PONE-D-25-65192An umbrella review of systematic reviews and meta-analysis navigating the nationwide burden of hepatitis B virus infection in Ethiopia: a call to actionPLOS One

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3. We note that you have referenced ( PHI , M., Epidemiology of Viral Hepatitis (B and C) among HIV Infected People in Ethiopia: a Systematic Review. unpublished work. )

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Reviewers' comments:

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Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: Yes

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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

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Reviewer #1: This manuscript is a meta-analysis of previous reviews and meta-analyses of the incidence of HBsAg+ already published in other reviews and meta-analyses. I am not able to understand the utility of making a summary of previous reviews. I would say that it could be more importnat to make a meta-analysis of previous primary results, but this is my opinion.

The manuscript is also extremely long and complex to basically arrive at the conclusion that the rate of HBsAg+ is about 5% in Ethiopia. A simplification of the text and the figure will be appreciated by the readers.

The nomenclature used by the authors needs attention:

For example: Abstract: " Hepatitis B virus (HBV) is one of the major strains of viral hepatitis"

I am sorry HBV is a virus and it is not a type ( strains) of liver disease ( hepatitis) !

The authors also use the term "HBV infection" to indicate the presence of HBsAg+.

I am sorry, but an individual can be HBV infected, control the infection and become anti-HBc+, and this is a subject that was HBV infected.

HBsAg+ is the rate of HBV chronic infection not infection.

The authors also wrote "According to the evidence synthesised from 187 countries by WHO, around 254 million people are living with hepatitis B"...

No, hepatitis B is an inflammatory liver disease caused by HBV. 254 million people are living with hepatitis B virus infection (or better use the term HBsAg+).

I recommend the authors use the terms virus, infection, and hepatitis appropriately, since this is supposed to be a scientific paper.

Reviewer #2: This is an valuable umbrella study on the HBV seroprevalence in Ethiopia, yet it can be slightly improved.

The title is to long.

In order to make the study more interesting a short introduction including Ethiopia general data should be added (population number, organisation of the health system, blood donations (voluntary? paid?), vaccination program in place?Prevention of vertical transmission in place?

The age range of the studied populations is not mentioned, I suppose those are all studies in adult populations but the age range should be mentioned.

The main risk factors (apart from sexual transmission) remain health system-associated: Blood donations, Tooth extractions, abortions-this fact needs to be commented on in more detail.

You call for action in the title but you do not specify which specific publichealth action measures should be undertaken based on your results.

The English language should be checked by a native English speaker. Avoid using the word "strain" for hepatitis B virus.

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Reviewer #1: No

Reviewer #2: No

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An umbrella review navigating the nationwide burden of hepatitis B virus infection in Ethiopia: a call for action on vaccination, safe blood, and infection prevention

PONE-D-25-65192R1

Dear Dr. Demeke,

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,

David Chibuike Ikwuka, Ph.D.

Academic Editor

PLOS One

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Reviewers' comments: