Malaria and HIV Co-Infection among Pregnant Women in Africa: Prevalence, Effect on Immunity and Clinical Management: Review

Round 1

Reviewer 1 Report

After having read the title of the manuscript, I started reading the manuscript with enthusiasm. But my enthusiasm proved to be short-lived: soon after finishing the abstract I asked myself what was the motivation of the author behind this research project. No satisfactory answer I got it from reading the abstract. Then I started reading the introduction section. After having finished reading a few paragraphs, I saw the paragraph that has the following at lines 73 - 76:

"... clear understanding of the overlapping effect of both infections among pregnant women in Cameroon is very important to control and improve on the clinical management of women during antenatal care visits a well as their babies postpartum."

The fact that the above sentence is in the introduction section tells me about the author's motivation behind the project. But the motivation should have made clear at the start of the introduction section. This should have been the case for the abstract, too. Potential readers of this manuscript should not be made to struggle to find it.

Further reading  of the methods section told me that the author had performed some literature searches ("articles published up to 2022") for telling the story in the manuscript. But how many articles were found and, finally, how many of those were used to backing up the story told in the manuscript is mentioned nowhere. Why?

I also found that the author do not have a results section. Instead, there are some numbered sections (3 through 7), which are between the methods and conclusion sections. This is a minor thing, which can be fixed easily. However, the stories in these numbered sections are not just about the situations of malaria-HIV co-infection in pregnant women in Cameroon only, which potential readers of the manuscript could infer. So, I suggest to either modify the title so that it better suits/captures the stories in these numbered sections or restrict your stories for the pregnant women's situation in Cameroon only.

Also, the abstract as well as the entire manuscript needs a careful proofreading. Some acronyms used in the abstract have not been explained. I do not know what an "MHC" stands for. (By the way, what one can infer from "MHC, prevalence" in line 20 - 21 in the abstract?) Likewise, the acronym "MTCT" has been used in the abstract without giving any care for the potential readers.

In summary, I think the author has a great story to tell in the manuscript. However, the organization and delivery of the story is very poor, which can be fixed by a thorough revision. And please do not forget to proofread the revised manuscript.

A minor thing. The following sentence at lines 274 - 276 

"The image depicts a possible depiction of how HIV-1 infection compromises various immunological mechanisms related with placental malaria prevention."

could be rewritten as follows:

"The image depicts how HIV-1 infection compromises various immunological mechanisms related to placental malaria prevention."

Author Response

Thank you very much for the highlighted points made during the review process. However, this is more of a narrative review than a systematic review. That is why the manuscript is not structured into the following; introduction, methods, results, discussion, and conclusion like a normal systematic review paper will do. Nevertheless, we have taken time to highlight the total number of articles sorted and the number used in the method section during the write-up process. Also, the abstract and introductory part of the manuscript has been written all over to bring out the story properly as you recommended. The different English errors and the full meaning of most of the text's abbreviations have been sorted out. The manuscript has been read by a couple of individuals to ensure that errors are limited and plagiarism levels have been checked to make sure it falls below 50% as recommended by the journal. The title of the image as well as has been adjusted as recommended.

Reviewer 2 Report

This is a fascinating manuscript and meaningfully brings together parasitology, virology, and maternal/child health. The manuscript is well-organised and I found the headings helpful. Tables and the figure are excellent. If anything, there could be a little more commentary about the role of malaria vaccination as a contributor to the overall management of the population under discussion, along with suggestions as to the specific studies that the author would recommend.

Author Response

My sincere gratitude for the comment made. As recommended a section on the role of the malaria vaccine in the fight against malaria has been added as well.

Reviewer 3 Report

This manuscript is a review regarding two infectious diseases of major public health importance. 

The litterature review is thorough and includes different aspects of these matters, such as epidemiology, immune response and clinical management. Nevertheless, specific sections are difficult for the reader to follow, and they should be shortened or be better organized, such as section 4,5,6.

Also, the english language and syntax need to be thoroughly reviewed. 

Moreover, minor grammar/typing errors are present throghout the text and shoule be corrected, for example :

page 3 line 103: "Child mortality rates are highest ..." - may the authors mean very high?

page 6 line 228: "With regards .., Antibodies.." the letter should be "a"

page 7 line 244: ".. Ayisi and collaborators. Who ... " . The full stop sign need to be ommited and the folllowing sentence to be included in the previous,

and so on.

Author Response

I am so grateful for the different points highlighted by the reviewer. As recommended, most of the sections of the manuscript have been summarized and broken down into sections e.g. heading “HIV and Malaria co-infection affects immune modulation during pregnancy” has been broken down into sub-headings as seen in the manuscript. Also, most of the English errors and typing errors have been adjusted as cited; page 3 line 103, page 6 line 228, and page 7 line 244. Most of the syntax as well as the English errors have been adjusted. The manuscript has been read by a couple of individuals to minimize English and typing errors. The plagiarism level has been minimized to meet the journal expectations below 50%.