Reviewer ’s report  
 
Title: Factors affecting cer vical cancer screening uptake, vis ual inspection with acetic acid 
positivity and its predictors among women attending cervical ca ncer screening service in Addis 
Ababa, Ethiopia  
 
Version: 0 Date: 31 Oct 2019  
 
Reviewer: Paolo Giorgi Rossi  
 
Reviewer's report:  
 
Here and in all the text, change "magnitude of lesions" in "VIA  positivity".  
 
 
Methods  
 
Please define the endpoint of the quantitative study: the authors state "status of precancerous 
lesion of the cervix" how was it determined? VIA only? Given that the protocol reported in the 
methods suggests a referral to Pap test for VIA positive women, d id you included VIA positive 
Pap negative women? Or histologically confirmed lesions? If so, what did you considered a 
"precancerous lesion"? usually only high grade lesions are considered real precancerous lesions.  
 
Please explain better what is the proto col for VIA positive, if any; if there is no standardized 
protocol, report the most common options. You mention a referral to cytology, this protocol is 
not really a standard for VIA based screening.  
 
I did not find the description of how the sample was se lected and how the individuals were 
contacted for the qualitative study. In general the description of the qualitative part of the study 
is not detailed.  
 
In the statistical methods, I suggest not to define a significance threshold since the study is 
explo rative. The interpretation of an association with p -value 0.051 or p -value 0.049 should be 
very similar in a study like this, while defining a significance threshold of 0.05 you are stating 
that in the first case you accept the H0 hypothesis and in the sec ond you refuse it… such a 
formal statistical test is needed only when you have to register a drug.  
 
Please describe how did you take into account the effect of multi -step sampling on variance. I do 
not see any mention in the description of the model confide nce interval estimate.  
 
Please report the intracluster correlation for each analysis. This is useful for other researchers 
who must plan similar survey.  
 
 
Results  
Table 1, table 2 and figure 1 can be merged in only one table. Figure has no added value 
compar ed  with the table. Confidence interval, computed taking into account the design effect on 
variance estimate due to the multistep sampling strategy, must be reported  for each proportion.  
Please report how the 95%CI have been computed.  
 
 
Discussion  
 
Page 14  first paragraph. There are several imprecise statements. I suggest too simply note that all 
these associations have been already observed and that they are consistent with what we know of 
the etiology and natural history of the disease.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please  specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written Engli sh 
Please indicate the quality of language in the manuscript:  
 
Not suitable for publication unless extensively edited  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares  in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you recei ved reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
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