Acute Respiratory Infections in Ghanaian Children: Epidemiology, Antimicrobial Resistance, and Prevention Strategies

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

Lines 95-97. Please, give a reference and more detailed information concerning 3.2 Goal. (what, who and where created this goal)

Lines 98-139. Please, combine text into Methodology section. 

Line 166. You described that Haemophilus influenzae type b was dominant during pre-Covid era, but you did not mention it in the table 1. 

PCV13 - please, give a full name in the text. 

Did you assess morbidity and mortality in pre- and post-pandemic era in children? How post-Covid trends influenced on these parameters? 

 

Author Response

Comment 1: Lines 95–97. Please, give a reference and more detailed information concerning 3.2 Goal. (what, who and where created this goal).

Response: We thank the reviewer for this important suggestion. We have expanded the first mention of Sustainable Development Goal (SDG) 3.2 to clearly describe its origin, purpose, and institutional context. Specifically, we now indicate that SDG 3.2 was adopted by the United Nations General Assembly in 2015 as part of the 2030 Agenda for Sustainable Development and explicitly state its child mortality targets. A primary United Nations reference has been added. (Pages 2 and 3; Lines 90-95).

 

Comment 2: Lines 98–139. Please, combine text into Methodology section.

Response: We appreciate this organizational recommendation. We have now clearly designated this content under a dedicated Methods section, consolidating all methodological details describing the narrative review approach, literature search strategy, inclusion criteria, and synthesis framework. No substantive content was removed. (Pages 3 and 4; Lines 96-146).

 

Comment 3: Line 166. You described that Haemophilus influenzae type b was dominant during pre-Covid era, but you did not mention it in Table 1.

Response: Thank you for noting this inconsistency. We have revised Table 1 to explicitly include Haemophilus influenzae type b among key bacterial pathogens in the pre-COVID-19 period, under “Key pathogens”, ensuring alignment between the narrative text and the table. (Page 4; Lines 169)

 

Comment 4: PCV13 – please, give a full name in the text.

Response: We agree and have now expanded the acronym at first mention to “13-valent pneumococcal conjugate vaccine (PCV13).” Subsequent references retain the abbreviated form. (Page 5; Lines 174)

 

Comment 5: Did you assess morbidity and mortality in pre- and post-pandemic era in children? How post-Covid trends influenced on these parameters?

Response: We thank the reviewer for this important clarification request. We have added a dedicated paragraph explicitly addressing how morbidity and mortality trends were considered within the scope of this narrative review. The revised text clarifies that direct comparative ARI-specific mortality estimates between eras are limited by heterogeneous surveillance and reporting, and that post-COVID-19 impacts are therefore interpreted using proxy indicators such as hospitalization patterns, pathogen circulation, and health system disruptions. This paragraph also synthesizes global and Ghana-specific evidence on pandemic-related declines and post-pandemic resurgence of respiratory infections, with appropriate citations. (Page 7; Lines 264-286).

Reviewer 2 Report

Comments and Suggestions for Authors

This review offers a well-organized synthesis of pediatric acute respiratory infections in Ghana, effectively integrating epidemiological trends, antimicrobial resistance, health system capacity, and prevention strategies across the pre- and post-COVID-19 periods. The manuscript is clearly written, logically structured, and supported by a comprehensive and relevant body of literature. The focus on oxygen systems, antimicrobial stewardship, and emerging RSV preventive interventions is particularly appropriate and well aligned with current global priorities.

As a narrative review, the manuscript would benefit from a more explicit acknowledgment of its methodological limitations. In particular, briefly discussing the heterogeneity of data sources, case definitions, and surveillance approaches, and how these may influence interpretation, would strengthen transparency. Additionally, a clearer distinction between evidence synthesis and policy recommendations in some sections would improve analytical clarity.

These are minor points that do not detract from the overall quality or relevance of the review.

Author Response

General Comment: As a narrative review, the manuscript would benefit from a more explicit acknowledgment of its methodological limitations.

Response: We appreciate this suggestion and have now added an explicit paragraph outlining the methodological limitations inherent to this narrative review. This includes discussion of heterogeneity in study designs, case definitions, surveillance systems, and the absence of a formal risk-of-bias assessment, and how these factors may influence interpretation. (Pages 3 and 4; Lines 139-146)

 

Additional Comment: A clearer distinction between evidence synthesis and policy recommendations in some sections would improve analytical clarity.

Response: We thank the reviewer for this helpful recommendation. To improve analytical clarity, we have explicitly signposted the transition from evidence synthesis to policy interpretation by adding framing language at the start of Sections 5 (now Section 6) and 6 (now Section 7) and by introducing transitional phrases before policy-oriented statements. These revisions clarify when the manuscript is summarizing evidence versus proposing policy-relevant implications, without altering the substance of the conclusions. (Pages 7 and 8; Lines 288,297-298 and 322-324).