The Influence of a Song on School Children’s Knowledge Growth for Sustainable Malaria Prevention: Teacher Perspectives

Round 1

Reviewer 1 Report

The authors (Anderson et al) made modest contribution on the usefulness of song (music) to educate young children on malaria prevention methods in a malaria endemic district of South Africa. Clearly, the outcome of this study when published will add to the body of literatures of the usefulness of this approach in the prevention of malaria and by extension can be applied to other endemic tropical disease and if appropriately deployed, will serve as a change agent in the control of infectious diseases.  

The titles for most of the tables were not satisfactory. A good title should be descriptive and convey the content of the table to the reader. I have made some suggestions but I will suggest that the authors review all the titles of the table.

The abstract was well written and I commend the authors for that. In general, the structure and organization of the manuscript must be improved to make reading and understanding interesting to the future readers. 

Specific comments includes

Line 16: consider changing “conducted” to “evaluated”

Line 29: sub-Saharan Africa

Line 172 -207: The methodological flow needs to be clearly presented. In the current form, there are several disjointed and unorganized flow of the presented methodological information. Also, some sentences are unnecessary. For instance, “The teacher questionnaires were administered by the first author”(line 190); “The findings were assessed to identify the most effective intervention method to educate young children about malaria and its prevention” (line 206). Also, in line 235 – 239, in my opinion, this lines are not necessary in the methodologly.`

Line 196: Why this confusion? Why mention that an additional questionnaire was used as table 1 when you have not mentioned the main questionnaire that was first used before the need for an additional questionnaire.

Line 210-213: are these lists of the 12 primary schools of Niani circuit that were selected for inclusion? If yes? This is expected to come after the mention in line 211. Also, you mentioned four intentions received but there are more than four interventions mentioned. Kindly reorganize your presentation for clarity as it only causes confusion here as it will take a reader several minutes to figure out the message you are passing across.

Line 245: the author must realize that in methodology, you are not expected to present your findings in this section. Instead the authors must present their ideas in an appropriate manner. For instance, there could say “From the feedback obtained from the phase 1 study, it was further validated in phase 2 study. Kindly rephrase and present your thoughts appropriately.

Line 248 – 249 should be removed as this is not necessary in the methodology.

Line 255 – 256: Why these sentences in the methodology for phase 2 interventions?

Line 261 – 262: Not necessary. Consider to remove this sentence.

Line 265: Which different questionnaire? Why all these confusion.

Line 274: Title of the table should be simple and descriptive. Current tile should be revised. For example,

“Questions asked of the teachers relating to pre-and post-intervention efforts during phase 1 and 2”

Line 292 – 298: Kindly remove and transfer to methodology as these are not results but mere methodology.

Line 295 – 300: These are all methodology and not results.

Line 301 – 311: It will be nice to see the authors discuss the result obtained as no discussion can be seen here.

 

Line 312: The title should be simple and descriptive enough. You could possibly say “Results from the comparison of the pre- and post-intervention study for phase 1 involving teachers”

Line 315: the first sentence is not necessary. These have already been stated in the statistical analysis section in the methodology. Kindly remove “A score of p<0.5 shows statistical significance in the table”

Line 316: of what use is it here in the result for you to make reference to sample size? 

Line 393 – 395: Repetition, see line 338 – 339

Line 457: why “age”?  or do you mean age appropriate?

Author Response

SUMMARY TABLE WITH REVISIONS

 

REVIEWER COMMENT	REVISIONS MADE
REVIEWER 1
The authors (Anderson et al) made modest contribution on the usefulness of song (music) to educate young children on malaria prevention methods in a malaria endemic district of South Africa. Clearly, the outcome of this study when published will add to the body of literatures of the usefulness of this approach in the prevention of malaria and by extension can be applied to other endemic tropical disease and if appropriately deployed, will serve as a change agent in the control of infectious diseases.	Thank you.
The titles for most of the tables were not satisfactory. A good title should be descriptive and convey the content of the table to the reader. I have made some suggestions but I will suggest that the authors review all the titles of the table.	The titles of the tables have been adjusted.
The abstract was well written and I commend the authors for that. In general, the structure and organization of the manuscript must be improved to make reading and understanding interesting to the future readers.	Thank you for the suggestion to revisit the organization of the paper; attempts have been made to improve the structure of the manuscript according to the suggestions.
Line 16: consider changing “conducted” to “evaluated”	Done.
Line 29: sub-Saharan Africa	Done.
Line 172 -207: The methodological flow needs to be clearly presented. In the current form, there are several disjointed and unorganized flow of the presented methodological information. Also, some sentences are unnecessary. For instance, “The teacher questionnaires were administered by the first author”(line 190); “The findings were assessed to identify the most effective intervention method to educate young children about malaria and its prevention” (line 206). Also, in line 235 – 239, in my opinion, this lines are not necessary in the methodologly.`	Done with the removal of unnecessary lines as well as arranged the last paragraph accordingly to remove confusion and put sole emphasis on the teacher's interview.
Line 196: Why this confusion? Why mention that an additional questionnaire was used as table 1 when you have not mentioned the main questionnaire that was first used before the need for an additional questionnaire.	Mentioned about the questions of the questionnaire listed in tables 2-4 main questionnaire that served as both pre- and post-intervention questionnaire. Didn't prepare the separate table to avoid repetition. “The present study was conducted in two phases. During Phase 1, pre-intervention questionnaire-based interviews [questions listed in tables 2-4] were conducted” Rephrased the sentence to make it more obvious. The questions listed in Table 1 belongs to the additional questionnaire that was given to the teachers post intervention.
Line 210-213: are these lists of the 12 primary schools of Niani circuit that were selected for inclusion? If yes? This is expected to come after the mention in line 211. Also, you mentioned four intentions received but there are more than four interventions mentioned. Kindly reorganize your presentation for clarity as it only causes confusion here as it will take a reader several minutes to figure out the message you are passing across.	Rephrased the oars to remove confusion... As mentioned, there were 4 groups based on 3 interventions received (song-only group, drama-only group, song and drama group) fourth was the control group that received no intervention.
Line 245: the author must realize that in methodology, you are not expected to present your findings in this section. Instead the authors must present their ideas in an appropriate manner. For instance, there could say “From the feedback obtained from the phase 1 study, it was further validated in phase 2 study. Kindly rephrase and present your thoughts appropriately.	It's about the fact that in phase 2 only that intervention was given that proofed to be the most effective intervention in phase 1 (out of three interventions given). If we do not mention it clearly then it may cause confusion to the reader that why only one intervention i.e., song-only intervention was given in phase 2. So, the purpose is to make clear that phase 2 was conducted to validate the findings of phase 1.
Line 248 – 249 should be removed as this is not necessary in the methodology.	Done.
Line 255 – 256: Why these sentences in the methodology for phase 2 interventions?	This was a typing error, which has since been corrected in the revised article.
Line 261 – 262: Not necessary. Consider to remove this sentence.	Removed.
Line 265: Which different questionnaire? Why all these confusion.	Clarified above ... Reference added here as well.
Line 274: Title of the table should be simple and descriptive. Current tile should be revised. For example,“Questions asked of the teachers relating to pre-and post-intervention efforts during phase 1 and 2”	Revised.
Line 292 – 298: Kindly remove and transfer to methodology as these are not results but mere methodology.	Done.
Line 295 – 300: These are all methodology and not results.	Done
Line 301 – 311: It will be nice to see the authors discuss the result obtained as no discussion can be seen here.	Done.
Line 312: The title should be simple and descriptive enough. You could possibly say “Results from the comparison of the pre- and post-intervention study for phase 1 involving teachers”	Revised.
Line 315: the first sentence is not necessary. These have already been stated in the statistical analysis section in the methodology. Kindly remove “A score of p<0.5 shows statistical significance in the table”	Removed.
Line 316: of what use is it here in the result for you to make reference to sample size?	Removed.
Line 393 – 395: Repetition, see line 338 – 339	line 338 – 339 is regarding Phase 1. Rephrased the line as that was the common observation of the teachers during both the phases. Line 393 – 395 refers to findings during phase 2.
Line 457: why “age”?  or do you mean age appropriate?	Yes, age as well as culturally appropriate. Simplified it as “an age- and culturally appropriate”

 

Author Response File: Author Response.docx

Reviewer 2 Report

 

Dear Authors

I was much pleased to review your paper “The influence of a song on school children’s knowledge growth for sustainable malaria prevention: teacher perspectives.” You tackle one of important but obviously poorly studied and underestimated fields in epidemiology, the connection of local culture with the epidemiologically safe habits of the population. Malaria is a great threat in Africa and finding new ways of its prevention and control may assist strongly in combating the disease.

Your study is well devised and described in sufficient details. However, I have a few remarks that, I am sure, you will not find difficult to answer and make the necessary amendments in the text.

Minor

1. Please bring your text to Introduction – Methods – Results and Discussion – Conclusions structure. Some of your chapters will become subchapters.

2. Please use the table formatting in accordance with the MDPI guidelines.

3. Line 448: “Teacher TA2D expressed using experts in the field of malaria to help answer questions about malaria.” “Suggested” instead of “expressed”?

 

Major

1. You’ve found that using the song genre only is the most effectual way of teaching young school children about malaria in South Africa, viz. in Limpopo river basin. I strongly recommend you inserting two or three samples of such songs in the text. You may opt to place them in a Supplemental File. As you study culture, it is very important for a reader to understand why these songs may be that effective for medicine. The best solution, in my opinion, is to provide not only the lyrics, but the musical score too. I advise you to consult the Editorial Office of Sustainability journal to check if they allow using audio files as supplemental materials. As we know, sometimes, music has a greater influence upon a human’s impression and consciousness than words. It would be crucial to know if it is so or not in your case.

2. I recommend adding several sentences in Conclusions where you could ponder on the heuristic value of your findings. The main question here is whether such a song-teaching will be effective in different regions of Africa and the world. E.g., Plasmodium knowlesi is spread in SE Asia, primarily in Malaysia. It is interesting if the schools and medical centres in Malaysia could use your method.

3. Lines 457-459. I am sure that songs as an oral folklore cannot be “approved by the medical experts.” Have you ever tried to convince a local to compose a song on malaria by the order of an educated medical expert? Or not sing a song if it is disapproved by the "experts"? I think it is better to remove this sentence at all, as it is very dubious. In addition, it may happen in your research that traditions and medical lore being kept by the locals are an alternative route to teach young school children about malaria in addition to the standard medical education. That is why I asked you to add musical score, lyrics or (if it is feasible) audio files in point 1.

Thank you. If you make the corresponding amendments, I shall gladly recommend your text for being published in Sustainability journal.

Sincerely,
the Reviewer

Author Response

SUMMARY TABLE WITH REVISIONS

 

REVIEWER 2
Minor 1. Please bring your text to Introduction – Methods – Results and Discussion – Conclusions structure. Some of your chapters will become subchapters.	Done
2. Please use the table formatting in accordance with the MDPI guidelines.	Done
3. Line 448: “Teacher TA2D expressed using experts in the field of malaria to help answer questions about malaria.” “Suggested” instead of “expressed”?	Done
Major 1. You’ve found that using the song genre only is the most effectual way of teaching young school children about malaria in South Africa, viz. in Limpopo river basin. I strongly recommend you inserting two or three samples of such songs in the text. You may opt to place them in a Supplemental File..........	The stance and example of such songs used for the diseases other than malaria where mentioned in Line 93-94: “In the past, songs on Ebola and HIV/AIDS have been used to educate the public on how to prevent the transmission of the disease [12,13].”   Yes, I will add their lyrics plus the lyrics of our song used in this study, in the Supplemental File.
2. I recommend adding several sentences in Conclusions where you could ponder on the heuristic value of your findings. The main question here is whether such a song-teaching will be effective in different regions of Africa and the world. E.g., Plasmodium knowlesi is spread in SE Asia, primarily in Malaysia. It is interesting if the schools and medical centres in Malaysia could use your method.	We mentioned in the conclusion regarding effect of such songs for diseases in other region of the world. Line 464-466. “This practice can assist other regions or countries in developing their own song for a particular disease and start the implementation process for the song to instill behavioural changes and knowledge growth” Yes, I added  E.g., Plasmodium knowlesi, as suggested.
3. Lines 457-459. I am sure that songs as an oral folklore cannot be “approved by the medical experts.” Have you ever tried to convince a local to compose a song on malaria by the order of an educated medical expert? Or not sing a song if it is disapproved by the "experts"?............	Good point; however, we wish to establish interdisciplinary expertise here.  Basically its about experts in the field of malaria, education, and music for age and cultural appropriateness coming together. Rephrased the sentence. As mentioned in Line 71-72 “The song was developed through Participatory Action Research (PAR), and tested by experts in the field of malaria, education, and music for age and cultural appropriateness.” Also Line 103-108 “A song about preventing malaria was developed in South Africa. The song was written using expert opinion surveys and focus groups to ensure that the song would be accepted in all areas of focus. The focus groups consisted of local caregivers and malaria specialists that concurred with what the experts had agreed on. All areas were able to come together by the end to agree that the researcher's song could be used in malaria prevention [9]. “   Lyrics of the example song will also be provided. See below.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Author Response File: Author Response.docx

Reviewer 3 Report

Dear Authors,

I must commend your effort in carefully reporting the results of this study. It is interesting to see from your findings that song-only intervention was the most effective learning intervention strategy for behavioral changes and knowledge growth regarding malaria and malaria prevention in the population studied.

I have a few comments and suggestions for your consideration:

Introduction:

This study focuses on sustainable malaria prevention, without information about malaria. You can strengthen this article by including a brief information on malaria, information about the population at risk of serious complications (including children, the elderly, pregnant women, and immunocompromised), and malaria prevention in the "Introduction" section. I find this article interesting and may be of resource in addressing this concern:

Aremu TO, Ajibola OA, Oluwole OE, Adeyinka KO, Dada SO, Okoro ON. Looking Beyond the Malaria Vaccine Approval to Acceptance and Adoption in Sub-Saharan Africa. Frontiers in Tropical Diseases. 2022;3. https://doi.org/10.3389/fitd.2022.857844

 

Line 31: Every individual living in a malaria-endemic region is at risk. So, I think you may be referring to individuals at risk of serious complications. Consider redressing this, and you may list some of the complications that may ensue. The article I shared has some information that may be resourceful in addressing this concern.

Method:

The design seems inadequate/incomplete. It appears this study utilized a mixed method study design. Consider addressing this concern if valid.

Consider including the ethical considerations for conducting this study. Was an Institutional Review Board (IRB) evaluation sought? You can strengthen this study by stating if this study was reviewed and approved by human subject protection/ethical board.

Because this study sought out direct information from "children," was assent taken from them and their parents/caregivers? Was informed consent taken from adult participants. If yes, please mention it.

Result:

Lines 296 - 298: Information about the reference significance level would serve better under the "4.4. Statistical analysis" section.

It would be nice to state the demographic characteristics of the study participants (including the gender, age group, etc.).

Information about the total number of participants is conspicuously missing. Consider including this information, and the demographic distribution of the total number.

Line 300: Including a reference no 20 for a finding in this new study may be unnecessary. Consider removing the citation from here.

Line 316: Information about the small sample size may be inappropriate here. Consider moving it to a limitation sub-section/paragraph under the discussion.

Discussion:

Consider including a paragraph on the limitations of this study, including its generalizability.

Conclusion: I like the conclusion; however, it made inferences that were not properly addressed in the introduction - morbidity and mortality. To improve the relevance of this conclusion, consider including information about the statistics/numbers about mortality rates from malarial infection in sub-Saharan Africa. The article shared earlier could be resourceful in filling some of the blanks.

 

Author Response

SUMMARY TABLE WITH REVISIONS

REVIEWER 3
This study focuses on sustainable malaria prevention, without information about malaria. You can strengthen this article by including a brief information on malaria, information about the population at risk of serious complications	Done
Line 31: Every individual living in a malaria-endemic region is at risk. So, I think you may be referring to individuals at risk of serious complications.	Done.  added the malaria complications as per suggested.
The design seems inadequate/incomplete. It appears this study utilized a mixed method study design. Consider addressing this concern if valid.	Yes, its mentioned at the end of methodology in section 2.4. Statistical analysis  Aldo added at the draft of study design
Consider including the ethical considerations for conducting this study. Was an Institutional Review Board (IRB) evaluation sought? You can strengthen this study by stating if this study was reviewed and approved by human subject protection/ethical board.	Added. In section 2.2 Ethical aspects
Because this study sought out direct information from "children," was assent taken from them and their parents/caregivers? Was informed consent taken from adult participants. If yes, please mention it.	Added. In section 2.2 Ethical aspects
Lines 296 - 298: Information about the reference significance level would serve better under the "4.4. Statistical analysis" section.	Done
It would be nice to state the demographic characteristics of the study participants (including the gender, age group, etc.).	All teachers were female, but one and they were within similar age groups.
Information about the total number of participants is conspicuously missing. Consider including this information, and the demographic distribution of the total number	Added in the legends of figures
Line 300: Including a reference no 20 for a finding in this new study may be unnecessary. Consider removing the citation from here.	Done
Line 316: Information about the small sample size may be inappropriate here. Consider moving it to a limitation sub-section/paragraph under the discussion.	Done
Consider including a paragraph on the limitations of this study, including its generalizability.	Done
Conclusion: I like the conclusion; however, it made inferences that were not properly addressed in the introduction - morbidity and mortality. To improve the relevance of this conclusion, consider including information about the statistics/numbers about mortality rates from malarial infection	Done

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The authors have adequately treated my concerns. The quality of the manuscript has improved substantially.

Reviewer 2 Report

The revision is quite satisfactory. I recommend publishing the text. Thank you.

Reviewer 3 Report

Dear Authors,

Thank you for incorporating some of the suggestions made to improve the quality of this article. This is an improved version of this important work.

Just one important suggestion for your consideration:

You seem to have duplicated the information on data analysis. The section (statistical analysis) on lines 355 - 362 is appropriate. So, you can remove lines 286 - 288 ("Data analysis was performed on the findings................effective interpretation.")