Reviewer ’s report  
 
Title: Effects of peer health education on perception and practic e of screening for cervical cancer  
among urban residential women in south -east Nigeria: a before and after study  
 
Version: 0 Date: 08 Dec 2016  
 
Reviewer: Ingeborg Zehbe  
 
Reviewer's report:  
 
The authors' research question is a pertinent one: Can cervical screening rates be improved after 
peer education? They recruited 300 informants but it is not known how many women were 
initially approached. It is shown that, before the intervention, cancer screening is underutilized 
despite high awareness rates (~60 to 87%), with <10% uptake overall. Given the fact of the cost 
of a Pap ($150) versus the monthly income: ~$30/month, this is not surprising.  
 
 
 
 
Introduction:  
 
The following statement needs to be re vised, it is not correct: It ranks as the second most 
common cancer among women in Nigeria, and it is estimated that about 40.43 million women 
(ages 15 years and above) are at risk of developing cervical cancer.  
 
 
The following statement needs a reference:  Cervical changes preceding cancer are most 
significant after 21 years and that is the age at which screening becomes relevant.  
 
 
 
 
Methods:  
 
Sampling of study participants: Why was this number chosen: difference of 13%?  
 
 
Data collection and analysis: questionn aires need to be provided as supplemental material.  
Statistical package for social sciences version 17 needs to be properly explained and a reference 
given.  
 
 
Appropriate summary statistics and tests of statistical significance of observed differences and 
associations were applied: What were these? Needs to be properly explained and referenced.  
Demographics: How exactly were the 300 participants recruited? Looks like convenience 
sampling. Is it known how many women were initially approached? What is the deno minator, i.e. 
total of number women that could potentially have participated in the study? What does tertiary 
school mean?  
 
 
 
 
Results:  
 
Willingness to screen: it was written as if these women had actually been screened, but this was 
not the case or was it?  
 
 
Results section would do much better with theme paragraphs rather than just referring to tables.  
 
 
Tables: numbers need to be checked, e.g. 54, is this 5.4, on table 2?  
 
 
 
 
Discussion:  
 
More recent references needed: it may require more than one hospital visit and the false -negative 
rate is estimated at 10% to 29% (Koss, 1993).  
 
 
Better positioning of the study with other like studies in sub -Saharan Africa and/or worldwide.  
 
 
The economical aspect seems to be a huge barrier to be screened and may add a bias to the  study; 
the socio -economic status of the participants needs therefore to be explained in more detail; was 
this captured in the questionnaires? The 300 participants may NOT be representative for the 
Nigerian population of the particular region under study.  
 
 
Ethics: an approval/protocol number has to be provided.  
 
 
 
 
 
 
 
 
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.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the auth ors. 
 
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 specify what aspects require further  
assessment in your comments to the edi tors. 
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the pa st five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
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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 received reimbursements, f ees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
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