Review for 10.1186/s12876-020-01504-8 (2020)

Reviewer’s report
Title: 
Hepatitis C virus infection and its associated factors among prisoners in a
Nigerian prison 1Ifeyinwa M. Okafor *, Solomon O. Ugwu and 1, U. Henshaw
U. Okoroiwu
Version: 
1 
Date: 
23 Sep 2020
Reviewer's report:
1. One hundred and forty-two (142) prison inmates within the age range of 18 -
50 years and above were recruited for this study 
In Methods "the sentence is not clear and the author should consider reframing
the sentence."
2. In methods: "The study was aimed at evaluating the prevalence of HCV
among prison inmates in Calabar, Cross River State, Nigeria and the associated
factors". 
What are the associated factors, that must be clearly documented.
3. In results: "Bivariate logistic regression showed that tattoo/scarification,
injection drug use, history of blood transfusion, sexual experience, shaving
equipment sharing and multiple sexual partners were not risk factor for
distribution of HCV prevalence in the studied population (p>0.05)". 
And 
In conclusion: "Attitude and behaviors by inmates such as tattooing/scarification,
injection drugs use, sharing of shaving equipment, multiple sexual partners
should be discouraged." 
These two statements from results and conclusions are contradictory
4. In background: "Hepatitis C virus (HCV) is a blood borne pathogen mostly
transmitted via percutaneous exposure [1] that results in inflammation of the
liver and is linked to a variety of adverse health outcomes including
hepatocellular cancer and cirrhosis" 
Details of "Variety" of adverse health outcomes should be mentioned
5. However, in practice, this basic principle is scarcely applied in real life and
prisoners in most countries have lesser possibility of medical assistance than the
non-incarcerated citizens [12]. 
Reference of first underlined statement is missing
6. Previous studies have shown that HCV infection is more frequently detected
in them than the general population [21,22,23]. 
"Them" 
doesn't imply anything. Clearly mention the population source
7. Who did randomization ?.
8. The knowledge of the epidemiology will aid in design and implementation of
public health policy geared towards reducing prison "reservoir" of infectious
diseases and harm to inmates. 
Grammar correction: Will aid in designing
Clearly mention HCV in this statement: "reservoir" of infectious diseases
Explain in detail: harm to inmates.
9. This study took a descriptive cross sectional approach using multi-stage
sampling technique and was conducted from May to October 2018 
Mention year of May month
10. On the day of the data collection, the prisoners were first stratified into male
and female; the females were all recruited (owing to the small number) 
Grammar correction: All females were recruited.
11. This study was conducted in Calabar, Cross River State. Cross River is a
state located in Southern Nigeria in the Niger Delta region [24] 
Grammar correction required
12. It is bounded in the north by Benue State, the west by Ebonyi and Abia State,
the east by Cameroon Republic and the south by Akwa Ibom and the Atlantic
Ocean [25]. The State has an area of 21,787km2 and a population of 2,892,988
(2006 census) [26] distributed across 18 Local Government Areas (LGAs)
[26,27]. 
Description of state can be reduced. As it is not related to study
13. A structured questionnaire was administered to all participating prison
inmates to obtain socio-demographic data of the study participants. 
Questionnaire cannot administered: 
14. The questionnaire was structured to bear minimal identity as names were not
included, rather serial number. 
Meaning and Elaboration of above statement should be included
15. Ethical approval was obtained from Cross River State Ministry of Health.
Informed consent was obtained from the prisoners before enrolment. 
Ethic committee reference number is missing
16. ASSAY PROCEDURE: The HCV assay was performed using serum/plasma
immunochromatographic rapid diagnostic test (RDTs) for HCV (Anti-HCV) by 
AND IN LAST LINE 
Serum sample was used for the assay. 
Correction: 
"Plasma" should be omitted 
17. Prevalence of HCV in this study was observed to be higher among males
(31.0%) than females (15.4%). However, the difference was not statistically
significant (p>0.05). Puga et al., [13] and Adjei and colleagues [1] reported
similar trend but a significant higher value in the males than females. Conversely
Poulin and colleagues and Vescio et al., reported higher values for females than
males [51,52]. This difference may be attributed to injection drug use practice
(19%) in our studied population which was absent in the prisoners in Nassarawa.
* Opinions are not evidence, hence statements based on opinions must be
removed.
* Also explain the reasons for contradictory results from previous studies
18. Surprisingly, the highest prevalence was observed in those incarcerated < 12
months periods. This points towards the conclusion that majority of the inmates
in our study population probably were infected before incarceration. However,
contrasting report has linked longer incarceration to higher risk of HCV
prevalence [13]. 
Results are contradictory: possible reasons
19. More so, the choice of HCV screening test method could as well influence
the variations observed. 
Explain with references, not with opinions 
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes