Dear Dr. Amoako,

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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: Yes

Reviewer #2: Yes

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Reviewer #1:  The manuscript “Dietary variability and micronutrient status of individuals with Yaws infection in Ghana: a case-control study” by Abigail Agbanyo et al. aims to reveal possible connections between nutritional status of individuals and yaws disease. This manuscript is well written and the topic is very interesting, but I have several concerns:

- Study setting:

o What was the reasoning behind selection of the studied communities and districts? Were they selected only because of consistent reports of yaws cases in the recent years, or were there other factors considered? Are these the only areas where cases of yaws are reported? I would appreciate more details and maybe a map of Ghana with the studied areas marked, as well as all the regions with yaws cases present.

- Study design:

o The participants were recruited over the period of seven months. Could the different times of the year have an influence on the nutrient intake? Discussion briefly mentions the seasonality of fruits and vegetables, does the season also affect availability of other food groups?

- Data analysis:

o Was any correction for multiple testing applied to the statistical tests used in the study?

- Results:

o In demographic characteristics description on lines 219 and 220, specify what is compared. It states that the sex distribution was not statistically significant, but the first part of the sentence mentions only 74% of males versus 26% females, which would be statistically significant difference.

o For the analysis of anthropometric characteristics, what data was used for the calculations? Baseline? Follow up? Both? Throughout the results, this information is stated only in some places. Please make this clear in both Methods and Results.

o Results are not divided by sex. It would be interesting to see such analysis as it would provide more details on how the nutrient intake differs between both sexes and if the nutrient intake inadequacy is more common in males or females. I only see the sex factor taken into account in the Adequacy of nutrient intake part of the Results, but not in the general analysis of the Nutrient intake and diversity. Is there a reason why this was not done?

o Figure 4 shows p-values, but which categories (clinical forms) were compared? The Dunn’s post-hoc test should identify which comparisons were statistically significant. Do the values shown always represent the comparison between Ulcers and Papillomas, as is currently marked in the Figure? Please add more details in the text.

- Discussion

o In general, the Discussion could be shorter. While the connections between different diseases and the stunting rates found in other studies and the possible effect of disease on nutrient intake or vice versa are very interesting, I would try to make this more concise.

Minor comments:

- Check the numbering of references. The citation on line 116 is numbered out of order.

- Line 163 and 166: Incorrect term. Sex should be used instead of gender.

- Text on Figures is too small and almost unreadable.

Reviewer #2:  This is a nice negative study demonstrating that nutrition seems to have little/no role in yaws but that under-nutrition is commonly found in yaws endemic communities.

Major Comments:

The methods are fairly well describe but there isnt a sample size section - was this calculated or was the sample size based on convenience of matching cases found in the previous study to controls? If there was a sample size calculation if should be included.

Please give a bit more detail on the matching of controls. For example I would have considered a similar age/gender might be important or potentially selecting someone without yaws but within the same household which would provide additional control for variations in exposure.

I would be more cautious in saying there are micronutrient differences - as the authors note the differences are not statistically significant and even if they were I dont think these are clinically significant differences i.e a <1% difference in Vitamin C intake etc.

There is a lot of testing (i,e if each micronutrient is associated with lesion type) - this is at least 13 comparisons; I would consider adjusting for multiple comparisons which i suspect would make even the weak associations detected become non-significant. (Similar point for table 7)

I suspect the discussion could be tigheter and shorter given the essentially null findings.

Minor Comments:

Drug names like Azithromycin dont need to be capitalised.

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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: No

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Dietary variability and micronutrient status of individuals with Yaws infection in Ghana: a case-control study

PONE-D-25-45732R1

Dear Dr. Amoako,

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.

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Kind regards,

Saki Raheem, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: (No Response)

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

Reviewer #2: (No Response)

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

Reviewer #2: (No Response)

**********

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

The PLOS Data policy

Reviewer #2: (No Response)

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

Reviewer #2: (No Response)

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Reviewer #2: I am satisfied the authors have responded to the comments adn the paper can be accepted for publication.

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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

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