Title: Factors associated with uptake of Human Papilloma Virus Vaccine among school girls
aged 9-14 years in Lira City northern Uganda: A cross-sectional study
Version: 4 Date: 28 Apr 2023
Reviewer:  Arthur Kiconco
Reviewer's report:
The write-up has generally improved, but a few more things to address here:
Lines 7-9: Need to have the first letters of the words Midwifery, Nursing and Faculty in
uppercase
Lines 40 and 43: You need proper punctuation e.g.,  commas between after Lira district i.e.,
However, in Uganda, most especially Lira district, … and between Lira city and northern Uganda
i.e., This study assessed the uptake of HPV vaccine and associated factors among in-school girls
aged 9-14 years in Lira City, northern Uganda.
Line 49: be consistent with Lira City, northern Uganda NOT Lira City west northern Uganda.
Line 50: Start the sentence with Uppercase letter.
Lines 51-53: be consistent with the font size when writing the figures in square parentheses.
Line 56: Use of the phrase “were more likely to receive” may be inappropriate compared to
using “…had more odds of receiving HPV…” since the measure of association is OR not risk.
Line 67: No need for uppercase ‘c’ on cervical cancer.
Lines 71-72: is this “Despite improvements in HPV in the past 15 years” a continuation of the
first sentence? It seems hanging.
Line 74: Need to have the 2 citations in similar parentheses.
Line 86: Uppercase ‘M’ for Ministry of Health
Line 97: There are double stops.
Line 98: need space between among and school i.e., among school.
Lines 114-115: Were the excluded ones replaced? If yes, what was the procedure? Because in
lines 162-163, you mention that response was 100%. If no one was excluded, is this (114-115)
still necessary.
Lines 156-157: Please break this into two sentences to bring out the specific levels of analysis,
otherwise, it is too long and disconnected.
Line 60: Can you indicate how you assessed statistical significance and how you chose factors
to include in the multivariable model?
Lines 166-167: the first sentence has similar information as in lines 162-163. Do you have to
keep both?
Line: 170: put a comma after ‘Also’ majority; and using words like, In addition…. Would be
better.
Line 173: unbold Table 1 and the stop before the first parenthesis
Line 179: space ‘out’ and ‘of’
Line 183: put a stop at the end.
Lines 186-214: Bivariate and multivariable results. It is fine to have only one single table
indicating all the factors that made it to multivariable analysis in table 4 with crude and adjusted
OR. The results descriptions should include all the parameters as you did in the abstract e.g.,
[aOR 9.09, 95% CI (3.19 – 25.88), P<0.001]. You need to maintain the font type all through and
have table text e.g., the characteristics to start with uppercase letters. There are factors that were
statistically significant at bivariate level but not included in the multivariable table. Could this
be an omission?  Were they not included in the multivariable model? One would have thought
that maybe they were not significant after, but it is unlikely. As commented on line 60, explain
how you considered which factors to drop or keep for the multivariable analysis since you talk
about backward conditional logistic regression method.
Line 224: have all the citations in similar parentheses.
Lines 225-229: I thought targeting grade five upwards regardless of their age would be inclusive
of those in grade six and above? Could you elaborate your argument? In addition, which result
informs this argument?
Line 230: are there citations for line 229? And they should be in similar parentheses.
LINE 231: USE “Odds of receiving HPV….” Not likelihood.
Line: 234: put the citations in in similar parentheses and a stop.
Line: 238: put the citations in in similar parentheses and a stop.
Lines 245-246: USE “Odds of receiving HPV….” Not likelihood. Consider this all through.
Line 246: put the citations in in similar parentheses.
Line 259: where does this citation at the beginning belong?
Lines 259-260: USE “Odds of receiving HPV….” Not likelihood.
Line 263: put the citations in in similar parentheses.
Line 270: Also, it would be good to acknowledge the limitation of not incorporating design
effect in sample size calculation, yet you did multilevel sampling.
Line 271: put a stop after the word region.
line 275: It would be good to acknowledge the possibility of some reported bias if you didn’t
confirm vaccination by vaccination card.
Line 281: why the dot without anything else?
282: It would be good to incorporate the recommendations  in the conclusion.