Epidemiology of SARS-CoV-2 Infection in Ethiopia: A Systematic Review and Meta-Analysis

Round 1

Reviewer 1 Report

 

 

Epidemiology of SARS-CoV-2 Infection in Ethiopia: A systematic review and Meta-analysis

This is a well written paper that worth publishing.

However, I have some comments:

study's objectives. This study was conducted to determine the prevalence of SARS-CoV-2 infection in Ethiopia?

To determine the prevalence of SARS-CoV-2 infection in a population, a systematic approach is required. Here are the general steps that can be followed:

Define the population: The first step is to define the population of interest, such as the general population or a specific group, such as healthcare workers or people living in a certain geographic area.

Identify the sample: The next step is to identify a representative sample from the defined population. The sample size should be sufficient to provide a valid estimate of the prevalence of SARS-CoV-2 infection.

Select a testing method: A testing method should be selected based on its sensitivity and specificity. The most common testing methods include RT-PCR, rapid antigen tests, and antibody tests.

Administer the test: The selected testing method is then administered to the sample population. It is important to follow the testing protocol correctly to ensure accurate results.

Analyze the results: The results of the tests are then analyzed to determine the number of positive cases and the number of negative cases. The prevalence of SARS-CoV-2 infection is then calculated by dividing the number of positive cases by the total number of individuals tested.

Interpret the results: The prevalence estimate is interpreted in the context of the population of interest and the testing method used. Other factors that may influence the prevalence estimate should also be considered, such as the timing of the testing and the demographic characteristics of the sample population.

It is worth noting that the prevalence estimate obtained from a single study may not accurately reflect the prevalence of SARS-CoV-2 infection in the broader population. Multiple studies conducted over time and across different populations are needed to obtain a more accurate estimate of prevalence.

 

 

Discussion:the author should include implications of the study's findings beyond a general call for routine screening and appropriate treatment. This is a missed opportunity to provide insight into the social, economic, and political factors that contribute to the high prevalence of SARS-CoV-2 infection in Ethiopia, and to suggest policy recommendations for addressing the problem.

Author Response

Dear Editors and Reviewers

We thank all the editors and reviewers for finding our work interesting before publication. We also thank them for raising interesting and insightful queries that made us incorporate additional information and render a better clarity to the paper as well as for giving us an opportunity to revise the manuscript. 

All the questions raised by the reviewers have been addressed and the manuscript is modified accordingly. Moreover, all the requested Editorial corrections are addressed in both the revised manuscript and the response letter. The main changes are highlighted in Yellow. We give below the details pertaining to the changes made during the course of the revision.

Manuscript ID number: covid-2311520

Title of paper: Epidemiology of SARS-CoV-2 Infection in Ethiopia: A systematic review and Meta-analysis

 Reviewer #1 comments

1. To determine the prevalence of SARS-CoV-2 infection in a population, a systematic approach is required. Here are the general steps

Author’s Response:  

• Thanks for critical comment. We revised the manuscript and highlighted yellow in the body of the manuscript

2. Implications of the study's findings: 

Author’s Response:  

• Thanks for vivid comment. The authors have amended well about the implications of the study finding and highlighted yellow in the revised manuscript.

Reviewer 2 Report

1-      Table 1 summarize the studies entered the study. How can you compare the results that are such different in the population under the study? Quarantine individuals and pregnant women for example cannot be compared!

2-      Fig 2: a forest plot can be used to show the prevalence of a condition or disease in a meta-analysis or systematic review. The individual studies' prevalence estimates are represented by the size of the squares or circles, with larger symbols indicating a higher prevalence. The pooled prevalence estimate and its confidence interval are represented by a diamond at the bottom of the plot. A forest plot can provide a quick visual summary of the prevalence estimates across studies and can help identify any patterns or trends in the data. However, it is important to note that forest plots should only be used to show prevalence estimates from studies that have used similar methods and populations.

3-      a funnel plot can show the absence of publication bias in a meta-analysis or systematic review. A funnel plot is a scatter plot that displays the effect size estimates of individual studies against their sample sizes or standard errors. In the absence of publication bias, the plot should resemble a symmetrical inverted funnel, with smaller studies scattered widely at the bottom and larger studies clustered around the top, forming a funnel shape. However, if publication bias is present, it may manifest as a distortion in the shape of the funnel plot. For example, if small studies with negative or non-significant results are missing from the analysis due to publication bias, the funnel plot may be asymmetrical, with fewer smaller studies on one side of the funnel. Therefore, a funnel plot that appears symmetrical and funnel-shaped can suggest the absence of publication bias. However, other factors, such as heterogeneity, can also affect the shape of the funnel plot, and additional statistical tests, such as Egger's test or Begg's test, may be needed to confirm the absence of publication bias.

Author Response

Dear Editors and Reviewers

We thank all the editors and reviewers for finding our work interesting before publication. We also thank them for raising interesting and insightful queries that made us incorporate additional information and render a better clarity to the paper as well as for giving us an opportunity to revise the manuscript. 

All the questions raised by the reviewers have been addressed and the manuscript is modified accordingly. Moreover, all the requested Editorial corrections are addressed in both the revised manuscript and the response letter. The main changes are highlighted in Yellow. We give below the details pertaining to the changes made during the course of the revision.

Manuscript ID number: covid-2311520

Title of paper: Epidemiology of SARS-CoV-2 Infection in Ethiopia: A systematic review and Meta-analysis

 

Reviewer #2 comments

 

1. How can you compare the results that are such different in the population under the study?

Author’s response:

• Thanks for your valuable comment. Of course, the population is different but our aim is to produce the pooled magnitude of SARS-COV-2 infection in Ethiopian population regardless of age and degree of risk exposure. This is why we have done all articles done on different populations. However, during comparison of the magnitude of SARS-COV-2 infection across studies, their proximity factors favouring infection should be considered.

2. Forest plots issue:

Author’s response:

• Thanks for your valuable comment. We understood your concerns but we have used forest plot for graphically summarizing the findings of meta-analysis. Moreover, we have also done subgroup analysis for population type and diagnostic methods by considering differences in a population and test method. Moreover, during subgroup analysis, the heterogeneity between groups i.e between population and diagnostics test method had a P-value of >0.05.

3. However, other factors, such as heterogeneity, can also affect the shape of the funnel plot, and additional statistical tests, such as Egger's test, may be needed to confirm the absence of publication bias.

Author’s response:

• Thanks for your important comment. We have done egger’s test and highlighted yellow the result in the revised manuscript.

 

Reviewer 3 Report

Dear authors,

After the review process, I have several comments: the paper does no discuss problems caused by SARS-CoV-2 can damage the brain via several routes, along with direct neural cell infection with the coronavirus. Chronic inflammatory reactions affect the brain with proinflammatory elements, damaging the neural cells and causing brain ischemia associated with other health issues; The associated inflammatory reaction in some COVID-19 patients has increased proinflammatory cytokines, and all these should be commented more in this paper; the figure legend should be expanded for a clear image of a study; what are the future applications of the study in the future.

Best regards!

Author Response

Dear Editors and Reviewers

We thank all the editors and reviewers for finding our work interesting before publication. We also thank them for raising interesting and insightful queries that made us incorporate additional information and render a better clarity to the paper as well as for giving us an opportunity to revise the manuscript. 

All the questions raised by the reviewers have been addressed and the manuscript is modified accordingly. Moreover, all the requested Editorial corrections are addressed in both the revised manuscript and the response letter. The main changes are highlighted in Yellow. We give below the details pertaining to the changes made during the course of the revision.

Manuscript ID number: covid-2311520

Title of paper: Epidemiology of SARS-CoV-2 Infection in Ethiopia: A systematic review and Meta-analysis

 

Reviewer #3 comments

1. Multi-organ effects of COVID-19

 Author’s response:

• Thanks for valuable comment. We have addressed the mechanism of brain damage, inflammatory disorders and cytokine storm due to COVID-19 and track changes are highlighted yellow in the revised manuscript.

2. Future applications of the study in the future.

Author’s response:

• Thanks for supportive comment. The authors have discussed in detail about the implications of the study finding and their importance and highlighted yellow in the revised manuscript

 

Round 2

Reviewer 2 Report

thank you very much. no more comments

Reviewer 3 Report

No other comments.