Pattern of family dynamics and treatment-seeking behaviour of caregivers of under-five children with uncomplicated malaria in a tertiary hospital in Ilesa, southwestern Nigeria

Abdulwasiu Akanfe Adegboyega; Abdulakeem Ayanleye Ahmed; Ibrahim Sebutu Bello; Olanrewaju Oloyede Oyegbade; Samuel Ademola Adegoke; Olufemi M. Olubiyi; Temitope Oluwafemi Olajubu; Kolawole Muideen Adewumi; Fatima Adenike Adegoke; Abraham Busola Oluwajuyitan

doi:10.1371/journal.pone.0354019

Peer Review History

Original SubmissionMarch 20, 2026
8 Jun 2026 Decision Letter - David Diemert, Editor -->PONE-D-26-12548-->-->Pattern of family dynamics and treatment-seeking behaviour of caregivers of under-five children with uncomplicated malaria in a tertiary hospital in Ilesa, southwestern Nigeria-->-->PLOS One Dear Dr. Ahmed, 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 Jul 23 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. 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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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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: Yes ******** -->2. Has the statistical analysis been performed appropriately and rigorously? --> Reviewer #1: Yes Reviewer #2: Yes ****** -->3. 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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: The manuscript is well written, employs an appropriate methodological approach, and addresses an important yet often overlooked aspect of health-seeking behavior. I have only a few minor comments for the authors to consider: 1. The study setting is not sufficiently described. It would be helpful to clarify whether the health facility is located in a rural or urban area, is the area high endemic or low, and whether it is publicly or privately owned. Also how malaria treatment service is provided-either freely accessible or with some consultation fee etc...(also patient trajectory in the event a referal is needed..if such health system info is available). 2. The study population includes only participants with a positive malaria test. The authors may wish to discuss how the findings might differ if individuals with negative test results were also included (e.g., as a test-negative comparison group), particularly in relation to general health-seeking behavior. 3. More than 80% of participants appear to report socially desirable or normatively acceptable characteristics (e.g., monogamy, prompt care-seeking, higher education levels). It would be valuable to discuss whether such a profile is representative of the broader population, especially in rural settings or other regions/ states. Additionally, while the manuscript provides useful insights into family-level dynamics, it lacks key contextual variables such as distance to the health facility and time to receive care upon arrival. 4. I recommend including the Family APGAR questionnaire and the Perceived Social Support Family Scale (PSS-Fa) in the supplementary materials to enhance readers’ understanding and interpretation of the findings. Overall, the study is timely and contributes meaningfully to the field. However, the conclusion could be strengthened by providing more explicit policy or programmatic recommendations, particularly regarding interventions to address potential family dysfunction. Reviewer #2: 1. Is the manuscript technically sound, and do the data support the conclusions? Yes, the sample size was well calculated, and the author even added about 10% for attrition and gave the paper statistical power. 2. Has the statistical analysis been performed appropriately and rigorously? Yes, I, however, would recommend more powerful statistical software like R. 3. Is the manuscript presented in an intelligible fashion and written in standard English? Yes, however, it would be advisable if he could operationalize words, e.g., "functional families" and "inappropriate treatment-seeking behavior." ****** -->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: Yes: Geofrey Makenga Reviewer #2: Yes: Brian Seda ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. 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Revision 1
1 Jul 2026 Author Response REVIEWER’S COMMENTS AND AUTHORS’ CORRECTIONS Thank you so much for your painstaking effort in reviewing our manuscript. Below are the comments to each of the points raised. SECTION REVIEWER’S COMMENTS AUTHORS’ CORRECTION 1. The study setting is not sufficiently described. It would be helpful to clarify whether the health facility is located in a rural or urban area, is the area high endemic or low, and whether it is publicly or privately owned. Also how malaria treatment service is provided-either freely accessible or with some consultation fee etc...(also patient trajectory in the event a referal is needed..if such health system info is available). Thank you for this valuable suggestion. We have expanded the description of the study setting in the Methods section to include the location of the hospital (urban), malaria endemicity of the study area (stable high transmission), ownership of the hospital (public tertiary hospital under Obafemi Awolowo University Teaching Hospitals Complex), the financing of malaria services (fee-for-service with health insurance coverage for some patients), and the referral pathway for children requiring higher levels of care. These additions provide better context for readers regarding the healthcare system within which the study was conducted. 2. The study population includes only participants with a positive malaria test. The authors may wish to discuss how the findings might differ if individuals with negative test results were also included (e.g., as a test-negative comparison group), particularly in relation to general health-seeking behavior. The objective of our study was to investigate the relationship between family dynamics and treatment-seeking behaviour among caregivers of under-five children with laboratory-confirmed uncomplicated malaria. Consequently, only children with parasitologically confirmed malaria were included to ensure a homogeneous study population and to minimise outcome misclassification. We agree that inclusion of children with negative malaria test results would have enabled comparison of treatment-seeking behaviour among caregivers of children with febrile illnesses irrespective of malaria status and enhanced understanding of general healthcare-seeking behaviour. We have acknowledged this as a limitation in the Discussion section and suggested it as an area for future research. 3. More than 80% of participants appear to report socially desirable or normatively acceptable characteristics (e.g., monogamy, prompt care-seeking, higher education levels). It would be valuable to discuss whether such a profile is representative of the broader population, especially in rural settings or other regions/ states. Additionally, while the manuscript provides useful insights into family-level dynamics, it lacks key contextual variables such as distance to the health facility and time to receive care upon arrival. Our study was conducted in a public tertiary hospital located in an urban area, where caregivers are generally more educated and have relatively better access to healthcare than populations in many rural settings. Consequently, the sociodemographic profile of our participants may not fully reflect caregivers in rural communities or other regions of Nigeria, and this has now been acknowledged in the Discussion. Although treatment-seeking behaviour was assessed using a validated interviewer-administered questionnaire, we recognise that socially desirable responses cannot be completely excluded. We have also acknowledged that contextual factors such as distance to the health facility and waiting time before receiving care were not collected and may influence treatment-seeking behaviour. These limitations have been added to the revised manuscript, and we recommend that future studies incorporate health system accessibility variables to provide a more comprehensive understanding of caregivers' treatment-seeking behaviour. 4. I recommend including the Family APGAR questionnaire and the Perceived Social Support Family Scale (PSS-Fa) in the supplementary materials to enhance readers’ understanding and interpretation of the findings. The Family APGAR questionnaire and the Perceived Social Support from Family Scale (PSS-Fa) were included in the questionnaire submitted as supplementary materials. Specifically, both instruments are presented in Section D of the questionnaire (Supplementary Files S3 and S4). 5. Overall, the study is timely and contributes meaningfully to the field. However, the conclusion could be strengthened by providing more explicit policy or programmatic recommendations, particularly regarding interventions to address potential family dysfunction. We have revised the Conclusion section to include explicit policy and programmatic implications of our findings. Specifically, we now recommend incorporating family functioning assessment into routine paediatric and primary healthcare, strengthening family-centred health education and counselling, and integrating psychosocial support for families with dysfunctional family relationships. These recommendations provide practical strategies for improving caregivers' treatment-seeking behaviour and, ultimately, childhood malaria outcomes. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0354019.r002
2 Jul 2026 Decision Letter - David Diemert, Editor Pattern of family dynamics and treatment-seeking behaviour of caregivers of under-five children with uncomplicated malaria in a tertiary hospital in Ilesa, southwestern Nigeria PONE-D-26-12548R1 Dear Dr. Ahmed, 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, David J. Diemert, M.D. Academic Editor PLOS One Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0354019.r003
Formally Accepted
Acceptance Letter - David Diemert, Editor PONE-D-26-12548R1 PLOS One Dear Dr. Ahmed, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. David J. Diemert Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0354019.r004

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