PWAT-D-24-00052

The utility of experiential water insecurity measures for monitoring and evaluating WASH programs: Case studies from Nepal and Sierra Leone

PLOS Water

Dear Dr. Miller,

Thank you for submitting your manuscript to PLOS Water. After careful consideration, we feel that it has merit but does not fully meet PLOS Water'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 Feb 24 2025 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 water@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pwat/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the 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'.

Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

We look forward to receiving your revised manuscript.

Kind regards,

Guillaume Wright

Staff Editor

PLOS Water

Journal Requirements:

1. Please include a complete copy of PLOS’ questionnaire on inclusivity in global research in your revised manuscript. Our policy for research in this area aims to improve transparency in the reporting of research performed outside of researchers’ own country or community. The policy applies to researchers who have travelled to a different country to conduct research, research with Indigenous populations or their lands, and research on cultural artefacts. The questionnaire can also be requested at the journal’s discretion for any other submissions, even if these conditions are not met.  Please find more information on the policy and a link to download a blank copy of the questionnaire here: https://journals.plos.org/water/s/best-practices-in-research-reporting. Please upload a completed version of your questionnaire as Supporting Information when you resubmit your manuscript.

2. In the ethics statement in the Methods, you have specified that verbal consent was obtained. Please provide additional details regarding how this consent was documented and witnessed, and state whether this was approved by the IRB

3. Please provide an Author Summary. This should appear in your manuscript between the Abstract (if applicable) and the Introduction, and should be 150–200 words long. The aim should be to make your findings accessible to a wide audience that includes both scientists and non-scientists. Sample summaries can be found on our website under Submission Guidelines:

https://journals.plos.org/globalpublichealth/s/submission-guidelines#loc-parts-of-a-submission.

Additional Editor Comments (if provided):

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

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Water’s publication criteria ? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: I don't know

Reviewer #3: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. 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

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Water 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

**********

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: Summary and overall impression

This paper by Miller et al. compared findings from observable (JMP indicators) and experiential (HWISE scale) measures that were used to assess the impact of interventions to improve water services in two distinct settings (rural Nepal & urban Sierra Leone). Both measures significantly changed after the interventions. The authors also demonstrate that experiential measures are useful to complement traditional indicators. Overall, this paper is contributing to the evidence of the value of using experiential indicators for evaluating water service interventions, which has not yet been documented extensively. In this sense, the paper is contributing to new evidence in this area.

The authors mention relevant literature and indicate the need of the present study, while employing a clear language.

The following comments include suggestions (minor revisions) that can improve the clarity of research findings and the overall robustness of the study before publication by PLOS Water.

Major/overall comments

-The authors describe the positive impact of interventions to improve water services on both observable (JMP indicators) and experiential (HWISE scale) measures. It would add value to statistically investigate if the extent of this positive impact is comparable the JMP and HWISE measures or if notable differences exist. The authors briefly address this when they mention that the “estimated project impact was likely higher using the HWISE Scale” (line 462). This statement could be further discussed by exploring potential reasons for this discrepancy, supported by statistical analysis. If such an in-depth analysis is beyond the scope of the current study, it could be identified as a future research area to better understand different dimensions of impact.

-In my opinion, the description of the propensity score matching process (line 277 and following) needs some further clarifications. It is not entirely clear whether both comparison and intervention households were asked to provide data for both 2016 and 2019. If yes, it would be helpful to specify which datasets exactly are used in this study (e.g., is the comparison and intervention data in Table 2 from year 2016 or 2019).

-The authors could expand the conclusion and elaborate on the broader implications of the findings. For example, the conclusion could highlight:

oThat experiential measures complement traditional indicators by providing a more nuanced understanding of water access challenges, enabling the design of more targeted and effective interventions.

oThat they can reveal disparities that might be overlooked by traditional measures.

oHow the findings might inform future initiatives and how they can impact policies (e.g., integration of experiential measures into water management policies) and contribute to SDG 6.

Minor/detailed comments

Abstract & Introduction:

-Line 36: “Nepal (n=83) and Sierra Leone (n=981)” – It’s not completely clear to what the number (n=…) refers (households surveyed to evaluate observational or experiential measures or both, or different levels of interventions). It becomes clear later in the methodology and in Table 2, but it should be clarified already in the beginning, by employing a clear language.

-Line 64: “water accessibility, affordability, sufficiency, and quality” – In my opinion, the term sufficiency is not very clear; reliability seems more adapted in this context. Also verify the formulation in line 463 to be consistent.

-Line 101/102: Is there a specific reference for this?

-Line 109: …associated WITH a range of…

-Line 126: I doubt that “sustainability” is truly measured with existing indicators; in my opinion, the social aspect of sustainability is not well captured in these indicators and many indicators rely on point measures/observations at the time of the assessment.

Methods:

-Lines 173-175: Some key activities in Phase I and II of the Freetown WASH Consortium project for improving WASH conditions could be briefly mentioned; in my opinion, it can be useful to know the entire context.

-Lines 197: Replace “S1 Text” with “S1 Survey” (same name as in the supporting information section).

-Lines 202/203: 109 of 400 households (surveyed about access to WASH services) were surveyed about HWISE. Why have not all the 400 households been surveyed and what exactly did the survey about access to WASH services assess; is this relevant for the present study (it seems like this data is not used for this study)?

-Line 247: I think the authors meant SDG 6.1 (not 2.1).

-Lines 274 & 291: When talking about “first and second aim”, briefly recall what those aims were. It will be easier for the reader to recall and follow along.

Results:

-Line 308, Table 2: Adjust the table description; Water source and JMP classifications are also included, not only “Demographic and household characteristics”.

-Line 309, Table 2: Specify if “Water source” is the “main drinking water source” or other.

-Lines 316-324: The authors claim that 100% of surveyed households in Nepal had a “safely managed service” after the intervention, implying water was free from fecal contamination. I would assume that water samples were taken at each surveyed household and all samples showed E. coli concentrations of 0 CFU/100ml. If this was the case, it should be mentioned in this paragraph.

-Line 332, Fig. 1: Please explain in the caption what is the meaning of ***.

-Lines 351/352: Is there any hypothesis why this one household shifted from low to moderate water insecurity? It might be interesting for the discussion.

-Lines 362, 364: Include p-values, similar to the analysis of Nepal in lines 339/340.

-Lines 371/372: It seems that Fig. 2 suggests that “angry” is also an affirmed experience in Nepal after intervention. In this case, it should also be mentioned here.

-Line 376, Fig. 4: Has such a figure also been generated for Sierra Leone, with comparison vs. intervention groups? Why is it only shown for Nepal?

Discussion & Conclusion:

-Lines 448/449: It would add value to discuss why there might have been differing impacts by region, i.e., what could have been the specific local conditions that affected the success of the interventions.

Final remarks

I encourage the authors to address these minor comments (to the extent possible) and resubmit a revised version.

Reviewer #2: 1.Abstract: The two aims are not coming out clearly in the abstract.

2.Introduction: Briefly talk about the importance of water accessibility, affordability, sufficiency, and quality to public health or human well-being.

3.Methodology: Under data analysis; a t-test is a statistical analysis that compares the means of two groups to determine if there is a statistically significant difference between them. It is a common tool used in hypothesis testing. Pearson's chi-square test is an inferential statistical test. This means that these two tests allow researchers to draw conclusions about a population based on a sample. In particular, they can be used to determine if two variables are related in a population. This therefore, means that t-test and Pearson's chi-square test are part of inferential statistics not descriptive statistics.

4.Results: In this chapter, you also need to show clearly how in your analysis you managed to come up with the inferential statistics in the same way you did, on descriptive statistics in table 1.

5.Discussion: In this chapter you do not need to explain much of what you already brought out in the preceding chapter (Results). You need to give a detailed discussion of results, bringing in your technical understanding of the issues at hand and the implications of the findings on the well-being of the subjects. You may need to include limitations that may have come in, as a result of the study design you employed.

6.Conclusion: In this section, you need to also bring out the implication of the findings and the overall recommendation.

Reviewer #3: Review of “The utility of experiential water insecurity measures for monitoring and evaluating WASH programs: Case studies from Nepal and Sierra Leone”.

Abstract

Well written.

Introduction

Good piece but my concern is why consider rural Nepal and Urban Sierra Leone since it seems like comparing apples to oranges. Although a justification was provided, comparing rural and urban setting from 2 different countries in two different regions raises concerns such as geographic and population commonalities.

Methods

Provide sources to statements between lines 141-144. This seems to run through the study settings. Authors should provide some citations to support the interventions implemented.

The last paragraph on line 297 can be added to the initial data analysis paragraph.

Results

The subsection on water infrastructure access, authors can report on the roundtrip time for Sierra Leone since it did that for Nepal. This will make the comparison clearer.

Conclusion

Authors should consider adding implications for policy and practice.

**********

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.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

[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.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: MANUSRIPT COMMENTS.docx

The utility of experiential water insecurity measures for monitoring and evaluating WASH programs: Case studies from Nepal and Sierra Leone

PWAT-D-24-00052R1

Dear Dr. Miller,

We are pleased to inform you that your manuscript 'The utility of experiential water insecurity measures for monitoring and evaluating WASH programs: Case studies from Nepal and Sierra Leone' has been provisionally accepted for publication in PLOS Water.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow-up email from a member of our team. 

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

IMPORTANT: The editorial review process is now complete. PLOS will only permit corrections to spelling, formatting or significant scientific errors from this point onwards. Requests for major changes, or any which affect the scientific understanding of your work, will cause delays to the publication date of your manuscript.

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 water@plos.org.

Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Water.

Best regards,

Richard Meissner, D.Phil. International Politics

Academic Editor

PLOS Water

***********************************************************

Additional Editor Comments (if provided):

Reviewer Comments (if any, and for reference):

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: All comments have been addressed

**********

2. Does this manuscript meet PLOS Water’s publication criteria ? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception. 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

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS Water 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

**********

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: Nicely written paper, all comments raised by the reviewers have been addressed. I therefore recommend to accept the paper.

Reviewer #2: The main concerns that came out in the initial submission were as follows:

1. Data Analysis

A t-test and Pearson's chi-square test were indicated as descriptive statistics. This has been corrected and the two tests now fall under inferential statistics.

2. Results

In this chapter the authors needed to show clearly the inferential statistics in the same way they did on descriptive statistics. This was attended to as can be seen in the manuscript.

3. Discussion

In this chapter the main concern was the repeating of presentation of results at the opening of the discussion of findings. The preamble of the discussion was summarised, and a detailed discussion of results, bring in the technical understanding of the issues at hand; and the implications of the findings on the wellbeing of the subjects came out clearly.

4. Study limitations

The authors were asked to include the limitations that may have come as a result of the study design. These were already embedded in the issues that were brought out earlier.

5. Conclusion

In this section the authors were asked to also bring out the implication of the findings of the study and the overall recommendation. These areas have now been covered adequately.

**********

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.

Do you want your identity to be public for this peer review? If you choose “no”, your identity will remain anonymous but your review may still be made public.

For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

**********