Reviewer’s report
Title:  Socio-Demographic  Characteristics  and  Associated  Factors  Influencing  Cervical  Cancer
Screening among Women Attending in St. Paul ’s Teaching and Referral Hospital, Ethiopia
Version: 1 Date: 21 Oct 2019
Reviewer: Ahti Anttila
Reviewer's report:
BMWH-D-19-00070R1
The focus of the manuscript is to describe cervical screening among 18-49 years old women attending a
teaching and referral hospital in Ethiopia. The study population is not consistent with a potential target
age for a cervical cancer screening programme. Taking into account the international recommendations
e.g.  by several  WHO  work  groups  (see  below),  the  age  group  of  the  current  manuscript  is  not
appropriate for a survey of cervical cancer screening. 
A couple of examples of the existing recommendations: 
IARC Handbook on cervical cancer prevention (2005) concludes: "There is sufficient evidence that
screening for cervical cancer precursors every 3-5 years between the ages of 35 and 64 years by
conventional cytology in a high-quality programme reduces the incidence of invasive cervical cancer
by 80% or more among the women screened. In women aged 25-34 years, screening at intervals of
three years or less may have smaller impact. This evidence is available for any country, also including
the very rich countries with lots of resources for their health services." 
The WHO Comprehensive Cervical Cancer Control, A guide to essential practice, Second edition
(2014) advising particularly rather low resources settings and countries recommends "Cervical cancer
screening should be performed at least once for every woman in the target age group where most
benefit can be achieved: 30-49 years." 
So, if the proportion of women screened e.g. at the age 18-25 was low that should be considered a good
finding based on the above documents, in contrast with e.g. the possible differences in the proportion of
tested at age 35 to 49 by the sociodemographic variables. This kind of analysis is lacking from the
paper, because the results by sociodemographic groups is provided by all ages (not specific to relevant
age groups). 
The references are often not appropriate. 1) For example, citing of global and regional cancer burden
(page 3, lines 46-57) could be done using the IARC Global Cancer Observatory (https://gco.iarc.fr/),
rather than some ad hoc publications. Then all the data could be from the same data source and include
the same, current observation period. 2) For effectiveness of screening programmes (page 4 lines 81-
82) e.g. the IARC Handbook V ol 10 (2005) and the WHO guide (2004) could be used along with
possible newer publications on the topic. Now the text uses a couple cross-sectional references, i.e.
some indirect statements without providing appropriate evidence. 
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.
No
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 editors.
I recommend additional statistical review
Quality of written English
Please indicate the quality of language in the manuscript:
Needs some language corrections before being published
Declaration of competing interests
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or has applied for patents relating to the content of the manuscript?
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