Blood transfusion service readiness and its associated factors in health facilities providing blood transfusion services across Ethiopia: A secondary analysis of the 2018 Service Availability and Readiness Assessment (SARA) survey

Tirualem Asmare Fenta; Gizachew Tadele Tiruneh; Nebiyou Fasil Ayele

doi:10.1371/journal.pone.0315665

Peer Review History

Original SubmissionAugust 1, 2024
20 Sep 2024 Decision Letter - Rena Hirani, Editor PONE-D-24-30780Blood transfusion service readiness and its associated factors in health facilities providing blood transfusion services across Ethiopia: A secondary analysis of the 2018 SARA surveyPLOS ONE Dear Dr. Tiruneh, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please make the requested alterations outlined below prior to further review. Please submit your revised manuscript by Nov 04 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Rena Hirani Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. For studies involving third-party data, we encourage authors to share any data specific to their analyses that they can legally distribute. PLOS recognizes, however, that authors may be using third-party data they do not have the rights to share. When third-party data cannot be publicly shared, authors must provide all information necessary for interested researchers to apply to gain access to the data. (https://journals.plos.org/plosone/s/data-availability#loc-acceptable-data-access-restrictions) For any third-party data that the authors cannot legally distribute, they should include the following information in their Data Availability Statement upon submission: 1) A description of the data set and the third-party source 2) If applicable, verification of permission to use the data set 3) Confirmation of whether the authors received any special privileges in accessing the data that other researchers would not have 4) All necessary contact information others would need to apply to gain access to the data 3. Please upload a new copy of Figure 1 as the detail is not clear. Please follow the link for more information: https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/ https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/ 4. Please include a copy of Table 5 which you refer to in your text on page 13. 5. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Please define the terms SSA and SARA as requested. Please take note of the statistical terminology requested by reviewers. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes Reviewer #3: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thanks to the authors for this interesting manuscript. I have a few suggested edits/comments that you may wish to consider. Critically, it would be helpful to have a bit more methodological clarity and detail to enable a full interpretation of results. Abstract - What is meant by “determinants” of blood transfusion services? I think keeping it to readiness alone better reflects what was carried out. - Please swap commas for semi-colons between the components in lines 19–22. Introduction - In the first two sentences, there is no link made to the importance of blood transfusion for these conditions. - It’s also not clear in lines 41/41 (over half of the deaths result from conditions that can be managed through prehospital and facility-based emergency care) what the reference is to needing blood. Please make this more explicit. - Please define SSA (line 50) - Before you introduce what influences readiness, it would be worthwhile to define what you mean by readiness within the context of this study - Remove “the” in line 58 - Please remove any acronyms that are not repeated in the manuscript (e.g. ERCS) Methods - It’s not clear how many facilities participated at what level in your study. The 2018 SARA included 764 facilities, a census of 303 hospitals, 164 health centers, 165 clinics, excluding the health posts, but you note that you included 632 facilities, excluding health posts, participated in your study? Why not all of the facilities in the SARA? It would also be helpful to see what those 632 facilities were in terms of level. Please clarify what the overall sample size (and if there was a calculation, please provide this) was and how it was expected to be generalizable (i.e. what parameters you used for sample size calculations to ensure this, especially as regressions were used—how did you ensure you had sufficient numbers for each variable to do this type of analysis?). - To that end, a table would be enormously useful (e.g. with a column for total health facilities by region/type, a column for those included in the SARA, and then a column for those included in this analysis). - Please remove “were” in line 96 - Interviews and a facility inventory questionnaire were carried out for the SARA, but it’s not clear what the function of the interviews was in terms of readiness? Which instrument actually gave insights around the seven tracer items used in the present study? - Please describe the seven tracer items in more detail, in terms of what was actually assessed for each, the time frames in which they may have been evaluated (e.g. previous three months? Only the day of the assessment?) - Please add “and” before “service readiness” in line 113 Results - Please add a “totals” row in Table 1. - The chi-squared test is not mentioned in your methods. Further, it’s not clear to me why this was done at all? For instance, would you expect all facilities to provide blood transfusion? In Table 2, please ensure n/N is reflected. It’s not clear what the total facilities is (and further, is this ALL facilities in the region, or only those expected to carry out blood transfusion? If it’s the latter, the chi-squared is useful, but if it’s the former, I would not include this analysis). - This is a minor comment, but please swap the [ ] and ( ) brackets (e.g. (Coef.: -0.74; 95% CI: 0.014 [-1.32--0.15]). In general, confidence intervals are usually in square brackets. Discussion - In line 192, please change “was significantly varied” to “varied significantly”. - Please revise “the readiness in facilities providing” in line 201 to “the readiness of facilities to provide”. - A limitation of this study is that it relies on the SARA, which only allowed for “available” or “not available” , but I imagine in many facilities (as has been my own experience), there is availability “sometimes”. How were these facilities coded? If it had to be all the time to be coded “available”, then the overall picture presented would be quite conservative, reflecting a worse picture. If there just had to be some availability for “available”, then the converse is true. It would be useful for the authors to reflect on the implications of this coding for reflecting the overall state of blood transfusion services. - It also strikes me as a clear finding that only 256 facilities actually provide blood transfusion, in practice, as I imagine the number, in theory is much higher. In your discussion you might consider adding a reflection on the proportion of facilities expected to offer blood transfusion services that actually do and the implications of this. - It would also be useful to see some reflections by the authors on the implications of this study for both policy and for practice. - Please revise “is” to “were” in line 235, and “investments” to “investing”, “in availing” to “to avail”, and “addressing” to “to address” in line 237. - In the list of acronyms, it should be “odds ratio”, not “odd ratio” Reviewer #2: A research study was conducted which aimed to examine the readiness and determinants of blood transfusion services in Ethiopian facilities. Minor revisions: 1- The standard statistical term for average is mean. When providing means, also state the corresponding standard deviations. 2- Line 127: To improve clarity consider replacing “for” to “with”. 3- Line 136: Add “for” to “check for multicollinearity”. 4- P-values never equal zero; express small p-values as < 0.001. 5- Line 169: State which pairwise regions and facility types differed with respect to mean readiness scores. 6- Line 128: The Student’s t-test is appropriate for comparing two groups. Locations and facility types have more than two groups, correct? ANOVA is an extension of the Student's t-test for comparing more than two groups. Reviewer #3: Methods - Measurement: I am not clear on how you obtain the mean percentage service readiness score. The description seemed confusing to me. What are the cut-off points? Results - Please do not represent # as number. It is not a standard symbol in journals - Line 152, first sentence is a repetition from your methods. I suggest rewording them - p-value of 0.000 should be changed to <0.001 - Line 179: Table 5 does not exist - Please change the way you present your regression analysis. Your p-value and 95%CI are reversed Discussion - How do you determine your results to be sub-optimal or optimal? Refer to methods comment. - We need more comparisons with other studies. If not African countries, how about other low-middle income countries for comparison? - Discussions for the availability of medical equipment is lacking. Please expand on your findings. Miscellaneousc - Please spell out the full term at its first mention, indicate its abbreviation in parenthesis and use the abbreviation from then on (SSA, SARA) ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0315665.r001
Revision 1
25 Sep 2024 Author Response A point-by-point response to reviews Dear Editor, We, the authors, would like to thank the reviewers for their valuable comments which we feel have significantly strengthened our paper. Our point-by-point responses to the reviewers and editor are below each comment. We also reviewed to ensure that this version of the manuscript conforms to the journal style. Response to Reviewers Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Response: In this version, we have updated the figure in-text citations accordingly and ensured that the manuscript adheres to PLOS ONE's style requirements. 2. For studies involving third-party data, we encourage authors to share any data specific to their analyses that they can legally distribute. PLOS recognizes, however, that authors may be using third-party data they do not have the rights to share. When third-party data cannot be publicly shared, authors must provide all information necessary for interested researchers to apply to gain access to the data. (https://journals.plos.org/plosone/s/data-availability#loc-acceptable-data-access-restrictions) For any third-party data that the authors cannot legally distribute, they should include the following information in their Data Availability Statement upon submission: 1) A description of the data set and the third-party source 2) If applicable, verification of permission to use the data set 3) Confirmation of whether the authors received any special privileges in accessing the data that other researchers would not have 4) All necessary contact information others would need to apply to gain access to the data Response: We updated the Data Availability Statement as follows: Conducted by the Ethiopian Public Health Institute (EPHI) between October and December 2017, the SARA 2018 dataset—generated from a facility-based cross-sectional survey—offers insights into service availability and readiness for general healthcare and various specific services at both national and regional levels. Interested researchers can access the dataset by following a data-sharing agreement. Researchers can request the dataset through EPHI’s data repository website for the “Ethiopia Services Availability and Readiness Assessment (SARA) Survey, 2018,” available at https://rtds.ephi.gov.et/public/showdetail/94. An assigned officer will review and facilitate the request. Upon submission, researchers will receive an email outlining the requirements, which include: 1) completing and returning the data request form; 2) providing a copy of the ethical approval certificate; and 3) attaching an official data request letter. 3. Please upload a new copy of Figure 1 as the detail is not clear. Please follow the link for more information: https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/ https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/ Response: Figure 1 with improved resolution has been uploaded. 4. Please include a copy of Table 5 which you refer to in your text on page 13. Response: It was a typo referring to Table 4, which has now been corrected. 5. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: Thank you. The references are checked and corrected for completeness. Additional Editor Comments: Please define the terms SSA and SARA as requested. Please take note of the statistical terminology requested by reviewers. Response: Thank you. The abbreviations have been defined, and all necessary changes have been made according to the reviewers' comments. Reviewers' comments: Reviewer #1: Thanks to the authors for this interesting manuscript. I have a few suggested edits/comments that you may wish to consider. Critically, it would be helpful to have a bit more methodological clarity and detail to enable a full interpretation of results. Response: We well-acknowledged the valuable comments. In this version, we have addressed them and improved the manuscript accordingly. Abstract - What is meant by “determinants” of blood transfusion services? I think keeping it to readiness alone better reflects what was carried out. Response: Thank you for the valid comments. Comment well taken and edited as follows “This study examined the readiness of blood transfusion services in health facilities across Ethiopia and its determinants.” - Please swap commas for semi-colons between the components in lines 19–22. Response: Comment well taken and edited accordingly. Introduction - In the first two sentences, there is no link made to the importance of blood transfusion for these conditions. - It’s also not clear in lines 41/41 (over half of the deaths result from conditions that can be managed through prehospital and facility-based emergency care) what the reference is to needing blood. Please make this more explicit. Response: The texts of the first two sentences as well as lines 41/42 have been revised for clarity as follows “Safe blood transfusion is essential for treating injuries and emergency obstetric conditions, serving as a life-saving intervention in various clinical scenarios. Timely and secure blood transfusion services are particularly vital in LMICs, where over half of deaths result from conditions manageable through emergency care.” - Before you introduce what influences readiness, it would be worthwhile to define what you mean by readiness within the context of this study Response: Thank you for the valid comments. The following definition is included in the text “Blood transfusion service readiness —defined as the preparedness and capability of a facility to provide safe, timely, and effective blood products and services, which includes trained staff, blood storage refrigerators, blood typing, cross-matching, supply safety and sufficiency, and guidelines for appropriate use—is crucial for ensuring safe and effective transfusions [12].” Lines 55-58 - Please define SSA (line 50) - Remove “the” in line 58 - Please remove any acronyms that are not repeated in the manuscript (e.g. ERCS) Response: We have defined the acronym SSA, removed 'the' where necessary, and eliminated the acronym ERCS accordingly. Methods - It’s not clear how many facilities participated at what level in your study. The 2018 SARA included 764 facilities, a census of 303 hospitals, 164 health centers, 165 clinics, excluding the health posts, but you note that you included 632 facilities, excluding health posts, participated in your study? Why not all of the facilities in the SARA? It would also be helpful to see what those 632 facilities were in terms of level. Please clarify what the overall sample size (and if there was a calculation, please provide this) was and how it was expected to be generalizable (i.e. what parameters you used for sample size calculations to ensure this, especially as regressions were used—how did you ensure you had sufficient numbers for each variable to do this type of analysis?). - To that end, a table would be enormously useful (e.g. with a column for total health facilities by region/type, a column for those included in the SARA, and then a column for those included in this analysis). Response: The 2018 SARA included 632 hospitals, health centers, and clinics, along with 162 health posts. We included all 632 facilities (excluding the 132 health posts, which are not expected to provide blood transfusion services). Tables 1 and 2 present the facility levels and location. Regarding the adequacy of the sample size check, we have added the following sentences “In this study, we included all 632 facilities (except the health posts which are expected to provide blood transfusion services) in the SARA survey were included. The adequacy of the sample size is assessed using a single proportion formula with a 5% margin of error, a 95% confidence level, a design effect of 1.5, and an assumption that 88% of hospitals reported performing compatibility testing for whole blood and RBC [20]. Additionally, a double population comparison is conducted for blood transfusion service readiness, considering managing authority and facility type as exposure variables, with an assumed power of 80%, a design effect of 1.5, and a 95% confidence interval [16].” Lines 104-109 - Please remove “were” in line 96 - Please add “and” before “service readiness” in line 113 Response: We have removed the word 'were' and added 'and' accordingly. - Interviews and a facility inventory questionnaire were carried out for the SARA, but it’s not clear what the function of the interviews was in terms of readiness? Which instrument actually gave insights around the seven tracer items used in the present study? Response: Thank you for the comments. The following sentence has been added in lines 120-122. “Specific to facility readiness, the interviewer was instructed to interview the person most knowledgeable about blood transfusion services at the facility where blood is collected, processed, tested, stored, or handled prior to transfusion.” - Please describe the seven tracer items in more detail, in terms of what was actually assessed for each, the time frames in which they may have been evaluated (e.g. previous three months? Only the day of the assessment Response: Thanks for the valid comments. The table below has been added to clarify each tracer items detailing what it means including its time timeframe. Lines 128-139 Items Definitions and data sources Guidelines on the appropriate use of blood and safe blood transfusion Observed availability of guidelines on the appropriate use of blood and safe blood transfusion in the service area Staff trained in the appropriate use of blood and safe blood transfusion At least one staff member providing the service trained in the appropriate use of blood and safe blood transfusion within the past 2 years based on the interview response from in-charge of service area day of the survey Blood storage refrigerator Observed availability and reported functionality and with temperature being monitored (checked that temperature has been monitored at least once in the past 24 hours and maintained at 2 – 6 oC) in the service area or adjacent area Blood typing Observed ability of the facility to conduct the ABO blood group test, Rhesus blood group test, and centrifuge tests on-site (in the facility) and functioning equipment and reagents needed to conduct the test on the day of the survey. Cross-match testing Observed ability of the facility to conduct the crossmatch (should use methods that demonstrate ABO incompatibility and incompatibility due to other clinically significant antibodies and should include an indirect anti-globulin test or a test of equivalent sensitivity), centrifuge, 37°C incubator, and grouping sera on-site on the day of the survey. Blood supply sufficiency Reported availability of no interruption of blood availability in the last three months Blood supply safety Reported availability of blood obtained only from national or regional blood bank, OR blood obtained from other sources but screened for HIV, Syphilis, Hepatitis B, and Hepatitis C Results - Please add a “totals” row in Table 1. - The chi-squared test is not mentioned in your methods. Further, it’s not clear to me why this was done at all? For instance, would you expect all facilities to provide blood transfusion? In Table 2, please ensure n/N is reflected. It’s not clear what the total facilities is (and further, is this ALL facilities in the region, or only those expected to carry out blood transfusion? If it’s the latter, the chi-squared is useful, but if it’s the former, I would not include this analysis). Response: The total number of facilities expected to provide blood transfusion services are 632 sampled facilities in the country in the SARA survey. The N and n/N are included in Tables 1 and 2, respectively. Ch2 is mentioned in the analysis section. Lines 147-149. - This is a minor comment, but please swap the [ ] and ( ) brackets (e.g. (Coef.: -0.74; 95% CI: 0.014 [-1.32--0.15]). In general, confidence intervals are usually in square brackets. Discussion - In line 192, please change “was significantly varied” to “varied significantly”. - Please revise “the readiness in facilities providing” in line 201 to “the readiness of facilities to provide”. Response: Thank you for bringing all these to our attention. These have been edited accordingly. - A limitation of this study is that it relies on the SARA, which only allowed for “available” or “not available” , but I imagine in many facilities (as has been my own experience), there is availability “sometimes”. How were these facilities coded? If it had to be all the time to be coded “available”, then the overall picture presented would be quite conservative, reflecting a worse picture. If there just had to be some availability for “available”, then the converse is true. It would be useful for the authors to reflect on the implications of this coding for reflecting the overall state of blood transfusion services. Response: This is an interesting insight. The survey estimates the all-time availability of blood transfusion services, which is indeed a concerning situation as you noted. We have reflected this in the Discussion section, lines 226-228. “As the SARA survey provided a conservative estimate of the all-time availability of blood transfusion services, highlighting a concerning situation that would significantly impact access to emergency care. “ - It also strikes me as a clear finding that only 256 facilities actually provide blood transfusion, in practice, as I imagine the number, in theory is much higher. In your discussion you might consider adding a reflection on the proportion of facilities expected to offer blood transfusion services that actually do and the implications of this. - It would also be useful to see some reflections by the authors on the implications of this study for both policy and for practice. Response: Comment well taken. We have discussed this dedicating a paragraph Lines 223-230 “The study revealed that a significant number of hospitals and most health centers and clinics lacked blood transfusion services, despite the expectation that hospitals and certain upgraded health centers and clinics should offer these services—particularly for emergencies, maternal health care, and other critical care situations. As the SARA survey provided a conservative estimate of the all-time availability of blood transfusion services, highlighting a concerning situation that would significantly impact access to emergency care. Previous studies have also shown that limited access, primarily due to the physical distance to facilities, is a major factor contributing to delays in receiving necessary care [21-23].” - Please revise “is” to “were” in line 235, and “investments” to “investing”, “in availing” to “to avail”, and “addressing” to “to address” in line 237. - In the list of acronyms, it should be “odds ratio”, not “odd ratio” Response: Thank you again for bringing them to our attention. We have edited them accordingly. Reviewer #2: A research study was conducted which aimed to examine the readiness and determinants of blood transfusion services in Ethiopian facilities. Minor revisions: 1- The standard statistical term for average is mean. When prov Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0315665.r002
26 Nov 2024 Decision Letter - Alemu Birara Zemariam, Editor PONE-D-24-30780R1Blood transfusion service readiness and its associated factors in health facilities providing blood transfusion services across Ethiopia: A secondary analysis of the 2018 Service Availability and Readiness Assessment (SARA) surveyPLOS ONE Dear Dr. Tiruneh, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jan 10 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Alemu Birara Zemariam Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: (No Response) Reviewer #3: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: Yes Reviewer #3: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Many thanks to the authors for their revised manuscript. This is reading more clearly now and I'm sure will make a useful contribution to literature. Reviewer #2: Minor revision: Line 104: For the sample size estimate, indicate the statistical testing method used to generate the confidence interval. Reviewer #3: Thank you for addressing all the reviewers' comments in your manuscript. I still have one issue with the writing that has not been resolved. In your methods, you have clearly outlined the seven tracer items and their definitions, and mentioned how you obtain the mean percentage service readiness score. Now, how do you determine what is the cut-off mean score? Situation 1: If 7 is the maximum score, would a mean score of 3.5 (50%) be the cut-off point between being optimum (>50%) and suboptimum (<50%)? Situation 2: A 70% a cut-off point, according to other SARA studies I've found. Situation 3: You simply categorize any score <100% a suboptimal score, according to what you have described in your discussion. In table 4, all mean scores according to the region, facility, managing authority and residence is at the range of 50% - 72.4%. Therefore, the service readiness is at "suboptimal" level? Whether the mean score readiness is set arbitrarily, or at a standard, or otherwise, please mention it in your methods. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Reviewer #3: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Reviewer comments_PONE-D-24-30780R1.docx https://doi.org/10.1371/journal.pone.0315665.r003
Revision 2
27 Nov 2024 Author Response A point-by-point response to reviews Dear Alemu Birara, Academic Editor, We, the authors, would like to express our gratitude to the reviewers and editors of PLOS ONE Journal for their valuable comments, which we believe have significantly strengthened our paper. Below, we provide point-by-point responses to each comment and suggestions in red font. We have also reviewed the manuscript to ensure that it conforms to the journal's style. Journal Requirements Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: The reference lists have been reviewed, and minor corrections have been made to the format Reviewers' comments Reviewer 1 All comments have been addressed. Many thanks to the authors for their revised manuscript. This is reading more clearly now and I'm sure will make a useful contribution to literature. Response: Thank you for taking the time to review our manuscript. Reviewer 2 Minor revision: Line 104: For the sample size estimate, indicate the statistical testing method used to generate the confidence interval. Response: Thank you for bringing this to our attention. We used the Wilson score interval method to generate the confidence interval for the proportion estimate and to assess the adequacy of the sample size. The following sentence has been included in the revised version “The Wilson score interval method was used to generate the confidence interval for the proportion estimate." See the Revised Manuscript with Track Changes, page 7, lines 105–106. Thank you for your valuable feedback. Reviewer 3 Thank you for addressing all the reviewers' comments in your manuscript. I still have one issue with the writing that has not been resolved. In your methods, you have clearly outlined the seven tracer items and their definitions, and mentioned how you obtain the mean percentage service readiness score. Now, how do you determine what is the cut-off mean score? Situation 1: If 7 is the maximum score, would a mean score of 3.5 (50%) be the cut-off point between being optimum (>50%) and suboptimum (<50%)? Situation 2: A 70% a cut-off point, according to other SARA studies I've found. Situation 3: You simply categorize any score <100% a suboptimal score, according to what you have described in your discussion. In table 4, all mean scores according to the region, facility, managing authority and residence is at the range of 50% - 72.4%. Therefore, the service readiness is at "suboptimal" level? Whether the mean score readiness is set arbitrarily, or at a standard, or otherwise, please mention it in your methods. Response: Thank you for your insightful explanation and guidance. We sincerely apologize for overlooking your comments in the previous version. Initially, we believed we had used the mean readiness score as a continuous variable. However, as you rightly pointed out, we categorized it into suboptimal and optimal scores in our Discussion section, while also reporting the mean score of 65% in the Results section. Accordingly, we have applied the 70% cut-off point, as you suggested, and as is commonly used in previous SARA-based surveys for assessing readiness in chronic disease services. The following sentence has been included in the revised version, with the corresponding references cited: "A cut-off mean score of 70% or more is considered optimal for determining readiness to provide blood transfusion services [21, 22].", Revised Manuscript with Track Changes, page 9, lines 142–143. Thank you for your thorough review and guidance. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0315665.r004
29 Nov 2024 Decision Letter - Alemu Birara Zemariam, Editor Blood transfusion service readiness and its associated factors in health facilities providing blood transfusion services across Ethiopia: A secondary analysis of the 2018 Service Availability and Readiness Assessment (SARA) survey PONE-D-24-30780R2 Dear Dr. Tiruneh, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Alemu Birara Zemariam Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0315665.r005
Formally Accepted
3 Dec 2024 Acceptance Letter - Alemu Birara Zemariam, Editor PONE-D-24-30780R2 PLOS ONE Dear Dr. Tiruneh, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr Alemu Birara Zemariam Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0315665.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .