R0:

Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Full Title:

Manuscript full title does not match with the short title. Full title reads "Climate change, livelihoods, gender and violence in Rukiga, Uganda: intersections and pathways". While short tile reads "Climate Change and Gender Based Violence". 'gender based violence' may not necessarily mean the same as 'gender and violence'. Authors should consider revising the wording in the full time if they meant gender based violence.

Abstract:

Inconsistency in FGD size, harmonize to consistent range across the manuscript. Author said "Between April and July 2021, we conducted 28 focus group discussions (FGDs), comprising 6-8 participants each (line 29-30" and in methods author said "From 20 April 2021- 02 July 2021 five focus group discussions (FGDs) were conducted in each community (28 in total) each consisting of four to six participants (lines 135-136)".

clarify the CBV emergent theme. You said "This study, though not originally intended to focus on GBV, examines how it interconnects with poverty, shifting gender roles, alcoholism, environmental stress, and family planning dynamics." (lines 26-28). Consider adding a statement signalling GBV emerged inductively during data colletion and/or analysis.

Methods: Revise the methods section to ensure the study can be reprodcible, and signal reliability of findings.

What study design did you use? not clear

Author said participants were " purposively selected... with the help of community leaders" (lines 140-141). Clearly elaborate the eligibility criteria and how the gatekeepers' influence was mitigated, and proper justification why 28 FGDs and 40 KIIs were sufficient. Talk about saturation, was maximum variation considered? and how?

Results:

Tag all quotes with data source (FGD or KII), sex, age to evidence diversity across the groups.

Make sure all quotes are in clear quotations marks (lines 220-222). fix that for the entire results section and be consistent.

Authors said "When describing their experiences and perceptions of poverty and its associated consequences including poor diets, sickness, and lack of ability to pay for healthcare and transport to medical facilities, most respondents explicitly identified poverty as a direct cause of GBV:" (lines 311-314). Revise the wording on participants' perceptions to avoid implying causality from qualitative data. Check the entire document for this including the abstract lines 36 to 41.

Ethics: Include ethical committee name that gave ethical clearance for the study, also include the reference number and date.

describe safeguardings and referral procedures followed in the study if any.

Conclusion: The concept for this paper is timely and relevant. However several important elements require revision before the manuscript can meet PLOS Global Public Health Standards. Work on the clarity and consistency of the methods (study design was not clearly mentioned, there are several qualitative designs one can use, e.g. phenomenology, case study, etc. what design did you use?). PLOS Global Public Health guidelines on data sharing require that you provide some de-identified data, nevertheless authors stated that they would share data and the justification for that leaves much to be desired.

Reviewer #2: 1. Kindly mention the methodological orientation adopted for the study? 2. Discrepancy between number of participants in FGD mentioned in abstract and methods – (6 – 8 in abstract and 4 – 6 participants in methods)…Kindly make it uniform 3. Additional context on domestic violence and related statistics can be added in study setting 4. Details on steps taken to ensure internal validity/rigor to be mentioned – member checking, reflexivity 5. Give details of the parent project briefly 6. Any conceptual model/framework adopted to guide data generation/analysis? 7. What efforts were taken to address/refer victims of GBV once disclosed? 8. Socio - demographic details of the respondents could be added for better interpretation 9. Key themes are restated multiple times; Many dimensions of GBV (more details on each typology, coping strategies, prevention, etc) not elicited

Reviewer #3: Overall Comments The paper takes a qualitative approach to “examine locally held perceptions of the relationships between climate and livelihood-related stressors and changing dynamcis, including the risk of Rukiga district. Climate change remains a global threat, with many countries and communities within Africa, ill prepared to adapt and mitigate the consequences. The paper is an attempt to paint a picture of climate-related impacts, particularly how gender-based violence, a persistent public health, socioeconomic and development issue is shaped by and influencing social, economic and environmental stressors.

In its current form, the paper need to be strengthened to get it to be sufficiently robust for publication in PLOS Global Public Health. The paper needs to be strengthened in at least three ways:

1) Overall, the paper needs to better contextualise their goal. Authors state in line 115 to 117, that their purpose is to understand locally held perceptions of the relationship between climate and livelihood-related stressors, and in several other sections, indicate make clear that, their original intention was not GBV, but undertook a thematic analysis on the latter. This can be confusing making it difficult for readers to follow. Authors need to clarify their focus – if it is on GBV, they may consider better contextualising their paper, especially in the introduction.

As part of contextualising, authors may consider highlighting the initial primary research focus – this helps to provide context for readers to begin to appreciate how and why GBV took center-stage during the analysis. In doing so, it also provides an opportunity for authors to properly situate their contributions to the literature.

Other minor issues include: • Authors make claims about projected exponential increase (line 51-52) and yet, do not support with any data. Similarly, authors may want to consider revising the sentence, as it appears redundant.

• In line 55-57, it argued “Uganda’s vulnerability to climate change and climate-sensitive disasters is extremely high – it is not immediately clear to readers what this means. By which benchmark or metric are authors assessing Uganda’s vulnerability. Authors may consider revising to ensure clarity (also see lines 108-110 for punctuation issues).

• Lastly, the study takes place in Rukiga District – it would be helpful if authors provided some additional background context. Will the results be different, if the study was conducted in a different district rather than Rukiga? Basically, some discussions of the rationale and/or choice of the selected district is be useful.

2) Overall, authors need to improve their methods by revising and clarifying, some of the sections. For example, under study setting (line 128-130), it is not clear if the concluding sentence is provided additional context for the prior statement. Authors may want to revise for clarity purpose.

I. Reconcile the number of participants for FGDs – in the abstract, authors indicate 6-8 people form a FDG and in line 136, it says “…each consisting of four to six participants,…”. II. For both FGD and KII, it is useful to indicate and/or describe the demographic/characteristics of the people participating in the study (Perhaps, authors could outline their demographics by sex and age, and any other stratifier in the results section in a tabular format. How were participants selected, especially among the FGD participants? III. On ethics statement, although the data emanates from key informants and community members, authors do not indicate whether they sought ethnical approval for their study. If ethics was obtained, it is useful to indicate so. IV. Regarding data collection, lines 172 to 173, authors indicate that “discrepancies in the coding were re-examined…”. It useful to explain how the independent assessor resolved discrepancies and reached consensus. V. In the data collection section (line 155 to 157), authors indicate that they “undertook a specific analysis of what participants said about GBV”. However, in the results, it is often not clear, the specific thematic issues or results arising from this analysis. Related to this and linked to the analysis, it is not clear to readers how the two main clusters (line 188 to 191) link to GBV. While lines 193 to 212, describe nature of GBV, for the most parts (for example, line 213 to 308), it is difficult to follow how GBV is an interconnector in the results being discussed. At times, it difficult to see, where the analysis departs from its original intended goal. Were the issues around climate change and environment among others emergent from the data?

3) Overall, the results section outlines some very interesting insights. However, I do feel this section can be deepened. In many instances, the narratives are often not immediately supported by the relevant quotes, linking to GBV. • In line 230 – 323, authors reflect that the disruption to livelihoods leading to family instabilities and conflict, demonstrate how GBV is triggered. This assumption is challenging to sustain, considering that “unrest in families” and not having “peace in a home” do not necessarily connote GBV. Similar reflections are presented at line 306 (“...they both resort to quarrels…”), lines 316 to 320 (…start quarrelling and fighting…”) and (“…you fight with the woman”). • Although authors indicate these are “euphemisms for GBV” (line 208) that participants use – without critical analysis, we risk painting a picture that may not be correct. For example, will readers be correct to assume, that in Ugandan context, such referencs always mean GBV?. To avoid readers assuming without appropriate understanding of context, authors may consider, making explicit any additional nunaces related to the quotations or contexts for this pharses, to clarify and make the links to GBV much clearer.

Minor • Line 199 – please clarify how and why unintended pregnancies is considered a form of GBV • Line 208 to 209 – revise sentence – it is not clear what authors mean by throughout their experiences and perceptions • Line 211 – “GBV was raised during the discussions of a wide range of factors” – perhaps, useful to outline the contexts which GBV was raised

R0:

Reviewers' comments:

The study addresses the ongoing H5N1 panzootic, a topic of major global health concern. By focusing on zoonotic spillover and potential human-to-human transmission, it connects well to pressing pandemic preparedness questions. Here are my suggestions

The study acknowledges asymptomatic cases but doesn’t deeply explore realistic ranges of asymptomatic infection in H5N1. Since asymptomatic carriage in humans is poorly understood, exploring a wider range of assumptions (from very low to moderate prevalence) would add robustness. Maybe authors can discuss this point

While the UK setting is clear, the contact structures and public health response capacity differ in low- and middle-income countries where zoonotic spillover risk is high. Discussion of transferability would broaden the relevance.

The agricultural contact data are valuable, but heterogeneity within and across communities (e.g., multi-generational households, seasonal work, market interactions) could have been discussed more fully. This heterogeneity may affect outbreak potential.

Only contact tracing and self-isolation are modeled. In reality, outbreak management could include infection control, health care facility and capacity, movement restrictions, or culling of infected animals. Considering at least one additional intervention would make the study more comprehensive.

The study convincingly demonstrates that early interventions like contact tracing and self-isolation can substantially reduce outbreak size when R₀ is low and symptomatic detection is reliable. However, if R₀ increases or asymptomatic transmission is significant, these interventions may not suffice. Authors can discuss this point

For policymakers, this suggests that contact tracing and self-isolation are valuable but fragile tools—effective only under certain epidemiological conditions. Maybe authors can discuss they should be embedded in a layered response strategy including rapid diagnostics, surveillance, and (eventually) vaccines or antivirals.

Editor comments: - Given that there is little to no evidence of human-to-human transmission for avian influenza (H5N1), is self-isolation recommended as a control measure for human cases? Additionally, is self-isolation applicable in the context of seasonal influenza as well? - Introduction section: Line number 66: However, cases without zoonotic exposure and limited human-to-human transmission have been documented. Specify the virus name. Seasonal or avian influenza. - In method: you mentioned "contact with birds". It is better to mention the name bird or poultry or chicken or turkey. The meaning of bird is different than poultry. - Does the model possess adequate capability to address avian influenza, considering the virus exhibits limited human-to-human transmissibility?

R1:

All comments have been addressed.

R0:

Reviewer #1: The review is important to improve outcomes on cholera surveillance and response. However, there are a number of critical issues that must be addressed to ensure the manuscript conforms to the standard of scientific writing and scoping review. 1. Certain sections were ommitted e.g Quality assessment and Data analysis 2. The roles of the authors in the scooping exercise also omitted 3. The results and discussion sections are mixed up. The authors began discussing the findings in the result.

Reviewer #2: Given the ongoing cholera pandemic and its recurrent outbreaks in sub-Saharan Africa, it is commendable that the authors undertook a comprehensive mapping of cholera research in Kenya. 1.For the search strategy, the query “cholera AND Kenya” across all databases is overly restrictive and likely excluded studies using alternative terminology such as “Vibrio cholerae”, “waterborne disease”, or “WASH-related cholera”. I would recommend providing the full keywords, filters and timelines used for each database, to help in reproducibility, as stated in the PRISMA-ScR Checklist (Item 8). 2.Please provide the last search date or timeframe. 3.The authors mentioned the systematic search of five databases, including Google Scholar, Web of Science, PubMed, Embase, and Scopus. However, in the PRISMA flow diagram (Figure 1), there is no data for Google Scholar. 4.The use of Rayyan is recognized. However, reviewer roles, conflict resolution, and data extraction validation are not stated. 5.The authors mentioned the inclusion of non-primary studies, such as reviews, but stated “ineligible study design” as a reason for exclusion in Figure 1. A clarification on this is could be beneficial. 6.For each included study, the authors should present the characteristics of the data charted with respective citations in a table. 7.In section 3.2, the authors provide an informative table which shows the geographic focus of the studies across multiple countries, including Kenya. For a scoping review centered on Kenya, a similar table or map that shows the distribution of studies/ data on the county-level could be added. 8.Themes such as mortality and risk factors of cholera could be explored and discussed further to strengthen the manuscript. 9.The Results-Discussion boundary seems blurred. Discussion begins to appear within “Future directions” paragraphs under each theme. I would recommend that the authors consolidate all “Future directions” into a single Discussion summarising what is known and unknown.