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While the paper itself seems correct, I noted that many references are incomplete and/or not in line with the professional standards (it may be very difficult for the reader to access them; for example, "20. Ministry of Health Mongolia. Guideline for ambulatory care 2010" is typically a reference that will be impossible to access...).
Please, check with the Editorial staff for correcting this under their guidance.
You have satisfactorily answered to most of the critiques raised by the reviewer. I may suggest to further take into account the remark of the reviewer about references in Mongolian. You stated that these are available on request. Is this clear in the paper as submitted ? Can you make these references available on a publicly-accessible server ? This would make your paper stronger.
We apologize for the long delay in reviewing your paper but we had difficulties in finding appropriate reviewers. Eventually, one reviewer provided a very valuable and detailed review. I myself examined your paper in detail and found all remarks and suggestions of this reviewer quite justified. Because of the extent of the changes required, I also came to the conclusion that your submission needed to be categorized as "major revision" rather than "minor revision" as suggested by the reviewer.
Basic reporting is fine; for details see comments to authors.
Experimental design (questionnaire) is fine; for details see comments to authors.
Validity of findings is fine; for details see comments to authors.
„A questionnaire study of injections prescribed and dispensed for patients diagnosed with mild/moderate communityacquired pneumonia in Mongolia”
By Gereltuya Dorj, Delia Hendrie, Richard W Parsons, Bruce Sunderland
The authors write a study about a questionnaire survey of drug injections in patients with community acquired pneumonia (CAP). They have published in this field before (refs 17 and 22)1,2. The paper is well written and the topic is an interesting one although limited to a geographical area. There are some issues that need to be clarified as mentioned below. Furthermore, several references are not accessable electronically (e.g. important refs like 23 and 30).
- Conclusion : « ..injection prescribing is a public health hazard .. » this sentence is not in line with the study results. That was not the aim of the study and was not analyzed in detail. The authors should adapt the wording accordingly.
- Line 66 and following : The readers should know whether this study was done with adult patients or children because the latter would be expected to show less compliance and getting rather injections in this setting. We learn in line 239 that giving injections to adults is not in line with the local guidelines. Can the reader derive from this, that the study was done with adults only? This should be clarified and added to the objective.
- There are questionnaires for doctors, pharmacists and community members in the supplemental documents. There we see that the authors collected much more data than they mention in the paper like how long and how doctors treat their patients with CAP. Why don’t they reveal this data? Is it already published ? The authors should explain themselves.
- Limitations : we don’t know what patients the prescriptions were for, children or adults or both ? There might be different indications for antibiotic injections and patient compliance is certainly different between the two patient groups.
- Line 277 : « Excessive prescribing of injections… » It is not clear what the comparator is here. I suppose it’s the Mongolian guidelines by Agvaandorj et al (2008)? Unfortunately, this ref. 23 is not electronically available and the international readers should know, what the guidelines in Mongolia are. At least the part regarding treatment of community acquired pneumonia and its treatment should be reproduced and explained in the paper.
- Tables: Words like „rarely“, « sometimes » and « often » are quantified in the questionnaire (1-10%, 11-40%, 41-80%) but not in the tables. The authors should mention this quantification in the tables to give the reader a hint about what these expressions mean.
- Table 1: footnote b about the value of the Mongolian National Tugrug is not clear : e.g. « Monthly income 90,000-200,000 MNT » in line 406: „b Mongolian National Tugrug, (MNT), currency, equivalent to 1300 USD at the time of study.“ This is not possible (1 MNT=1300 USD ?); the authors should clearly state the value e.g. « 100 USD are equivalent to 2000 MNT » or the like.
- Line 72 : spelling of « pharmacists »
- Line 121 « technicians (61) » : second parenthesis missing
- Line 139 : the word « wasfemale » has to be separated into « was female »
- References of statistical output (lines 182, 187, 190): there are just the p-values of interest; the rest is explained in the methods section e.g. line 182 „(p=0.01)“ is sufficient without degrees of freedom etc.
- Line 179: „agreed/agreed“ the repeated word should get erased.
- Line 200: „..that patients preferred oral medicines than injections (Table 4). » in english it should be « preferred…over » not « than ».
- Lines 235-236: „The questionnaire studies with doctors and pharmacists including pharmacy technicians indicated that they chose an injection if the patient was severe.“ This sentence is cut off ; the authors should write a complete sentence like « …if the patient was severly ill. » or something like this.
1. Dorj G, Hendrie D, Parsons R, Sunderland B. An evaluation of prescribing practices for community-acquired pneumonia (CAP) in Mongolia. BMC Health Serv Res 2013;13:379.
2. Dorj G, Sunderland B, Hendrie D, Parsons R. Parenteral Medication Prescriptions, Dispensing and Administration Habits in Mongolia. PLoS ONE 2014;9:e115384.
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