-->PONE-D-26-05429-->-->Content-qualified antenatal care coverage in Lesotho: an ordinal logistic regression analysis of the 2023-2024 demographic and health survey-->-->PLOS One

Dear Dr. Wondie,

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 08 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,

Alfredo Luis Fort, M.D., M.Sc., Ph.D.

Academic Editor

PLOS One

Journal Requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please amend the manuscript submission data (via Edit Submission) to include author Tazeb Alemu Anteneh.

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.

3. 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.

Additional Editor Comments:

The authors have presented an important study of a topic key for maternal health. The study is conducted with quantitative methods to demonstrate the most important content of quality antenatal care. However, there are a few areas that require a better description and reordering before putting it into publication. Please look at the reviewers' comments, plus I have included also a file with comments on the manuscript. Thank you.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

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

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 #2: Partly

**********

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

Reviewer #1: Yes

Reviewer #2: No

**********

-->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: No

Reviewer #2: Yes

**********

-->4. 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 #2: Yes

**********

-->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: Line 66-67 -ANCq has been validated as a predictor of lower mortality in neonates (18)-A reference that buttresses the effectiveness in predicting maternal mortality is preferable since the focus is on maternal mortality.

Lines 68-71 do not seem to be properly placed and do not flow.

Line 105-114, same citation all through. Better to restructure the wording so the citation is used only once.

Line 73-79: Statistical analytical method is mentioned in the introduction. It should be moved to the methodology section, under data management and statistical analysis. The introduction should focus on the research gap and the study's objective.

Table 2: District of residence. Wrong calculations. Please rectify

Table 3: The asterisk legend is rough. Please replace with a clean legend.

Reviewer #2: The abstract is missing key information, particularly a clear summary of the main findings, and the conclusion does not explicitly describe the study outcomes or their implications. In addition, some content currently presented in the methodology section such as the structural factors affecting access to maternal health services would be more appropriately placed in the introduction to improve the overall flow of the paper.

The methodology section requires greater clarity, particularly regarding the choice of ordinal logistic regression. While the approach is appropriate for an ordered outcome, the authors should explicitly state that the model relies on the proportional odds (parallel lines) assumption and justify its applicability. The advantages of ordinal regression over multinomial regression should also be clearly explained, including its greater efficiency and parsimony, given that multinomial models estimate more parameters and may reduce statistical power. The statement that the model “preserves information” needs clarification for the reader by explaining that the natural ordering of outcome categories is retained rather than collapsing them into binary outcomes.

There is also a lack of clarity regarding data inclusion. Butha-Buthe does not appear among the study clusters, yet it is unclear whether data from this district were analyzed or excluded. Any exclusions should be clearly stated and justified. Furthermore, the description of independent variables is insufficient; the authors should clearly define the categories and provide examples of both individual-level and community-level variables. The data management and statistical analysis section includes inferential results that would be more appropriately presented in the results section, unless these were directly obtained from DHS reports. Finally, the manuscript does not clearly specify which confounders were adjusted for in the analysis, and these should be explicitly stated and consistently reflected in the results.

**********

-->6. 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: No

Reviewer #2: Yes:Abel Mokua Nyabera

**********

[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.

-->

Attachments

Attachment

Submitted filename: PLOS one review-ANCq manuscript.docx

Attachment

Submitted filename: PONE-D-26-05429-AF.pdf

<p>Content-qualified antenatal care coverage in Lesotho: an ordinal logistic regression analysis of the 2023-2024 demographic and health survey

PONE-D-26-05429R1

Dear Dr. Wondie,

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,

Alfredo Luis Fort, M.D., M.Sc., Ph.D.

Academic Editor

PLOS One

Additional Editor Comments (optional):

The authors have made the necessary changes to ensure the methods, results and discussion are well described and positioned so the reader can understand and follow well this complex study and its implications. So, we are deciding to publish it. Stay alert in case there are final issues to resolve. Thanks.