-->PONE-D-25-42947-->-->Motorization and Its Consequences: A Mixed-Methods Study on the Epidemiology, Impact, and Stakeholder Perspectives of Road Traffic Injuries Among Undergraduate Students in Nepal-->-->PLOS ONE

Dear Dr. Bhattarai,

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We look forward to receiving your revised manuscript.

Kind regards,

Satabdi Mitra, M.D(Community Medicine )

Academic Editor

PLOS ONE

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3. Thank you for stating the following in the Acknowledgments Section of your manuscript:

We would like to thank all the undergraduate who contributed to our studies as participants, students along with Dr. Nishchal Dhakal, Mr. Ujjwal Upadhyay, Father Augustine Thomas for providing me the necessary support to conduct the study in their respective. We would also like to thank the 5 key informants who provided their valuable time and experience without whom the research would not have been completed. We would like to acknowledge Nepal Health Research Council for providing the financial support by awarding the "Post Graduate Health Research Grant, 2020".

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Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows:

The funding was awarded by Nepal Health Research Council for PG health research grant 2020 to the corresponding author, Nikita Bhattarai (NB) for her master thesis. The funder has no role in study design, data collection, analysis, decision to publish nor preparation of the manuscript

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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?

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

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 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

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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-->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: Title – acceptable but title says about all students but result is only for two-wheeler drivers? change the title or add the data of pillion riders also if you have the data.

Methods – is there secondary records of the police system and triangulate with your prevalence of RTI? As the prevalence you claim is lower 23%

Results – a response rate of 64.8% is very low and your results may be biased – justify

, 6.3% were under the influence of alcohol -is this self-reported? or was it confirmed by some agency?

Discussion – line 129 -lower limbs were most affected, but in line 190 -Injury patterns showed the upper limb was most affected (49.9%), is this from different study or the narration is inconsistent.

Recommendations- are general – what u can say (my suggestions only) is drive for better licencing program, proper multi-level data capture for RTA and RTI.

Most important

What are the infrastructure data you have collected for RTA? road banking, road marking etc.

Environmental factors – rain/fog/road repair / road illumination at a particular place,

You can use some CI for proportions presented.

Some good data is with this team needs proper presentation.

Reviewer #2: REVIEW

Motorization and Its Consequences: A Mixed-Methods Study on the Epidemiology, Impact, and Stakeholder Perspectives of Road Traffic Injuries Among Undergraduate Students in Nepal

Over all: This study is relevant as it addresses the rising burden of road traffic injuries among youth in Nepal, a vulnerable yet often overlooked population in public health policy. With the suggested changes, it can be considered for publication.

Abstract

Line 29: Methodology: to check this statement ’Methodology: The quantitative section was conducted among undergraduate students in the four colleges in Kathmandu district.’ Quantitative section?

Introduction:

Line 52 and 54: ‘Injuries are disproportionately high

among males, disadvantaged groups,’ add why they are disadvantaged groups.

Line 77, 78: It is mentioned 28 classes, Specify what are classes. ‘ Participation was voluntary and gave informed consent ‘ check the grammar of this statement

Methodology: Add timeline/ duration of the study

Results: Line 168, Check the grammar. Table 23 appears before table 4. Where are table 2 and 3?

Discussion:

Line 198 and 199: ‘no statistically significant association

was found between licensing status and RTI occurrence’. This is not reflected in results.

‘The themes and recommendations from the qualitative study’ should be better discussed in this section.

The discussion could be strengthened further through more robust comparisons with national and international studies, which would help contextualize the findings, highlight unique challenges in the Nepali context, and support evidence-based recommendations.

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Reviewer #1: Yes:Dr Shrinivasa B Marinaik

Reviewer #2: No

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Attachments

Attachment

Submitted filename: PLOS 1 review.doc

-->PONE-D-25-42947R1-->-->Motorization and Its Consequences: A Mixed-Methods Study on the Epidemiology, Impact, and Stakeholder Perspectives of Road Traffic Injuries Among Undergraduate Two-Wheeler Riding Students in Nepal-->-->PLOS One

Dear Dr. Bhattarai,

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 Apr 30 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.

We look forward to receiving your revised manuscript.

Kind regards,

Emma Campbell, PhD

Associate Editor

PLOS One

On behalf of:

Satabdi Mitra, M.D(Community Medicine )

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.

Additional Editor Comments:

Thank you for making revisions to your manuscript in response to Reviewer 3 comments, unfortunately the wrong decision letter was sent when requesting these changes, as such we are re-issuing the decision to give you the opportunity to formally respond to the concerns and provide the marked up version of the manuscript to show the changes you have made in response to Reviewer 3. We apologise for the inconvenience caused.

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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

Reviewer #3: All comments have been addressed

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-->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

Reviewer #3: Partly

**********

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

Reviewer #1: Yes

Reviewer #3: 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

Reviewer #3: 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

Reviewer #3: No

**********

-->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: The presentation has improved a lot at the same time - follow-up publication can not be justification for clarity of this manuscript . further the conclusion and recommendation are general but not restricted to your findings - you can also suggest for better clinical facility to reduce morbidity and disability among affected .

Reviewer #3: Abstract: 5 key recommendations that came forward; change it it 5 key recommendations that emerged

Line 79: Qualitative study was conducted; is it qualitative or quantitative, because rest of the paragraph describes the quantitative data collection process.

Line 82-84: very colloquial

Line 85-86: The data 85 was collected from students enrolled in first to fourth year across 28 academic classes across four colleges, Kathmandu Medical College, Nepal Medical College, College, reword to remove the word appearing across twice.

Line 95-99: It appears that the qualitative and quantitative data were collected from different populations. Additionally, the qualitative component involved only five participants; however, the process by which data saturation was determined is not clearly described. Although the study is presented as a mixed-methods design, the Methods section lacks clarity regarding the specific mixed-methods design employed, the sampling strategies used for each component & in the perspective of mixed methods research, and how the qualitative and quantitative strands were integrated.

Data Analysis:

line 101-107: The data analysis software used both for qualitative and quantitative data analysis to be specified.

Results:

Line 112: was 1878, this number is 1879 in the methods section, (line number 89), be consistent with this data.

Line 114: and 65.6.6 (what is this two decimal number to be clarified)

What does table 1 describe, the table title should be appropriate, if it is of respondents then the n=1217, if it is the one using two wheeler, the findings reveal 578 (line 113), but the table has n=579, to provide titles for all the tables.

Line 154: The expansion of abbreviation NPR is not found in the prior to the usage

Table 3: The themes identified in the qualitative analysis need to be described in greater detail to enhance better understanding. Themes and related verbatim can be jotted together. However, the emerged recommendation require additional description and details with the base for this.

Qualitative data/verbatims clearly lack saturation.

For clarity and uniformity, the Results section should report categorical variables using the n (%) format.

The Results section shows inconsistency in the tense used for reporting findings and requires revision to ensure uniform tense throughout

Discussion:

line 184: This study applied the Safe Systems Approach, and the this approach was not introduced in the background or methodology, and all these need to be consistently aligned throughout.

RTIs/RTI need not be expanded in each section

References: 36, is not found cited

Carefully review the manuscript for typographical errors, punctuation issues (including spacing and use of periods), and inconsistent capitalization between sentences.

**********

-->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:Dr Shrinivasa B M

Reviewer #3: No

**********

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Motorization and Its Consequences: A Mixed-Methods Study on the Epidemiology, Impact, and Stakeholder Perspectives of Road Traffic Injuries Among Undergraduate Two-Wheeler Riding Students in Nepal

PONE-D-25-42947R2

Dear Dr.Nikita Bhattarai,

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,

Satabdi Mitra, M.D(Community Medicine )

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: