Peer Review History
| Original SubmissionFebruary 8, 2025 |
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Dear Dr. Das, 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 29 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.
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In the online submission form, you indicated that “The codes are based on python and R and available from the corresponding author on proper request”.-->--> -->-->All PLOS journals now require all data underlying the findings described in their manuscript to be freely available to other researchers, either a. In a public repository, b. Within the manuscript itself, or c. Uploaded as supplementary information.-->-->This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If your data cannot be made publicly available for ethical or legal reasons (e.g., public availability would compromise patient privacy), please explain your reasons on resubmission and your exemption request will be escalated for approval.-->--> -->-->5. Please amend either the abstract on the online submission form (via Edit Submission) or the abstract in the manuscript so that they are identical.-->?> [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: Partly Reviewer #2: Yes ********** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: No Reviewer #2: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ********** Reviewer #1: Dear Authors Summary of the Study: The study evaluates machine learning (ML) algorithms to identify predictive factors of hypertension among married women in Bangladesh using data from the Bangladesh Demographic and Health Survey (2017–18). The authors employed 12 ML algorithms and 6 class-balancing techniques, with the Extra Tree algorithm combined with SMOTE+ENN yielding the highest performance (F1-score: 94%). SHAP analysis highlighted key factors, such as overweight status, parity, and partner’s education, as significant predictors. ________________________________________ Strengths of the Study: • Methodology: The comprehensive evaluation of 12 ML algorithms and 6 class-balancing techniques, validated through parametric and non-parametric tests, strengthens the robustness of the findings. • Interpretability: Integration of SHAP values enhances model transparency, enabling clear identification of both global and local predictive factors. • Focus on married women in Bangladesh addresses a critical gap in hypertension research. • Effective use of imbalanced data techniques (e.g., SMOTE+ENN) mitigates bias and improves minority-class prediction. Weaknesses of the Study: • The provided link does not lead to the dataset which makes it impossible to verify the findings because of insufficient reproducibility. • The models were not externally validated, limiting generalizability. • Insufficient rationale for selecting the Extra Tree algorithm over other high-performing models (e.g., XGBoost, Random Forest). ________________________________________ Discussion of Specific Areas for Improvement: Major Issues 1. The dataset link provided (https://dhsprogram.com/data/dataset_admin/index.cfm) does not grant direct access to the BDHS 2017–18 data. The authors must clarify access procedures (e.g., registration requirements) or provide an alternative repository link 2. Quantitative results are presented in the study for the 12 tested machine learning algorithms yet a clear academic methodological approach remains inadequate. The authors need to create a single performance metrics table in the main text to display F1-score, AUC-PR, recall, precision, accuracy alongside each algorithm-class-balancing combination. A model-specific table must present all the hyperparameter settings selected in order to guarantee experimental repeatability. This enhanced approach will make results more transparent and allow results comparison while making the research methodological practices stronger.. 3. The model requires external validation through independent data to validate its ability to generalize accurately. You should document unavailability of verification data while recommending researched methods for future validation experiments. 4. The author demonstrates why their Extra Trees model performed best by exploring features regarding parameter optimization and variable relationships. The research credibility can be improved by comparing results from equivalent studies which employed XGBoost in hypertension prediction. ________________________________________ Minor Issues 1. Standardize terms (e.g., use "class-balancing techniques" instead of variations like "class-balanced techniques"). 2. Ensure figures (e.g., SHAP plots) are labeled clearly, with legible font sizes and color contrasts for accessibility. 3. Minor errors exist (e.g., "infectundity" → "infecundity," ). Perform thorough proofreading. Reviewer #2: 1. The author has not used the latest Bangladesh Demographic and Health Survey 2022 (URL: https://www.dhsprogram.com/pubs/pdf/FR386/FR386.pdf). Is there any special reason. Please respond and justify. 2. The author have used data for 4,253 married women in Bangladesh. As we are aware that to assess the predictive power of machine learning algorithms, a sufficiently large sample is required. 3. Please keep the format and use of comma (,) properly throughout the text such as Row Number 154, 214, 218, 395, 482 etc. 4. Provide heading t table 2 and avoid repeatedly mentioning A and p-values within the table. 5. Avoid repeatedly mentioning chi-squared, df and p-values in table 5. 6. The conclusion part of the study is very short. It should be explanatory and exhaustive in nature. ********** 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: Ali Abbas Abbod Reviewer #2: Yes: Muhammad Abdus Salam ********** [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. |
| Revision 1 |
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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 Oct 22 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.
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, Benojir Ahammed, M.Sc. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #3: All comments have been addressed Reviewer #4: (No Response) ********** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #3: Yes Reviewer #4: Partly ********** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #3: Yes Reviewer #4: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #3: Yes Reviewer #4: No ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #3: Yes Reviewer #4: Yes ********** Reviewer #3: Thank you for reviewing the article. This a good scientific paper with public health importance. The article will be more palatable and readable if authors make it simple for wider audience. Reviewer #4: Detailed Comments Title and Abstract The title is clear and descriptive, effectively capturing the dual focus on evaluating ML algorithms and identifying hypertension factors. It could perhaps be tightened for conciseness, something like "Machine Learning Approaches to Predict and Rank Hypertension Risk Factors Among Married Women in Bangladesh" – but that's minor. The abstract is generally well-structured, summarizing the introduction, methods, results, and conclusion. I like how it highlights key metrics (e.g., F1 score jumping from 8% to 94% with SMOTE+ENN) and the top positive/negative factors from SHAP. However, there are a few awkward phrasings that make it feel a bit rough – for instance, "we aimed to develop a machine learning model to identify and rank predictive factors" could be more precise as "we developed..." since it's a completed study. Also, the prevalence stats (76.9% normal BP vs. 23.1% hypertensive) are useful, but tying them to broader implications right away might help. Grammatically, "infectundity" in the methods section should be "infecundity" (noted in responses to reviewers, but check if it's fixed). Overall, it's informative, but revise for smoother flow and ensure it matches the submission form version exactly, as flagged by the journal. Introduction The introduction sets up the problem nicely, starting with global hypertension stats and narrowing to Bangladesh, with a focus on women and married subgroups. I appreciate the literature review on ML applications in health outcomes – it's comprehensive, covering everything from SVMs in CHD prediction to SHAP's advantages over LASSO/ANOVA. References seem up-to-date and relevant, like the emphasis on tree-based models outperforming logistic regression. That said, it feels a tad lengthy in places, with some repetition (e.g., multiple paragraphs on ML superiority). The knowledge gap – why married women specifically? – is stated, but could be backed with more evidence on cultural/economic factors in Bangladesh. Also, since the current date is 2025, mentioning why 2017-18 data was used over the 2022 BDHS (as addressed in reviewer responses) should be integrated here for transparency. In my opinion, this section is strong but could be streamlined to about 80% of its length to keep the reader engaged. Methods This is one of the stronger sections, with detailed descriptions of data source (BDHS 2017-18, n=4,253), preprocessing, and analysis. The choice of 12 algorithms (e.g., Extra Trees, XGBoost, SVM) and 6 balancing techniques (SMOTE, ADASYN, etc.) is justified well for handling imbalance. Validation methods (hold-out + repeated stratified k-fold) and hyperparameter tuning via random search are appropriate, and the evaluation metrics (F1, AUC-PR, etc.) suit imbalanced data. SHAP for feature importance is a great addition for interpretability. However, a few clarifications are needed. How were features selected initially? The manuscript mentions demographic/clinical vars, but no explicit feature engineering or selection (e.g., Boruta or LASSO, as hinted in intro). Sample size justification is weak – 4,253 is decent, but discuss power for ML, especially with imbalance. Ethical considerations are covered, but confirm if any sensitive vars (e.g., religion) were handled with care. Hardware/software details are fine, but the GitHub repo for code is a plus – ensure it's fully reproducible. I'd suggest adding a flowchart for the workflow to make it easier to follow. Results The results are presented logically, starting with descriptive stats (Table 1 is comprehensive, showing hypertension stratification by demographics). Prevalence of 23.1% aligns with prior studies, and breakdowns (e.g., higher in Rangpur, urban areas) add context. Model performances are detailed, with Extra Trees + SMOTE+ENN shining (F1=94%, big improvement from baseline). SHAP plots (Figs 11a-c) effectively rank factors – age <35 negative, overweight positive, etc. – and the directionality (blue/red bars) is intuitive. But some issues: Tables 4-8 on stats tests (Anderson-Darling, Friedman) are dense; consider consolidating or moving non-essential to supp. Figures need better labels – e.g., ensure font sizes are legible and color contrasts accessible (as per reviewer comments). No mention of overfitting checks beyond CV scores. Also, while top 20 factors are screened, discuss if multicollinearity (e.g., age and parity) was addressed. Overall, solid but polish the presentation for clarity. Discussion The discussion ties results back to literature effectively, comparing to studies like Asadullah et al. (hybrid model at 78% accuracy vs. yours at 91%) and others using XGBoost. It highlights strengths: better performance in imbalanced data, context-specific factors for married women. Limitations are acknowledged (no external validation, old data), with plans for BDHS 2022 – good, but expand on how this affects generalizability (e.g., post-COVID changes in health behaviors?). I think it could delve deeper into implications – e.g., how factors like spousal education inform policy (education campaigns for men?). The SHAP insights are under-discussed; why might secondary education for husbands increase risk? (Perhaps socioeconomic stress?) Avoid overclaiming – e.g., "outperformed other models" is fine, but quantify vs. benchmarks. End with future directions, like integrating real-time data or multi-omics. Add these recent studies as references to your bibliography: DOI: 10.1007/s40200-020-00536-x, DOI: 10.1016/j.numecd.2021.09.029 Conclusion The conclusion recaps key findings concisely: Extra Trees + SMOTE+ENN best, lists top factors. It emphasizes ensemble methods' potential for imbalanced data, which is spot-on. However, it's a bit short and repetitive of the abstract. Expand to discuss broader impacts (e.g., public health applications in LMICs) and reiterate limitations briefly. As per reviewer #2, make it more explanatory – e.g., how this model could aid screening programs. General Comments • Figures and Tables: Mostly clear, but ensure PACE compliance for figures (as noted). Table 1 is excellent; others could use consistent formatting (e.g., avoid repeating stats in Table 5). • Writing and Language: Mostly good, but some typos/awkward sentences (e.g., "we aimed" in abstract should be past tense). Proofread thoroughly – e.g., "infectundity" fixed? Use consistent terms like "class-balancing" throughout. • References: Comprehensive (over 100), but check for recency – some pre-2020; add if newer ML-hypertension studies exist. • Reproducibility: GitHub code is a strength, but confirm data access instructions are precise. • Originality and Significance: Novel in focusing on married women with SHAP; contributes to ML in global health. But update with 2022 data for timeliness. ********** 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 #3: No Reviewer #4: 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.
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| Revision 2 |
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Predicting Hypertension and Identifying most important Factors among Married Women in Bangladesh using Machine Learning Approach. PONE-D-25-05724R2 Dear Mr. Das, 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, Benojir Ahammed, M.Sc. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #3: All comments have been addressed ********** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #3: Yes ********** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #3: Yes ********** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #3: Yes ********** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #3: Yes ********** Reviewer #3: The authors have addressed and incorporated all the necessary corrections as requested, ensuring that the revised manuscript aligns with the provided feedback and meets the required standards. ********** 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 #3: No **********
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| Formally Accepted |
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PONE-D-25-05724R2 PLOS ONE Dear Dr. Das, 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. 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 Mr. Benojir Ahammed Academic Editor PLOS ONE |
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