WASH and Health in Sindhupalchowk District of Nepal after the Gorkha Earthquake
Round 1
Reviewer 1 Report
This manuscript provides helpful information for use in managing risks of waterborne diseases during disasters and identifying hygiene needs of affected populations. I offer the following revision suggestion and needs for the submitted manuscript:
Figure 1: Define "Wards" sections in the description.
Line 88: What percentage of the households did the sample size of 210 represent?
Line 92: Explain what is meant by "Structured" questionnaire; and the duration periods for the pre- and post- monsoon seasons.
Line 95: Explain further how samples were collected and stored prior to being analyzed.
Line 98: Explain if the "improved" waster source included any type of treatment or disinfection.
Line 101: Explain further if the water consumption was calculated based on self-reported water use data.
Line 106: Clarify that cleaning intervals were the number of days between each cleaning?
Line 110: Define solid waste; included municipal household waste?
Line 111: Explain further how personal hygiene behavior was measured. Clarify whether water consumption was only for hygiene use or drinking as well?
Line 115: Specify supplier information for the water test kit.
Line 121: Specify level of significance for the statistical tests.
Line 137: Explain what kind of waste was buried.
Figures: Where applicable, define error bars, specify sample size.
Discussion: This section can be improved by including more details on hygiene behavior and frequency of cleaning intervals and relationships to disease outcomes. Additionally, the authors can discuss how disinfection availability could make a difference and whether any disinfectant, such as chlorine, was used and/or residual was measured in the study.
Line 257: Define the term DDR.
Author Response
Dear Reviewer,
Thank you for providing valuable comments and suggestions. We have tried our best to address and incorporate your comments and suggestions in the revised manuscript as far as possible. Please let us know further on the revised version of the manuscript. Thank you again.
Warm regards,
Authors
Author Response File: 
Author Response.pdf
Reviewer 2 Report
No comments, No suggestions
Author Response
As there are no comments and suggestions from the reviewer, we have already incorporated comments and suggestions from other two reviewers. Thank you.
Author Response File: 
Author Response.docx
Reviewer 3 Report
The manuscript "WASH and Health in Sindhupalchowk district of Nepal after the Gorkha Earthquake" presents a case study that evaluated water quality during pre-monsoon and monsoon season to inform WASH practices and risks. A questionnaire survey was also conducted to evaluate how much water is used and the length of time in which storage vessels are cleaned.
While the study presents an interesting public health issue, there are significant limitations with how it is presented. The authors need to clarify how natural disasters, specifically an earthquake, ties in with the pre-monsoon and monsoon seasons. If the study's aim was to be a follow-up on WASH practices after a community has experienced an earthquake, then this should be explicitly stated. For the methods section, a copy of the questionnaire should be included with the paper or attached as supplemental information. Also, why was the questionnaire administered in 2017 and during what time frames? A more detailed discussion of the survey approach and how samples were collected (what type of bottles, how much water, was there any sampling procedures) should be included. In the results section, if there was a significant result, please state the p-value (and consistently list it as p<#). The discussion provides an insightful interpretation of the data though and the importance of WASH following natural disasters. Overall, the manuscript also requires significant editing for clarity.
A few specific comments include:
Line 103: Please define the units c/d.
Lines 103-104: How were households categorized for water consumption? Was that a question asked in the survey?
Lines 115-120: Were there any blanks or controls included in the microbiological analyses of your samples? Please explicitly state with microorganism is being detected that indicates fecal contamination (is it fecal coliforms).
Line 129: Please clarify the frequency statistics (present as a percentage).
Figure 2 needs a y-axis description.
Lines 142-148: This section should include descriptive text as well instead of a solid block of two graphs and a table.
Line 149: A different visual or text description would be more appropriate for this statistic.
Line 171: Figure 5 seems to be missing data under the monsoon season.
Lines 267-271: The text seems out of place.
Author Response
Dear Reviewer
Thank you for taking time and providing us your valuable comments and suggestions on the submitted manuscript. We have tried our best to address and incorporate the comments and suggestions as far possible to our level best. Please let us know further on the revised version of the submitted manuscript. Thank you again.
Warm regards,
Authors
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
The authors have adequately addressed the comments raised in my earlier review of the manuscript. The revised manuscript is much improved and the results are clearly presented. Since the authors comments regarding chlorine residual indicates that it was not measured in the samples, I recommend that the authors add this to the limitations of the study.
Author Response
Dear Reviewer
Thank you for your valuable comments and suggestions and making time for the review. We have tried our best to address your comments and suggestions as in the attached file and in the manuscript as a whole.
Sincerely,
Authors
Author Response File: Author Response.pdf
Reviewer 3 Report
Significant revisions were made to the manuscript which is appreciated. Lines 223-226 appear to have an outline of table that should be removed. Authors should consider editing the manuscript for clarity and conciseness so that the topics, aims, and findings are better articulated.
Author Response
Dear Reviewer
Thank you for your valuable comments and suggestions and making time for the review. We have tried our best to address your comments and suggestions as in the attached file and in the manuscript as a whole.
Sincerely,
The authors
Author Response File: Author Response.pdf
