Were Women Staying on Track with Intermittent Preventive Treatment for Malaria in Antenatal Care Settings? A Cross-Sectional Study in Senegal
Round 1
Reviewer 1 Report
The submitted article provides an interesting subject in the respective domain and existing literature is undoubtedly sparse. The overall quality and presentation are satisfactory; however, a few suggestions could bring further enhancement to the paper.
1. “Intermittent preventive treatment in pregnancy (IPTp) is a core intervention recommended by the World Health Organization (WHO) for the prevention of malaria in pregnancy.” When claiming a report, it is mandatory to provide solid evidence. I believe the authors have missed citing the WHO report link. Else, provided above, even though it has to be mentioned again.
2. Again, the same issue arose. The authors didn’t support their claim. “It has been estimated that if 90% of pregnant women received at least three doses of IPTp, an additional 206,000 low birthweights would have been averted in these 33 countries.” I would highly suggest revising the introduction part carefully and backing up their claim, where applicable.
3. In the sentence, “All pregnant women shall receive at least two doses of sulfadoxine-pyrimethamine (SP) after the onset of active fetal movements. […]” what is […] for? Please revise carefully.
4. In the contribution part, the authors have mentioned information about the data utilized which was supposed to be mentioned under the data source section. The contribution part is written extensively weak and needs to be revised with proper clarity and understanding.
5. The material provided under the heading study setting should be moved from there to the introduction part as a background of the study subject.
6. There is no need to put a separate heading on the study design. Merge it under the heading “data source and study sample”.
7. “Visits where providers “gave malaria prophylaxis medicine (SP) to [the] client during the consultation” or “prescribed malaria prophylaxis medicine (SP) to [the] client to obtain elsewhere” were coded as 1 and 0 otherwise.” What is [the] stand for?
8. The data source, study sample, measures, and analysis subheadings are irrelevantly large. Please revise it and remove the irrelevant material.
9. A few acronyms are defined in the first place. Please revise.
10. The heading “patient and public involvement” need to be replaced with “ethical considerations”.
11. Under table 2, it should be mentioned what the significant level of the estimated statistics was.
12. The endorsement of the current findings with prior literature is insufficiently discussed in the discussion section. Please endorse your results with the most recent literature.
13. There are plenty of grammatical errors which require to be rectified professionally.
Author Response
- “Intermittent preventive treatment in pregnancy (IPTp) is a core intervention recommended by the World Health Organization (WHO) for the prevention of malaria in pregnancy.” When claiming a report, it is mandatory to provide solid evidence. I believe the authors have missed citing the WHO report link. Else, provided above, even though it has to be mentioned again.
----Thanks for your suggestion. We have inserted the reference of the WHO report.
- Again, the same issue arose. The authors didn’t support their claim. “It has been estimated that if 90% of pregnant women received at least three doses of IPTp, an additional 206,000 low birthweights would have been averted in these 33 countries.” I would highly suggest revising the introduction part carefully and backing up their claim, where applicable.
----Thanks for your suggestion. We have inserted the reference for this claim and checked the introduction part.
- In the sentence, “All pregnant women shall receive at least two doses of sulfadoxine-pyrimethamine (SP) after the onset of active fetal movements. […]” what is […] for? Please revise carefully.
----Sorry for the confusion. The original document is in French. The omitted sentences were about the side effects of SP (Effets indésirables de la SP). We rephrased these sentences and deleted […].
- In the contribution part, the authors have mentioned information about the data utilized which was supposed to be mentioned under the data source section. The contribution part is written extensively weak and needs to be revised with proper clarity and understanding.
----Thanks for your suggestion. We added a paragraph (the second to last paragraph) in the introduction part to further outline the previous literature and knowledge gap on this topic.
- The material provided under the heading study setting should be moved from there to the introduction part as a background of the study subject.
----Thanks for your suggestion. We have removed this section and incorporated it into the introduction part.
- There is no need to put a separate heading on the study design. Merge it under the heading “data source and study sample”.
----Thanks for your suggestion. We have removed the subheading on the study design and merge it with “data source and study sample.”
- “Visits where providers “gave malaria prophylaxis medicine (SP) to [the] client during the consultation” or “prescribed malaria prophylaxis medicine (SP) to [the] client to obtain elsewhere” were coded as 1 and 0 otherwise.” What is [the] stand for?
----We added “[the]” because the article was omitted in the SPA questionnaire. To keep the sentence consistent with the SPA questionnaire, we have deleted “[the].”
- The data source, study sample, measures, and analysis subheadings are irrelevantly large. Please revise it and remove the irrelevant material.
----Thanks for your suggestions. We have condensed these sections.
- A few acronyms are defined in the first place. Please revise.
----Sorry for the confusion. We have checked the acronyms and added all acronyms to the list of abbreviations.
- The heading “patient and public involvement” need to be replaced with “ethical considerations”.
----Thanks for your suggestion. This heading has been replaced with “ethical considerations.”
- Under table 2, it should be mentioned what the significant level of the estimated statistics was.
----Thanks for your suggestion. We have mentioned the significance level under the Table.
- The endorsement of the current findings with prior literature is insufficiently discussed in the discussion section. Please endorse your results with the most recent literature.
----Thanks for your suggestions. We have revised the discussion part accordingly.
- There are plenty of grammatical errors which require to be rectified professionally.
----Sorry for the inconvenience. We have checked and revised the manuscript.
Reviewer 2 Report
Dear authors,
Thank you for your article. I have some questions that may improve the scientific soundness. However, please, include your answers in the text of your work (do not send a response only for me).
- Maybe it should be very interesting (and important) to include information about how far the pregnant women live from Hospital/Health center/Clinic in your logistic regression. Although you were not able to do it, I believe it is important to discuss how this information could impact in your study.
- Did you find any association among your results and the regional levels presented in Appendix Table 4? Again, although you did not developed this analysis, you should discuss about if there is the possibility of clustering of your results.
- Please, reorganize the Table 2. It may be misconfigured.
Thank you for attention.
Author Response
- Maybe it should be very interesting (and important) to include information about how far the pregnant women live from Hospital/Health center/Clinic in your logistic regression. Although you were not able to do it, I believe it is important to discuss how this information could impact in your study.
----Thanks for your suggestions. We agree that the distance to ANC facility could be an important factor affecting attendance of ANC and the ultimate uptake of IPTp. Unfortunately, we were not able to include this variable in our logistic regression because SPA did not collect such information. To discuss this issue, we first mention the importance of this variable in the introduction part. In the discussion part, we acknowledged this omitted variable bias and emphasized the importance of community engagement to involve women who did not arrived at ANC facilities.
- Did you find any association among your results and the regional levels presented in Appendix Table 4? Again, although you did not developed this analysis, you should discuss about if there is the possibility of clustering of your results.
----Thanks for your suggestions. We have considered the clustering issue at the regional level when analyzing the data. To control for regional variations, we created dummy variables to indicate each region in the logistic model. We did not further adjust for clustering because Stata does not allow us to account for complex survey weights and clustering at the same time. We have further conducted sensitivity analysis by accounting for clustering at the regional level (without survey weight adjustment). The results were similar to our current findings. We mentioned this issue in the data analysis section.
- Please, reorganize the Table 2. It may be misconfigured.
----Sorry for the inconvenience. We have changed the font size.
Reviewer 3 Report
Significant public health issue.
Excellent presentation ready for publication.
Study limitations are well identified and making sense.
In particular, the prescription issue should be more developed.
In many areas in Senegal, prescription is not followed up because affordability and access to drugs availability on time.
An other point to be emphasized related to the training of care providers and to logistics in drugs distribution from regional centers is the importance of seasonal transmission risk.
Maybe these isssues could be considered for further data collection from the next DHS survey.
Author Response
----Thanks for your comments and suggestions. Your comments have been incorporated into the discussion section.
