PWAT-D-22-00064

DETERMINANTS OF CONSISTENCY OF USE OF HOUSEHOLD WATER FILTERS IN EMERGENCIES: INSIGHTS FROM A PROTRACTED DROUGHT IN NORTHERN KENYA

PLOS Water

Dear Dr. Wainaina,

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 Oct 21 2022 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,

Iddo Kan

Academic 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. Please amend your Data Availability Statement and indicate where the data may be found.

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: Partly

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 (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: No

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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: No

Reviewer #2: Yes

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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: Overall comments: This paper aims to identify variables that are significantly correlated with filter use as a household water treatment method. The authors developed household surveys to measure variables that have been reported in the literature as influencing consistent household water treatment, and associated them with a self-reported measurement of consistent filter use.

The methodology for the study seems appropriate. The aim of understanding how consistent filter use may be influence by a drought context is also interesting and would fill a gap. However, I have two overall concerns:

1. I don’t feel that the authors have met their stated objective of “taking into account the unique challenges faced during emergencies”. No data is collected on how the drought affected filter use versus normal conditions, and the drought is scarcely mentioned in the discussion. I believe the drought is only referred to in lines 228 – 231, in which the authors make an assumption that the drought increased consistent use, but this is not backed by any data. Without knowing how the drought actually influenced use, this paper rather re-confirms some findings about general filter use that have already been known for a long time (as outlined in their literature review).

2. The results and discussions sections need improvement. I found the writing difficult to comprehend, and the discussion section contains a mix of newly presented results, re-presenting results, and uneven discussion. I think a professional copyedit of these sections would help readability.

My second point could be corrected through revisions. However, my first point calls into question whether the paper makes a substantive contribution to knowledge

My specific comments are below:

Line 8: Do you mean household surveys rather than interviews?

Lines 16 – 19: These recommendations of reducing the number of parts and developing flexible designs are not really discussed in the paper.

Line 30: “safe” water supplies instead of “reliable” water supplies? Reliability usually refers to continuity or availability of water.

Line 70: I think it would be worthwhile to describe in basic terms how each of the filters work (especially how the two designs differ), in addition to the diagram.

Line 113: “This factor was composed of the physical conditions…” is awkward phrasing. Do you means to say something like “Questions about environmental and contextual factors aimed to assess physical conditions…”?

Line 119: Same as above.

Lines 126 – 133: Overreporting of hygienic practices is very common. There is a risk that participants overreported how frequently they used the filters because of various reasons (they might have felt it was the “right” answer to giver, the answer the enumerators wanted to hear, ashamed to report less consistent use, etc.). I think this should be acknowledged somewhere in the paper.

Line 174: Elsewhere in the paper, the authors indicate there were 108 surveys?

Lines 186 – 201: I found this paragraph difficult to comprehend and had to read it multiple times while cross-referencing Table 1 to understand the findings. It might not be necessary to identify the number of percentage units for each variable. Rather it might be more straightforward to say something like “Consistent use of the one-bucket filter was positively correlated with X, Y, and Z variables. Consistent use of the two-bucket filters was positively correlated with B and C variables and negatively correlated with A variable.”

Table 1: Why is the row about remembering to filter water included here? It looks like it didn’t have a significant correlation with consistent use.

Lines 248 – 250: Do the authors have any thoughts on why peer approval would drive consistent use of the one-bucket filter, but not the two bucket filter?

Lines 253 – 260: This paragraph isn’t really discussion of the results – it’s a presentation of more results that weren’t included in the results section. Some of the results have figures attached to them (e.g. 53% of respondents did not forget to treat water) and others don’t. If any of these variables were found to significantly correlate with filter use, should they be presented in the results section and then their implications discussed here?

Lines 256 – 258: This link between consistent filter use and knowledge of diarrheal diseases isn’t listed in table 1. Did the authors find a statistically significant correlation between these two?

Lines 261 – 264: I think this is meant to be discussion of the finding that consistent filter use correlated with agreement with the question “it is possible to situate and operate the filter anywhere in my house”? If yes, good to make this more explicit.

Lines 297 – 299: I don’t see how the data backs up this claim that having a functionality indicator would drive consistent use. The authors suggest respondents used their filters less consistently when they perceived a reduced flowrate meant the filter wasn’t working properly. I think it’s a logical fallacy to assume that means a graphical indicator would increase consistent use.

Lines 304 – 305: I feel unclear – did Nusrat & Shaila identify changes in colour, large space requirements, and need for elevation were barriers? Or the authors? Or both? Also, what is “changes in the colour of the filter element” referring to? This hasn’t been presented or discussed anywhere.

Lines 311 – 313: As above, I don’t think the data supports this claim.

Lines 313-314: This appears to be the information about the changes in colour that I asked about above. Was this a FGD finding? If yes, then it should be presented with the FGD findings.

Reviewer #2: This is an important manuscript on filtration in emergencies, particularly droughts. To prepare for publication, the following is recommended:

-- There is a lack of clarity in the text and the tables between the four filter models distributed, the two types of filters, and all filters together. More information is need on the four total models, how they were distributed, did individuals receive or buy one or all models?, were the groups the same who received the models?, and why in various points of the text the description is based on four models, two types, or individual. Currently, the presentation is elusive and confusing for the reader.

-- Additional tables are needed to present data beyond the regression (demographics between groups by filter, etc).

-- Self-reported use is confounded - especially if the filters were provided for free. Did people pay for the filters? Or were they provided for free? Can you discuss the limitations and biases of this research if the filters were provided for free?

-- p-values of 0.000 are inappropriate. The correct terminology is <0.001

-- The FGD results are so minimally analyzed as to suggest either: drop the FGD completely because it does not add value as it is biased, or appropriately analyze and present the FGD. In either case, it is a severe limitation there was only one FGD.

-- The authors state there is no comparative work on filters in emergencies previously, which is inaccurate. Please see (at minimum) Rayner et al - https://iwaponline.com/washdev/article-abstract/6/1/42/30419/Evaluation-of-household-drinking-water-filter and others, at minimum. There is extensive work on this topic. A review is indicated of previous work for the authors.

-- The consistency of use indicator - does 0% mean "no use" or "completely inconsistent use" - the text is unclear, please clarify.

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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

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[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.

PWAT-D-22-00064R1

DETERMINANTS OF CONSISTENCY OF USE OF HOUSEHOLD WATER FILTERS IN EMERGENCIES: INSIGHTS FROM A PROTRACTED DROUGHT IN NORTHERN KENYA

PLOS Water

Dear Dr. Wainaina,

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 Apr 17 2023 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,

Iddo Kan

Academic 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.

Additional Editor Comments (if provided):

I have now one report from one of the reviewers of the original version of your manuscript, Determinants of consistency of use of household water filters in emergencies: insights from a protracted drought in northern Kenya (the other reviewer declined the invitation to provide a report on the revised version).

Unfortunately, I cannot accept the revised version for publication. The reviewer has recommended Major Revision, while casting considerable doubts on the significance of the scientific contribution of the study, the validity of the methodology (as it relies only on self-reported information), and the relevance of the paper to emergency cases. Specifically, you asked people if they used the filter and did a regression on those self-reported use results, and found out you need spare parts, and a simpler filter, and a household shelter big enough. These are: 1) questionable results (self-reported data is not generally acceptable in results); and, 2) not novel (as in the need for enough space in the house and spare parts and supply chain access in emergency filter distributions goes back to some of the original papers published on household water treatment in emergencies). It seems that the manuscript provides another piece of evidence in another context saying the same thing as previous ones.

Based on the reviewer’s recommendation and my own reading, I invite you to submit a revised version of the manuscript for further considered for publication in PLOS Water.

[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: (No Response)

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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 #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 (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 #2: Yes

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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 #2: Yes

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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: This manuscript is much improved after the revision process. Thank you.

Some final thoughts for consideration:

1) Can the authors provide more detail on why self-reported use is the metric used, and how this limits the analysis (is it expected self-reported use would be accurate), and why filter flow measurement devices should were not used to verify self-reported use results?

2) The need for supply chain and shelter are novel - how are they related to previous results - published on other reviews and comparative reviews of filters?

3) How is this study related to drought?

4) What is the novelty of this manuscript?

5) There are some statements where filter use is expected to be lower, and some where it is expected to be higher? Is there an expected more or less use of filters expected in emergencies?

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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.

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 #2: No

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[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.

DETERMINANTS OF CONSISTENCY OF USE OF HOUSEHOLD WATER FILTERS IN EMERGENCIES: INSIGHTS FROM A PROTRACTED DROUGHT IN NORTHERN KENYA

PWAT-D-22-00064R2

Dear Mr Wainaina,

We are pleased to inform you that your manuscript 'DETERMINANTS OF CONSISTENCY OF USE OF HOUSEHOLD WATER FILTERS IN EMERGENCIES: INSIGHTS FROM A PROTRACTED DROUGHT IN NORTHERN KENYA' 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,

Iddo Kan

Academic Editor

PLOS Water

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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 #2: All comments have been addressed

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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 #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 (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 #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 #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: Thank you.

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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.

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 #2: No

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