethical considerations - how did you handle ethical issues regarding the geographic locations of women? Explain the steps you took.

Results:

Data presentation on table 1 requires simplification. Suggestion - you can have one column for the number of participants and once column for "yes" responses, i.e. column %s. Presenting the "no" responses doesn't add any value.

Move the methods-related results to the methods section where your presented the analysis and considerations. Present only the results related to the study question in the results section.

Discussion

The discussion lacks focus and is too long. Please only discuss the key findings and their implications to assist the readers follow the discussion, with the focus on the key findings.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Spatial Disparities in Zero-Dose Vaccination Coverage for Children Aged 12-23 Months in Ethiopia: A Geographically Weighted Regression Analysis

Synopsis: Using data from Ethiopia’s most recent national immunization survey, the authors examined the prevalence and geographic distribution of zero-dose children. Zero dose children are defined as children not having received the first dose of the diphtheria, tetanus, pertussis vaccine. Results from this study indicate that the prevalence of zero-dose children is 25% and spatial analyses identified statistically significant clusters of zero-dose children. Other results suggested that no antenatal care utilization, poor perception of benefits of immunization, no maternal tt/td vaccination and perception of the distance of the nearest facility as a big problem were significant predictors of zero-dose status. Overall, the authors highlight that contextual and social factors are crucial to consider for immunization programs, and that tailored approaches are needed.

Overall comments: The methods are sound; however, the manuscript would greatly benefit from editing for clarity and grammatical accuracy.

Major comments:

o Methods

� The authors write that the OLS was used as a baseline model with classical assumptions of linear regression such as multicollinearity. Did the authors omit a word and in fact meant no multicollinearity? The assumptions of linear regression are linearity, homoscedasticity, independence (of error), normality and no multicollinearity.

� How was vaccination status assessed? Was verbal report of receipt of DTP-vaccine by the caregiver accepted or was status based only on card confirmation?

o Results

� The authors should present column percents and not row percents in Table 1

� Please include total n in Table 1 (for yes zero-dose and no zero-dose). Additionally, please include a row for missing for the descriptive characteristics (e.g. n = 1,359 for perception of immunization benefit (poor/good) vs 1,537 for place of residency (urban/rural) among zero-dose children)

Minor comments:

o The authors write that they used data from a recent immunization program evaluation. Do the authors have information on when the immunization program evaluation was conducted? The data were accessed in 2024 but when was the survey conducted? If so, please include in the methods section.

o Line 27 – 29: The sentence is not grammatically correct and is too long. The reviewer suggests that the authors separate the sentence into two sentences. Example: “Though Ethiopia has made significant progress in childhood vaccination, many children remain unvaccinated, making it the third largest contributor to the global burden of zero-dose children. Zero-dose children are those children who have not received the first dose of diphtheria, tetanus and pertussis containing vaccine.”

o Line 82 – There is a typo in this sentence : “highest number of for un-…”

o Line 83 – This sentence is grammatically incorrect : “…children are estimated to haven’t received…”

o Line 102 – there is a typo in this sentence (“evidences”)

o Line 102 – there is a typo in this sentence.

o Line 212 – 212 : Error – reference source not found

o Line 345 – There is a typo in this sentence

o Line 348 – there is a typo in this sentence “ the coefficients from your GWR model”

Reviewer #2: The manuscript has been highlighting a strong background and justification as Ethiopia is contributing to over 6% of zero-dose burden globally and inequities exit between various geographies. The methodologies and study design are explicitly defined. The results are well explained while the ethical approvals have also been indicated.

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what does this mean? ). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: Yes:  SOOFIA YUNUS

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Attachments

Attachment

Submitted filename: PLOS One Review_8April2025.docx

Attachment

Submitted filename: PONE-D-24-59668 (1).pdf

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:

Please submit your revised manuscript by Sep 28 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Bereket Yakob, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

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. 

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

o Please update the section on sample size and sampling in response to my previous queries #6 and 7. Currently, it’s unclear whether this was part of the original study or if your team performed it during sampling. It appears you handled the sampling yourselves. If you want to keep the “sampling and sample size” section, I recommend describing how the national immunization survey conducted this process, rather than explaining how your team did it.

o Also, include a citation for the survey report as a reference. Clarify who conducted the study, owned the data, and shared it with you. The survey report is now available, and you can cite it in the 'Data source and type description' subsection. I have attached the survey report for your reference. Check if this was the survey you were referring to. 

o For my query #10, please indicate how you addressed it or provide justification for any modifications you chose not to make.

o In response to Reviewer 1’s comments #2 and 3, you did not specify the actions you took or modifications made. Please clearly state what changes, insertions, or omissions you implemented.

o Regarding Reviewer 1’s comment #10, the concern was valid, and the “Error – reference not found” message still appears in lines 211-212. It looks like your citation manager has not been updated recently, which causes this error in the PDF version of your manuscript. Updating your citations should resolve the issue.

[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.

Attachments

Attachment

Submitted filename: National_immunization_program_evaluation 2023-ETHIOPIA.pdf

Spatial Disparities in Zero-Dose Vaccination Coverage for Children Aged 12-23 Months in Ethiopia: A Geographically Weighted Regression Analysis

PONE-D-24-59668R2

Dear Dr. Endehabtu,

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.

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Kind regards,

Bereket Yakob, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: