Reviewer's report
Title:Awareness of HPV and Cervical Cancer Prevention among Cameroonian
Healthcare Workers
Version: 2Date:19 August 2011
Reviewer: Twaha TM Mutyaba
Reviewer's report:
Review of article titled: Awareness of HPV and Cervical Cancer Prevention
among Cameroonian Health Workers;
Major considerations
The title depicts representativeness of Cameroonian health workers. However
the study involved participants from Yaoundé, the capital city. It is know that rural
based health workers have less access to new medical knowledge compared to
urban ones. Methods like HPV DNA testing, VIA and HPV vaccination are
relatively new. This would mean if the majority of health workers are rural based,
the results of the study may be over estimating knowledge about cervical cancer
prevention. It may necessitate change of title to reflect this.
The response rate was low at less than 50%. As the authors acknowledge at the
end of the discussion, this has big impact on the validity of the study findings.
Most likely the non responders were the ones who had least knowledge about
cervical cancer prevention. Did they collect information on place of work like
which hospital and which department. Workers in teaching hospitals tend to be
more up to date with new knowledge. I wonder if there was an effort to send
reminders to the participants.
Doctors seem to have had very good knowledge about cervical cancer
prevention issues except HPV test and VIA. This is not unexpected. However in
Table 1, the variable category of health workers, it would have been informative
to know how many were Obstetricians/Gynecologists, GPs or Pediatricians.
Since response rate was <50%, maybe only the gynecologists responded among
the doctors. The results may not be representative of doctors of all categories.
Gynecologists are expected to have more knowledge about cervical cancer
prevention. Similarly the responders among nurses/midwives could have been
those working in Obstetrics/gynecology departments
One other factor that might have affected knowledge levels is duration of
practice. This was not included in the questionnaire but a proxy could have been
age to see if there was a difference between the older and younger participants.
In the discussion, the authors should try to explain the disparity in knowledge
between the doctors and nurses. Probably differences in curriculums? This would
help address the cause and maybe offer practical solutions.
The discussion should also highlight the issue of low knowledge of VIA and HPV
DNA testing because these are the more feasible alternatives for low resource
settings.
Minor considerations
Page 3; Statement: Cervical cancer is a favorable site for an effective screening
program should be rephrased.
Page 3; There is mention that the available prevention services are limited to
some main cities. The authors should provide information on what percentage of
the population of Cameroon is urban or rural. This will highlight the problem
better
In table 1
Marital status: divorced and widowed should not be included in couple. They
should be in single category.
Order of references in the text should be looked at
Dr Twaha Mutyaba, MD, PhD
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests.
Twaha Mutyaba, MD, PhD