Lack of pocket money impacts Ethiopian undergraduate health science students learning activities.

BACKGROUND: The cost of university presents various challenges with regards to students' daily learning activities. This is particularly evident in developing countries, where higher education students face acute financial problems that greatly affect their daily educational activities. In Ethiopia, public university students do benefit from governmental cost-sharing programs. Moreover, health sciences students have additional costs during their clinical placements that are above the common expenses for university students.
OBJECTIVES: Authors aim to explore the challenges that undergraduate health sciences students in their clinical year face with limited pocket money, as well as how students perceive these limited funds affecting their learning activities and their ability to meet challenges.
METHODS: This descriptive qualitative study was conducted at the Department of Medical Radiologic Technology, College of Health Sciences, at Addis Ababa University in Ethiopia. Interviews were conducted between January 28, 2019 and February 1, 2019 with twelve students; and only ten participants were included in the study. The semi-structured questions explored participants' experiences and perceptions regarding the challenges of a lack of pocket money and its impacts on their learning activities. Their reaction to financial challenges was assessed.
RESULTS: Four themes that are related to the impact of a lack of money on learning activities emerged from our interviews. First, students believed that their difficulty in obtaining pocket money from family or other funding sources contributed to their financial stress, which negatively impacted their learning. Moreover, their difficulty in affording the basic needs for a student greatly affected their learning abilities in the classroom as well as in their clinical placements. The ability to self-manage was also a significant concern for students, with the pressure to use self-control and proper money management adding to their financial stress. Lastly, students observed that the lack of pocket money affected their ability to make social connections at university, which they saw as negatively impacting their learning abilities.
CONCLUSION: Ethiopian undergraduate health sciences students faced many challenges due to the lack of pocket money and these challenges affected student learning both directly or indirectly. Based on our data, we believe that the underlying causes of student financial hardship can be addressed by increasing public awareness of university expenses, clarifying the cost-sharing system to the public, redesigning the cost-sharing policy, and improving university services. Additionally, teaching students self-management skills is also another area that could increase student success.

Introduction

The United Nations Educational, Scientific and Cultural Organization’s World Conference on Higher Education stated that "higher education needs to be a fundamental right for all", regardless of a student’s socioeconomic status (SES) [1]. However, students from low SES backgrounds have lower educational aspirations, persistence rates, and educational achievements during college [2-5]. Moreover, several previous studies suggest that during clinical placements, health sciences students face increased financial costs such as transportation, food expenses, clothing, and other material needs [6-8], further exacerbating the stress on low SES students.

In Ethiopia, the Ethiopian Higher Education Proclamation and Cost Sharing Regulations provide room and board, and cover the tuition fees for those public university students who pass the Ethiopian Higher Education Entrance Examination; however, it does not provide students with pocket money for other expenses [9].

The aim of this study is to explore the impact of a lack of pocket money on undergraduate health sciences students’ learning activities during their clinical years, with pocket money being defined as the income that a student receives from a parent or guardian [10]. This research helps identify the challenges that undergraduate health sciences students face due to the lack of pocket money and the perceived effects of their financial hardships on their learning activities.

Methods

Study design and setting

This study is a descriptive qualitative study that was used to explore the impacts of a lack of pocket money on undergraduate health sciences students’ learning activities during their clinical years. Semi-structured interviews were used to gather data and the questions aimed to determine the students’ perceptions of the effects of their financial hardships on their learning activities. This study was conducted with third- and fourth-year students from the Department of Medical Radiology Technology, College of Health Sciences, Addis Ababa University (AAU) in Ethiopia.

Ethical considerations

Ethical clearance was obtained from the Department of Medical Education Ethical Review board. All potential participants were told that they have the right to decline participation in the study and that their non-involvement would not affect their status as health sciences students (S1 Appendix). In addition, they were informed that if they chose to participate in the study it would be completely anonymous. Written informed consent was obtained from each individual participant (Appendix B in S1 File).

Participant recruitment and data collection

In order to meet the objectives of this study, purposeful sampling was employed to identify financially challenged third- and fourth-year health sciences students. First, we invited those who had submitted letters to the department seeking financial support to participate in the study. When interested individuals arrived, they were informed of the project and asked to declare if they are faced financial challenges. Subsequently, snowball sampling was used to obtain the remaining potential study participants. During all interviews, participants were asked to self-declare their financial status. In the end, seven third-year students and five fourth-year students were interviewed.

Our data starts to be similar after five participants were interviewed. Thematic saturation was reached after reviewing the transcripts of ten participants. Moreover, during our transcription of the participants’ interviews, we found that two of the participants self-declared that they were experiencing financial hardship, but from their answers, this was determined not to be the case and they were dropped from the study. Therefore, interviews from ten participants were transcribed verbatim, and translated. The characteristics of the participants are summarized in the Table 1.

Table 1

The characteristics of the ten participants enrolled in this study.

Participant Label	Gender	Age	Year of Study	Place of Origin	Parent/family job
A	Male	21	4	Addis Ababa	Government
B	Male	23	4	Oromia region	Farmer
C	Male	24	4	Amhara Region	Self-employed
D	Male	23	4	Oromia Region	Farmer
E	Female	22	3	Oromia Region	Government
F	Female	21	3	Addis Ababa	Self-employed
G	Male	21	3	Amhara Region	Teacher
I	Male	20	3	Oromia	Farmer
H	Male	21	3	Addis Ababa	Self-employed
J	Female	20	3	Amhara Region	Teacher

Interviews

The semi-structured interviews were designed using Pierre Bourdieu’s concepts of social capital [11]. Two pilot interviews (not included in the analysis) were carried out to help refine the interview questions. One of the pilot interviews was conducted by the corresponding author with another colleague and the other one was conducted by the interviewer. An emphasis was placed on the lack of pocket money and its impacts on learning activities (S2 Appendix).

The interviewer, Debela Gela, was an instructor from the Department of Nursing, AAU. The interviewer had never taught the participants, nor had any role in the Medical Radiologic program, and was fluent in Amharic and Afaan Oromo.

The interviews began on January 28, 2019 and were completed on February 1, 2019. The participants were interviewed in their language of choice (11 in Amharic and one in Afaan Oromo). Interview length ranged between 10 and 25 min. Participants were thanked for their participation and were given a notebook and 50 Ethiopian birr worth of mobile cards each. These gifts were discussed and agreed upon by the researchers.

Data analysis

Researchers used a qualitative content analysis method [12-14], and thematically analyzed the interviews to explore the challenges that low SES health sciences undergraduate students face in their clinical year. The audio-recordings were transcribed verbatim and translated into English by the researchers. The data were assessed by researchers at multiple levels. The three levels of data analysis (code, category, sub-themes, and theme) were taken as appropriate for coding the data [14]. We held four meetings to transcribe, translate, code, categorize, and theme the data and we coded the transcripts based on our research objectives. The codes, themes, and categories were formulated and modified throughout the entire research process with the full participation of all researchers.

Results

Four themes emerged from our interviews with health sciences undergraduate students at AAU. These themes included: (1) The challenges in obtaining pocket money, (2) impacts of limited pocket money on essential activities and education, (3) the challenges of self-management, and (4) effects of limited pocket money on socialization. From our data analysis, sub-themes emerged from some of the main themes and categories were merged within some of the sub-themes. Our findings are depicted in Fig 1.

Fig 1

Conceptual framework for impacts of pocket money on learning activities: Ethiopian undergraduate health science students.

All participants discussed their experiences related to their lack of pocket money and conceptualized its impacts on their learning process. They also explained the means by which they overcame these problems in order to succeed in their studies. Participant responses were categorized into the aforementioned four themes and Table 2 displays their representative responses.

Table 2

Representative quotes, within the four identified themes, from health sciences students at Addis Ababa University regarding the effects of a lack of pocket money on learning.

Themes	Sub-themes	Verbatim Quotes
The Challenges in obtaining Pocket Money	Poor understanding of university expenses	'My parents do not know about handouts, assignments, and that I go to my clinical placements using transportation…they do not know and have no experience with higher education, and I am afraid to talk about all of these issues with them.' B
		‘…my parents assume that the government covers every expense, and think that there are no additional expenses which the government does not cover. I use an exercise book that was bought by my parents once a year when we were in lower and high schools. However, at university there are handouts which I pay to copy and my parents do not know about handouts, assignments, and that I am going to my clinical practice using transportation…they are not educated and they have no experience with university life. So there are a lot of problems.’ B
		'…from my parents’ perspective, they thought that there were no expenses in a governmental university and my opinion was the same at that time. We talked about the government covering everything. However, after coming here (AAU) it was evident that this was not the case.' D
		‘My parents have their business; they work at Merkato (the biggest market in the Addis Ababa, Ethiopia). Both are educated up until seventh grade. They do not care about education. It is up to me; I have to learn on my own. They assume that I need nothing.’ F
	Lack of family resources	‘My parents believe that we can be changed by education. However, they do not have and cannot provide me with better things. They give me what they can from what they have.' H
	Difficulty of asking for assistance	‘…you have to talk about the expenses at university and convince your families and others to get the money that you need. However, I lack these persuasion skills…the other possibility is that you have to ask for financial aid…unfortunately there is no well-established financial aid.' I
Impacts of limited pocket money on essential Activities and education	Transportation	‘… when I ran out of pocket money I went on foot. Sometimes I arrived late to class and this made me not as attentive. Other times I missed class completely.’ A
		‘… when I go to my clinical practice there is no convenient transport service. I remember that I had to go on foot many times. The clinic takes attendance, so I often had no choice but to go on foot.' D
		‘…during our first year as health science students there is no place that we need to go…; however, in the second year we start our clinical practice. The transportation service (which is provided by the government) is not suitable or available when we need it. Therefore, we are forced to pay for transportation'. E
	Food	‘Time goes by fast. For example, the purchasing power of our birr when we were in year one and two is not the same as when I was in year three and four…the price of food goes up’ A
		'…for example, I often eat in the cafeteria. However, since the food is not very good, I sometimes eat off campus, which can be expensive.' C
		My expenses increased after I joined AAU. Before I joined, I ate food from home. But, now I eat from the university cafeteria or have to buy food. When I cannot afford food, I do not eat. Thus, I am often hungry and cannot study.' H
	Educational Resources	‘I cannot access materials on the internet in my dormitory…so I have to wait until I come to another university campus to use the internet. Look, if I had enough money, I would just use my mobile phone’s internet access to get on the internet at any time and place.’ B
		‘…in Tikur Anbessa (one the campus where we had classes), Wi-Fi is available. However, when we go to Sefere Selam (the other campus where we live) there is no internet access and poor access to electricity. So, the university must work on this issue.’ C
		‘…at our campus there is no good internet connectivity…therefore, I use internet off campus by paying for it.' E
		‘…typically, we have to pay out of pocket for the small things like pens, notebooks, copying handouts, and printing assignments.' E
The Challenges of self-management during financial hardships and its effects learning activities	Independent decision-making	‘University is a place where a person confronts some of life’s greatest challenges. It is where one faces a crossroad: a way to bad and good. So, it is better to control oneself.’ A
		‘….You have to manage everything. Here, there is no family around to guide you. There are so many students and some smoke and drink alcohol. You have to decide your future for yourself.’ B
	Pocket money management	‘Let me tell you the truth. If I want to have what is necessary for me, the money that I get is not enough. But, I have to compromise some needs to survive.’ A
		‘… I do not spend for unnecessary things. When I run out of pocket money I borrow from my friends and give them back when I get money from my parents.’ B
		‘…everything you use comes out of your pocket. You cannot ask your family every day. You are given money for a period of time and must use this money for little and big things. Therefore, this is a challenge.’ E
		'…One has to use the small amount of pocket money received sparingly…' I
		‘…when I was with my parents, there were very few things I had to worry about. Here, I have to worry about how to manage my money…' J
Effects of limited pocket money on socialization	Establishing relationships	‘…sharing resources among students is good if a common understanding is created. At university, you have some students that have a lunch and some students that go without eating. Thus, sharing our resources can help alleviate these problems.’ F
		‘…you have to make good relationships with students if you want to succeed.’ G
	Participation in social activities	‘…here, I need a lot… I need money to go off campus for refreshments with my friends.’ C
		‘…when I failed to get what I want then I get depressed… For example, when my friends go to the cinema and I can’t go, I feel It.’ H
		‘… I may miss celebrating birthdays with my friends.’ J

Theme 1. Challenges in obtaining pocket money

Nearly all participants mentioned that getting enough money for their various expenses at university was a significant problem. Most students attributed this issue to a lack of awareness of university expenses among parents, absolute poverty, and an inability to request financial aid when needed (Table 2). This lack of pocket money for their daily expenses hampers student learning in a number of ways that will be outlined in subsequent sections.

Sub-theme 1: Poor understanding of university expenses

There is a common misunderstanding among parents and students (before they enter university) that once they join public universities, all of their expenses are going to be paid by the government. Parents assume that their child does not suffer from a lack of money and thus do not provide their child with the necessary funds to live comfortably. The belief that there are no expenses for food, transportation, and stationery materials is common. The students identified this as being the most important factor that contributes to their financial trouble.

Additionally, some families do not emphasize the importance of education, and hence, do not give sufficient support to their children. Given this attitude, some parents show a lack of interest in even discussing the financial problems that accompany university life. Participants described such family members as ‘education ignorant’. Students from these families not only feel financial pressure, but also feel unsupported, which can be detrimental to their ability to learn.

Sub-theme 2: Lack of family resources

Some students explained that even though some of their parents know the expenses that are associated with university life, their economic status does not allow them to cover those expenses. This financial burden is a significant obstacle for those students trying to get the most out of their education. These students are usually advised and taught by their parents how to withstand the financial challenges in order to be successful (this will be discussed further in Theme 3).

Sub-theme 3: Difficulty in asking for assistance

Participants explained that given their parent’s poor understanding of university expenses, they felt that they must develop the ability to persuade parents and family members to give them pocket money. Unfortunately, several participants did not ask parents or family members for money because of the lack of cultural acceptance for this sort of behavior. Thus, many participants identified asking for pocket money as a real problem and they mentioned that this contributed significantly to them being unable to afford what they need, which had a significant impact on their learning activities.

Theme 2: Impacts of limited pocket money on essential activities and education

Several study participants indicated that the lack of pocket money had a tremendous impact on their daily lives, particularly affecting their ability to accomplish their learning goals. Most participants stated that the small amount of pocket money that they had went to fulfilling their basic needs, leaving them unable to afford other very important materials and services. This included transportation costs, food expenses, the purchasing educational resources, and other smaller needs, which are discussed below (Table 2).

Sub-theme 1: Transportation

Many participants mentioned that most of their pocket money was spent on transportation. Data collected from the participants revealed that a lack of pocket money affects their capacity to secure convenient transport from where they live to where they learn; they identified that the campus where they live and the campus where they have class are far apart and the transportation that the university provides is usually unreliable. Moreover, students from Addis Ababa who were not entitled to get a dorm room and live with their parents get cash allowances instead of using the university cafeteria and dormitory as part of the cost sharing regulations; however they do not receive any money for transportation. For health sciences students, this problem is compounded by the need to absorb the cost of transportation to their clinical practice away from the university campus. The participants in this study indicated that when students run out of pocket money and are unable to afford transportation, they either arrive late or miss class altogether. The participants also indicated that arriving late negatively impacted their concentration and thereby their ability to learn.

Sub-theme 2: Food

Food is one of the biggest expenses for university students. Several issues that were described by participants included an unfavorable timing of food service at the university cafeteria, unpalatable cafeteria food being served, and the need to buy food during times of illness, during clinical placement, and at night. They explained that they typically buy food on campus when they have money, but simply deal with their hunger when they run out of pocket money. These participants indicated that their hunger made it very difficult to study or attend classes.

Sub-theme 3: Educational resources

Educational resources are another significant drain on a student’s pocket money. The educational resources on which participants spent their pocket money included necessities like stationery materials and internet access.

Category 1: Stationery materials. Participants indicated that they spent money on buying pens, notebooks, copying and printing handouts and printing assignments almost daily. Several participants identified that their inability to afford educational materials affected their overall learning ability.

Category 2: Access to the internet. Many of the participants specified that the campus where they live does not provide internet access, and thus they needed to either use mobile data or go to an internet café, both of which require money. Here, the participants identified internet access as an important part of their learning process. Unfortunately, they do not have access to free internet services and are generally unable to pay for it out of pocket.

Theme 3: The challenges of self-management

Several participants mentioned that leaving their family and living at the university was the most challenging aspect of getting their education. Most of them discussed it as it relates to challenges of self-control and pocket money management, with some participants indicating that these were the keys to success at university (Table 2).

Sub-theme 1: Independent decision making

University is a place where students need to exercise self-control. Most of the participants indicated that when someone does not have enough pocket money and has poor self-control it is very difficult to be successful at university. In addition, they mentioned that good self-control helps to reduce the stress that develops due to a lack of pocket money and therefore improves proper learning.

Many participants focused on self-management and its importance in being successful at university. They believed that, even though many students have financial problems, it is possible to be successful at university if self-management is practiced effectively. Interestingly, most of the participants mentioned that they have developed good self-management skills.

Sub-theme 2: Pocket money management

The effective use of the small amount of pocket money that the students have while in university is very important. Even though some participants mentioned that it is difficult to manage their money, several participants discussed that planning ahead and giving priority to urgent needs is crucial. Those who possessed good pocket money management described that their financial pressures were lessoned by their cautious behavior.

Theme 4: Effects of limited pocket money on socialization

Several participants believed that success in pursuing a higher education is highly dependent on having a reliable network of friends. They stated that their lack of pocket money affected their ability to make connections with peers and noted that the lack of a social life affected their learning activities. A few participants indicated that meeting with other students and understanding each other’s financial status is very helpful in creating a support network. Therefore, a student’s inability to go to the cinema, and/or attend ceremonies and other celebrations with their peers often led to students feeling depressed, which negatively affected their learning activities (Table 2).

Sub-theme 1: Establishing relationships

Participants indicated that having compatible friends is of paramount importance to their success at university. They felt that making good friendships with classmates increases one’s chances of educational success. Participants also mentioned that leaving their family and entering new environments carries with it many challenges that they believe can be reduced if they have compatible friends. Some mentioned that friends are very helpful when one runs out of pocket money and also when you need help academically. Therefore, having good friends is supportive in times of financial need; unfortunately, they felt that it is difficult to make and maintain friends without having pocket money.

Sub-theme 2: Participation in social activities

A lack of pocket money affects student relationships. The participants of this study identified that they have difficulty either making friends or interacting with existing friends without pocket money. Most of them mentioned that they could not go out with their friends as they could not afford to pay for tea or coffee. Moreover, some participants mentioned that when they were unable to afford refreshments or go out with their friends they became depressed and stressed, which decreased their academic drive and success.

Discussion

Various factors contribute to student success at university. Here, we investigated how a lack of pocket money influences student learning by discussing the topic with health sciences students in their clinical year at AAU. This study revealed that student financial hardships at AAU occurred mainly due to the lack of understanding about university expenses from families, familial poverty, poor self-management, inhibited social interactions, and poor university administrative services. This study also indicated that the government’s cost-sharing system does not fully support financially disadvantaged students. Moreover, we found that the lack of student pocket money negatively impacted student learning both directly (e.g., being unable to afford internet or other materials necessary for learning) and indirectly (e.g., increasing stress and depression in impacted students), and is a substantial concern this student population.

This study showed that the familial habitus of the participants’ affected their life at university. Participants described that many of their challenges originated from the significant changes that accompanied moving away from their home and into a university environment. For instance, they went from having their lives mainly managed by their parents and families to self-management. Moreover, they went from living with students with similar lifestyles to living with students of different backgrounds. The ease with which this transition occurs is dependent on the student’s social class and related cultural capital, as well as their habitus, which consistently constrains and structures a students’ college adaptation. With all these changes, the lack of pocket money adds another stress to their university life.

Several participants mentioned that the absence of a government policy that entitles students to get financial support during their undergraduate studies increased their financial hardship, which is similar to the findings of a study done in the United Kingdom [8]. These financial stresses can be buoyed by a positive social structure. For instance, a previous study demonstrated that students with a low SES and good self-management benefited from gaining social capital [11]. Findings from our study support this idea and indicate that there does indeed appear to be a link between social bonding and achieving relief from financial crisis.

This study also found that students perceived self-management as the most important thing to combat the financial pressures encountered at university. Bourdieu’s concept of habitus, describing the way of acting, feeling and being, is related to the participants’ idea of self-control and pocket money management.

Similar to a study done in Australia [15], most participants in this study had expected financial hardship to be a substantial concern at the beginning of their degree, however, many of them experienced acute financial hardship during clinical placements. We found that students, who relocated for placements, were economically disadvantaged and experienced increased financial stress [6]. Furthermore, this study indicated that financial stress increased student stress overall, which was also observed in Greece [16] and in another locations in Ethiopia [17].

Unlike the studies presented by Bennett [18] and Trombitas [19], this study does not support the idea that financial pressure causes students to drop-out or quit their education. Instead of dropping out, the participants of the study reported different methods of overcoming their acute financial problems, including borrowing from friends for urgent needs and developing strong self-management skills (i.e., prioritizing their basic and urgent needs and compromising other non-essentials). Further research is necessary to determine the relationship between financial hardship for Ethiopian health sciences undergraduate students and dropout rates.

The importance of friends and social networks while in university can perhaps be understood with the concept of `social capital’ [20], which is said to be important in communities for overcoming social exclusion. It is used to signify the extent to which people have access to networks, their levels of political and civic engagement, and their membership in various associations [21]. Social capital—or mutual support—seems to be occurring within this study, enabling students to overcome the internal and external problems that they face, including the lack of pocket money. Social relations are shaped largely by the habitus [22], and therefore it is instructive to observe the extent to which the institutional habitus and associated practices can challenge the familial habitus (which Bourdieu shows to be more influential in France).

This study indicated that even though many families misunderstood the expenses associated with higher education and this affected student learning, the students worked diligently to overcome these challenges and often relied upon social circles to help overcome acute financial stress [23].

Conclusions

The current identified the challenges that undergraduate health sciences students faced due to acute financial hardships by exploring their perceptions and experiences. The main limitation of this study is that it included students from one department and one institution, with small number of participants. However, with this limitation, the current study contributes to a broader overview of the effects of financial hardship on undergraduate academic success and provides a better understanding of its causes. It would be interesting to compare the perceptions and experiences of other students who do not have acute financial problems in the field of study to determine key differences.

The results of this study suggest that policy improvements should occur at the university and national level. With respect to the latter, the Ethiopian cost-sharing policy should be revised to allow for loans or scholarships to students, as well as paid clinical year internships for undergraduate health sciences students. Addressing student financial hardship, especially during clinical placements, is essential for improving the student experience and increasing student competency.

Moreover, creating awareness about student expenses at university within the community will likely improve students’ financial status. Additionally, teaching students self-management skills is also another area that could increase student success. Future studies should further investigate the factors that contribute to student financial hardship in the health sciences.

Information leaflet for participants.

(DOCX)

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Semi-structured interview guide.

(DOCX)

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(DOCX)

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Semi-structured interview coding.

(DOCX)

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6 Aug 2020

PONE-D-19-29025

Title:  Exploring the effects of lack of pocket money on undergraduate clinical year health science students’ learning activities: a Qualitative Study

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Reviewer #1: Yes

Reviewer #2: No

**********

5. 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: Dear authors, thank you for producing this very interesting descriptive study. Your study is a descriptive study based on self-reported challenges in receiving an education due to financial difficulties from 10 health sciences students in Ethiopia. Your study highlights the challenges which Ethiopian health sciences students face due to financial difficulties

The framework within which you conducted the interviews, followed by transcribing, translating, coding and categorizing the data collected, was structured and systematic. The descriptions of what students expressed were interesting and provided granular detail on the challenges they faced.

Some suggestions on improvements:

1. The prose can be edited for clarity. Also edit for grammatical and typographical issues.

2. The conclusion has to be supported by robust data. Consider amending the conclusions to suit the amount of data you have. Eg.To ask the government to adjust certain policies based on interviews of 10 students may not be justified.

3. Add in some benchmark information such as the monthly income of Ethiopians, the school fees, cost of transport etc, so that international readers can understand the context of figures you cited (eg. what is the value 500 Ethiopian Birr).

4. A more in-depth discussion on the significance of each of the Themes and Categories should be done.

5. Consider making a Figure or Diagram to depict your findings graphically

6. Consider clarifying the recruitment process of your interviewees in terms of anonymity, voluntary participation, why they need to be rewarded with mobile cards and money and whether they may be disadvantaged in any way should they not participate. This is important as they may be considered a vulnerable population.

7. Consider increasing the sample size, and also quantifying the challenges that they face in terms of how many respondents face each of the challenges you raised, and also rank these challenges in terms of importance to them. This can be done in subsequent studies.

Reviewer #2: This paper has the potential to make an important contribution to the understanding of the impact of financial limitations on the education of health science students in Ethiopia. It presents qualitative analysis of interviews with students.

However, further clarification of methods is required. In addition, the structure should be revised to enhance the clarity of the manuscript.

Abstract

Background- should include a sentence on previous data and the gap in knowledge

Objectives- tightened up to be more specific

Methods- should start with we conducted 10 semistructured interviews of a description of subjects, time course, place.

Conclusion- should start with the conclusion and then advance to potential solutions. The solutions in abstract should have been discussed in the paper (e.g. educating students on money management)

Body

Introduction

Should include previous data and studies on the challenges that students face and areas of potential misunderstanding (if documented) and then discuss the gap in knowledge

Lines 68-70; is there a reference

Lines 70-71; please explain what cost-sharing is

Line 72; the cited article does not address pocket money

Line 75; the population belongs in the methods

Method

This requires major revision and clearly delineated sections- such as Participants/Recruitment/Ethical considerations, Interviews and then data analysis.

Participants- who was eligible, Recruitment- who were they recruited; Lines 96-96-98 belong in results

Interview-needs more information about the design of interview guide; it should be submitted as a supplement. Pierre Bourdieu's concept of social capital should be described further in that section.

How was interviewer selected. The information about languages used should be in results, as also interview length.

Data analysis- what technology was used for transcription?

Delete lines 115-116 because redundant.

How did the group come to consensus on codes?

Was saturation achieved?

Table 2 should be under results- with elimination of column that includes codes. Headings should be domain, theme, representative quotations.

Consider substituting

"Lack of family resources" for "Poverty"

"Difficulty asking for aid," for "poor skills of asking money

"Transportation" for "transportation expenses"

"Food" for "Food expenses"

It is unclear how the theme of "self-control" or "social life and learning activities" relate to financial limitations

The segment summarizing the themes 127-131 belong in the results

Lines 132-135 are redundant and should be deleted

The section on theoretical approach 136-154 should be deleted

Results

Start with the themes and domains that emerged.

The theme's and subcategories would be better served by capitalizing domains (themes) and using italics for "subcategories" or themes. Because the quotes are already included on the table which will be moved to this section, no need to include again in the narrative. Themes need further detail and elaboration; they are unclear.

Discussion-

The connection to findings and Bourdieu's theory need further clarification. It is difficult to understand. Concepts are introduced in the discussion which were not described in the results (e.g. lines 337-341)

Conclusion-

It is unclear how authors concluded that lack of funds adversely impacted clinical skill acquisition.

Please specify how the Ministry of Science and Higher Education should revise the Ethiopian cost-sharing system.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

22 Sep 2020

Response to reviewers

Subject: Point-by-point response to the reviewers’ comments

First of all I would like to offer my sincere gratitude to academic editor and the reviewers of the at PLOS ONE journal. Please find the point-by-point response provided below.

Response to Reviewer #1:

The prose can be edited for clarity. Also edit for grammatical and typographical issues.

• The authors have revised the manuscript several times for grammatical errors, language usage and typographical issues and incorporated all changes. As well professional scientific editing service (Excision editing) has edited the manuscript. All changes are included in the revised version of the manuscript.

The conclusion has to be supported by robust data. Consider amending the conclusions to suit the amount of data you have. Eg.To ask the government to adjust certain policies based on interviews of 10 students may not be justified.

• We have revised our conclusion of the study. Data presented in the study used to dram conclusion. Example, we added these findings indicate that the department, the school, the college, and the university need to find a way to help students afford university, outside of their room and board. Moreover, creating awareness about student expenses at university within the community will likely improve students’ financial status. Additionally, teaching students self-management skills is also another area that could increase student success. Future studies should further investigate the factors that contribute to student financial hardship in the health sciences.

Add in some benchmark information such as the monthly income of Ethiopians, the school fees, cost of transport etc, so that international readers can understand the context of figures you cited (eg. what is the value 500 Ethiopian Birr).

• The column indicating average monthly income of students is deleted as there is no established benchmark.

A more in-depth discussion on the significance of each of the Themes and Categories should be done.

• The result has been modified significantly. We have thoroughly discussed each themes, sub-themes and categories.

Consider making a Figure or Diagram to depict your findings graphically

• The importance of depicting the findings graphically is considered and we developed a conceptual frame work. The conceptual frame work is added as Figure 1 in the result section.

Consider clarifying the recruitment process of your interviewees in terms of anonymity, voluntary participation, why they need to be rewarded with mobile cards and money and whether they may be disadvantaged in any way should they not participate. This is important as they may be considered a vulnerable population.

• Participant recruitment process discussed thoroughly in the method section. The rewards are not communicated before the interview and to give after interview is decided by authors. Each participant was informed during consent that participant or not participating will not affect them.

Consider increasing the sample size, and also quantifying the challenges that they face in terms of how many respondents face each of the challenges you raised, and also rank these challenges in terms of importance to them. This can be done in subsequent studies.

• The small size is considered as limitation of this study and we consider other future study.

Response Reviewer #2

Background- should include a sentence on previous data and the gap in knowledge We added the established data.

• The cost of university presents various challenges with regards to students’ daily learning activities. This is particularly evident in developing countries, where higher education students face acute financial problems that greatly affect their daily educational activities. And gap of study in Ethiopian context is added as: health sciences students have additional costs during their clinical placements that are above the common expenses for university students.

Objectives- tightened up to be more specific

• Objectives are modified as: Authors aim to explore the challenges that undergraduate health sciences students in their clinical year face with limited pocket money, as well as how students perceive these limited funds affecting their learning activities and their ability to meet challenges.

Methods- should start with we conducted 10 semi-structured interviews of a description of subjects, time course, and place.

• The place and time of study specified in the method. As well the number of participants and tool of data collection discussed.

Conclusion- should start with the conclusion and then advance to potential solutions. The solutions in abstract should have been discussed in the paper (e.g. educating students on money management)

• We modified the conclusion section and added: Undergraduate students faced many challenges due to the lack of pocket money. Due to challenges students faced affects students learning activities either directly or indirectly. Additionally, teaching students self-management skills is also another area that could increase student success

Should include previous data and studies on the challenges that students face and areas of potential misunderstanding (if documented) and then discuss the gap in knowledge.

• Previous studies on students of low socioeconomic status and the international data have been assessed and the Ethiopian context was analyzed. The absence of study on the matter in Ethiopia is taken as a gap.

Lines 68-70; is there a reference

• Lines 68-68 are omitted.

Lines 70-71; please explain what cost-sharing is

• Cost sharing in Ethiopia is defined. Ethiopian Higher Education Proclamation and the Cost Sharing Regulations: provide room and board, and covers the tuition fees for those who students who pass Ethiopian Higher education entrance examination and joined public universities, however it does not provide students with pocket money for other expenses.

Line 72; the cited article does not address pocket money

• The referenced article is corrected to: Bonke J. Do Danish children and young people receive pocket money ? Rockwool Foundat Res Unit. 2013;(57).

Line 75; the population belongs in the methods

• Line 75 is omitted.

Method: This requires major revision and clearly delineated sections- such as Participants/Recruitment/Ethical considerations, Interviews and then data analysis.

• The method section is revised several times. And subsections are also well organized and enriched. Participants- who was eligible, Recruitment- who were they recruited; Participants selected using purposive sampling technique. Students who show financial support and submitting letter to the department in order to get financial support and those who declare themselves as financially challenged students were eligible.

Lines 96-96-98 belong in results

• Lines 96-98 have been modified.

How was interviewer selected? The information about languages used should be in results, as also interview length.

• The interviewer, Debela Gela, was an instructor from the Department of Nursing, AAU. The interviewer had never taught the participants, nor had any role in the Medical Radiologic program, and was fluent in Amharic and Afaan Oromo.

Data analysis- what technology was used for transcription?

• Authors transcribe manually. Three of the authors transcribed each interview individually and then finally come to consensus after several discussions over transcripts.

Delete lines 115-116 because redundant.

• Lines 11-116 are deleted.

How did the group come to consensus on codes?

• As we with transcription, authors code separately and then came together to discuss and combine the codes. Through several discussions consensus has been reached.

Was saturation achieved?

• Based on our objective the data became saturated.

Table 2 should be under results- with elimination of column that includes codes. Headings should be domain, theme, representative quotations.

• Table two moved to under result section.

• The column containing codes is deleted.

Consider substituting

"Lack of family resources" for "Poverty"

"Difficulty asking for aid," for "poor skills of asking money

"Transportation" for "transportation expenses"

"Food" for "Food expenses"

• We have substituted accordingly.

It is unclear how the theme of "self-control" or "social life and learning activities" relate to financial limitations

• Participants of the study stated that their lack of pocket money affected their ability to make connections with peers and noted that the lack of a social life affected their learning activities. A few participants indicated that meeting with other students and understanding each other’s financial status is very helpful in creating a support network. Therefore, a student’s inability to go to the cinema, and/or attend ceremonies and other celebrations with their peers often led to students feeling depressed, which negatively affected their learning activities.

The segment summarizing the themes 127-131 belong in the results

• The section is moved into result section

Lines 132-135 are redundant and should be deleted

• Lines 132-135 are deleted.

The section on theoretical approach 136-154 should be deleted

• The theoretical approach section is removed.

Results: Start with the themes and domains that emerged

• The result section is modified significantly. It is started with major themes and explained. And diagram depicting the findings is developed.

The theme's and subcategories would be better served by capitalizing domains (themes) and using italics for "subcategories" or themes. Because the quotes are already included on the table which will be moved to this section, no need to include again in the narrative. Themes need further detail and elaboration; they are unclear.

• Themes, sub-themes and categories are edited accordingly. And quotes are no longer used in the narratives.

Discussion-

The connection to findings and Bourdieu's theory need further clarification. It is difficult to understand. Concepts are introduced in the discussions which were not described in the results (e.g. lines 337-341)

• The discussion section has been modified and enriched. It is edited for misunderstandings and more clarified.

Conclusion-

It is unclear how authors concluded that lack of funds adversely impacted clinical skill acquisition. Please specify how the Ministry of Science and Higher Education should revise the Ethiopian cost-sharing system.

• Our data show lack of pocket money affects student’s class attendance, clinical placement attendance, and prolonged studying. This believed that students, miss learning different cases on daily basis as they arrive late, stay there while hungering and total absent. Based on participants’ ideas, The Ethiopian cost-sharing policy should be revised to allow for loans or scholarships to students, as well as paid clinical year internships for undergraduate health sciences students. Addressing student financial hardship, especially during clinical placements, is essential for improving the student experience and increasing student competency.

Submitted filename: Response to Reviewers.docx

Click here for additional data file.

22 Oct 2020

PONE-D-19-29025R1

Lack of pocket money impacts on learning activities: Ethiopian undergraduate health science students

PLOS ONE

Dear Dr. Kumsa,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

The authors should be commended for providing this revised manuscript. It is much easier to read and the data are presented with better clarity. However, as outlined by reviewer #2, there are still a few points that need to be addressed that will further improve the paper.

Although the investigators had professional assistance in revising the paper, there are a few areas where the punctuation is incorrect. Specifically, when "however" is used as a conjunction, the proper punctuation is  "first sentence; however, second sentence." In addition, in figure 1, I don't understand why there are five boxes interacting with pocket money when four themes were identified.

Please submit your revised manuscript by Dec 06 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Richard Bruce Mink

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. 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: Dear Authors, thank you for your efforts in replying to our comments and in improving the manuscript. You have produced an interesting article that will give insights to how financial difficulties affect undergraduate health sciences students in Ethiopia.

Reviewer #2: This is MUCH better! It is understandable. Now just needs some refinement, especially the discussion.

1. The discussion needs further organization.

Paragraph- 1 286-292 rehashes what was performed. Key findings (e.g. summarized in the conclusion) should be emphasized and should be the structure upon which each paragraph is based. What is most interesting about the manuscript is that it demonstrates that financial hardships are common and adversely impact many aspects of the students’ education and experience. In addition, the authors identify causes leading to potential solutions. The authors should capitalize on these in their discussion.

The application of Bordeau’s theory remains difficult to understand.

2. Conclusions- should summarize implications and next steps

3. Table 1- the participant labels should be revised so they are alphabetical, with subsequent changes in Table 2.

4. Results p 8- some of the theme titles need further refinement, suggested below. Changes made throughout subsequent narrative, tables, figures.

Four themes on the impact of limited pocket money

(1) The challenges obtaining pocket money

3. Difficulty asking for assistance

(2) impacts of limited pocket money on essential activities and education

(3) the challenges of self-management

1. Independent decision-making

(4) effects of limited pocket money on socialization

1. Establishing relationships

2. Participation in social activities

5. Figure 1 p 8 This figure outlining the conceptual framework was an excellent addition. However, the directionality of the relationships (arrows) were unclear. Is central circle/spoke- “limited pocket money”? For some it aligns with themes, for others it doesn’t

Minor

Page 15, line 171- the belief that there are no expenses for food, transportation and writing materials is common.

Page 16- lines 207-210 revise.

Results- Do not reiterate (Table 2) in each subtheme. Introduced in results- may introduce in themes,

Page 6, lines 106-108- Thematic saturation was reached after reviewing the transcripts for 10 participants.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

4 Nov 2020

Rebuttal letter

To academic editor:

Figure 1. There are four themes emerged from the data. In the conceptual framework we tried to show the relationship between limited pocket money and learning activities. Some of the themes emerged are factors leading to limited pocket money, some are emerged due to lack of pocket money and others are voce-versa. For instance, poor understanding of university expenses, lack of family resources and difficulty of asking for aid are the main factors causing lack of pocket money. While, maintaining social life and self-management could lead to limited pocket money and limited pocket money also lead to poor social life activities and poor self-management. On the other hand, limited pocket money leads unable to afford very important needs. Finally, the figure shows that limited pocket money and inability of affording very important needs Impacts on Learning Activities. Learning activities are affected by missing class, coming late to class, coming late to clinical, placement, missing clinical placement and loosing attention.

We correct punctuation whenever however is used.

To reviewer 2

� The central circle was pocket money and changed to limited pocket money. The directions show the relationship between limited pocket money, emerged themes and its impacts on learning. In some the limited pocket money has unilateral direction and in others bilateral and vice-versa.

� Table 1 and 2 are modified so that the participants’ orders are listed alphabetically in both tables.

� The discussion part is modified accordingly. The main findings are emphasized. And the implications and future steps are capitalized in the conclusion.

� We found the suggestion for improvement of theme titles and modified accordingly.

� Page 15, line 171 is changed accordingly

� Page 6, lines 107-108 is modified to thematic saturation is reached after reviewing the transcripts for ten participants.

� The first paragraph of the discussion part is modified. We tried to focus on the main findings in discussion followed.

� The conclusion summarized with implications and future steps in solving the raised in the paper.

� Referencing (table 2) redundantly in subthemes is correct, so table 2 is referenced in the result section and main themes.

Submitted filename: Rebuttal letter.docx

Click here for additional data file.

12 Nov 2020

PONE-D-19-29025R2

Lack of pocket money impacts on learning activities: Ethiopian undergraduate health science students

PLOS ONE

Dear Dr. Kumsa,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

While this revision has addressed the reviewers' concerns and the paper reads much better, there are a few more corrections needed. These relate to sentence construction and appropriate punctuation and include:

Abstract

page 3, lines 50-51: change sentence to "The challenges students faced affected their learning activities, either directly or indirectly."

page 3, line 55: add a period at the end of the sentence

Introduction

page 4, line 74: correct punctuation- "...examination and joined public universities; however, it does not...."

Methods

page 6, lines 107-108: change sentence to "...we realized that thematic saturation was reached after reviewing the transcripts of ten participants."

page 7, line 137: delete the comma after process

Results

page 15, lines 164-165: delete bold

page 15, line 182: correct point size of "how."

Discussion

page 22, line 318: add comma: "...beginning of their degree, however, many of them...."

page 23: lines 342-343: Rewrite this sentence because I do not understand it: "This is similar to a previous study title on Causes and Consequences of Higher Education:"

I suggest that you have an expert in English review the paper before you submit the revision.

Please submit your revised manuscript by Dec 27 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.

A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.

An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Richard Bruce Mink

Academic Editor

PLOS ONE

[Note: HTML markup is below. Please do not edit.]

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

20 Nov 2020

Response to Academic Editor

• Om page 3 we changed the sentence and modified it.

• We added a period on page three at the end of the sentence.

• On page 4 we corrected the punctuation accordingly.

• On page 6 we changed the sentence to “Our data starts to be similar after five participants were interviewed. Thematic saturation was reached after reviewing the transcripts of ten participants.”

• On page 7, comma is deleted after process.

• On page 15, the bold is deleted.

• On page 15, the pint size of how is corrected.

• On page 22, comma has been added.

• On page 23, the confusing sentence was deleted.

The titled is modified based on professional editor comment. Therefore the tile is modified from; Lack of pocket money impacts on learning activities: Ethiopian undergraduate health science students to Lack of pocket money impacts Ethiopian undergraduate health science students learning activities

Table 1 is formatted by professional editor and accepted.

Submitted filename: Rebuttal letter.docx

Click here for additional data file.

25 Nov 2020

Lack of pocket money impacts Ethiopian undergraduate health science students learning activities

PONE-D-19-29025R3

Dear Dr. Kumsa,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Thank you for having a professional editor review the manuscript.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Richard Bruce Mink

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

27 Nov 2020

PONE-D-19-29025R3

Lack of pocket money impacts Ethiopian undergraduate health science students learning activities

Dear Dr. Kumsa:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Richard Bruce Mink

Academic Editor

PLOS ONE