-->PONE-D-25-41860-->-->Time to age at first marriage among women in Lesotho: Multilevel survival analysis (insights from recent 2023-24 demographic and health survey data)-->-->PLOS One

Dear Dr. Shibeshi,

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.

==============================

ACADEMIC EDITOR:

The reviewers have raised major conceptual and methodological concerns that need to be addressed. As noted by one reviewer, framing the outcome as ‘time to age at first marriage’ is conceptually unclear, given that age at first marriage is itself a time variable. The added value of survival analysis over simpler analytical approaches is not sufficiently justified, particularly in the context of cross-sectional DHS data, where key covariates (e.g. education, employment, and wealth) may be attained after marriage, raising concerns about reverse causality. In addition, the choice of the log-logistic model is largely supported by theoretical rather than empirical grounds, and claims of methodological novelty appear overstated and should be tempered. The manuscript would also benefit from improved clarity and focus. Terminology related to the outcome is used inconsistently, and interpretations in the Discussion at times extend beyond what can be supported by observational data. Finally, inconsistencies between the ethics statement in the manuscript text and the submission information need to be corrected.

==============================

Please submit your revised manuscript by Feb 11 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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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.

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We look forward to receiving your revised manuscript.

Kind regards,

Emmanuel Adewuyi

Academic Editor

PLOS One

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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?

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

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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.-->

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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

Reviewer #3: Yes

Reviewer #4: Yes

Reviewer #5: 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: Time to age at first marriage among women in Lesotho study is important study for their community. Its important to improve the morbidity and mortality of mother and birth outcome. Clear methodology and discussion

Reviewer #2: Overall, the manuscript addresses an important demographic and public health issue using nationally representative DHS data and multilevel log-logistic accelerated failure time (AFT) modeling. The topic is timely, relevant to SDG 5.3, and expands the limited analytical work available for the study area. The methods are generally appropriate, the manuscript is well structured, and the results are clearly presented.

However, the following scientific, methodological, and reporting issues needs to be addressed to make the manuscript more suitable for publication.

1. Clarity on Study Design

The manuscript repeatedly refers to a “population-based cross-sectional design” while using retrospective time-to-event analysis.

Although this is permissible in DHS studies, the design description must be scientifically precise. I recommend the author should State explicitly that the study analyzed retrospective age-at-event data from a cross-sectional DHS survey, not longitudinal data.

2. Model Justification and Parametric Distributions

The manuscript includes long, textbook-style descriptions of exponential, Weibull, gamma, log-normal, and log-logistic distributions. These sections are unnecessary for a research paper and reduce readability.

The author should Remove mathematical derivations unless essential and condense model justification to 2–3 paragraphs focusing on:

1. Why the log-logistic distribution was optimal

2. Its empirical fit compared to alternatives

3. Its appropriateness for non-monotonic hazards in marriage timing

3. Interpretation of Findings

Some interpretations overstate small effects. TR values close to 1.00 (e.g., 1.019 or 1.033) represent modest delays. The manuscript calls these “protective,” which is subjective.

I suggest the author should use neutral, quantitative language. For Example:

“Higher education was associated with a modest but statistically significant delay in marriage timing.”

4. Inconsistency Between Observed and Survival-Adjusted Medians

The observed median age (21 years) differs from the survival-estimated median (24 years). This is expected due to right-censoring but not clearly explained.

The author should add a brief explanation in Results or Discussion to avoid confusion.

5. Overemphasis on Household-Head Variables

The manuscript includes head occupation and head education but does not justify their conceptual relevance.

The authors should provide rationale based on household decision-making theories or remove non-essential predictors.

6. Community-Level Variables

Only two community-level variables were included (poverty level and residence). DHS allows aggregation of many others (education, media exposure, employment patterns, etc.).

The author should either justify why these two were selected or expand community-level variables.

7. Language and Redundancy

There are multiple redundant sections, overly long sentences, and repeated explanations. The authors should revise these for conciseness and scientific tone.

8. Minor Comments

a) Figures should include confidence bands and be referenced with clear captions.

b) Tables require formatting improvement for readability, especially Table 3 and Table 4.

c) Some references are incomplete or incorrectly formatted.

d) Avoid subjective terms such as “protective,” “persistent influence,” or “empower.”

e) The Background section is lengthy and can be shortened.

Reviewer #3: This is a well written manuscript. The authors provided a concise background to the study, clearly defined the objective of the study, and described the methods in sufficient details for reproducibility. The results were clearly presented, and the discussions captured the essence of the findings and its relatedness to previous studies.

However, the authors introduced a new thought in the first paragraph of the conclusions indicating higher age at first marriage in Lesotho compared to other sub-Saharan African countries. This opinion had not been previously established in the discussions. I would encourage the authors to substantiate this claim in the discussion, before introducing it in their conclusions.

Reviewer #4: The manuscript can be passed as a good and scientific research that is publishable.

The title: I suggest that the authors should consider to re-write the title to be simple, catchy and bind every section of the paper of the paper tightly together (Age at first marriage among women in Lesotho: Multilevel survival analysis- insight from 2023-24 demographic and health survey data).

Data management and the statistical analyses were thoroughly done with the right data tools STATA and R studio needed to perform Multilevel survival analysis. I would suggest that all the calculations be taken to appendix section of the manuscript. Data analysis and result interpretation were excellently presented.

All the supporting data needed for this manuscript were available, appropriate and detailed enough for this research. Although the data used was a secondary data derived from Lesotho demographic and health survey data, I expect to see more elements of ethical considerations line 245: data accuracy, reduction of bias and respect for the different categories of women to feel protected and respected. The discussion drew insights from the result analysis for informed decision making and recommending strategic shift in policy making in Lesotho.

Reviewer #5: This manuscript addresses an important demographic and public health issue using recent DHS data and multilevel survival methods. While the topic and dataset are appropriate, there are major methodological, conceptual, and reporting issues that must be addressed before the manuscript can be considered for publication.

Lines 49–54; lines 252–259

The manuscript defines “time to age at first marriage” as duration from birth to first marriage (lines 49–54), yet later interprets results primarily as age at first marriage without revisiting the implications of this time origin.

Starting the survival clock at birth rather than at a socially relevant risk onset (e.g., adolescence) requires stronger justification, particularly given that marriage before puberty is biologically and socially implausible.

The reported minimum age at marriage of 11 years (line 257) raises concerns about data validity and plausibility checks, which are not described.

The authors should clarify the rationale for using birth as the time origin, discuss potential left-truncation issues, and explicitly state whether any data validation or sensitivity analyses were conducted for extreme ages.

Lines 135–237

The Methods section includes extensive derivations of exponential, log-logistic, log-normal, and gamma distributions (lines 168–228).

Although the authors state that the log-logistic model was chosen as the “best-fitting” model (lines 309–315), no quantitative model comparison statistics (e.g., AIC, BIC, likelihood values) are reported.

The authors can condense this section (unless allowed by the Plos one), move mathematical derivations to supplementary material, and explicitly report formal model selection criteria.

Lines 254–261; lines 268–272

The survival-based median age at first marriage is reported as 24 years (line 254), while the observed median among married women is 21 years (line 259).

Although right-censoring is mentioned (lines 259–261), the implications of this discrepancy are not fully discussed.

In Table 3, median ages by subgroup often cluster around 18–21 years, which appears inconsistent with the narrative emphasis on later marriage.

The authors should provide clearer interpretation of survival-based vs observed medians and align conclusions with DHS-standard reporting practices to avoid overstatement.

Lines 113–121

Religion is listed as a potential independent variable (line 119) but is not included in the final models (Table 4).

Other well-established predictors of marriage timing (e.g., region/district, ethnicity, age at sexual debut) are not discussed.

Household head characteristics are modeled on a reduced subsample (n = 3,226), but implications of this restriction are not addressed.

The authors should justify variable selection more explicitly and acknowledge omitted confounders more clearly in the limitations.

Lines 319–435

Several statistically significant associations have very small effect sizes (e.g., TR = 1.019–1.059).

These effects are repeatedly described as “protective” or “delaying” without discussion of practical significance.

Policy recommendations (lines 420–435) imply causal effects despite the cross-sectional design acknowledged earlier (lines 443–445).

Authors should discuss effect magnitude more critically, and frame policy implications as suggestive rather than prescriptive.

Lines: 48–54, 93–100, 254–261

The manuscript alternates between “time to age at first marriage,”

“age at first marriage,” and “time to first marriage.” The authors should be consistent.

**********

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Reviewer #1: No

Reviewer #2: Yes: Lawan Adamu

Reviewer #3: Yes: Oluwasanmi Akanji Adedokun

Reviewer #4: Yes: Adegoke Olufemi Dickson PhD

Reviewer #5: No

**********

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Attachments

Attachment

Submitted filename: PONE-D-25-41860_Lesotho_2.pdf

-->PONE-D-25-41860R1-->-->Age at first marriage among women in Lesotho: Multilevel survival analysis- insight from 2023-24 demographic and health survey data-->-->PLOS One

Dear Dr. Shibeshi,

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.

==============================

ACADEMIC EDITOR: -->

• The comments made previously by the editor were not  addressed. Authors need to clearly address all those comments and provide a response in their revision. Here are the comments. "The reviewers have raised major conceptual and methodological concerns that need to be addressed. As noted by one reviewer, framing the outcome as ‘time to age at first marriage’ is conceptually unclear, given that age at first marriage is itself a time variable. The added value of survival analysis over simpler analytical approaches is not sufficiently justified, particularly in the context of cross-sectional DHS data, where key covariates (e.g. education, employment, and wealth) may be attained after marriage, raising concerns about reverse causality. In addition, the choice of the log-logistic model is largely supported by theoretical rather than empirical grounds, and claims of methodological novelty appear overstated and should be tempered. The manuscript would also benefit from improved clarity and focus. Terminology related to the outcome is used inconsistently, and interpretations in the Discussion at times extend beyond what can be supported by observational data. Finally, inconsistencies between the ethics statement in the manuscript text and the submission information need to be corrected."
• There are additional editor comments below that authors need to respond to alongside the comments of one of the reviewers.

-->==============================

Please submit your revised manuscript by May 03 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,

Emmanuel O Adewuyi, BPharm, MPH, 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.

Additional Editor Comments:

Abstract

• Use significant only in terms of a statistical test. Extend this correction to all relevant sections of the manuscript

• Study aims to assess ‘determinants’, use ‘factors associated with’ instead. Extend this correction to all relevant sections of the manuscript

• Define TR at first mention

• In the results section, the confidence intervals are consistently narrow and exclude the null despite effect sizes being close to 1.0, raising concerns about underestimated standard errors. It is unclear whether the complex survey design (clustering and stratification) was fully accounted for, particularly within the multilevel AFT framework. I see that the authors claimed this was done in the full methods section. What then explains these near-zero estimates? The authors should clarify their variance estimation approach and provide sensitivity analyses (e.g., robust or survey-adjusted standard errors). Additionally, the interpretation should better reflect the modest magnitude of effects.

• The term ‘intergenerational norms’ is unclear and not operationally defined. It is not evident how this construct was measured or derived from the data.
• The study uses data from Lesotho, but no authors appear to have local affiliations. The authors should clarify any local collaboration or, if none, acknowledge this as a limitation and consider a brief reflexivity statement to address potential contextual and interpretive implications (https://gh.bmj.com/content/9/1/e014743).

Background

• The background provides useful context and statistics, but is repetitive and occasionally unclear. Key concepts, such as “time to first marriage” versus “age at first marriage,” could be stated more precisely, and multiple statistics could be summarised for readability. Some terminology (e.g., “limited opportunity structures”) is vague and could be clarified. The rationale for multilevel survival analysis and SDG 5.3 references could be tightened, and citation placement should be checked for consistency. There is a need for improved clarity, flow, and conciseness.

• The authors justify their study by noting a lack of multilevel analysis on first marriage in Lesotho. It would strengthen the rationale to clearly summarise what previous studies have done, their key findings, and how this study will add value to the existing literature. What will your method contribute or find that others did not? The authors should also briefly define what they mean by “multilevel analysis,” explain how it differs from prior approaches, and specify which methodological limitations of earlier studies they aim to address. That is, let your work be written for a broad audience, since this is not a method-focused journal.

• The study applies multilevel survival analysis to cross-sectional DHS data. The authors should briefly clarify how survival methods are valid in this context, given that the data are retrospective and not longitudinal,

• This background section would benefit from language editing

Methods

• Authors mentioned that ‘…survey included 6,413 women between the ages of 15 and 49’. It is unclear whether the 6,413 women represent the total survey sample or a subset included in this analysis. The authors should clarify the sample selection process, including any inclusion/exclusion criteria, handling of missing data, and whether survey weights were applied, to ensure transparency and reproducibility.

Results

• The results raise several concerns. Many 95% confidence intervals are extremely narrow, suggesting possible underestimation of standard errors or insufficient accounting for the survey design.
• The distinction between observed medians and survival-based medians, including the handling of right-censoring, should be clearly explained.
• Covariates such as education, employment, and wealth are measured at survey time, potentially after marriage, raising concerns about reverse causality.
• Some statistically significant effects are very close to 1.0, and their practical significance should be interpreted cautiously.
• While random effects and ICC are reported, their implications and the reporting of sample sizes and censoring across categories should be clarified.

Discussion

• The Discussion section is generally comprehensive but would benefit from greater clarity and precision. Several associations are interpreted too strongly, sometimes implying causality despite the cross‑sectional design and the fact that key covariates were measured after marriage.
• Effect sizes that are statistically significant but very small should be discussed more cautiously.
• The distinction between observed and survival‑based medians needs clearer integration, as subgroup medians often differ from the overall survival estimate.
• While the discussion references relevant literature, deeper analytical comparison would strengthen the narrative. \
• The implications of the reported ICC and cluster-level variance should be elaborated to highlight why community-level differences matter.
• Policy recommendations should be softened to avoid causal inference.
• Finally, the section could be streamlined to reduce redundancy and sharpen its focus on the study's most novel contributions.

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

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

-->2. 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 #2: Yes

Reviewer #3: Yes

**********

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

Reviewer #2: Yes

Reviewer #3: 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.-->

Reviewer #2: Yes

Reviewer #3: Yes

**********

-->5. 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 #2: Yes

Reviewer #3: Yes

**********

-->6. 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 #2: Overall, the study is methodologically sound and clearly written. The analytical approach is appropriate for the research question, the data are handled correctly, and the conclusions are supported by the results. The manuscript does not make unwarranted claims of novelty and adheres to principles of transparency and reproducibility.

However, I recommend the following minor revisions, which are largely editorial and clarificatory in nature.

1. If feasible, reporting formal model selection criteria (e.g., AIC or BIC) for the compared parametric models could further strengthen the justification for model choice, although this is not essential for publication.

2. A brief expansion explicitly linking findings to existing educational or rural development policy frameworks in Lesotho could further enhance the discussion, but this is optional.

3. Some long sentences could be shortened to improve readability.

4. Figure captions could explicitly state whether confidence intervals are omitted for clarity.

5. A final language polishing at copy-editing stage is recommended.

Finally, The recommended revisions are minor and largely editorial, and addressing them would further improve clarity and presentation without requiring substantial reanalysis.

Reviewer #3: The manuscript presents a relevant subject for Sub-Saharan Africa. The methods have been well elaborated and results discussed. My previous comments have also been properly addressed.

**********

-->7. 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 #2: Yes: Lawan Adamu

Reviewer #3: Yes: Oluwasanmi A. Adedokun

**********

[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.]

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

<div>PONE-D-25-41860R2-->-->Age at first marriage among women in Lesotho: Multilevel survival analysis- insight from 2023-24 demographic and health survey data-->-->PLOS One

Dear Dr. Shibeshi,

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 Jun 22 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.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Jianhong Zhou

Staff 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.

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

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #2: All comments have been addressed

**********

-->2. 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 #2: Yes

**********

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

Reviewer #2: 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.-->

Reviewer #2: Yes

**********

-->5. 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 #2: Yes

**********

-->6. 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 #2: Generally, this revised version represents a clear and substantial improvement over the previous submission. Your responses to the editor—particularly regarding standard error estimation and sensitivity analyses—are thorough and commendable.

That said, the following few refinements will further strengthen the manuscript.

1. Despite improvements, a few interpretations still lean toward causality. For example: Statements implying that education or employment delays marriage should consistently reflect association, not effect.

Hence, you should ensure consistent phrasing such as: “associated with later age at first marriage” and Avoid language suggesting direct influence or impact

2. You acknowledge that variables like education, wealth, and employment are measured at survey time. However, this limitation should be: More prominently emphasized and briefly reiterated when interpreting key findings

I Suggest you should add the following short reinforcing sentence in Discussion:

“These associations should be interpreted cautiously, as key covariates were measured after the occurrence of marriage for many participants.”

3. You correctly note that TR values are close to 1.0. However, this caution should be made more prominent, not only in one paragraph

I Recommend you add the following sentence in the Results section acknowledging small effect sizes:

“Although statistically significant, the magnitude of these effects is modest.”

4. Some sections remain unnecessarily long, particularly:

• Background (repetition of DHS context and early marriage impacts)

• Methods (especially multilevel explanations)

• Discussion (repetition of findings)

I Recommend you should:

• Reduce redundancy by ~10–15% overall

• Focus on precision rather than repetition

5. You report ICC = 0.1461, but interpretation could still be clearer if you explicitly state that: “Approximately 14.6% of the variation in age at first marriage is attributable to differences between communities.” This improves accessibility for non-technical readers.

6. The manuscript states: “N/A” initially, then later provides explanation, I recommend you Remove “N/A”, and keep only the full DHS-based ethical explanation for consistency

7. For Language and Grammar, the manuscript has improved, but minor issues persist: Examples:

• “We conducted a retrospective time-to-event data…” (grammatical inconsistency)

• Occasional long sentences affecting readability

To address this, I think a Final professional copy-editing is still needed

**********

-->7. 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.

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Reviewer #2: Yes: Lawan Adamu

**********

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-->

-->PONE-D-25-41860R3-->-->Age at first marriage among women in Lesotho: Multilevel survival analysis- insight from 2023-24 demographic and health survey data-->-->PLOS One

Dear Dr. Shibeshi,

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.-->--> -->-->The previous academic editor was not available and I have taken over. The last reviewer asking for revisions, who insisted on the reverse causality aspects, recommends acceptance.-->--> -->-->I understand that, to the extent possible, the editorial service should not revise previous decisions without a good reason, but I believe there are very good reasons why this manuscript needs to be revised.-->--> -->-->Let me first point to the internal contradictions: Reference 17, on adolescent fertility, is the only reference provided for the choice of covariates. But this is very mistaken: adolescent fertility is generally studied with women currently exposed to the risk. Age at first marriage with women 15-49 analysis an event that in many cases happened 20 or 30 years ago. This makes interpretation radically different.-->-->There are also problems in the description of the variables: "Head education Educational level", this is the minimum educational level a woman achieved ...-->-->For the reason mentioned first, it is not enough to pay lip service to reverse causality. One needs to avoid unnecessary use of variables that are of a short-nature or that have a confusing relationship to the variable under study.-->-->In particular, in order to qualify for publication three variables that have clear problem should be removed from the model: mass media exposure, head occupation and head education level.-->-->The reason for the first is that current mass media exposure cannot be or remotely be a cause of a marriage that might have happened decades ago. The reason to remove the head variables is that they do not capture any meaningful association given that the head variables will be mostly those of the father (or similar figure) for currently unmarried women and the spouse in currenly married (or the women in no longer married women). This creates a particular conflict in the kind of analysis used, survival analysis, since the relationship to the ego of the measured variable is dependent on the transition having occurred. I do not believe that any association so poorly measured can be of any value for policy.-->-->On the other respect, one more variable should be added to capture changes over time. It is well known that marriage has been postponing in most countries of the world in the last decades including in Lesotho (see, for instance, doi:10.1007/s11113-013-9301-x), although a recent article points to continuity in the context of Lesotho (https://doi.org/10.1007/s42650-025-00107-6). Note that some of the variables currently included might be capturing changes over cohorts that are not included in the model as a possibility through other variables that change over cohorts and currently appear in the model. You should at least include some variable indicating the birth cohort, probably as a categorical variable for consistence with the current approach, to capture these possible changes over time.-->--> -->-->To compensate for the delays in the revision process, the revised manuscript will not be sent to reviewers. I will personally evaluate whether these changes have been introduced.

Please submit your revised manuscript by Jul 29 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:-->

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We look forward to receiving your revised manuscript.

Kind regards,

José Antonio Ortega, Ph.D.

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.

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

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #2: All comments have been addressed

**********

-->2. 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 #2: Yes

**********

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

Reviewer #2: 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.-->

Reviewer #2: Yes

**********

-->5. 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 #2: Yes

**********

-->6. 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 #2: The manuscript is scientifically sound and methodologically appropriate and suitable for publication

**********

-->7. 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 #2: Yes: Lawan Adamu

**********

[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.

Age at first marriage among women in Lesotho: Multilevel survival analysis- insight from 2023-24 demographic and health survey data

PONE-D-25-41860R4

Dear Dr. Shibeshi,

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.

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Kind regards,

José Antonio Ortega, Ph.D.

Academic Editor

PLOS One

Additional Editor Comments (optional):

The ammendments to the manuscripts have avoided the most problematic issues and the expanded limitations make its limits clearer. The manuscript is apt for publication.

Reviewers' comments: