At the outset, I congratulate the authors for reporting the first systematically obtained data from three African countries concerning the use of S. boulardii in acute gastroenteritis among children. However, there are areas of concern in the present study, including the methodology and presentation of the scientific data, which need both clarification and improvisation. I would suggest authors to take the help of a qualified statistician to further refine the data presentation. Some of the specific comments are as follows. 

1. Definition of diarrhea in breastfed infants is subjective and not clear… why are symptoms of dehydration considered for patient inclusion only in this age group??
2. Were all recruited children previously healthy? Whether children with chronic diseases, including HIV, excluded?
3. The term ‘normal nutritional status’ needs qualification.
4. Whether a written consent obtained in the local language…? Ethical approval was provided by what body in these set-ups? A statement addressing these issues needs to be included.
5. It is important to let the reviewer know the names of the Hospitals where the study was conducted.
6. It is not clear whether the study was community-based or hospital -based (primary care or referral centre??) (26% of the investigators were medical assistants in Togo, whereas only doctors and nurses recruited children in Benin)
7. It’s essential, at the submission stage, to reveal the affiliations of all the co-authors. A statement mentioning the contributions of each co-author is desirable.
8. It is stated in Methods that patient recruitment and follow-up were performed by health personnel of different cadre. Was any kind of training provided for health assistants/midwives? A statement clarifying who supervised the data collection process is warranted. Was the data entry verified by a second investigator?
9. Statistical method section is untouched upon…It needs mention as “limitations of the study” in the discussion part
10. Since the primary objective of the study was to evaluate the use of Saccharomyces boulardii in the absence of a planned control-group, collecting the information on symptoms of intolerance could have added more value to this descriptive study. Also, vomited and/or skipped doses are not reported
11. The trial medication: whether the storage, quality control, and distribution-related expenses handled by the local governments or pharma companies, or the authors themselves?

Discussion

1. The sentence ‘previous campaigns to raise…..’(paragraph1, line 10 in Discussion section) is not related to the study. I would vomit this sentence..
2. The discussion section needs to be written analytically rather than mere reporting of the statistical numbers from other studies. Majority of the studies quoted by the authors are RCTs where we have control groups to compare the results. It is important to quote descriptive epidemiological studies for comparing the results of the present study….. I would suggest the authors to restructure whole of the 2^nd paragraph in discussion section. 
3. The age group studied here is broad (1-15 yrs) and etiology of diarrhea not looked into…These need mention under “limitations of the study”.

Trained at a tertiary care center in a developining-country set up for three years; involved in the sample and data collection process in an institutional study of acute diarrhea in children.