-->PONE-D-25-64861-->-->A Decade of Progress and Challenges in Water, Sanitation and Hygiene (WASH) Coverage in Bangladesh: Insights from Bangladesh Demographic and Health Survey 2011-2022-->-->PLOS One

Dear Dr. Jitu,

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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: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

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-->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

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Reviewer #1: Yes

Reviewer #2: No

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-->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: Abstract

1) Line 16-17: The first sentence is generic. I would expect at least one quantified global or Bangladesh‑specific burden estimate to anchor importance. Also, write the full abbreviation of WASH the 1st time you use it.

2) Line 22-25: It is not clear how “improved” WASH, sanitation, and hygiene are defined, nor whether the WHO/UNICEF JMP definitions are strictly followed and consistent across all four BDHS rounds. This should be explicit.

3) Authors mentioned spatial mapping, survey‑weighted logistic regression, GVIF, and classification trees. For an abstract, this is heavy on technical jargon; consider prioritising what is essential for understanding the findings.

4) Reporting “sanitation (22%), hygiene (30.5%), and overall WASH facilities (28%)” needs clarification: are these absolute percentage‑point increases or relative percentage changes? Please properly state that it is the percent change from 2011 to 2022.

5) Line 41-42: The statement “primary factors influencing WASH access have remained largely unchanged” is interesting but not supported with numerical evidence here. It would help to name those factors explicitly.

6) The policy recommendations are sound but generic. Please provide more specific policy recommendations.

Introduction

7) The introduction should more clearly situate Bangladesh in the global WASH and SDG‑6 landscape: How does its progress compare with regional neighbours or LMIC averages? At present, the text largely rehearses the importance of WASH but not Bangladesh’s relative performance. Please properly mention Bangladesh's standing in achieving the SDG 6 goals.

Methods

8) Line 171-73: Please mention whether descriptive statistics are weighted frequency and percentages.

9) Line 173-77: The authors correctly mentioned the use of survey‑weighted models. The methods should specify whether clustering and stratification were accounted for. Also, clarify whether analyses were done separately by survey round or as pooled data with year fixed effects.

10) Line 177-78: How was multicollinearity assessed using GVIF, and what decision rule (threshold) was applied?

11) Line 179-184: Please specify which outcome (overall WASH vs component) was modelled in the classification tree analysis. How you handled survey weights in tree building and how overfitting was addressed.

12) Line 185: For Spatial analysis, indicate whether you used smoothed estimates or raw weighted proportions. Clarify whether statistical tests for spatial clustering (like Moran’s I) were performed or if maps are descriptive only.

Results

13) I don’t understand why the authors provided the same information in Table 1 and Figure 3, and also in text lines 201-203. Please remove Table 1 and add the value labels in the figure.

14) As the main stated objective of this paper is to demonstrate decadal progress in WASH coverage, I strongly recommend that the authors add a table presenting the Average Annual Rate of Increase (AARI) for each WASH indicator. This should be shown both overall and stratified by key background characteristics. It will allow readers to see whether improvements have accelerated or stalled in specific subgroups.

15) Line 332-336: It does not add anything in result section. Please transfer the text in the methods and Table 4 as a supplementary table.

16) Line 341-350: The abstract mentioned that wealth is the most important split. This is unsurprising and already evident from regression. For the tree to justify inclusion, the Results should highlight novel high‑risk combinations (like “poorest quintile + large family size + no media access in specific divisions”), and quantify how much of the remaining unserved population is concentrated in these nodes.

17) As an optional but valuable addition, I encourage the authors to consider incorporating formal equity metrics, such as the concentration index and the slope index of inequality (SII), to quantify wealth‑ and education‑related gradients in WASH coverage over time.

Discussion

18) The Discussion should be restructured around a clear set of messages, like what magnitude of national progress has been achieved, by component, and to what extent have regional and wealth inequalities narrowed, persisted, or widened? What plausible policy or programmatic explanations exist? Please don’t repeat the result in this section.

19) The Discussion currently seems to restate the statistical associations (wealth, education, media access, phone ownership) without deeply exploring mechanisms or referring to implementation experience in Bangladesh (for example, roles of DPHE, NGO programs, national sanitation campaigns). Readers will expect linkage between numbers and real‑world systems.

20) Please provide a dedicated Policy Implication section before the conclusion. The recommended actions (“prioritize economically marginalised groups, subsidize WASH equipment, awareness campaigns”) are appropriate but broad. Consider being more concrete, like which subgroups, what types of investments, and how might the classification tree-identified high‑risk nodes be used operationally?

Reviewer #2: Major Comments

1. Novelty and Contribution

The manuscript claims (Lines 107–108, 428–429) that no study has comprehensively analyzed decade-long WASH progress using nationally representative data, or that this is the first such study. These statements are questionable. Several previous studies have used DHS, MICS, or similar datasets to examine WASH inequalities in Bangladesh.

Among others, the Bangladesh Health Watch publication “50 Years of Independence: Progress of Health Sector in Bangladesh” (University Press Limited, 2023) includes a dedicated chapter on WASH, where even 50 years of progress and challenges have been articulated.

The authors are encouraged to undertake a more comprehensive literature review, revisit these claims, and clearly articulate what additional knowledge this study contributes beyond the existing body of work.

2. Definitional Ambiguity and Incomplete Analysis

The manuscript relies on the term “improved WASH,” which was primarily used during the MDG era. In the SDG era (2015–2030), the monitoring framework has moved away from this terminology and uses service-level ladders. Continued use of “improved” without alignment to SDG definitions limits the usefulness of the findings for policy and programme purposes.

a) Drinking Water

Under the SDG framework, drinking water services are categorized as surface water, no service, unimproved, limited, basic, and safely managed. These indicators are central to SDG-6 monitoring, and their absence should be acknowledged as a limitation.

BDHS variables (e.g., Q103, Q107, Q108) allow at least partial classification into “basic” and “safely managed” services. The manuscript reports that access to improved drinking water exceeds 98% in Bangladesh (Line 203). However, under the WHO/UNICEF JMP framework, an “improved source” does not necessarily imply safe or safely managed drinking water.

In the Bangladesh context—where arsenic contamination and water quality remain significant concerns—this figure may overstate actual access to safe water. Furthermore, if collection time exceeds 30 minutes (Q103), the service cannot be classified even as “basic.” Therefore, such statements, if not properly qualified, may be misleading for policy interpretation. The authors should clarify this distinction or explicitly acknowledge it as a limitation.

b) Sanitation

Under the SDG framework, sanitation is classified as open defecation, unimproved, limited, basic, and safely managed. BDHS variables (Q110, Q111) capture shared sanitation, which is essential to distinguish between “limited” and “basic” services.

With additional analysis of the same dataset, it is possible to derive SDG-relevant sanitation service levels. The current analysis stops short of this, which limits its policy relevance.

c) Hygiene

In the SDG framework, hygiene is classified as no facility, limited, and basic. The term “improved hygiene” is not used. Therefore, the use of this terminology in the manuscript is not consistent with current global monitoring standards and should be revised.

Minor Comments

1. The descriptive results (Lines 250–251) suggest no notable differences in WASH coverage between male- and female-headed households. However, the regression results (Lines 304–305) indicate significantly higher odds of improved WASH access among female-headed households. The authors should clarify this apparent discrepancy and explain how adjustment for socioeconomic and demographic factors influences the observed relationship.

2. The manuscript applies classification tree analysis in addition to logistic regression models. However, the tree analysis appears to largely replicate the regression findings, particularly the dominant role of wealth in predicting WASH access. The authors should clarify the added analytical value of this approach or consider simplifying the analysis.

Interpretation of Findings

The discussion section largely reiterates statistical findings rather than providing deeper interpretation. For example, the strong association between wealth and WASH access is well established in the literature. The authors are encouraged to go beyond description and discuss why such inequalities persist despite improvements in coverage. Relevant factors may include amongst others are urban–rural infrastructure gaps, affordability constraints, governance, communication, access to TV and mobile phone, service delivery issues, and climate-related vulnerabilities.

Policy Implications

The policy recommendations are currently quite general. The manuscript would benefit from stronger linkage to specific national policies, sector strategies, or financing mechanisms in Bangladesh related to WASH and SDG implementation. This would enhance the practical relevance of the study.

Recommendation to the Editor

Decision: Major Revision

The manuscript addresses an important topic and uses a robust nationally representative dataset. However, substantial revisions are required. In particular, the authors should, to the extent possible, align the analysis with SDG-consistent WASH definitions; clarify where such alignment is not feasible; strengthen the articulation of novelty; improve methodological transparency; deepen interpretation of findings; and enhance policy relevance. Language and overall presentation also require improvement before the manuscript can be considered for publication.

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Reviewer #1: Yes:  Syed Toukir Ahmed Noor

Reviewer #2: Yes:  Md Khairul Islam

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Attachments

Attachment

Submitted filename: Comment to authors_PlosOne.pdf

-->PONE-D-25-64861R1-->-->A Decade of Progress and Challenges in Water, Sanitation and Hygiene (WASH) Coverage in Bangladesh: Insights from Bangladesh Demographic and Health Survey 2011-2022-->-->PLOS One

Dear Dr. Jitu,

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 Aug 06 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.

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We look forward to receiving your revised manuscript.

Kind regards,

Rajib Chowdhury, M.Sc.; MPH

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.

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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 #1: All comments have been addressed

Reviewer #2: (No Response)

Reviewer #3: (No Response)

**********

-->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 #1: Yes

Reviewer #2: (No Response)

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: (No Response)

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 #1: Yes

Reviewer #2: (No Response)

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 #1: Yes

Reviewer #2: (No Response)

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 #1: The revision addresses my comments well overall. Good luck. For the classification tree, I would still encourage the authors to report, for the lowest‑coverage terminal nodes, the proportion of all households lacking improved WASH that fall into these nodes, to better quantify how concentrated unmet need is within the identified high‑risk subgroups.

Reviewer #2: (No Response)

Reviewer #3: I am honored to participate in this review. Below are several comments intended to strengthen the manuscript.

Comment 1

This first concern had already been raised by previous reviewers but does not appear to have been adequately addressed. The terminology “improved” versus “unimproved” corresponds to the classification used under the Millennium Development Goals (MDGs), which remained in effect until 2015. Since the adoption of the Sustainable Development Goals (SDGs), water, sanitation, and hygiene (WASH) services have been classified into the following categories: safely managed, basic, limited, unimproved, and no service.

Based on the definitions adopted by the authors, the water sources categorized as “improved” in this study more closely correspond to “limited” water services under the SDG framework. Indeed, SDG limited water services include sources such as piped water into a dwelling, yard, or plot, public standpipes, boreholes or tube wells, protected dug wells, protected springs, rainwater, tanker trucks, carts with tanks, and bottled water. However, this classification does not take into account the time required to collect water. In contrast, a basic water service requires not only the use of an improved source but also that the total round-trip time for collecting water does not exceed 30 minutes.

Basic sanitation services refer to the use of improved sanitation facilities, including flush or pour-flush toilets connected to a sewer system, septic tank, or pit latrine, improved pit latrines with slabs, and composting toilets. However, this category includes an additional requirement: the facility must not be shared with other households. By contrast, limited sanitation services refer to the same types of improved facilities when they are shared by two or more households. Therefore, the distinction between “basic” and “limited” sanitation services is based not on the type of facility used, but rather on whether its use is exclusive or shared.

Basic hygiene facilities are handwashing facilities with soap and water available on the household premises.

Consequently, the study’s focus on limited water and sanitation services appears misaligned with the SDG programmatic targets. SDG 1 aims to end poverty in all its forms and includes Target 1.4, which calls for universal access to basic services, particularly for poor and vulnerable populations.

Comment 2

Furthermore, the authors chose to recategorize the wealth index variable. In Demographic and Health Surveys (DHS), this variable is originally constructed as quintiles, with households distributed approximately equally across five groups. However, the authors’ recategorization, combining the first two quintiles on one hand and the fourth and fifth quintiles on the other, resulted in an uneven distribution of observations across the resulting categories.

In this context, the rationale for referring to these categories as terciles is not respected. A more methodologically rigorous approach would have been to use the wealth index in its continuous form to generate true terciles based on the corresponding percentiles, rather than regrouping existing quintile categories.

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-->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 #1: Yes:  Syed Toukir Ahmed Noor

Reviewer #2: Yes:  Md Khairul Islam

Reviewer #3: No

**********

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A Decade of Progress and Challenges in Water, Sanitation and Hygiene (WASH) Coverage in Bangladesh: Insights from Bangladesh Demographic and Health Survey 2011-2022

PONE-D-25-64861R2

Dear Dr. Jitu,

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,

Rajib Chowdhury, M.Sc.; MPH

Academic Editor

PLOS One

Additional Editor Comments (optional):

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 #1: All comments have been addressed

Reviewer #2: (No Response)

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 #1: Yes

Reviewer #2: (No Response)

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: (No Response)

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 #1: Yes

Reviewer #2: (No Response)

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 #1: Yes

Reviewer #2: (No Response)

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 #1: (No Response)

Reviewer #2: (No Response)

Reviewer #3: Upon review of the submitted manuscript, several comments were raised. The authors have addressed them satisfactorily by providing the necessary clarifications.

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Reviewer #1: No

Reviewer #2: Yes:  Md Khairul Islam

Reviewer #3: No

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