Towards Sustainable Community-Based Systems for Infectious Disease and Disaster Response; Lessons from Local Initiatives in Four African Countries

Round 1

Reviewer 1 Report

Dear Authors,

Thank you very much for your paper concerning four countries in Africa. Please add information about authors (affiliations), Acknowledgments and Funding. After reading I have some suggestions concerning the situation in Sierrra Leone and Ethiopia.

About methodology – can author explain who collected these data? From description in the text I can’t follow the idea of the research: Uganda and Ethiopia case materials emerged from co-design and co-production methodologies, emerging from various activities in which researchers, government agencies and non-governmental organisations engaged with local communities. From this text it is impossible to know, who realized the research. It would be also very valuable to write which scientific methods authors used in this research: primary, secondary qualitative, quantitate (mix methods)? In the line 189-191 authors mentioned about that, but please make this part more clear. I suggest to read about methodology of the research e.g. book Methods and methodology in composition research or in the paper New technologies and innovative solutions in the development strategies of energy enterprises. 

It is worth mentioning the wealth of the society in Sierra Leone and the approach to the issue in the context of education and earnings. As in neighboring Guinea, these factors play an important role. In HDI report Sierra Leone is ranked lower that Guinea, so similar problem are in both countries. Please mentioned about social situation, pollutions which have influence on health condition. Please support by information from Environmental pollution as a threats to the ecology and development in Guinea Conakry. 

In the case of Ethiopia, the authors only mentioned Jimma University. It would be worth adding a few activities carried out at other universities, such as the University of AA. In the case of one university, it is difficult to generalize and infer about the academic community. Did the authors use official data or their own observations? The authors from Ethiopia know perfectly well that the official data differs significantly from the actual data.

I hope that my report will help Authors to improve the paper. Good luck.

Author Response

Responses to reviewer 1.

We thank reviewer 1 for the praise to our manuscript and the constructive and useful comments, that mainly address the materials and methods section. We also thank reviewer 1 for the reminder about information about authors (affiliations), Acknowledgments and Funding. We will include that in the final version after acceptance.

In the following we have copied the comments in parts (with the text in italics) and wrote our response after it.

About methodology – can author explain who collected these data? From description in the text I can’t follow the idea of the research: Uganda and Ethiopia case materials emerged from co-design and co-production methodologies, emerging from various activities in which researchers, government agencies and non-governmental organisations engaged with local communities. From this text it is impossible to know, who realized the research. It would be also very valuable to write which scientific methods authors used in this research: primary, secondary qualitative, quantitate (mix methods)? In the line 189-191 authors mentioned about that, but please make this part more clear. I suggest to read about methodology of the research e.g. book Methods and methodology in composition research or in the paper New technologies and innovative solutions in the development strategies of energy enterprises. […] Did the authors use official data or their own observations? The authors from Ethiopia know perfectly well that the official data differs significantly from the actual data.

We have substantially rewritten the materials and methods section. That resolves most issues mentioned by reviewer 1. Before describing details for each case study we mentioned that all case studies used standard qualitative methods for field research in participatory research methods for qualitative data collection, “including interviews, observations, participatory workshops as well as triangulation with quantitative descriptive data on health indicators.” 

It is worth mentioning the wealth of the society in Sierra Leone and the approach to the issue in the context of education and earnings. As in neighboring Guinea, these factors play an important role. In HDI report Sierra Leone is ranked lower that Guinea, so similar problem are in both countries. Please mentioned about social situation, pollutions which have influence on health condition. Please support by information from Environmental pollution as a threats to the ecology and development in Guinea Conakry.

We thank reviewer 1 for these suggestions. It is true that Sierra Leone ranks low on the Human Development Index. However all case study countries rank in the low range (see: https://en.wikipedia.org/wiki/List_of_African_countries_by_Human_Development_Index; accessed 15-08-2021). Moreover, factors related to poverty and ‘pollutions’ are a given in all case study countries and express in particular form. At the beginning of the Discussion section, we note the similarities across the four case-study contexts and have added in the point (in the first sentence) about all four countries sharing low-income status. In presenting our findings, we emphasised key emerging themes and factors which were more prominent than the HDI and pollution factors over other factors; we would prefer to stay close to our data.

In the case of Ethiopia, the authors only mentioned Jimma University. It would be worth adding a few activities carried out at other universities, such as the University of AA. In the case of one university, it is difficult to generalize and infer about the academic community.

Each country case study focuses on the actions of a single institution in that country which led or was involved in the project and analytical work. Undoubtedly other institutions have done interesting work in the same area but these were not examined in our analysis and are thus beyond the scope of this paper. Clearly there is value in being able to generalize. However, our method (case study) only allows to identify themes from a particular intervention and explore how these manifest across multiple countries rather than generalise within a single country based on multiple institutions (including academic). We can do this because all cases we report, except Madagascar, involved university researchers. Moreover, throughout our paper we describe, infer and make statements about the need to increase community-based research at and with universities in LMICs.

Reviewer 2 Report

Dear authors, thank you for your contributes to the understanding of sustainable community-based systems in this work you presented us.

I have some suggestions to improve your manuscript:

Keywords:

I suggest to take the names of the regions from the keywords. It is not a necessary keyword for scientific word searching;

Introduction:

In line 39 I would put this sentence: "This paper investigates the potential and limitations of community-based systems of care for effective firstline responses to environmental threats." In the materials and methods or in the end of the introduction in the form of aims. For eg:

The aims of this research are: To identify the potentialities and limitations of coommunity-based systems for effective firstline responses to environmental threats. You have an objective in line 152, but see wich one is better to describe your work. 

Check the formating of the word "first-re-sponders" in line 124 (maybe the hifen should be after the "s". 

 

The sentence in line 154: "We present a series of case studies describing different approaches to community-led outbreak and disaster response. From these we distil common elements and principles for supporting community-based initiatives for infectious disease response and consider how such initiatives can be connected and supported through mainstream health institutions to promote sustainability." it would be better in the material and methods. 

From line 162 to 173 is not necessary to be in the introduction as it referes to results. 

 Materials and Methods

In line 195 change "Results from Madagascar" to "Data from Madagascar" as you don't collect results but data. :)

In the same line you say that the study in Madagascar was made "through a participatory action research approach". Who were the participants and how they were involved?

Next you say that: "the Uganda and Ethiopia case materials emerged from co-design and co-production methodologies, emerging from various activities in which researchers, government agencies and non-governmental organisations engaged with local communities." How do you arrive to this issues?

And about ethical issues? Did you ensure it? How? Did you had an authorization for analysing this case studies? 

Results:

Results are too much descriptive. I was expeting an organization of data based on qualitative methods (such as categorization that could make the reader understand the relation of the case studies to the identification of "potentialities and limitations of coommunity-based systems for effective firstline responses to environmental threats." as you proposed in the introduction.  You describe it, but can you put it a litle more friendly, using a categorization board of analyses for example?

E.g.

Casestudy(region)/ Problematic description/Strategies description/potentialities/ limitations/ results achieved. 

Conclusions:

Conclusions are ok. But if you arrange the results and discussion the conclusions will be more valued. ;)

Maybe you could talk about the limitations of your studie and the contributes of your conclusions to science and to society to value more your work.

 

References:

Some references need to be checked in formating some words (E.G. Referecene 1: "infec-tion"

 

Thank you again. A litle effort to make your manuscript perfect! :)

Author Response

Responses to reviewer 2:

We thank reviewer 2 for the constructive and useful comments. Our responses to specific comments are inserted after the copied comments (in italics).

Keywords: I suggest to take the names of the regions from the keywords. It is not a necessary keyword for scientific word searching;

Thank you, we have deleted the country names.

Introduction: In line 39 I would put this sentence: "This paper investigates the potential and limitations of community-based systems of care for effective firstline responses to environmental threats." in the materials and methods or in the end of the introduction in the form of aims. For eg: The aims of this research are: To identify the potentialities and limitations of community-based systems for effective firstline responses to environmental threats. You have an objective in line 152, but see which one is better to describe your work. 

We thank reviewer 2 for this comment. We can understand that the first quoted sentence may be read as the paper objective and we have moved it to the end and rephrased. However, with this sentence we intended to inform the reader about what s/he can expect, which is different from stating the aim/objective of the paper. As the reviewer rightly remarks, we have stated our objective in line 152.

Check the formating of the word "first-re-sponders" in line 124 (maybe the hifen should be after the "s". 

Thank you for pointing this out. There should not be any hyphen in “responders”. The hyphening is a result from the page layout that comes with the journal format. We will seek advice from the (copy)editor on how to solve this particular instance.

The sentence in line 154: "We present a series of case studies describing different approaches to community-led outbreak and disaster response. From these we distil common elements and principles for supporting community-based initiatives for infectious disease response and consider how such initiatives can be connected and supported through mainstream health institutions to promote sustainability." it would be better in the material and methods. From line 162 to 173 is not necessary to be in the introduction as it referes to results. 

Our intention was that the paragraphs referred to are to inform the reader about the structure of the paper and what s/he can expect in following sections. We agree that this can be shortened, however, and thus have deleted several sentences (164-169).

 

Materials and Methods: In line 195 change "Results from Madagascar" to "Data from Madagascar" as you don't collect results but data. :) In the same line you say that the study in Madagascar was made "through a participatory action research approach". Who were the participants and how they were involved? Next you say that: "the Uganda and Ethiopia case materials emerged from co-design and co-production methodologies, emerging from various activities in which researchers, government agencies and non-governmental organisations engaged with local communities." How do you arrive to this issues? And about ethical issues? Did you ensure it? How? Did you had an authorization for analysing this case studies? 

We have substantially rewritten the materials and methods section. That resolves the issues mentioned by reviewer 2. In doing so, we also took into account recommendations by reviewer 1.

Results: Results are too much descriptive. I was expeting an organization of data based on qualitative methods (such as categorization that could make the reader understand the relation of the case studies to the identification of "potentialities and limitations of coommunity-based systems for effective firstline responses to environmental threats." as you proposed in the introduction.  You describe it, but can you put it a litle more friendly, using a categorization board of analyses for example? E.g. Casestudy(region)/ Problematic description/Strategies description/potentialities/ limitations/ results achieved. 

Thank you for this comment. The reason we chose to present the results by case study is that each involved rich detail on the approaches that was important to capture before looking at the wider cross-cutting issues (potentialities and limitations categories) which are taken up more in the Discussion.

Nevertheless, we very much like your suggestion of adding some of this as analysis in the Results section and have therefore added a new paragraph at the end of the results section with a table summarising the important categories for the potential and limitations of the different approaches.

Conclusions: Conclusions are ok. But if you arrange the results and discussion the conclusions will be more valued. ;) Maybe you could talk about the limitations of your studie and the contributes of your conclusions to science and to society to value more your work.

Thank you. We have now added a summary section in the Results, at the end, that makes explicit the key characteristics and limitations of our case studies, from which our conclusions arise. We trust that this will increase the value of our conclusions. We also made a table in which we highlight key findings, relevance and limitations of the case studies.

 

References: Some references need to be checked in formating some words (E.G. Referecene 1: "infec-tion"

 Thank you, we have corrected errors in the references.

Reviewer 3 Report

Thank you very much for your article. I just have a few remarks: The introduction could probably be structured a little bit more deductive and less like an essay. 

What really is important: Please indicate much clearer on your method. Qualitative case study research is fine, but the description of material and methods is too vague.

 

This makes the results not too comprehensible, as we do not know how data was collected, it could also be an essay, a very interest essay indeed, but the soundness is a little bit missing.

 

Discussion and conclusions are fine.

 

One error in the bibliography: in your reference No. 53 you show the first name.

Author Response

We thank reviewer 3 for the constructive and overall positive comments. Our responses to specific comments are inserted after the copied comments (in italics)..

The introduction could probably be structured a little bit more deductive and less like an essay. 

Given that the paper reports from various case studies, the introduction requires a proper introduction that explains the ‘how, what and why’ of these case studies. This may leave the impression having written a full essay as introduction. However, to minimise this, we have shortened the introduction and also separated out the more conceptual part into a different section.

What really is important: Please indicate much clearer on your method. Qualitative case study research is fine, but the description of material and methods is too vague. This makes the results not too comprehensible, as we do not know how data was collected, it could also be an essay, a very interest essay indeed, but the soundness is a little bit missing

Thank you – this was suggested by all three reviewers and we have substantially rewritten the materials and methods section, which provides more clarity on methods.

One error in the bibliography: in your reference No. 53 you show the first name.

 Thank you, we have corrected errors in the references.

Round 2

Reviewer 1 Report

Dear Authors

Thank you for your new version of your paper. After reading I feel that you should supported your paper by more citations, because scientific paper requires to support existing ideas by literature.

Authors wrote about Ebola in Congo, so it would be valuable to add about other countries e.g. diseases in Guinea. If there is only Congo, it is not sufficient. It should be kept the symmetry in descriptions.

Authors added few sentences about methodology: All case studies relied on standard participatory research methods for qualitative data collection, including interviews, observations, participatory workshops as well as triangulation with quantitative descriptive data on health indicators. But it is obligatory to add any references concerning the methodology. There are many scientific articles which used similar methodology and Authors should support their ideas by citations. Authors wrote about qualitative methods, observations, interviews – please write/justify why qualitative methods are enough for your research so please support by citation.

Moreover please add more citation in the paper where knowledge is from external sources e.g. The availability of arable land, forest resources and clean water are crucial assets for human health and well-being. The negative impact of environmental threats aggravated by climate change may create a long-term negative cycle of resource depletion, reduced effectiveness of existing support systems and increasing poverty. This part should have a citation.

I encourage authors to support their article with further citations. Sticking to the current number of 53 citations is insufficient and shows insufficient support for the various statements used in the article.

Author Response

We thanks reviewer 1 for the further comments and suggestions on our revisions. We agree with the importance of good referencing. For the passages reviewer 1 mentions we have done the following.

In the methods sections we have changed the wording and added two references. The passage now reads as follows:

All case studies relied on standard participatory research methods for qualitative data collection which requires long-term engagement which can lead to improved health outcomes [a]. These methods included interviews, observations, participatory workshops as well as triangulation with quantitative descriptive data on health indicators [b]. 

In the other passage we have added two references [c,d]. For convenience we have now listed the additional references a-d. We will integrate this in the numerical reference system after approval. The references are in the new version and copied below.

We are not aware about a minimum number of references required for the journal or research papers in the (interdisciplinary) field of science covered by the journal. To our experience, the number of references of our paper fits the median range.  

The additional references are:

a. Viswanathan M, Ammerman A, Eng E, et al. Community‐Based Participatory Research: Assessing the Evidence: Summary. 2004 Aug. In: AHRQ Evidence Report Summaries. Rockville (MD): Agency for Healthcare Research and Quality (US); 1998-2005. 99. 

b. Tolley E., Ulin P.R., Mack N. et al. (eds) Qualitative Methods in Public Health: A Field Guide for Applied Research Second Edition. Wiley. 2016

c. Wu, T. (2021). The socioeconomic and environmental drivers of the COVID-19 pandemic: A review. Ambio, 50(4), 822-833. doi:10.1007/s13280-020-01497-4

d. Austin, K. F. (2021). Degradation and disease: Ecologically unequal exchanges cultivate emerging pandemics. World Development, 137, 105163. doi:https://doi.org/10.1016/j.worlddev.2020.105163

 

 

Reviewer 2 Report

Dear autora, congratulations! The manuscript is now much better. 

Thank you for considering my suggestions. 

Author Response

We thank reviewer 2 for going through our revised paper and we are very grateful our revisions are considered adequate. 

Round 3

Reviewer 1 Report

Dear Authors, the number of citations does not refer to the median or statistical analysis, but where authors have written sentences that should be supported by quotes and other readers want to read more about the topic and deepen their knowledge, references are required. This is the main idea behind the references. I don't know why the authors were afraid to add references to the main text? And why are authors afraid to write their affiliations? Very strange.

Author Response

We thank reviewer 1 for the further clarification on additional references. And we agree with the main idea behind references. At the same time, readers of the journal are expected to have a basic understanding of the kind of topics addressed in the journal and a capacity to look up further information for themselves, if required. Striking a balance between what can be assumed general knowledge and providing explanation with references is indeed not about statistics. We were referring to this balance, and arriving at this balance with a fairly standard number of references, when talking about a median range. We apologize for the misunderstanding our formulation created. To the best of our knowledge and judgement, our paper has found such a balance. All the complex interactions between ecology, climate change, diseases and community health that we address in our paper are referenced. This is a rather novel topic and although for each of the components, listed in the previous sentences, there is a wealth of literature, there are only few studies into the complex interactions between these components. We do not think it is helpful, and indeed would underestimate the capacity of the reader, to provide more references on each of the components separately. For example, when we talk about zoonotic diseases in the African context, we consider it not very helpful to provide references on these diseases as such. We assume people know the basics of Ebola or Malaria and, if needed, are able to look for further information themselves. We have concentrated on studies that address complex interactions between, for example, zoonosis and climate change, and taken those up in the list of references. It might be that we have overlooked important studies on complex interactions similar to the ones addressed in our paper. If so, we are happy to be informed about these studies and include a reference to it.

The comment of reviewer 1 on affiliations is somewhat puzzling, as this is not raised before. We have not yet included affiliations for pragmatic reasons and have no problem in sharing them. In the new version they are now included.

Author Response File: Author Response.docx