Dear Dr. orish,

Please submit your revised manuscript by Dec 19 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.. 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.. 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.. 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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Kind regards,

Masoud Foroutan, Ph.D.

Academic Editor

PLOS ONE

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3. 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.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

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

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Partly

**********

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

Reviewer #1: No

Reviewer #2: I Don't Know

Reviewer #3: Yes

**********

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.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

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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Reviewer #1: 1. Methods should clearly state which test (ELISA vs RDT) defines seropositivity for the association analyses. If ELISA is the reference standard, all inferential analyses (logistic regression) should use ELISA-defined seropositivity. Currently Tables and text sometimes mix RDT and ELISA and this is confusing.

2. The authors imply that past transfusions lead to seropositivity. This is not provable in a cross-sectional design because timing of infection relative to transfusion is unknown. Reword conclusions and discuss that transfusion is an exposure that is consistent with but not proven to be the transmission route.

3. Define precisely: “ever had blood transfusion” vs “transfusion in past 12 months” (both appear in the manuscript). Use one primary exposure and justify. If both are used, show separate models.

4. For participants with transfusion in the past 12 months, consider sensitivity analysis excluding individuals whose seropositivity might have preceded transfusion (if dates available) or at least stratify by time since last transfusion.

5. For every table and subgroup report the exact n used. If any missingness exists for covariates or outcomes, report number and pattern; explain handling (complete-case only, imputation).

6. Table 4 & 5: For subgroup comparisons (age categories, genotype, etc.) provide risk differences and 95% CIs or prevalence ratios rather than p-values alone. This gives clinical meaning to findings.

7. Use Fisher’s exact test when expected cell counts <5. For example, groups with very small n (age ≥60) must use Fisher’s exact or combine categories.

9. Provide a priori rationale for covariates included in the adjusted model. Avoid data-driven “stepwise” selection unless justified; if used, report selection procedure and results.

10. For each fitted logistic model, report:

• Number of events and non-events (EPV — events per variable) to ensure model is not overfitted. With 83 ELISA positives, be cautious about the number of covariates in adjusted model (rule of thumb: >10 events per parameter).

• VIFs for multicollinearity.

• Hosmer–Lemeshow result

• ROC AUC with 95% CI.

11. Investigate interaction between age and blood transfusion (biologically plausible). If interaction is present, present stratified ORs.

13. Provide the full 2×2 table in the main text or supplement (you have provided TP/TN/FP/FN but ensure clarity). State whether ELISA is true gold standard or imperfect reference and discuss implications.

14. Report exact binomial (Clopper–Pearson) CIs for sensitivity/specificity and predictive values; indicate the method used to compute CIs.

15. Kappa = 0.634 is “substantial” agreement; state the scale used for interpretation (e.g., Landis & Koch).

16. Discuss that PPV/NPV depend on prevalence and provide context (e.g., expected values in general population).

Reviewer #2: Dear Editor,

In a cross-sectional study conducted with 156 patients suffering from sickle cell disease (SCD) at Ho Teaching Hospital in the Volta Region of Ghana, the authors observed that the seroprevalence of Toxoplasma gondii, detected by ELISA, was significantly higher at 53.0% compared to 38.5% detected by rapid diagnostic tests (RDT). Furthermore, a history of blood transfusion was associated with an increased likelihood of T. gondii seropositivity among SCD patients, suggesting that transfusions may represent a potential route for transmission within this population.

Several questions arise from this study:

- Were consecutive SCD (sickle cell disease) patients enrolled, or is there potential for sampling bias?

- Were any exclusion criteria applied that might influence seroprevalence?

- How were discordant IgG and IgM results managed?

- A positive IgG result indicates past exposure to the infection but does not confirm an active infection. To distinguish the timing of infection, IgG avidity testing should be performed.

- Why didn't you use molecular tests to detect active infections?

- How was transfusion history defined in this study?

- Were potential confounders included in the analysis model?

- What is the prevalence of Toxoplasma gondii in the general population?

- How is transfusion interpreted as a transmission route, given the cross-sectional design?

- How is the discrepancy between ELISA and RDT prevalence reconciled?

- Were the results communicated to the clinic or to the patients, and was follow-up offered for those who tested positive?

Reviewer #3: Dear editor

Thank you for the opportunity to review the manuscript titled “seroprevalence of Toxoplasma gondii among sickle cell disease (SCD) patients in Ghana”. I would like to appreciate the authors' effort to undertake this valuable task”. The study investigates the seroprevalence of Toxoplasma gondii among sickle cell disease (SCD) patients in Ghana, with emphasis on the potential association between blood transfusion history and seropositivity. The topic is clinically relevant and fills a local research gap, especially since transfusion-transmitted T. gondii infections are poorly characterized in sub-Saharan Africa.

However, despite its importance, the study has several methodological and presentation flaws that undermine the robustness and reproducibility of the findings. Major revisions are required before the paper can be considered for publication in a journal such as PLOS ONE.

Major Comments

Study Design and Objectives

The cross-sectional design is appropriate for prevalence estimation but cannot establish causality or temporal relationships between transfusion and infection. The authors acknowledge this in the discussion, but they should emphasize it clearly in the Abstract and Methodology.

The objective (“to find out the prevalence of T. gondii infection and the association of blood transfusion among patients with SCD”) is acceptable but could be phrased more precisely as:

“To determine the prevalence of anti-Toxoplasma gondii antibodies among SCD patients and to assess the association between seropositivity and history of blood transfusion.”

Sample Size and Sampling Procedure

The sample size calculation using Cochran’s formula is correctly presented, but the population (N=300) was taken from clinic attendance, not total SCD population in the region—this introduces selection bias. The manuscript lacks details on sampling technique (e.g., consecutive sampling, random selection). Specify how participants were recruited to ensure representativeness.

Diagnostic Testing

The use of RDT and ELISA is appropriate, but the RDT performance characteristics should have been validated with a local control group or WHO-standard panels to confirm accuracy.

Details on kit lot numbers, manufacturer references, and quality control measures are missing. For reproducibility, these must be stated.

Defining “seropositive” as IgG or IgM or both is acceptable, but distinguishing recent (IgM) from past (IgG) infections would have improved epidemiological interpretation.

Data Analysis

The analysis using SPSS v25 is fine, but the variable coding and handling of missing data are not described.

The logistic regression model should include confidence intervals for all variables, not only blood transfusion. Also, justification for including variables in the multivariate model should be given (based on univariate p<0.2, for example).

The adjusted OR (3.14) is significant but could be confounded by age and exposure factors not properly adjusted for. Sensitivity analyses would strengthen the claim.

Results Interpretation

The results are clearly tabulated, but some tables are overcrowded (e.g., Table 4 and 5) — consider splitting into demographic vs. clinical characteristics.

The conclusion that blood transfusion may transmit T. gondii is overstated. Seropositivity does not confirm transmission via transfusion; longitudinal or donor-recipient studies are needed.

Discussion should better distinguish between association and causation, and avoid speculative statements without molecular evidence.

Language and Style

Numerous grammatical, typographical, and stylistic errors (e.g., “varried,” “haemoglobinopathy,” “lectrophoresis”) need correction by a professional English editor.

The tone should be more scientific and concise; many sentences in the Introduction and Discussion are repetitive or verbose.

References are inconsistently formatted — ensure compliance with PLOS ONE reference style (DOI, complete author list, year, journal, volume, pages).

Ethical and Data Availability Statements

Data availability statement (“data cannot be shared publicly because it was generated from patients attending the Ho Teaching Hospital”) does not meet PLOS ONE’s open data policy. A controlled-access mechanism (e.g., through institutional data office) should be mentioned.

Minor Comments

Abstract:

Include numeric results for odds ratios and p-values.

Avoid abbreviations like “RDT” without prior definition.

Figures:

Figures 1–3 are informative but should include error bars and legends. The quality should be improved for publication.

Tables:

Add column totals and indicate statistical tests (e.g., χ², Fisher’s exact) in captions.

For clarity, present p-values to three decimal places consistently.

Introduction:

Reduce literature overload; several global prevalence citations could be summarized more succinctly.

Add rationale for selecting SCD patients beyond frequent transfusion — e.g., immunocompromised state.

Discussion:

Avoid restating the results; instead, focus on comparative analysis with prior studies.

Include a short section on public health implications, e.g., the need for donor screening for T. gondii in Ghana.

Conclusion:

Should emphasize limitations and recommend future longitudinal or molecular studies.

**********

what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

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Dear Dr. orish,

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 Mar 14 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.. 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.. 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.. 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 . 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 . 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 . 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,

Masoud Foroutan, PhD

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.

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 #1: (No Response)

Reviewer #4: (No Response)

**********

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

Reviewer #1: (No Response)

Reviewer #4: Partly

**********

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

Reviewer #1: (No Response)

Reviewer #4: Yes

**********

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.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: (No Response)

Reviewer #4: Yes

**********

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

Reviewer #1: (No Response)

Reviewer #4: Yes

**********

Reviewer #1: • The primary outcome should be clearly defined as ELISA-defined seropositivity. Analyses using RDT results should be limited to reporting diagnostic performance and should not be used as the outcome in regression models to avoid misinterpretation due to misclassification. State the seropositivity definition in the Methods section and reference the ELISA cutoff per manufacturer; reserve RDT results for supplementary sensitivity analyses.

• Choose a single primary exposure (e.g., ever transfused or transfusion in the past 12 months) with a priori justification.

• Present full diagnostic metrics for the adjusted model: variance inflation factors (VIFs) for multicollinearity, Hosmer-Lemeshow goodness-of-fit, area under the curve (AUC) with 95% confidence interval, and calibration metrics (e.g., Brier score or calibration plot).

• Interaction between age and transfusion was considered; the authors decided not to pursue it due to a non-significant p-value in the figure. Pre-specify a clinically plausible interaction (e.g., age × transfusion) and test it in the full model. Report stratum-specific odds ratios if interaction is present. If not, state that the interaction was not supported by the data and discuss clinical relevance.

• Ensure tables (Table 1 and Table 2) include column totals where helpful, with explicit test names in captions.

• Throughout the text, use "multiple logistic regression" instead of "multivariate logistic regression."

Reviewer #4: Title: Toxoplasma gondii seropositivity among patients with sickle cell disease: Prevalence and Association with Blood Transfusion History

Comment to authors

General comment

Authors dedicate the comments of all reviewers but some are still need to get more explanation. Title is more prefer to the epidemiological study but the methods are combined with diagnostic accuracy study. The reviewers also give the comment for confusing the usage both RTD and ELISA for assessing the seropositive [already known that the ELISA is more accurate for detection than the RTD – to align with the title, just suggest 1- removing the result of accuracy finding, 2- all analysis with reference diagnosis (ELISA) by setting the operational definition of seropositive.]

Specific comment

Comment 1: Abstract, p value should be consistent in decimal (suggested three decimal)

Comment 2: Abstract, the sentence of “This cross-sectional design allowed estimation of prevalence and associations, but not causality or temporality. More robust longitudinal studies are needed to help elucidate the true contribution of blood transfusion transmission of T. gondii” should be removed to limitation in discussion.

Comment 3: Abstract, the recommendations based on significant associations should be added in conclusion.

Comment 4: Study Design, “study design was employed to estimate the prevalence of T. gondii infection and to examine associations with blood transfusion history. While suitable for prevalence estimation and association testing, this design cannot establish causal or temporal relationships.” Is nearly the same with Line No. 105-107 and these sentences should be removed.

Comment 5: Study Area and Site, the subheading should be “Study Area”.

Comment 6: Sample size determination, please recheck the sample size (would be 169?).

Comment 7: Sample size determination, can you explain the usage of n = n/ 1+(n/N) instead of n = n/ 1+(n-1/N) as Cochran’s modified formula for finite populations?

Comment 8: Sampling and Recruitment Procedure, please revise as “Given the relatively small clinic population of 300 registered patients, a consecutive sampling was employed, where all eligible SCD patients attending the clinic during the study period were recruited sequentially until the required sample size was achieved” in Line No. 162-165.

Comment 9: Figure 1 and 2, please specify visualization to clear for describing the type of variables. Error bars are reliable for numerical data and should not be add in description of categorical or nominal data. (numerical data - bar for mean and error bar for its SD or SE, categorical or nominal data - bar for number or percent and error bar for 95% CI of percent).

**********

what does this mean?). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). If published, this will include your full peer review and any attached files.). 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 For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our For information about this choice, including consent withdrawal, please see our Privacy Policy..-->

Reviewer #1: 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.]

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.

Dear Dr. orish,

Please submit your revised manuscript by Apr 12 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.. 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.. 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.. 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 . 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 . 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 . 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,

Masoud Foroutan

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.

2. 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 #1: (No Response)

Reviewer #4: All comments have been addressed

**********

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

Reviewer #1: Partly

Reviewer #4: Yes

**********

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

Reviewer #1: No

Reviewer #4: Yes

**********

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.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 #4: Yes

**********

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

Reviewer #1: Yes

Reviewer #4: Yes

**********

Reviewer #1: The suggested revisions to Table 1 and Table 2 are intended to improve the clarity and interpretability of the data distributions. Specifically:

A total column should be added to summarize the overall frequency or percentage across all categories for each explanatory variable.

Two separate columns should be included to show the distribution of each explanatory variable stratified by the levels of the outcome (response) variable.

This structure will allow readers to clearly see both:

(a) the conditional distribution of each predictor across outcome strata, and

(b) the marginal (overall) distribution of each predictor in the entire sample.

Furthermore, it is strongly recommended that:

Column totals be included where they meaningfully contribute to data interpretation.

The exact names of the statistical tests used (e.g., chi-square test, Fisher's exact test, trend test) be explicitly stated in the table captions to ensure transparency and reproducibility.

Reviewer #4: (No Response)

**********

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Toxoplasma gondii seropositivity among patients with sickle cell disease: Prevalence and Association with Blood Transfusion History

PONE-D-25-53926R3

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