Dear Dr. Ngwira,

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Academic Editor

PLOS ONE

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Additional Editor Comments:

Please address the serious concerns from the reviewers around the purpose of a KAP study.

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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: No

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: I Don't Know

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

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: A KAP survey should assess knowledge, attitudes, and practices directly related to bovine TB. The included variables such as age, sex, education, occupation, marital status, and income are purely demographic and socioeconomic, lacking disease-specific insights. Without assessing awareness, risk perception, and preventive behaviors, the study fails to provide actionable findings for bovine TB control and intervention.

Reviewer #2: - This paper would add critical information regarding farmers and cattle handlers’ knowledge and practices with respect to bovine tuberculosis in Malawi. As it stands, the paper lacks information regarding the various findings obtained from the survey instrument, the survey development and recruitment processes used, discussion of the findings in relation to similar studies in literature, and the implications of this research. I believe addition of these important pieces of information will strengthen the manuscript. I have highlighted areas where additions should be made below.

- Consider adding more information in the abstract: for instance, information regarding the questionnaire used in the methods, along with other important findings obtained in the results sub-section.

- In the abstract, in the sentence ‘Overall knowledge, attitude, and practices about BTB among participants were good’ – how do you define ‘good’?

- In the keywords section, consider adding the keywords ‘KAP survey’ or ‘knowledge, attitude, practice study’.

- The introduction section could do better with additional information and more context on bovine TB. What is the burden of BTB in Malawi as compared to its neighboring countries? How does bovine TB differ from zoonotic TB? Are symptoms similar between bovine and human TB? How does bovine TB occur? What is your hypothesis regarding this particular study population on bovine TB?

- The questionnaire used for this study- was it developed for this study, or has it been adapted from other studies? If so, please provide citations. Were the surveys conducted in person or via mail? Please provide more information on the recruitment and study advertisement processes used. Did you provide any incentives to participants as part of the study? What was the language in which the KAP survey was administered in? Were translation and back-translation processes needed for the survey?

- Which software/platform did you use to perform the statistical analyses?

- I am curious, is there any reason as to why you chose to show that higher scores for knowledge corresponds with more knowledge whereas higher scores in attitudes and practices corresponds to low perceptions and practices?

- I think it would be helpful and informative if you added separate findings obtained for the knowledge, attitude, and practice sections of the survey instrument in the results section, in addition to what is currently presented.

- How do the results from this KAP study stand in relation to other KAP studies on human/bovine TB? Are these results similar or different?

- Please discuss in more detail the interpretation of the results and regression analyses and the implications of these findings in context with other studies on this topic. Was the KAP survey successful in capturing knowledge gaps and data gaps among the surveyed participants in Malawi?

- What would be some future directions as an outcome of this study?

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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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Dear Dr. Ngwira,

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 Feb 25 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.

• 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 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,

Rebecca Lee Smith, D.V.M., M.S., Ph.D.

Academic Editor

PLOS One

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If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

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

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #3: (No Response)

Reviewer #4: All comments have been addressed

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

Reviewer #3: Yes

Reviewer #4: Yes

**********

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: Yes

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

Reviewer #3: Yes

Reviewer #4: Yes

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Reviewer #3: The manuscript by Ngwira et al. provides some interesting and useful results regarding the knowledge, attitudes, and practices (KAP) regarding BTB in high-burden areas of Malawi. This study demonstrates how demographics influence KAP jointly. Insights gained from this KAP assessment can inform public health officials for targeted health campaigns to reduce the spread of BTB.

Overall, the paper was well structured. There are some minor points that should be addressed.

Comment to the Editor

I found the paper interesting, and useful. I recommend acceptance and addressing my quite minor issues.

General Comments:

The manuscript by Ngwira et al. provides some interesting and useful results regarding the knowledge, attitudes, and practices (KAP) regarding BTB in high-burden areas of Malawi.

This study demonstrates how demographics influence KAP jointly. Insights gained from this KAP assessment can inform public health officials for targeted health campaigns to reduce the spread of BTB.

Overall, the paper was well structured. There are some points that should be addressed, as listed below.

Specific Comments:

Page 4, Line 2 – 4, please explain how income level was determined.

Page 4, Line 20: Add “≥” before 50%

Page 5, Line 7 – 9: If the statement implies statistical significance, please add the corresponding p-values (or confidence intervals). If no statistical test was performed, avoid using “significant” and instead use neutral phrasing such as: “A considerable proportion of participants…” or “A high proportion of participants...”

Page 5, Line 29: Mention which test was used to test significant differences in standard errors and coefficients.

Page 5, Line 39-43: If the values in table 5 are Pearson correlations among the KAP scores, the correct notation is r.

Table 1 and 2: For both the univariate and multivariate regression tables, please include p-values for each coefficient to indicate statistical significance.

Table 3: Please clarify this table. Please include p-values for each coefficient to indicate statistical significance.

S1 Appendix Question

In Background characteristics, how was income determined?

S1 Appendix Question/Statement 3 “BTB is not inherited from parents”:

The term hereditary is not appropriate because BTB is not a genetic disease; it implies a genetic predisposition, which is incorrect. Therefore, I understand that answering “Yes” would reflect correct knowledge. However, I wonder if the statement was intended to address vertical transmission instead. The translation from the African language (based on Google) reads: “Bovine TB is not acquired at birth.” If this is the intended interpretation, then “No” would be correct, since BTB can be transmitted vertically via milk or in utero.

To ensure accuracy and consistency in the manuscript, I recommend reviewing the survey translation carefully. Also, ensure consistency between the questions shown in S1 Table 1 and those in the S1 Appendix.

If the correct explanation is the former then I suggest rephrasing the results section for this question to “For Among participants, 37.87% answered ‘Yes,’ correctly recognizing that BTB is not transmitted through heredity.”

S1 Appendix, Section B

Knowledge about BTB in cattle and humans: Are questions B7, B8, B9 specific for BTB in humans or cattle? Or is both? Please clarify in page 5 line 1 and 2 “Participants also demonstrated limited knowledge on clinical signs, such as lymph node enlargement, weight loss, and low-grade fever.”

Reviewer #4: I have carefully reviewed the revised manuscript and the accompanying response to reviewers. The authors have satisfactorily addressed all the comments raised in the previous review. Revisions have been appropriately incorporated into the abstract, methods, results, and discussion, with improved clarity on the KAP framework, questionnaire development, analytical approach, and interpretation of findings. The manuscript has substantially improved in rigor, transparency, and coherence, and the responses provided are adequate and convincing. I therefore have no further substantive comments at this stage.

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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 #3: No

Reviewer #4: No

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<p>Knowledge, attitudes and practices regarding bovine tuberculosis in cattle and humans in Malawi

PONE-D-25-03110R2

Dear Dr. Ngwira,

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,

Rebecca Lee Smith, D.V.M., M.S., Ph.D.

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments: