Birth preparedness and complication readiness knowledge, practices and its associated factors among recently delivered women: A cross-sectional study in Bharatpur, Chitwan, Nepal

Asmita Ghimire; Bipan Bahadur Tiwari; Eak Narayan Poudel; Mamta Chhetri; Devraj Regmi; Laxman Poudel

doi:10.1371/journal.pone.0340376

Peer Review History

Original SubmissionJuly 21, 2024
6 Sep 2024 Decision Letter - Adaoha Agu, Editor Dear Dr. Ghimire, 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. ============================== Therefore, we invite you to submit a revised version of the manuscript before it can be sent to external reviewers. Discuss the study limitations on the effects of the study outcomes to fully satsfy PLOS ONE's publication criteria number 7. ============================== Please submit your revised manuscript by Oct 21 2024 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 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 are unable to open your Supporting Information file [FInal data 101.sav]. Please kindly revise as necessary and re-upload. [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. 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Revision 1
16 Sep 2024 Author Response 16 September 2024 Subject: Re: Manuscript PONE-D-24-29050R1 – Revisions and Resubmission Dear Dr. Delas Alas Vida, Thank you for your email regarding our manuscript entitled “Birth Preparedness and Complication Readiness Knowledge and Practices Among Recently Delivered Women: A Cross-Sectional Study in Bharatpur, Chitwan, Nepal” (Manuscript ID: PONE-D-24-29050R1). We appreciate your feedback and are addressing the requested revisions as follows: 1. Removal of Duplicate Files: We have reviewed the files in our submission and removed all unnecessary or duplicate files. Only the relevant files pertaining to the current version of the manuscript have been included. 2. Inclusion of Figure Legends: We have updated the manuscript to include separate, detailed legends for each figure. The legends now provide clear and comprehensive descriptions to enhance the reader's understanding of the figures. 3. Reference to Table 9: We have ensured that Table 9 is properly referenced in the text of the manuscript. This reference is included to facilitate easy linking between the text and the table upon acceptance. We have resubmitted the revised manuscript with the requested changes. Please let us know if any further adjustments are needed. Thank you for your consideration and for providing us with the opportunity to revise our manuscript. We look forward to your feedback and hope for a favorable review. Best regards, Asmita Ghimire Chitwan Medical College, Tribhuwan University, Nepal ghimireasmita570@gmail.com +9779866615678 Attachments Attachment Submitted filename: Response To Reviewers..docx https://doi.org/10.1371/journal.pone.0340376.r002
3 Aug 2025 Decision Letter - Adaoha Agu, Editor Dear Dr. Ghimire, Title :The aspect of associations and predictors being explored in this study, is not reflected in the title. Abstract : State the justification for this study in the background section. State the figure for the overall proportion of women who.... in the Conclusion section. Introduction : Last sentence- "Assess" not "Access" .Grammar editing needed in this and other sections. Study Design : Restructure the first sentence to read "A community based cross-sectional study was conducted using.....from 25th September to 29th December 2022. State which stages of the immunisation schedule, the babies had to be in for their mothers to be eligible for this study.Explain why women seeking vaccination for MR 2nd dose and Typhoid were excluded. Sample Size and Sampling Methods : This phrase is not clear "hypothesis of 95% confidence interval". State the reason behind the purposive selection of the 3 wards selected. (Convenience was stated as the reason for the choice of the 3 health institutions). Explain how you selected subjects from the 3 sites and how you intended to distribute the sample size across the 3 sites. Measurement :State the outcome variables clearly. Data Analysis :State the number of components BCPR has and provide information on the scoring criteria for the knowledge variables. State the p-value <0.05 you used to set statistically significant variables in the multivariable analysis as mentioned in the abstract. Why was this value chosen? Results-->?>DiscussionReferencing : should be uniform. Please submit your revised manuscript by Sep 17 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 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, Adaoha Pearl Agu, MBBS, MSc, FMCPH 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. Additional Editor Comments (if provided): Please address the following concerns in addition to those raised by the reviewer.The entire manuscript will benefit from serious grammar and spelling editing. Title:The aspect of associations and predictors being explored in this study, is not reflected in the title. Abstract: State the justification for this study in the background section. State the figure for the overall proportion of women who.... in the Conclusion section. Introduction: Last sentence- "Assess" not "Access" .Grammar editing needed. Study Design: Restructure the first sentence to read "A community based cross-sectional study was conducted using.....from 25th September to 29th December 2022. State which stages of the immunisation schedule, the babies had to be in for their mothers to be eligible for this study.Explain why women seeking vaccination for MR 2nd dose and Typhoid were excluded. Sample Size and Sampling Methods: This phrase is not clear "hypothesis of 95% confidence interval". State the reason behind the purposive selection of the 3 wards selected. (Convenience was stated as the reason for the choice of the 3 health institutions). Explain how you selected subjects from the 3 sites and how you intended to distribute the sample size across the 3 sites. Measurement:State the outcome variables clearly. Data Analysis:State the number of components BCPR has and provide information on the scoring criteria for the knowledge variables. Results: State whether the adequate knowledge in 59.1% of the respondents, refers to a composite knowledge score (composite score is not seen on the Table with Knowledge variables- Table 2). Table 1 should be left as it is (do not split). The narrative below Table 3 begins with "Table 8"...., refers to the information contained in Table 4, and is a repetition of the narrative below Table 4. Table 3 should appear before Table 2. Table 4 subheading should read"Assistance" not "Assistant".,Merge Tables 5 and 6.Remove "other" from Table 7 title. The information in Table 8 can be presented as a narrative only, not as a table. Was a composite knowledge score used in Table 9?. Do not repeat the information presented in the figures, in the tables. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: No ****** Reviewer #1: The manuscript addresses an interesting and important topic in maternal and child health and findings will support informed decisions. I, however, have few comments for the authors to consider Abstract The abstract's background only defines Birth preparedness. Kindly shed more light on it. Let us know what necessitated this study/purpose. Methods You probably want to say structured interview “tool/questionnaire” instead of schedule In the methods session, line 4 has a typographical error. Please check and correct it. Results The first sentence needs structuring Conclusion For the conclusion of the abstract, there should be an “and” between “antenatal care” and interventions, and all the commas should be removed as shown below. It will be good to give the magnitude/ proportion of women who prepared for birth and its complications Main Work Introduction 1. You need to check typos and grammatical errors. Have tried to input in the document Methods Justification for the study area is not available. Sample size calculation 1. Any justification for considering 7% as margin of error instead of 5%? In the calculation, however, 6% is used. With an expected prevalence of 29% one will have expected a smaller margin of error, at least the default 5% Besides, the paper you referenced stated that 29% lacked information on BPP and I am wondering if this is the same as prevalence of poor BPCR practice 2. How was the sample size distributed among the wards and health institutions? Measurements 3. Any reference to the previously validated questionnaire? 4. Were the regular reviews of the questionnaire done during data collection? 5. Study design needs to be written well and concisely 6. The sampling of participants for the study should be clearly written 7. Examples of obstetric and institutional factors investigated Data collection process 8. Data collection procedure needs to be written well/clearly 9. There was no mention of who did the data collection and whether training was done before the data collection Data Analysis 10. It would have been good to describe a bit more about scoring Results 11. IQR is between 25th and 75th percentiles not min and max 12. Table 1 could have been divided into three (1. Socio-demographic 2. Obstetric 3. Complication experience) instead of one table running through several pages 13. The tables need to be constructed well and referenced 14. Section on support received by women is repeated 15. Chose Fig 2 or Table 5, Fig 3 or Table 6. You should not present same data on both tables and figures Discussion 16. The discussion seemed to have repeated the results and compared with other studies but failed to discuss any implication of the findings Generally, the document needs a lot of work grammatically References Bibliography should be done well. They are not uniform. A common reference style should be used. Figures The title of all the figures should be placed below the figures, not above them. ****** 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 ******** [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: PONE-D-24-29050_R1_manuscript for review_Awini.pdf https://doi.org/10.1371/journal.pone.0340376.r003
Revision 2
14 Oct 2025 Author Response 17 September 2025 To Adaoha Pearl Agu, MBBS, MSc, FMCPH Academic Editor PLOS ONE Subject: Rebuttal Letter for Manuscript (PONE-D-24-29050R1)- Birth Preparedness And Complication Readiness Knowledge And Practices Among Recently Delivered Women: A Cross-Sectional Study In Bharatpur, Chitwan, Nepal Dear Editor and Reviewers, Thank you for the opportunity to revise our manuscript entitled "[Birth Preparedness And Complication Readiness Knowledge And Practices Among Recently Delivered Women: A Cross-Sectional Study In Bharatpur, Chitwan, Nepal ]" (Manuscript ID: [PONE-D-24-29050R1]). We sincerely appreciate the time and effort you and the reviewers have invested in providing thoughtful and constructive feedback. We have carefully considered all the comments and have revised the manuscript accordingly. Below, we provide a detailed point-by-point response to each comment. Reviewer comments are shown in bold, followed by our responses in regular text. All changes made in the manuscript are highlighted. Reviewer #1 Comments and Author Responses Abstract: We have revised the abstract’s background to include the rationale and purpose of the study. The term “structured interview schedule” has been replaced with “structured interview questionnaire” in the Methods section. The typographical error has been corrected. The first sentence of results has been restructured for better clarity and readability. We have added the specific proportion (46.8%) of women who were well prepared for birth and complications in the abstract. Main Manuscript Introduction Comment: You need to check typos and grammatical errors. Response: The introduction section has been carefully proofread and revised to correct all typographical and grammatical errors. Methods Comment: Justification for the study area is not available. Response: We have added a justification for selecting Bharatpur Metropolitan City, citing its population size, diversity, and accessibility of maternal health services. Sample Size Calculation Comment: Any justification for considering 7% as margin of error instead of 5%? In the calculation, however, 6% is used. Response. We have clarified that 6% was used as a practical compromise between statistical rigor and resource feasibility. This choice balanced sample size and field constraints while maintaining acceptable precision. Comment: The paper you referenced stated that 29% lacked information on BPCR. Is this the same as the prevalence of poor practice? Response: We acknowledge this distinction and have clarified in the text that we used the 29% as an approximate indicator due to the lack of direct prevalence data on BPCR practice in a similar setting. This limitation is now noted in the methodology. Comment: How was the sample size distributed among wards and health institutions? Response: We have added a description explaining that proportional allocation was used based on delivery caseloads of health facilities within selected wards. Measurements Comment: Any reference to the previously validated questionnaire? Response: Yes, we have added references to the WHO and JHPIEGO tools from which the questionnaire was partially adapted. Comment: Were there regular reviews of the questionnaire during data collection? Response: We have now included a note that data collection was monitored regularly by the principal investigator, and weekly review meetings were held to address field challenges. Comment: Study design needs to be written well and concisely. Response: The study design section has been rewritten concisely as “A community-based descriptive cross-sectional study.” Comment: The sampling of participants for the study should be clearly written. Response: The sampling procedure has been revised to clearly explain how participants were selected . Comment: Examples of obstetric and institutional factors investigated. Response: Examples such as parity, place of delivery, and support received from health staff have been added to clarify these factors. Data Collection Process Comment: Data collection procedure needs to be written well/clearly. Response: We have rewritten this section for clarity, detailing the steps followed during data collection. Comment: There was no mention of who did the data collection and whether training was done before the data collection. Response: Added. The data collection was carried out by the author, and data analysis was done with guidance from a university statistics professor. Pretesting of the tool were conducted prior to data collection. Data Analysis Comment: It would have been good to describe a bit more about scoring. Response: We have elaborated on the scoring criteria used for BPCR components and knowledge levels. ________________________________________ Results Comment: IQR is between 25th and 75th percentiles, not min and max. Response: Corrected. Comment: Table 1 could have been divided into three parts. Response: Revised as suggested. Table 1 is now split into three separate tables: Socio-demographic, Obstetric, and Complication Experience. Comment: The tables need to be constructed well and referenced. Response: All tables have been reconstructed for clarity and are now properly numbered and referenced in the manuscript. Comment: Section on support received by women is repeated. Response: The repeated section has been removed. Comment: Chose Fig 2 or Table 5, Fig 3 or Table 6 – avoid duplication. Response: We have retained the tables and removed the duplicate figures to avoid redundancy. Discussion Comment: Discussion repeats results and lacks implications. Response: The discussion section has been revised to focus more on interpreting findings and drawing implications. We now include a specific section titled “Implications of the Findings,” summarizing key practical and policy takeaways. Language and Grammar Comment: The document needs a lot of work grammatically. Response: The entire manuscript has undergone thorough grammar and language editing to improve clarity and academic tone. We sincerely thank the reviewer for their helpful and detailed comments. We believe the revised manuscript has been significantly improved and now meets the journal’s standards. We are happy to make any additional changes if needed. Sincerely, Asmita Ghimire On behalf of all co-authors Chitwan Medical College, Tribhuwan University ghimireasmita570@gmail.com 17 September 2025 To Adaoha Pearl Agu, MBBS, MSc, FMCPH Academic Editor PLOS ONE Subject: Rebuttal Letter for Manuscript (PONE-D-24-29050R1)- Birth Preparedness And Complication Readiness Knowledge And Practices Among Recently Delivered Women: A Cross-Sectional Study In Bharatpur, Chitwan, Nepal Dear Editor and Reviewers, Thank you for the opportunity to revise our manuscript entitled "[Birth Preparedness And Complication Readiness Knowledge And Practices Among Recently Delivered Women: A Cross-Sectional Study In Bharatpur, Chitwan, Nepal ]" (Manuscript ID: [PONE-D-24-29050R1]). We sincerely appreciate the time and effort you and the reviewers have invested in providing thoughtful and constructive feedback. We have carefully considered all the comments and have revised the manuscript accordingly. Below, we provide a detailed point-by-point response to each comment. Reviewer comments are shown in bold, followed by our responses in regular text. All changes made in the manuscript are highlighted. Reviewer #1 Comments and Author Responses Abstract: We have revised the abstract’s background to include the rationale and purpose of the study. The term “structured interview schedule” has been replaced with “structured interview questionnaire” in the Methods section. The typographical error has been corrected. The first sentence of results has been restructured for better clarity and readability. We have added the specific proportion (46.8%) of women who were well prepared for birth and complications in the abstract. Main Manuscript Introduction Comment: You need to check typos and grammatical errors. Response: The introduction section has been carefully proofread and revised to correct all typographical and grammatical errors. Methods Comment: Justification for the study area is not available. Response: We have added a justification for selecting Bharatpur Metropolitan City, citing its population size, diversity, and accessibility of maternal health services. Sample Size Calculation Comment: Any justification for considering 7% as margin of error instead of 5%? In the calculation, however, 6% is used. Response. We have clarified that 6% was used as a practical compromise between statistical rigor and resource feasibility. This choice balanced sample size and field constraints while maintaining acceptable precision. Comment: The paper you referenced stated that 29% lacked information on BPCR. Is this the same as the prevalence of poor practice? Response: We acknowledge this distinction and have clarified in the text that we used the 29% as an approximate indicator due to the lack of direct prevalence data on BPCR practice in a similar setting. This limitation is now noted in the methodology. Comment: How was the sample size distributed among wards and health institutions? Response: We have added a description explaining that proportional allocation was used based on delivery caseloads of health facilities within selected wards. Measurements Comment: Any reference to the previously validated questionnaire? Response: Yes, we have added references to the WHO and JHPIEGO tools from which the questionnaire was partially adapted. Comment: Were there regular reviews of the questionnaire during data collection? Response: We have now included a note that data collection was monitored regularly by the principal investigator, and weekly review meetings were held to address field challenges. Comment: Study design needs to be written well and concisely. Response: The study design section has been rewritten concisely as “A community-based descriptive cross-sectional study.” Comment: The sampling of participants for the study should be clearly written. Response: The sampling procedure has been revised to clearly explain how participants were selected . Comment: Examples of obstetric and institutional factors investigated. Response: Examples such as parity, place of delivery, and support received from health staff have been added to clarify these factors. Data Collection Process Comment: Data collection procedure needs to be written well/clearly. Response: We have rewritten this section for clarity, detailing the steps followed during data collection. Comment: There was no mention of who did the data collection and whether training was done before the data collection. Response: Added. The data collection was carried out by the author, and data analysis was done with guidance from a university statistics professor. Pretesting of the tool were conducted prior to data collection. Data Analysis Comment: It would have been good to describe a bit more about scoring. Response: We have elaborated on the scoring criteria used for BPCR components and knowledge levels. ________________________________________ Results Comment: IQR is between 25th and 75th percentiles, not min and max. Response: Corrected. Comment: Table 1 could have been divided into three parts. Response: Revised as suggested. Table 1 is now split into three separate tables: Socio-demographic, Obstetric, and Complication Experience. Comment: The tables need to be constructed well and referenced. Response: All tables have been reconstructed for clarity and are now properly numbered and referenced in the manuscript. Comment: Section on support received by women is repeated. Response: The repeated section has been removed. Comment: Chose Fig 2 or Table 5, Fig 3 or Table 6 – avoid duplication. Response: We have retained the tables and removed the duplicate figures to avoid redundancy. Discussion Comment: Discussion repeats results and lacks implications. Response: The discussion section has been revised to focus more on interpreting findings and drawing implications. We now include a specific section titled “Implications of the Findings,” summarizing key practical and policy takeaways. Language and Grammar Comment: The document needs a lot of work grammatically. Response: The entire manuscript has undergone thorough grammar and language editing to improve clarity and academic tone. We sincerely thank the reviewer for their helpful and detailed comments. We believe the revised manuscript has been significantly improved and now meets the journal’s standards. We are happy to make any additional changes if needed. Sincerely, Asmita Ghimire On behalf of all co-authors Chitwan Medical College, Tribhuwan University ghimireasmita570@gmail.com Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0340376.r004
23 Oct 2025 Decision Letter - Adaoha Agu, Editor Dear Dr. Ghimire, Please submit your revised manuscript by Dec 07 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 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, Adaoha Pearl Agu, MBBS, MSc, FMCPH 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. Additional Editor Comments: You are yet to address point by point, the issues raised by the second reviewer. [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.] To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications. https://doi.org/10.1371/journal.pone.0340376.r005
Revision 3
1 Dec 2025 Author Response 29 November 2025 To Adaoha Pearl Agu, MBBS, MSc, FMCPH Academic Editor PLOS ONE Subject: Rebuttal Letter for Manuscript (PONE-D-24-29050R1)- Birth Preparedness And Complication Readiness Knowledge And Practices Among Recently Delivered Women: A Cross-Sectional Study In Bharatpur, Chitwan, Nepal Dear Editor and Reviewers, Thank you for the opportunity to revise our manuscript entitled "[Birth Preparedness And Complication Readiness Knowledge And Practices Among Recently Delivered Women: A Cross-Sectional Study In Bharatpur, Chitwan, Nepal ]" (Manuscript ID: [PONE-D-24-29050R1]). We sincerely appreciate the time and effort you and the reviewers have invested in providing thoughtful and constructive feedback. We have carefully considered all the comments and have revised the manuscript accordingly. Below, we provide a detailed point-by-point response to each comment. Reviewer comments are shown in bold, followed by our responses in regular text. All changes made in the manuscript are highlighted. Reviewer #1 Comments and Author Responses Abstract: We have revised the abstract’s background to include the rationale and purpose of the study. The term “structured interview schedule” has been replaced with “structured interview questionnaire” in the Methods section. The typographical error has been corrected. The first sentence of results has been restructured for better clarity and readability. We have added the specific proportion (46.8%) of women who were well prepared for birth and complications in the abstract. Main Manuscript Introduction Comment: You need to check typos and grammatical errors. Response: The introduction section has been carefully proofread and revised to correct all typographical and grammatical errors. Methods Comment: Justification for the study area is not available. Response: We have added a justification for selecting Bharatpur Metropolitan City, citing its population size, diversity, and accessibility of maternal health services. Sample Size Calculation Comment: Any justification for considering 7% as margin of error instead of 5%? In the calculation, however, 6% is used. Response. We have clarified that 6% was used as a practical compromise between statistical rigor and resource feasibility. This choice balanced sample size and field constraints while maintaining acceptable precision. Comment: The paper you referenced stated that 29% lacked information on BPCR. Is this the same as the prevalence of poor practice? Response: We acknowledge this distinction and have clarified in the text that we used the 29% as an approximate indicator due to the lack of direct prevalence data on BPCR practice in a similar setting. This limitation is now noted in the methodology. Comment: How was the sample size distributed among wards and health institutions? Response: We have added a description explaining that proportional allocation was used based on delivery caseloads of health facilities within selected wards. Measurements Comment: Any reference to the previously validated questionnaire? Response: Yes, we have added references to the WHO and JHPIEGO tools from which the questionnaire was partially adapted. Comment: Were there regular reviews of the questionnaire during data collection? Response: We have now included a note that data collection was monitored regularly by the principal investigator, and weekly review meetings were held to address field challenges. Comment: Study design needs to be written well and concisely. Response: The study design section has been rewritten concisely as “A community-based descriptive cross-sectional study.” Comment: The sampling of participants for the study should be clearly written. Response: The sampling procedure has been revised in manuscript to clearly explain how participants were selected . Comment: Examples of obstetric and institutional factors investigated. Response: Examples such as parity, place of delivery, and support received from neighbours, distance to health institutions have been incorporated from the begining to clarify these factors. Data Collection Process Comment: Data collection procedure needs to be written well/clearly. Response: We have rewritten this section for clarity, detailing the steps followed during data collection. Comment: There was no mention of who did the data collection and whether training was done before the data collection. Response: Added. The data collection was carried out by the author, and data analysis was done with guidance from a university statistics professor. Data was collected on the day of immunization in respective health institutions of selected wards. Pretesting of the tool were conducted prior to data collection. Data Analysis Comment: It would have been good to describe a bit more about scoring. Response: We have elaborated on the scoring criteria used for BPCR components and knowledge levels. Firstly, we selected the BPCR components from which critical components was categorized. On the basis of practice of those critical components we gave score 1 for each components. We clearly set up this scoring criteria in operational definition. ________________________________________ Results Comment: IQR is between 25th and 75th percentiles, not min and max. Response: Corrected. Comment: Table 1 could have been divided into three parts. Response: Revised as suggested. Table 1 is now split into three separate tables: Socio-demographic, Obstetric, and Complication Experience. Comment: The tables need to be constructed well and referenced. Response: All tables have been reconstructed for clarity and are now properly numbered and referenced in the manuscript. Comment: Section on support received by women is repeated. Response: The repeated section has been removed. Comment: Chose Fig 2 or Table 5, Fig 3 or Table 6 – avoid duplication. Response: We have retained the tables and removed the duplicate figures to avoid redundancy. Discussion Comment: Discussion repeats results and lacks implications. Response: The discussion section has been revised to focus more on interpreting findings and drawing implications. We now include a specific section titled “Implications of the Findings,” summarizing key practical and policy takeaways. Language and Grammar Comment: The document needs a lot of work grammatically. Response: The entire manuscript has undergone thorough grammar and language editing to improve clarity and academic tone. We sincerely thank the reviewer for their helpful and detailed comments. We believe the revised manuscript has been significantly improved and now meets the journal’s standards. We are happy to make any additional changes if needed. Sincerely, Asmita Ghimire On behalf of all co-authors Chitwan Medical College, Tribhuwan University ghimireasmita570@gmail.com Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_3.docx https://doi.org/10.1371/journal.pone.0340376.r006
21 Dec 2025 Decision Letter - Adaoha Agu, Editor Birth Preparedness And Complication Readiness Knowledge, Practices and Its Associated Factors Among Recently Delivered Women: A Cross-Sectional Study In Bharatpur, Chitwan, Nepal PONE-D-24-29050R3 Dear Dr. Ghimire, 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, Adaoha Pearl Agu, MBBS, MSc, FMCPH Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0340376.r007
Formally Accepted
Acceptance Letter - Adaoha Agu, Editor PONE-D-24-29050R3 PLOS One Dear Dr. Ghimire, 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 Dr. Adaoha Pearl Agu Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0340376.r008

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