Reviewer's report
Title:knowledge, attitude and practice about cancer of the uterine cervix among
women living in Kinshasa, The Democratic Republic of Congo
Version: 1Date:29 August 2013
Reviewer: serena donati
Reviewer's report:
The research question of the article is of interest and current importance. In fact
women’s awareness about cervical cancer prevention is unsatisfactory in
developing countries where incidence and mortality for cervical cancer are still
high.The cross sectional design described in the methods section is appropriate
for the KAP survey. Nevertheless, some changes are requested to improve the
manuscript. I recommend the following:
Major compulsory revisions:
1) Better description of the multilevel sample selection procedures.
- were the municipalities, the districts and the streets randomly selected? All
women living in the selected streets were enumerated and approached by the
interviewers?
- Did interviewers computed refusals and “not found” women?
All these aspects should be clearly described in the methods section in order to
assure the representativeness of the selected sample. In fact representativeness
is a crucial issue in sample surveys.
2) Age distribution of the interviewed women should be reported extensively in 5
years age groups (16-20;21-25;26-30 ...) also in table 1 because we don’t know if
the age distribution is linear.
3) I would describe (if available) also the distribution of women’s parity because
this information could help in understanding if the pluparous women compared to
the nulliparous received information on cervical cancer. This information could
help in understanding and evaluating if health services are available and if they
work properly. In fact such information could be proactively offered by health
professionals, especially during ante, intra and post natal care. Authors should
comment in the discussion section on these missed opportunities.
4) Authors should describe the major characteristics (eg socio-demographic
characteristics and health services availability) of the selected Kinshasa
municipalities and districts in order to facilitate the comprehension of the reported
differences.
5) Authors should describe the different religious groups
6) In the Participants section of the results authors should report the denominator
for the 524 interviewed women, specifying the number of women who refused the
interview and those who were not found
7) I would like to see the socio-demographic characteristics of respondents (table
1) presented separately for single districts in order to verify the uniformity among
districts.
8) Discussion is enough supported by the data but conclusions are lacking and
authors should suggest how to increase women’s awareness on cervical cancer
prevention in Kinshasa.
9) In the second paragraph of the discussion section should be specified that
82% of interviewed women reported they had heard about cervical cancer only
by recall memory and not by active memory.
10) Including in the multiple logistic regression by default all independent
variables with a P-value < 0.2 on bivariate analysis is methodologically non
correct. On the contrary, authors should include all relevant variables according
to their research hypotheses
11) Are the regression models checked for some likely 'interactions'? In fact
considerations reported at page 9 on possible interaction between place of
residence and women’s education and occupation should be better investigated.
12) In table 3B and 3C some information (OR and CI) are lacking
Minor essential revisions:
13) Improvement of the adopted score system
- for the questions involving more than one correct answer (eg table 2 which
diseases of the female genital tract do you know?) I would describe all options
and assign a point for each possible correct answer rather than a point for any
correct answer. In fact, it is not appropriate to attribute equally one point to
women mentioning any of the possible diseases of the female genital tract
compared to those recalling the carcinoma of the cervix.
14) The tables presenting the regression models should report also a column
with the percentage of women having a score >4 for the different characteristics
of the mentioned variables.
15) The last sentence of the attitude paragraph should be moved in the methods
section.
16) The writing should be improved
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, and I have assessed the statistics in my report.
Declaration of competing interests:
I declare that I have no competing interests'.