Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief

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Preterm birth remains a major public health challenge in Rwanda, affecting approximately 13.8% of birth. The World Health Organization estimates that 15 million babies are born prematurely each year. While the association between periodontitis and preterm deliveries is increasingly recognized, little is known about this link in Rwanda. This policy brief aims to bridge this knowledge gap by presenting the findings of a recent study investigating the prevalence of periodontitis among pregnant women in Rwanda and its association with preterm deliveries. This policy brief also aims to inform and guide decision making towards incorporating periodontal screening into the antenatal care package in Rwanda. This has the potential to improve pregnancy outcomes and contribute to improved oral health in the future. Policy outcome and Implications Contemporary evidence has shown a six-fold increased risk of preterm delivery for women with periodontitis in Rwanda, with a concerningly high prevalence (60%) among pregnant women. Additionally, nurses working in antenatal clinics displayed insufficient knowledge about gum disease. Actionable recommendations The adoption of basic periodontal screening within existing antenatal care packages is recommended. This, coupled with nurse training and public awareness campaigns, can empower women and healthcare professionals to prioritize oral health for better pregnancy outcomes. Conclusions Integrating periodontal screening into antenatal care has the potential to significantly reduce preterm deliveries and contribute to a healthier future generation in Rwanda. 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F1000Research 2024, 13 :647 ( https://doi.org/10.12688/f1000research.152760.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Policy Brief Revised Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] Peace Uwambaye https://orcid.org/0000-0002-8602-5625 1 , Kehinde Kazeem Kanmodi 2 Peace Uwambaye https://orcid.org/0000-0002-8602-5625 1 , Kehinde Kazeem Kanmodi 2 PUBLISHED 05 Aug 2024 Author details Author details 1 Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda 2 School of Health and Life Sciences, Teeside University, London, Middlesbrough, UK Peace Uwambaye Roles: Conceptualization, Data Curation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kehinde Kazeem Kanmodi Roles: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Preterm birth, which is child delivery before 37 weeks of pregnancy, is the primary cause of perinatal mortality worldwide. Preterm birth remains a major public health challenge in Rwanda, affecting approximately 13.8% of birth. The World Health Organization estimates that 15 million babies are born prematurely each year. While the association between periodontitis and preterm deliveries is increasingly recognized, little is known about this link in Rwanda. This policy brief aims to bridge this knowledge gap by presenting the findings of a recent study investigating the prevalence of periodontitis among pregnant women in Rwanda and its association with preterm deliveries. This policy brief also aims to inform and guide decision making towards incorporating periodontal screening into the antenatal care package in Rwanda. This has the potential to improve pregnancy outcomes and contribute to improved oral health in the future. Policy outcome and Implications Contemporary evidence has shown a six-fold increased risk of preterm delivery for women with periodontitis in Rwanda, with a concerningly high prevalence (60%) among pregnant women. Additionally, nurses working in antenatal clinics displayed insufficient knowledge about gum disease. Actionable recommendations The adoption of basic periodontal screening within existing antenatal care packages is recommended. This, coupled with nurse training and public awareness campaigns, can empower women and healthcare professionals to prioritize oral health for better pregnancy outcomes. Conclusions Integrating periodontal screening into antenatal care has the potential to significantly reduce preterm deliveries and contribute to a healthier future generation in Rwanda. READ ALL READ LESS Keywords Antenatal care, periodontitis, preterm birth, preterm deliveries, policy brief, Rwanda Corresponding Author(s) Peace Uwambaye ( [email protected] ) Close Corresponding author: Peace Uwambaye Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Uwambaye P and Kanmodi KK. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Uwambaye P and Kanmodi KK. Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.12688/f1000research.152760.2 ) First published: 17 Jun 2024, 13 :647 ( https://doi.org/10.12688/f1000research.152760.1 ) Latest published: 05 Aug 2024, 13 :647 ( https://doi.org/10.12688/f1000research.152760.2 ) Revised Amendments from Version 1 The difference is that we addressed the comments given by reviewers where there were some typing errors, we corrected and we also added the new references as recommended. We have responded to the review reports at the end of each report. The difference is that we addressed the comments given by reviewers where there were some typing errors, we corrected and we also added the new references as recommended. We have responded to the review reports at the end of each report. See the authors' detailed response to the review by Juliana Velosa-Porras See the authors' detailed response to the review by Jaume Miranda-Rius READ REVIEWER RESPONSES Background Preterm birth, which is child delivery before 37 weeks of pregnancy, is the primary cause of perinatal mortality worldwide and a risk factor for preterm delivery. It remains a major public health concern in Rwanda, affecting approximately 13.8% of birth. 1 – 3 The World Health Organization estimates that 15 million babies are born prematurely each year. 1 Periodontitis is a chronic inflammatory disease of the gums that can lead to tooth loss. It is one of the most common chronic diseases in the world, affecting nearly half of all adults. 4 While the association between periodontitis and preterm deliveries is increasingly recognized, little is known about this link in Rwanda. This policy brief aims to bridge this knowledge gap by presenting the findings of a recent study investigating the prevalence of periodontitis among pregnant women in Rwanda and its association with preterm deliveries. This policy brief also aims to inform and guide decision making towards incorporating periodontal screening into the antenatal care package in Rwanda. This has the potential to improve pregnancy outcomes and contribute to improved oral health in the future. Policy outcomes and implications Different studies have suggested a complex link between periodontitis and preterm birth. Chronic inflammation in the gums associated with periodontitis releases inflammatory mediators into the blood stream and this potentially triggers early labor through various biomedical pathways. 5 – 8 Also, oral bacteria from infected gums can reach the placenta and amniotic fluid, triggering an inflammatory response in the uterus and inducing preterm labor. 9 , 10 Also, periodontitis can impair nutrient absorption, impacting fetal growth and development which may contribute to preterm birth. 11 Periodontal diseases occur as result of dysbiosis in bacterial biofilm inhabiting the sulcus, below the gingival margin. Periodontal diseases are inclusive of the main diagnostic categories of periodontitis and gingivitis. 7 , 8 , 12 Existing research from Rwanda, like some other African countries, demonstrates a significant association between periodontitis and preterm birth. A study in Kenya reported that women with periodontitis have 2 times risk of giving birth to preterm babies than women without periodontitis. 13 In Ethiopia, a study reported 2-4 times the odds of giving birth to preterm babies in women with periodontitis 14 while in Rwanda is six-fold risk of preterm in women with periodontitis than those with no periodontitis. 15 The above findings show that Rwandan pregnant women with periodontitis have higher risks of preterm deliveries compared to those in neighboring countries. 13 – 15 Further, research has also shown that nurses and midwives in Rwanda had insufficient knowledge on periodontitis. 16 Therefore, there is a need for a tool to nurses and midwives in Rwanda in the detection of periodontal diseases among pregnant women during antenatal care consultations. Periodontal screening is not currently part of the antenatal care package in Rwanda, despite the increasing prevalence of periodontitis among pregnant women in Rwanda. Research evidence has shown the strong association between periodontitis and preterm birth. 15 Several studies confirm that the treatment of periodontitis during pregnancy reduces the risk of preterm delivery. 17 – 21 Antenatal care consultations constitute an important opportunity to perform screening for periodontitis during pregnancy in the context of Rwanda. Firstly, antenatal care consultations are mandatory for all pregnant women. Secondly, the uptake is high (98%) and a greater number of pregnant women meet the required number of antenatal care visits. 22 The increasing uptake of antenatal care services in Rwanda is supported by more comprehensive medical insurance schemes (e.g “Mutuel de Sante” that covers 85% of the cost). Community health workers (CHWs) identify all pregnant women in their villages and follow them up until delivery. CHWs ensure that these pregnant women attend antenatal care. Oral diseases, including periodontitis, are neglected and it is rare for a woman to go for dental check-ups unless when in pain. Antenatal care is an important platform that offers the opportunity to bring awareness on periodontitis during pregnancy. Periodontitis screening during antenatal care consultations will facilitate the access of all pregnant women to oral health. The development of a periodontal screening tool that can be utilized and integrated in an antenatal care package would therefore be desirable and cost-effective. Thus, this policy brief calls for the development of a screening tool as well as the sustainable implementation of such a tool. If a robust screening tool is successfully developed, then future studies may be conducted to explore the management of periodontitis during pregnancy and its effect on preterm delivery in Rwanda. Actionable recommendations To address the potential link between periodontitis and preterm birth in Rwanda, multiple recommendations are proposed. Some of these recommendations were raised during the policy engagement workshop that was held and led by the lead author of this policy brief, in October 2023, where there was a presentation of the study findings to different policy makers and partners that included professional associations, representatives from hospitals and representatives from Rwanda Ministry of Health through the Rwanda Biomedical Center. These recommendations are below: The incorporation of Periodontal Screening in Antenatal Care : There is a need to integrate a basic periodontal screening into the existing Rwandan ANC package. This screening can be performed by trained nurses and could involve visual inspection and probing to identify signs of gum inflammation and potential periodontitis. This can be done by developing clear protocols and guidelines for nurses on how to conduct the screening, interpret results, and refer women with suspected periodontitis to dentists for further evaluation and treatment. Capacity Building for Nurses: There is need to implement training programs to equip nurses working in antenatal clinics with the knowledge and skills to effectively: conduct basic periodontal screenings, educate pregnant women about oral hygiene practices and the link between gum health and pregnancy outcomes and advise women on appropriate referrals for periodontal treatment when necessary. Public Awareness Campaigns: There is a need to develop and disseminate public awareness campaigns to educate women of childbearing age about periodontal disease, its risks during pregnancy, and the importance of maintaining good oral hygiene. Conclusion While the causal relationship between periodontitis and preterm birth requires further investigation, the existing evidence suggests a potentially significant link. By integrating oral health into maternal care, promoting oral hygiene practices, and conducting further research, we can take crucial steps to address this issue and improve maternal and child health outcomes in Rwanda. Policymakers, healthcare professionals, and community leaders in Rwanda should recognize the potential impact of periodontitis on preterm birth. By implementing the recommended actions and prioritizing oral health promotion, we can work together to ensure mothers and babies have a healthy start in life. Author contributions Both authors (PU and KK) contributed to writing of the original draft, reviewing, editing and conceptualization of the manuscript. Ethics and consent Ethical approval and consent were not required. Data and software availability No data are associated with this article. Acknowledgements Nil. References 1. Rutayisire E, Mochama M, Ntihabose CK, et al. : Maternal, obstetric and gynecological factors associated with preterm birth in Rwanda: findings from a national longitudinal study. BMC Pregnancy Childbirth. 2023; 23 (1): 1–10. Publisher Full Text 2. Shewale AH, Gattani DR, Bhatia N, et al. : Prevalence of periodontal disease in the general population of India-A systematic review. J. Clin. Diagn. Res. 2016; 10 : ZE04–ZE09. PubMed Abstract | Publisher Full Text | Free Full Text 3. Eke PI, Dye BA, Wei L, et al. : Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J. Dent. Res. 2012 Oct 30 [cited 2018 Jun 20]; 91 (10): 914–920. Publisher Full Text 4. Jain N, Dutt U, Radenkov I, et al. : WHO's global oral health status report 2022: Actions, discussion and implementation. Oral Dis. 2024 Mar; 30 (2): 73–79. PubMed Abstract | Publisher Full Text | Free Full Text 5. 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PubMed Abstract | Publisher Full Text | Free Full Text 18. Miranda-Rius J, Brunet-Llobet L, Blanc V, et al. : Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis. 2023; 29 (2): 772–785. PubMed Abstract | Publisher Full Text 19. Coleman M, Orvis A, Merillat S, et al. : Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. 2019. Reference Source 20. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, et al. : Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev. Dent. 2022; 20 (1): 363–368. 21. Muwazi L, Rwenyonyi CM, Nkamba M, et al. : Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health. 2014; 14 : 42. PubMed Abstract | Publisher Full Text | Free Full Text 22. Dusingizimana T, Ramilan T, Weber JL, et al. : Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda. BMC Pregnancy Childbirth. 2023; 23 (1): 69–69. PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Jun 2024 ADD YOUR COMMENT Comment Author details Author details 1 Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda 2 School of Health and Life Sciences, Teeside University, London, Middlesbrough, UK Peace Uwambaye Roles: Conceptualization, Data Curation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Kehinde Kazeem Kanmodi Roles: Conceptualization, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 05 Aug 2024, 13:647 https://doi.org/10.12688/f1000research.152760.2 version 1 Published: 17 Jun 2024, 13:647 https://doi.org/10.12688/f1000research.152760.1 Copyright © 2024 Uwambaye P and Kanmodi KK. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Uwambaye P and Kanmodi KK. Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.12688/f1000research.152760.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 05 Aug 2024 Revised Views 0 Cite How to cite this report: Miranda-Rius J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.169859.r310988 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v2#referee-response-310988 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 26 Aug 2024 Jaume Miranda-Rius , Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Sant Joan de Déu Hospital, Institut de Recerca Sant Joan de Déu (IRSJD), University of Barcelona, Barcelona, Spain Approved VIEWS 0 https://doi.org/10.5256/f1000research.169859.r310988 The authors have addressed ... Continue reading READ ALL The authors have addressed consistently all reviewers' comments. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Periodontology and Periodontal Medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Miranda-Rius J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.169859.r310988 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v2#referee-response-310988 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Velosa-Porras J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.169859.r310987 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v2#referee-response-310987 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 07 Aug 2024 Juliana Velosa-Porras , Pontificia Universidad Javeriana, Bogotá, Colombia Approved VIEWS 0 https://doi.org/10.5256/f1000research.169859.r310987 Dear Authors. My suggestions were taken ... Continue reading READ ALL Dear Authors. My suggestions were taken into account and added to the text. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Clinical Epidemiology, Epidemiology, Periodontics, Periodontal disease and its relationship to systemic diseases, pregnancy and oral health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Velosa-Porras J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.169859.r310987 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v2#referee-response-310987 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 17 Jun 2024 Views 0 Cite How to cite this report: Velosa-Porras J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.167558.r298808 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v1#referee-response-298808 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 22 Jul 2024 Juliana Velosa-Porras , Pontificia Universidad Javeriana, Bogotá, Colombia Approved VIEWS 0 https://doi.org/10.5256/f1000research.167558.r298808 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. ... Continue reading READ ALL Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. As the first point of contact with patients, this manuscript shows the fundamental role of nurses and midwives in the prevention of oral diseases. Minor revision I suggest this two references: Pockpa ZAD, et. al., 2022 (Ref 1) Muwazi L, et. al., 2014 (Ref 2) Background I suggest that sentences 1 and 6 in the first paragraph could be synthesized – the information is the same. Policy outcomes and implications Please check the wording in the last sentence of the first paragraph. I suggest that the second paragraph focus on the association of periodontitis and preterm birth. In the third paragraph the information on the association of periodontitis and preterm birth is unnecessary. Third paragraph, line 3 – " There is a need fora tool to support the nurses/midwives to detect periodontal diseases among pregnant women during antenatal care consultations.…" Please check the wording. Actionable recommendations First paragraph, line 2 – " ….. the lead author of this policy brief, in October 2024 where there…..” Please check the wording. Please check this date, since it has not yet passed, I believe it was a typing error. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? No Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Yes References 1. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, et al.: Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent . 2022; 20 (1): 363-368 PubMed Abstract | Publisher Full Text 2. Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, et al.: Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health . 2014; 14 : 42 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Clinical Epidemiology, Epidemiology, Periodontics, Periodontal disease and its relationship to systemic diseases, pregnancy and oral health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Velosa-Porras J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.167558.r298808 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v1#referee-response-298808 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Aug 2024 Peace UWAMBAYE , Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda 05 Aug 2024 Author Response REVIEWER 2 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote ... Continue reading REVIEWER 2 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. As the first point of contact with patients, this manuscript shows the fundamental role of nurses and midwives in the prevention of oral diseases. Minor revision I suggest this two references: Pockpa ZAD, et. al., 2022 (Ref 1) Muwazi L, et. al., 2014 (Ref 2) Response: Thank you. We have now cited these two references in the revised manuscript. Reviewer 2- Background: I suggest that sentences 1 and 6 in the first paragraph could be synthesized – the information is the same. Response: Thank you. Both sentences have now been synthesized. Reviewer 2- Policy outcomes and implications: Please check the wording in the last sentence of the first paragraph. Response: Thank you. This sentence has now been revised. Reviewer 2: I suggest that the second paragraph focus on the association of periodontitis and preterm birth. In the third paragraph the information on the association of periodontitis and preterm birth is unnecessary. Response: Thank you. This sentence, and paragraph, has now been revised. Reviewer 2: Third paragraph, line 3 – " There is a need fora tool to support the nurses/midwives to detect periodontal diseases among pregnant women during antenatal care consultations.…" Please check the wording. Response: Thank you. This sentence has now been revised. Reviewer 2- Actionable recommendations: First paragraph, line 2 – " ….. the lead author of this policy brief, in October 2024 where there…..” Please check the wording. Please check this date, since it has not yet passed, I believe it was a typing error. Response: Thank you. This sentence has now been revised. Reviewer 2- References: 1. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, et al.: Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent . 2022; 20 (1): 363-368 PubMed Abstract | Publisher Full Text 2. Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, et al.: Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health . 2014; 14 : 42 PubMed Abstract | Publisher Full Text Response: Thank you. We have now cited these two references in the revised manuscript. REVIEWER 2 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. As the first point of contact with patients, this manuscript shows the fundamental role of nurses and midwives in the prevention of oral diseases. Minor revision I suggest this two references: Pockpa ZAD, et. al., 2022 (Ref 1) Muwazi L, et. al., 2014 (Ref 2) Response: Thank you. We have now cited these two references in the revised manuscript. Reviewer 2- Background: I suggest that sentences 1 and 6 in the first paragraph could be synthesized – the information is the same. Response: Thank you. Both sentences have now been synthesized. Reviewer 2- Policy outcomes and implications: Please check the wording in the last sentence of the first paragraph. Response: Thank you. This sentence has now been revised. Reviewer 2: I suggest that the second paragraph focus on the association of periodontitis and preterm birth. In the third paragraph the information on the association of periodontitis and preterm birth is unnecessary. Response: Thank you. This sentence, and paragraph, has now been revised. Reviewer 2: Third paragraph, line 3 – " There is a need fora tool to support the nurses/midwives to detect periodontal diseases among pregnant women during antenatal care consultations.…" Please check the wording. Response: Thank you. This sentence has now been revised. Reviewer 2- Actionable recommendations: First paragraph, line 2 – " ….. the lead author of this policy brief, in October 2024 where there…..” Please check the wording. Please check this date, since it has not yet passed, I believe it was a typing error. Response: Thank you. This sentence has now been revised. Reviewer 2- References: 1. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, et al.: Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent . 2022; 20 (1): 363-368 PubMed Abstract | Publisher Full Text 2. Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, et al.: Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health . 2014; 14 : 42 PubMed Abstract | Publisher Full Text Response: Thank you. We have now cited these two references in the revised manuscript. Competing Interests: No competing interest Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Aug 2024 Peace UWAMBAYE , Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda 05 Aug 2024 Author Response REVIEWER 2 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote ... Continue reading REVIEWER 2 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. As the first point of contact with patients, this manuscript shows the fundamental role of nurses and midwives in the prevention of oral diseases. Minor revision I suggest this two references: Pockpa ZAD, et. al., 2022 (Ref 1) Muwazi L, et. al., 2014 (Ref 2) Response: Thank you. We have now cited these two references in the revised manuscript. Reviewer 2- Background: I suggest that sentences 1 and 6 in the first paragraph could be synthesized – the information is the same. Response: Thank you. Both sentences have now been synthesized. Reviewer 2- Policy outcomes and implications: Please check the wording in the last sentence of the first paragraph. Response: Thank you. This sentence has now been revised. Reviewer 2: I suggest that the second paragraph focus on the association of periodontitis and preterm birth. In the third paragraph the information on the association of periodontitis and preterm birth is unnecessary. Response: Thank you. This sentence, and paragraph, has now been revised. Reviewer 2: Third paragraph, line 3 – " There is a need fora tool to support the nurses/midwives to detect periodontal diseases among pregnant women during antenatal care consultations.…" Please check the wording. Response: Thank you. This sentence has now been revised. Reviewer 2- Actionable recommendations: First paragraph, line 2 – " ….. the lead author of this policy brief, in October 2024 where there…..” Please check the wording. Please check this date, since it has not yet passed, I believe it was a typing error. Response: Thank you. This sentence has now been revised. Reviewer 2- References: 1. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, et al.: Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent . 2022; 20 (1): 363-368 PubMed Abstract | Publisher Full Text 2. Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, et al.: Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health . 2014; 14 : 42 PubMed Abstract | Publisher Full Text Response: Thank you. We have now cited these two references in the revised manuscript. REVIEWER 2 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. As the first point of contact with patients, this manuscript shows the fundamental role of nurses and midwives in the prevention of oral diseases. Minor revision I suggest this two references: Pockpa ZAD, et. al., 2022 (Ref 1) Muwazi L, et. al., 2014 (Ref 2) Response: Thank you. We have now cited these two references in the revised manuscript. Reviewer 2- Background: I suggest that sentences 1 and 6 in the first paragraph could be synthesized – the information is the same. Response: Thank you. Both sentences have now been synthesized. Reviewer 2- Policy outcomes and implications: Please check the wording in the last sentence of the first paragraph. Response: Thank you. This sentence has now been revised. Reviewer 2: I suggest that the second paragraph focus on the association of periodontitis and preterm birth. In the third paragraph the information on the association of periodontitis and preterm birth is unnecessary. Response: Thank you. This sentence, and paragraph, has now been revised. Reviewer 2: Third paragraph, line 3 – " There is a need fora tool to support the nurses/midwives to detect periodontal diseases among pregnant women during antenatal care consultations.…" Please check the wording. Response: Thank you. This sentence has now been revised. Reviewer 2- Actionable recommendations: First paragraph, line 2 – " ….. the lead author of this policy brief, in October 2024 where there…..” Please check the wording. Please check this date, since it has not yet passed, I believe it was a typing error. Response: Thank you. This sentence has now been revised. Reviewer 2- References: 1. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, et al.: Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent . 2022; 20 (1): 363-368 PubMed Abstract | Publisher Full Text 2. Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, et al.: Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health . 2014; 14 : 42 PubMed Abstract | Publisher Full Text Response: Thank you. We have now cited these two references in the revised manuscript. Competing Interests: No competing interest Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Miranda-Rius J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.167558.r294152 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v1#referee-response-294152 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 03 Jul 2024 Jaume Miranda-Rius , Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Sant Joan de Déu Hospital, Institut de Recerca Sant Joan de Déu (IRSJD), University of Barcelona, Barcelona, Spain Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.167558.r294152 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need ... Continue reading READ ALL Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need to acquire knowledge about periodontitis and its possible repercussions on the foeto-placental unit. Perhaps I could suggest to the authors to add these three references as they are studies also carried out in East Africa. Gesase N, et. al., 2018 (Ref 1) Miranda-Rius J, et. al., 2023 (Ref 2) Coleman M, et. al., 2019 (Ref 3) Minor Revision: COMMENTS TO THE DOCUMENT INCORPORATING BASIC SCREENING INTO ANTENATAL CARE SERVICES PROVIDED IN RWANDA: A POLICY BRIEF Peace Uwambaye, Kehinde Kazeem Kanmodi (2024) This is a brief policy brief on the issue of preterm births in Rwanda. It has been shown that the rate of these births is very high. Simultaneously, several studies have found periodontitis to be a risk factor for preterm birth (<37 weeks). The aim of this study is to assess the prevalence of periodontitis in the country and to recommend a social policy of periodontitis control in pregnant women: diagnosis and prenatal care to reduce it and decrease the incidence of preterm births. Some objectives to be commented on: --In section "Policy outcomes and implications", 4th paragraph, last line, there is a reference to some studies but the citations of these studies are not given. They should be referenced. -- It is said that periodontal screening should be carried out on pregnant women to find out their periodontal situation, and from there to apply statistics, records and treatment; but it is not explained how this is to be carried out. No action plan is specified. It is only recommended to implement actions to prioritise oral health and to establish joint boundaries between specialties. Therefore, it will be good to start from this document a prospective cohort study design, in order to present guidelines to the Ministry of Health. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? No Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Yes References 1. Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al.: The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci . 2018; 18 (3): 601-611 PubMed Abstract | Publisher Full Text 2. Miranda-Rius J, Brunet-Llobet L, Blanc V, Álvarez G, et al.: Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis . 2023; 29 (2): 772-785 PubMed Abstract | Publisher Full Text 3. M, Coleman A, Orvis S, Merillat J, et al.: Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. https://link.springer.com/article/10.1177/1933719119834079?utm_source . 2019. Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Periodontology and Periodontal Medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Miranda-Rius J. Reviewer Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.167558.r294152 ) The direct URL for this report is: https://f1000research.com/articles/13-647/v1#referee-response-294152 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 05 Aug 2024 Peace UWAMBAYE , Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda 05 Aug 2024 Author Response REVIEWER 1 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. ... Continue reading REVIEWER 1 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need to acquire knowledge about periodontitis and its possible repercussions on the foeto-placental unit. Response: Thank you. REVIEWER 1: Perhaps I could suggest to the authors to add these three references as they are studies also carried out in East Africa. Gesase N, et. al., 2018 (Ref 1) Miranda-Rius J, et. al., 2023 (Ref 2) Coleman M, et. al., 2019 (Ref 3) Response: Thank you. We have now cited these three references in the revised manuscript. REVIEWER 1: This is a brief policy brief on the issue of preterm births in Rwanda. It has been shown that the rate of these births is very high. Simultaneously, several studies have found periodontitis to be a risk factor for preterm birth (<37 weeks). The aim of this study is to assess the prevalence of periodontitis in the country and to recommend a social policy of periodontitis control in pregnant women: diagnosis and prenatal care to reduce it and decrease the incidence of preterm births. Some objectives to be commented on: --In section "Policy outcomes and implications", 4th paragraph, last line, there is a reference to some studies but the citations of these studies are not given. They should be referenced. Response: Thank you. We have now provided references to support this sentence. We cited the three references you recommended as well as the two references recommended by Reviewer 2. Reviewer 1: It is said that periodontal screening should be carried out on pregnant women to find out their periodontal situation, and from there to apply statistics, records and treatment; but it is not explained how this is to be carried out. No action plan is specified. It is only recommended to implement actions to prioritise oral health and to establish joint boundaries between specialties. Therefore, it will be good to start from this document a prospective cohort study design, in order to present guidelines to the Ministry of Health. Response: Thank you. We would like to avoid being too specific by saying that a prospective cohort study design should be conducted in our recommendations, because all research investigations should be welcome by the government on this area. However, this we will put at the back of our mind. We will be very glad to pursue a research project on that and we are very open to collaborative opportunities. Reviewer 1- References: 1. Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al.: The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci . 2018; 18 (3): 601-611 PubMed Abstract | Publisher Full Text 2. Miranda-Rius J, Brunet-Llobet L, Blanc V, Álvarez G, et al.: Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis . 2023; 29 (2): 772-785 PubMed Abstract | Publisher Full Text 3. M, Coleman A, Orvis S, Merillat J, et al.: Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. https://link.springer.com/article/10.1177/1933719119834079?utm_source . 2019. Response: Thank you. We have now cited these three references in the revised manuscript. REVIEWER 1 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need to acquire knowledge about periodontitis and its possible repercussions on the foeto-placental unit. Response: Thank you. REVIEWER 1: Perhaps I could suggest to the authors to add these three references as they are studies also carried out in East Africa. Gesase N, et. al., 2018 (Ref 1) Miranda-Rius J, et. al., 2023 (Ref 2) Coleman M, et. al., 2019 (Ref 3) Response: Thank you. We have now cited these three references in the revised manuscript. REVIEWER 1: This is a brief policy brief on the issue of preterm births in Rwanda. It has been shown that the rate of these births is very high. Simultaneously, several studies have found periodontitis to be a risk factor for preterm birth (<37 weeks). The aim of this study is to assess the prevalence of periodontitis in the country and to recommend a social policy of periodontitis control in pregnant women: diagnosis and prenatal care to reduce it and decrease the incidence of preterm births. Some objectives to be commented on: --In section "Policy outcomes and implications", 4th paragraph, last line, there is a reference to some studies but the citations of these studies are not given. They should be referenced. Response: Thank you. We have now provided references to support this sentence. We cited the three references you recommended as well as the two references recommended by Reviewer 2. Reviewer 1: It is said that periodontal screening should be carried out on pregnant women to find out their periodontal situation, and from there to apply statistics, records and treatment; but it is not explained how this is to be carried out. No action plan is specified. It is only recommended to implement actions to prioritise oral health and to establish joint boundaries between specialties. Therefore, it will be good to start from this document a prospective cohort study design, in order to present guidelines to the Ministry of Health. Response: Thank you. We would like to avoid being too specific by saying that a prospective cohort study design should be conducted in our recommendations, because all research investigations should be welcome by the government on this area. However, this we will put at the back of our mind. We will be very glad to pursue a research project on that and we are very open to collaborative opportunities. Reviewer 1- References: 1. Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al.: The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci . 2018; 18 (3): 601-611 PubMed Abstract | Publisher Full Text 2. Miranda-Rius J, Brunet-Llobet L, Blanc V, Álvarez G, et al.: Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis . 2023; 29 (2): 772-785 PubMed Abstract | Publisher Full Text 3. M, Coleman A, Orvis S, Merillat J, et al.: Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. https://link.springer.com/article/10.1177/1933719119834079?utm_source . 2019. Response: Thank you. We have now cited these three references in the revised manuscript. Competing Interests: No competing interest Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 05 Aug 2024 Peace UWAMBAYE , Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda 05 Aug 2024 Author Response REVIEWER 1 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. ... Continue reading REVIEWER 1 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need to acquire knowledge about periodontitis and its possible repercussions on the foeto-placental unit. Response: Thank you. REVIEWER 1: Perhaps I could suggest to the authors to add these three references as they are studies also carried out in East Africa. Gesase N, et. al., 2018 (Ref 1) Miranda-Rius J, et. al., 2023 (Ref 2) Coleman M, et. al., 2019 (Ref 3) Response: Thank you. We have now cited these three references in the revised manuscript. REVIEWER 1: This is a brief policy brief on the issue of preterm births in Rwanda. It has been shown that the rate of these births is very high. Simultaneously, several studies have found periodontitis to be a risk factor for preterm birth (<37 weeks). The aim of this study is to assess the prevalence of periodontitis in the country and to recommend a social policy of periodontitis control in pregnant women: diagnosis and prenatal care to reduce it and decrease the incidence of preterm births. Some objectives to be commented on: --In section "Policy outcomes and implications", 4th paragraph, last line, there is a reference to some studies but the citations of these studies are not given. They should be referenced. Response: Thank you. We have now provided references to support this sentence. We cited the three references you recommended as well as the two references recommended by Reviewer 2. Reviewer 1: It is said that periodontal screening should be carried out on pregnant women to find out their periodontal situation, and from there to apply statistics, records and treatment; but it is not explained how this is to be carried out. No action plan is specified. It is only recommended to implement actions to prioritise oral health and to establish joint boundaries between specialties. Therefore, it will be good to start from this document a prospective cohort study design, in order to present guidelines to the Ministry of Health. Response: Thank you. We would like to avoid being too specific by saying that a prospective cohort study design should be conducted in our recommendations, because all research investigations should be welcome by the government on this area. However, this we will put at the back of our mind. We will be very glad to pursue a research project on that and we are very open to collaborative opportunities. Reviewer 1- References: 1. Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al.: The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci . 2018; 18 (3): 601-611 PubMed Abstract | Publisher Full Text 2. Miranda-Rius J, Brunet-Llobet L, Blanc V, Álvarez G, et al.: Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis . 2023; 29 (2): 772-785 PubMed Abstract | Publisher Full Text 3. M, Coleman A, Orvis S, Merillat J, et al.: Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. https://link.springer.com/article/10.1177/1933719119834079?utm_source . 2019. Response: Thank you. We have now cited these three references in the revised manuscript. REVIEWER 1 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need to acquire knowledge about periodontitis and its possible repercussions on the foeto-placental unit. Response: Thank you. REVIEWER 1: Perhaps I could suggest to the authors to add these three references as they are studies also carried out in East Africa. Gesase N, et. al., 2018 (Ref 1) Miranda-Rius J, et. al., 2023 (Ref 2) Coleman M, et. al., 2019 (Ref 3) Response: Thank you. We have now cited these three references in the revised manuscript. REVIEWER 1: This is a brief policy brief on the issue of preterm births in Rwanda. It has been shown that the rate of these births is very high. Simultaneously, several studies have found periodontitis to be a risk factor for preterm birth (<37 weeks). The aim of this study is to assess the prevalence of periodontitis in the country and to recommend a social policy of periodontitis control in pregnant women: diagnosis and prenatal care to reduce it and decrease the incidence of preterm births. Some objectives to be commented on: --In section "Policy outcomes and implications", 4th paragraph, last line, there is a reference to some studies but the citations of these studies are not given. They should be referenced. Response: Thank you. We have now provided references to support this sentence. We cited the three references you recommended as well as the two references recommended by Reviewer 2. Reviewer 1: It is said that periodontal screening should be carried out on pregnant women to find out their periodontal situation, and from there to apply statistics, records and treatment; but it is not explained how this is to be carried out. No action plan is specified. It is only recommended to implement actions to prioritise oral health and to establish joint boundaries between specialties. Therefore, it will be good to start from this document a prospective cohort study design, in order to present guidelines to the Ministry of Health. Response: Thank you. We would like to avoid being too specific by saying that a prospective cohort study design should be conducted in our recommendations, because all research investigations should be welcome by the government on this area. However, this we will put at the back of our mind. We will be very glad to pursue a research project on that and we are very open to collaborative opportunities. Reviewer 1- References: 1. Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al.: The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci . 2018; 18 (3): 601-611 PubMed Abstract | Publisher Full Text 2. Miranda-Rius J, Brunet-Llobet L, Blanc V, Álvarez G, et al.: Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis . 2023; 29 (2): 772-785 PubMed Abstract | Publisher Full Text 3. M, Coleman A, Orvis S, Merillat J, et al.: Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. https://link.springer.com/article/10.1177/1933719119834079?utm_source . 2019. Response: Thank you. We have now cited these three references in the revised manuscript. Competing Interests: No competing interest Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 17 Jun 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 05 Aug 24 read read Version 1 17 Jun 24 read read Jaume Miranda-Rius , University of Barcelona, Barcelona, Spain; University of Barcelona, Barcelona, Spain Juliana Velosa-Porras , Pontificia Universidad Javeriana, Bogotá, Colombia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Miranda-Rius J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Aug 2024 | for Version 2 Jaume Miranda-Rius , Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Sant Joan de Déu Hospital, Institut de Recerca Sant Joan de Déu (IRSJD), University of Barcelona, Barcelona, Spain 0 Views copyright © 2024 Miranda-Rius J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed consistently all reviewers' comments. Competing Interests No competing interests were disclosed. Reviewer Expertise Periodontology and Periodontal Medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Miranda-Rius J. Peer Review Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.169859.r310988) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-647/v2#referee-response-310988 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Velosa-Porras J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 07 Aug 2024 | for Version 2 Juliana Velosa-Porras , Pontificia Universidad Javeriana, Bogotá, Colombia 0 Views copyright © 2024 Velosa-Porras J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors. My suggestions were taken into account and added to the text. Competing Interests No competing interests were disclosed. Reviewer Expertise Clinical Epidemiology, Epidemiology, Periodontics, Periodontal disease and its relationship to systemic diseases, pregnancy and oral health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Velosa-Porras J. Peer Review Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.169859.r310987) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-647/v2#referee-response-310987 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Velosa-Porras J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 22 Jul 2024 | for Version 1 Juliana Velosa-Porras , Pontificia Universidad Javeriana, Bogotá, Colombia 0 Views copyright © 2024 Velosa-Porras J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. As the first point of contact with patients, this manuscript shows the fundamental role of nurses and midwives in the prevention of oral diseases. Minor revision I suggest this two references: Pockpa ZAD, et. al., 2022 (Ref 1) Muwazi L, et. al., 2014 (Ref 2) Background I suggest that sentences 1 and 6 in the first paragraph could be synthesized – the information is the same. Policy outcomes and implications Please check the wording in the last sentence of the first paragraph. I suggest that the second paragraph focus on the association of periodontitis and preterm birth. In the third paragraph the information on the association of periodontitis and preterm birth is unnecessary. Third paragraph, line 3 – " There is a need fora tool to support the nurses/midwives to detect periodontal diseases among pregnant women during antenatal care consultations.…" Please check the wording. Actionable recommendations First paragraph, line 2 – " ….. the lead author of this policy brief, in October 2024 where there…..” Please check the wording. Please check this date, since it has not yet passed, I believe it was a typing error. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? No Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Yes References 1. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, et al.: Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent . 2022; 20 (1): 363-368 PubMed Abstract | Publisher Full Text 2. Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, et al.: Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health . 2014; 14 : 42 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Clinical Epidemiology, Epidemiology, Periodontics, Periodontal disease and its relationship to systemic diseases, pregnancy and oral health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (1) Author Response 05 Aug 2024 Peace UWAMBAYE, Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda REVIEWER 2 Dear Authors, It was a pleasure for me to read your manuscript. The research topic is of interest, countries with limited resources should incorporate these strategies to promote oral health and prevent diseases such as preterm birth. As the first point of contact with patients, this manuscript shows the fundamental role of nurses and midwives in the prevention of oral diseases. Minor revision I suggest this two references: Pockpa ZAD, et. al., 2022 (Ref 1) Muwazi L, et. al., 2014 (Ref 2) Response: Thank you. We have now cited these two references in the revised manuscript. Reviewer 2- Background: I suggest that sentences 1 and 6 in the first paragraph could be synthesized – the information is the same. Response: Thank you. Both sentences have now been synthesized. Reviewer 2- Policy outcomes and implications: Please check the wording in the last sentence of the first paragraph. Response: Thank you. This sentence has now been revised. Reviewer 2: I suggest that the second paragraph focus on the association of periodontitis and preterm birth. In the third paragraph the information on the association of periodontitis and preterm birth is unnecessary. Response: Thank you. This sentence, and paragraph, has now been revised. Reviewer 2: Third paragraph, line 3 – " There is a need fora tool to support the nurses/midwives to detect periodontal diseases among pregnant women during antenatal care consultations.…" Please check the wording. Response: Thank you. This sentence has now been revised. Reviewer 2- Actionable recommendations: First paragraph, line 2 – " ….. the lead author of this policy brief, in October 2024 where there…..” Please check the wording. Please check this date, since it has not yet passed, I believe it was a typing error. Response: Thank you. This sentence has now been revised. Reviewer 2- References: 1. Pockpa ZAD, Soueidan A, Koffi-Coulibaly NT, Mobio GS, et al.: Association Between Periodontitis and Preterm Birth in a Cohort of Pregnant Women in Ivory Coast. Oral Health Prev Dent . 2022; 20 (1): 363-368 PubMed Abstract | Publisher Full Text 2. Muwazi L, Rwenyonyi CM, Nkamba M, Kutesa A, et al.: Periodontal conditions, low birth weight and preterm birth among postpartum mothers in two tertiary health facilities in Uganda. BMC Oral Health . 2014; 14 : 42 PubMed Abstract | Publisher Full Text Response: Thank you. We have now cited these two references in the revised manuscript. View more View less Competing Interests No competing interest reply Respond Report a concern Velosa-Porras J. Peer Review Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . F1000Research 2024, 13 :647 ( https://doi.org/10.5256/f1000research.167558.r298808) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-647/v1#referee-response-298808 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Miranda-Rius J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 03 Jul 2024 | for Version 1 Jaume Miranda-Rius , Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Sant Joan de Déu Hospital, Institut de Recerca Sant Joan de Déu (IRSJD), University of Barcelona, Barcelona, Spain 0 Views copyright © 2024 Miranda-Rius J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need to acquire knowledge about periodontitis and its possible repercussions on the foeto-placental unit. Perhaps I could suggest to the authors to add these three references as they are studies also carried out in East Africa. Gesase N, et. al., 2018 (Ref 1) Miranda-Rius J, et. al., 2023 (Ref 2) Coleman M, et. al., 2019 (Ref 3) Minor Revision: COMMENTS TO THE DOCUMENT INCORPORATING BASIC SCREENING INTO ANTENATAL CARE SERVICES PROVIDED IN RWANDA: A POLICY BRIEF Peace Uwambaye, Kehinde Kazeem Kanmodi (2024) This is a brief policy brief on the issue of preterm births in Rwanda. It has been shown that the rate of these births is very high. Simultaneously, several studies have found periodontitis to be a risk factor for preterm birth (<37 weeks). The aim of this study is to assess the prevalence of periodontitis in the country and to recommend a social policy of periodontitis control in pregnant women: diagnosis and prenatal care to reduce it and decrease the incidence of preterm births. Some objectives to be commented on: --In section "Policy outcomes and implications", 4th paragraph, last line, there is a reference to some studies but the citations of these studies are not given. They should be referenced. -- It is said that periodontal screening should be carried out on pregnant women to find out their periodontal situation, and from there to apply statistics, records and treatment; but it is not explained how this is to be carried out. No action plan is specified. It is only recommended to implement actions to prioritise oral health and to establish joint boundaries between specialties. Therefore, it will be good to start from this document a prospective cohort study design, in order to present guidelines to the Ministry of Health. Does the paper provide a comprehensive overview of the policy and the context of its implementation in a way which is accessible to a general reader? Yes Is the discussion on the implications clearly and accurately presented and does it cite the current literature? No Are the recommendations made clear, balanced, and justified on the basis of the presented arguments? Yes References 1. Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al.: The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci . 2018; 18 (3): 601-611 PubMed Abstract | Publisher Full Text 2. Miranda-Rius J, Brunet-Llobet L, Blanc V, Álvarez G, et al.: Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis . 2023; 29 (2): 772-785 PubMed Abstract | Publisher Full Text 3. M, Coleman A, Orvis S, Merillat J, et al.: Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. https://link.springer.com/article/10.1177/1933719119834079?utm_source . 2019. Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Periodontology and Periodontal Medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 05 Aug 2024 Peace UWAMBAYE, Preventive and Community Dentistry, University of Rwanda, Kigali city, Rwanda REVIEWER 1 Dear Authors, I enjoyed reading this manuscript. Especially in countries where there is a shortage of dental surgeons it is important to involve nurses in oral health education. Maternity is important in women's lives so midwives need to acquire knowledge about periodontitis and its possible repercussions on the foeto-placental unit. Response: Thank you. REVIEWER 1: Perhaps I could suggest to the authors to add these three references as they are studies also carried out in East Africa. Gesase N, et. al., 2018 (Ref 1) Miranda-Rius J, et. al., 2023 (Ref 2) Coleman M, et. al., 2019 (Ref 3) Response: Thank you. We have now cited these three references in the revised manuscript. REVIEWER 1: This is a brief policy brief on the issue of preterm births in Rwanda. It has been shown that the rate of these births is very high. Simultaneously, several studies have found periodontitis to be a risk factor for preterm birth (<37 weeks). The aim of this study is to assess the prevalence of periodontitis in the country and to recommend a social policy of periodontitis control in pregnant women: diagnosis and prenatal care to reduce it and decrease the incidence of preterm births. Some objectives to be commented on: --In section "Policy outcomes and implications", 4th paragraph, last line, there is a reference to some studies but the citations of these studies are not given. They should be referenced. Response: Thank you. We have now provided references to support this sentence. We cited the three references you recommended as well as the two references recommended by Reviewer 2. Reviewer 1: It is said that periodontal screening should be carried out on pregnant women to find out their periodontal situation, and from there to apply statistics, records and treatment; but it is not explained how this is to be carried out. No action plan is specified. It is only recommended to implement actions to prioritise oral health and to establish joint boundaries between specialties. Therefore, it will be good to start from this document a prospective cohort study design, in order to present guidelines to the Ministry of Health. Response: Thank you. We would like to avoid being too specific by saying that a prospective cohort study design should be conducted in our recommendations, because all research investigations should be welcome by the government on this area. However, this we will put at the back of our mind. We will be very glad to pursue a research project on that and we are very open to collaborative opportunities. Reviewer 1- References: 1. Gesase N, Miranda-Rius J, Brunet-Llobet L, Lahor-Soler E, et al.: The association between periodontal disease and adverse pregnancy outcomes in Northern Tanzania: a cross-sectional study. Afr Health Sci . 2018; 18 (3): 601-611 PubMed Abstract | Publisher Full Text 2. Miranda-Rius J, Brunet-Llobet L, Blanc V, Álvarez G, et al.: Microbial profile of placentas from Tanzanian mothers with adverse pregnancy outcomes and periodontitis. Oral Dis . 2023; 29 (2): 772-785 PubMed Abstract | Publisher Full Text 3. M, Coleman A, Orvis S, Merillat J, et al.: Inhibition of the Chemokine Response Prevents Preterm Labor but Not an Invasive Infection in a Nonhuman Primate Model. https://link.springer.com/article/10.1177/1933719119834079?utm_source . 2019. Response: Thank you. We have now cited these three references in the revised manuscript. View more View less Competing Interests No competing interest reply Respond Report a concern Miranda-Rius J. Peer Review Report For: Incorporating basic periodontal screening into antenatal care services provided in Rwanda: A policy brief [version 2; peer review: 2 approved] . 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