Knowledge Assessment of E-Bug Assisted Antimicrobial Resistance Education Module in Class VII School Students of South Indian Coastal Town of Manipal
Round 1
Reviewer 1 Report
Resistance to antibiotics is undoubtedly a major public health problem. Awareness of the population and school-age children is very important in combating inappropriate use of antibiotics and the development of bacterial resistance.
Although the manuscript focuses on a major problem, the approach, the methodology and the analysis that is done do not seem to have enough scientific rigor to draw conclusions.
Author Response
Dear Reviewer,
We thank and appreciate for the critiquing the manuscript and helping us to improve the quality of presentation. We, the authors of this manuscript have accepted all the comments and have responded to the comments and modified the manuscript accordingly. On reviewing the manuscript we sincerely hope to have made significant changes and improved the content.
Table 2 we have done left alignment for better presentation.
We would like to bring to our reviewers notice that, Table 3 is modified in accommodate with frequency of each schools posttest responses while we have retained the same format as presented in the earlier version. Formula for computation of the overall % score is written as a table legend and also included in the methodology.
Another correction made in Table 2. Q10 post-test percentage, corrected from the earlier value (from 84 to 85) which was a typographical error.
Sincerely,
Authors
Review comments:
Resistance to antibiotics is undoubtedly a major public health problem.
Awareness of the population and school-age children is very important in combating inappropriate use of antibiotics and the development of bacterial resistance.
Comment1
Although the manuscript focuses on a major problem, the approach, the methodology and the analysis that is done do not seem to have enough scientific rigor to draw conclusions.
General response 1:
We appreciate and thank for supporting the study in principle and the critique. We have cited the rationality and objectives of the study to improvise the introduction portion of the manuscript. The authors believe that the study findings and its analysis justifies the now modified introduction and objective of the study.
Specific response 1:
The approach to use school education as a novel stewardship tool is adapted from programs reported from a spectrum of nations globally.
Specific response 2:
As our study is a prospective pre-post education study we have followed the prescribed method as published in earlier studies (cited.. Maria-Manuel Azevedo et.al 2013) and as per IEC recommendations/suggestion provided for community school children.
Specific response 3:
We have tried to present the findings based on our objective and discuss them. By implementing the e-bug module, we intended to test baseline children’s knowledge on AMR and tested the impact of education intervention. We believe that our results is to be interpreted in line with other earlier reported similar findings and stewardship initiatives reported globally.
Reviewer 2 Report
Thank you for allowing me to review the following manuscript:
Assessment of e-bug database assisted education of class VII school children on antimicrobial resistance determinants: a non-randomized education study in a cross-section of schools around Manipal town, Udupi, India
I have following compulsory revisions for the authors:
Title is too long please improve
Abstract line 15 needs to be re-written
Most references are incomplete and need to be in journal style
Line 43 use full forms
Line 60 the word “hypothesized” is wrong, suggestion is to use “implemented”
Line 70 to 75 should be written in a better manner. There is no need of questions in the text.
Line 82 Medium of the written quiz and education was in English and Kannada. Please specify- if the education was given in English in a English medium school and in Kannada in a vernacular school OR a mix of two language was used?
Lines 137-138 needs to be rewritten
Lines 147-149 are unclear and need a reference at the end of sentence.
Lines 170-177 need reference
An English language review will greatly benefit the manuscript's readability.
Author Response
Dear Reviewer,
We thank and appreciate for the critiquing the manuscript and helping us to improve the quality of presentation. We, the authors of this manuscript have accepted all the comments and have responded to the comments and modified the manuscript accordingly. On reviewing the manuscript we sincerely hope to have made significant changes and improved the content.
Table 2 we have done left alignment for better presentation.
We would like to bring to our reviewers notice that, Table 3 is modified in accommodate with frequency of each schools posttest responses while we have retained the same format as presented in the earlier version. Formula for computation of the overall % score is written as a table legend and also included in the methodology.
Another correction made in Table 2. Q10 post-test percentage, corrected from the earlier value (from 84 to 85) which was a typographical error.
Sincerely,
Authors
Review comments:
I have following compulsory revisions for the authors:
Comment1
Title is too long please improve
Previous title: Assessment of e-bug database assisted education of class VII school children on antimicrobial resistance determinants: a non-randomized education study in a cross-section of schools around Manipal town, Udupi, India
Response1
We appreciate the suggestion on shortening the title. With modifications made we have retained the geography of our study site.
Modified Title: Knowledge assessment of e-bug assisted antimicrobial resistance education module in class VII school students of south Indian coastal town of Manipal..
Comment2
Abstract line 15 needs to be re-written
response2
Word hypothesised changed to implemented
Comment3
Most references are incomplete and need to be in journal style
response3
Styled as per journal recommendations
Comment4
Line 43 use full forms
R2response4
Done with full forms
Comment5
Line 60 the word “hypothesized” is wrong, suggestion is to use “implemented”
response5
Word hypothesised was modified to another better term ‘conducted’
R2Comment6
Line 70 to 75 should be written in a better manner. There is no need of questions in the text.
response6
Line 70 to 75 rewritten and the questions in the text converted into points
R2Comment7
Line 82 Medium of the written quiz and education was in English and Kannada. Please specify- if the education was given in English in a English medium school and in Kannada in a vernacular school OR a mix of two language was used?
response7
Line 82 language medium clarified.
Comment8
Lines 137-138 needs to be rewritten
response8
Lines 137-138 rewritten
Comment9
Lines 147-149 are unclear and need a reference at the end of sentence.
response9
Lines 147-149 made clear and reference cited
Comment10
Lines 170-177 need reference
response10
Lines 170-177 reference cited
Comment11
An English language review will greatly benefit the manuscript's readability
response11
We accept the recommendation on English language improvement. We copyedited a significant portion of the manuscript with assistance from a dept. colleague.
Author Response File: 
Author Response.docx
Reviewer 3 Report
In the manuscript „Assessment of e-bug database assisted education of class VII school children on antimicrobial resistance determinants: a non-randomized education study in a cross-section of schools around Manipal town, Udupi, India” the authors reported on a non-randomized intervention study on more than 300 students of schools class VII around Manipal town, India. The authors used questions on AMR determinants as pre-test followed by an education intervention on the same questions followed by a post-test to end the session. The results were statistically analysed. The analysis of the post-test performance showed that the students had inadequate knowledge on AMR determinants. The authors suggested that early pedagogic interventions on AMR could be potential tool for AMR prevention for future generations.
The manuscript is interesting and well written. However, this article will only reach a very limited group of interested readers. This reviewer feels that the introduction needs more information, as addressed below, to be interesting for a broad readership. However, the reviewer also misses some striking suggestions/discussion on the pro’s and con’s of such pre-education studies.
Introduction should be extended to explain its global impact. This reviewer also misses an introduction into the suitability of such “pre-education” studies in other countries…
Line 42: please include some examples for clinical antimicrobial stewardship programs (ASP)
Line 43: WHO, ECDC, CDC: Abbreviation should be explained
Line 46: Reference needs to be re-place before dot
Line 58/60: Please delete the space between [13] and . & [14] and .
Line 68: Change Figure.1 to Figure 1
Line 82: please adapt the text style
Line 94: Change Figure.2 to Figure 2
Line 97 Change eg: to e.g. (also in Figure 2 Probiotics…)
Line 114: Change Table-1 to Table 1
Line 121: intervention(Table.2) A space is missing and delete the dot
Line 122: Change Table.3 to Table 3
Line 136: (3) [Table.2 and 3] please shift this before the dot and change Table.3 to Table 3
Please revise the manuscript carefully to match all minor mistakes in the revised submission…
Author Response
Dear Reviewer,
We thank and appreciate for the critiquing the manuscript and helping us to improve the quality of presentation. We, the authors of this manuscript have accepted all the comments and have responded to the comments and modified the manuscript accordingly. On reviewing the manuscript we sincerely hope to have made significant changes and improved the content.
Table 2 we have done left alignment for better presentation.
We would like to bring to our reviewers notice that, Table 3 is modified in accommodate with frequency of each schools posttest responses while we have retained the same format as presented in the earlier version. Formula for computation of the overall % score is written as a table legend and also included in the methodology.
Another correction made in Table 2. Q10 post-test percentage, corrected from the earlier value (from 84 to 85) which was a typographical error.
Sincerely,
Authors
Review comments:
The manuscript is interesting and well written. However, this article will only reach a very limited group of interested readers.
This reviewer feels that the introduction needs more information, as addressed below, to be interesting for a broad readership.
Comment1
The reviewer also misses some striking suggestions/discussion on the pro’s and con’s of such pre-education studies.
response1
The authors accept the reviewers comment on pre-education. We have made efforts to present the need for educating junior school students by justifying as per the cited literature in introduction and discussion part of the manuscript.
Comment2
Introduction should be extended to explain its global impact.
response2
We again thank the reviewer’s observation on the need for the study in Indian sub-special-population which we have introduced in the global context and past report from India.
Comment3
This reviewer also misses an introduction into the suitability of such “pre-education” studies in other countries…
response3
The suitability of pre-education studies as highlighted by the reviewer, the authors’ response for comment1 and comment2 to be considered.
Comment4
Line 42: please include some examples for clinical antimicrobial stewardship programs (ASP)
response4
Line 42: We appreciate the reviewer’s observation on the need to list various ASP strategies. The authors however believe that AMR is an established reality and ASPs being an evidence based practice reported within various categories of healthcare professionals. We, hence have avoided listing various ASP strategies. However, we have cited Céline Pulcini et.al review attempting to merge ASPs with a special need for education as an useful strategy.
Comment5
Line 43: WHO, ECDC, CDC: Abbreviation should be explained
response5
Line 43 – Abbreviations expanded
Comment6
Line 46: Reference needs to be re-place before dot
response6
Line 46 - corrected
Comment7
Line 58/60: Please delete the space between [13] and . & [14] and .
response7
Line 58/60 – Space deleted
Comment8
Line 68: Change Figure.1 to Figure 1
response8
Line 68: formatted
Comment9
Line 82: please adapt the text style
response9
Line 82: Text style formatted
Comment10
Line 94: Change Figure.2 to Figure 2
R3response10
Line 94: formatted
Comment11
Line 97 Change eg: to e.g. (also in Figure 2 Probiotics…)
response11
Line 97 formatted
Comment12
Line 114: Change Table-1 to Table 1
R3 response12
Line 114: formatted
Comment13
Line 121: intervention(Table.2) A space is missing and delete the dot
response13
Line 121: formatted
Comment14
Line 122: Change Table.3 to Table 3
response14
Line 122: formatted
Comment15
Line 136: (3) [Table.2 and 3] please shift this before the dot and change
response15
Line 136: formatted
Comment16
Table.3 to Table 3
response16
Formatted
Please revise the manuscript carefully to match all minor mistakes in the revised submission…
Round 2
Reviewer 2 Report
The authors have addressed my comments. I have no further comments to offer.
Reviewer 3 Report
The quality of the revised manuscript has been improved.
