Diarrhoea among Children Aged 5 Years and Microbial Drinking Water Quality Compliance: Trends Analysis Study in South Africa (2008–2018)
Round 1
Reviewer 1 Report
The aim of the study should be more clear formulated. The aim of the study is not what the study is about (see lines 77-79 "(..) and the presence of pathogenic microorganisms exceeding drinking water quality standards/guidelines in South Africa") - in the study (and conclusions) there is about the microbial water quality compliance and the diarrhoea among children under 5 years old. There is one province where the compliance with the quality standard cited (SANS 241:2015, ed. 2) is 88.55, so below the standard (table 3.1) and it's data are not presented separately in results - all the other provinces seem to comply with the cited standard (SANS).
Materials and methods:
line 94 - review how many deaths? 460 or 250?
point 2.4. - study population (lines 115-117) - included all children (...) under the age of 5 who were exposed to microbial drinking water quality pathogens - ALL children under 5 were included, or just those with diarrhoea?
Results:
Information from lines 174-182 - should be placed in the Materials and Methods section.
line 176 - E. coli is abbreviated with a dot, not a line (E-coli)- if you want to change over the paper
Figure 3 - Please, revise the figure - it misses at least the years on the x axis.
lines 213-219 - the information belong better to Discussion section, and it seems that it was added there! (lines 373-379).
line 221 - E. coli - make it italic
Figure 4. - what represents the numbers from left and right? - please, specify (in other graphs, too!). Also, is missing the year 2018 (the number in the figure). Please, verify the explanation of the figure - lines 232 - 238. (ex. the compliance increased in 2016 and not decreased; it decreased in 2017, from the figure). And according to your information (line 151-152), therperc means compliance status. In the figure here and next ones (5-9), is mentioned "theperc".
Figure 5. Inside the figure, in the title, you have an abbreviation (U-5, which is also found in other figures!). Please, explain it or remove the title inside the figure, since you have the title of the figure below.
line 249 - new paragraph when talking about E. coli.
line 278 - the way the name of the figure 8 is edited completely different than the other
What authors mean by "diarrhoea with dehydration new"? (ex. table 3.3 and line 309)
lines 338-340 - need to be deleted
Discussion:
lines 352-358 are repeating! (see lines 176-182) - and should belong to Materials and Methods.
Conclusions:
lines 435-437 - reformulate!
lines 444-445 - to be deleted
Institutional Review Board Statement: to be added in here, too. (line 142).
References:
- to be formulated according to this journal (numbered, numbers in square brackets... see author information).
Author Response
| reviewer 1 | |
Author Response File: 
Author Response.docx
Reviewer 2 Report
This study addressed the very important topic about diarrhoea outbreaks. The authors provide the trends analysis of diarrhoea in South Africa during 2008-2018.. However, the manuscript needs some revision before publication. They found that as compliance status improved, the mortality rate among children under 5 years old decreased by 31% over the study period and the microbiological pathogens detected in drinking water at levels complying with SANS 241: 2015 edition 2 and diarrhoea incidences were not the primary cause of the mortality of children under 5 years old in South Africa between 2008 and 2018.
1. Why select the period of 2008-2018?
2. Some figures are directly from statistics software, if they can be modified will be better .
3. Please add more description about DWS IRIS database and the DOH DHIS 100 database.
Author Response
Greetings,
Please see attached responses cover letter.
Thank you so much.
Feida
Author Response File: Author Response.docx
