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closeReferee comments: Referee 2
Posted by PLOS_ONE_Group on 10 Apr 2008 at 16:29 GMT
Referee 2's review:
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N.B. These are the comments made by the referee when reviewing an earlier version of this paper. Prior to publication the manuscript has been revised in light of these comments and to address other editorial requirements.
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This is a much improved paper and an important study. However, I still have a few reservations:
1. The paper is not an evaluation of a "combination of interventions" (which would require a 2x2 factorial design), but a study of the efficacy of IPTp in the context of high ITN use. The title should be changed ("Efficacy of Intermittent Preventive in Pregnant Women in the Context of High Bednet Use") The second sentence of the summary and the section title on page 11 should also be changed to reflect this.
2. The primary study objective needs to be clearly stated in the Methods section. (According to clinicaltrials.gov, it was "severe maternal anemia at delivery"). Also a clear statement is needed that the RCT demonstrated no effect of IPTp on this primary outcome.
3. The authors should delete "in HIV-negative women to increase the number of doses in HIV-positive women" (p. 3) as this is unsupported by the data in the MS
4. The authors still make the statement that "IPTp might not be required in HIV-negative women". They should qualify this by adding the clause "in the context of high bednet use"
5. The authors did not respond to my request for more information on ITN use. This is very important. What exactly does "reported ITN use" mean in this study? Other ITN studies ask whether someone used an ITN always, usually, often, sometimes or never. Or they may ask about use the previous night. Since ITNs are such a critical part of this paper, it would be important to know which question was asked.
Anna van Eijk's Comments (Reviewer #3) –e1934 Menendez
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N.B. These are the comments made by the referee when reviewing an earlier version of this paper. Prior to publication the manuscript has been revised in light of these comments and to address other editorial requirements.
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Review Menendez et al Oct 08/Jan 08
Generally, the authors have adequately addressed the points. There are a few issues where I have a different opinion.
I do not see a clean-up of decimals in the abstract, despite the authors assertion. I still think you can not put a conclusion by HIV-status in the abstract, when this is not supported by data in the findings-section of the abstract. The sentence could be replaced by: the use of ITNs during pregnancy may reduce the need to administer IPTp. Perhaps "Coverage of ITNs" could be changed into "The use of ITNs". On second thought, I think the word "relevant" may also be removed from the abstract, because less clinical malaria will be highly relevant to pregnant women.
Introduction
The author has chosen not to follow my suggestion, and although I do not agree with the reasoning, this is not of importance for the article.
Methods
The issues in this section were adequately addressed.
Design:
I still think the word use of "primary analysis" is confusing, when it is not dealing with the primary outcome; I don't think the modification made this clearer. But this is not an important issue.
It may be preferable to replace "women with multiple delivery" by multigravidae, unless women with twin pregnancies were intended.
Results:
It may help to add the clarification of randomized women who did not receive the SP as a footnote to figure 1. It would also be good to add somewhere (e.g. at the bottom of a table) how many twin babies were included in each arm. Twins are more likely to be of low birth weight, and may decrease the overall prevalence in each arm. However, given the randomization, it should not effect the difference in arms.
It would be nice if the added documentation on safety issues as reported in the reply could be summarized in the article, but I can understand that with the strict word limits, this may not be feasible.
Discussion
The points for the discussion have been adequately addressed.