Reviewer ’s report  
 
Title: Women's knowledge and attitudes towards cervical cancer prevention: A cross sectional 
study in Eastern Uganda  
 
Version: 1 Date: 07 Jun 2016  
 
Reviewer: Allen Bateman  
 
Reviewer's report:  
 
My comments for this review  
This manuscript describes a cross -sectional study in Eastern Uganda for  knowledge and attitudes 
of women about cervical cancer and screening. It is a well -conducted study of a large number of 
women (900), and provides important information to guide future education and sc reening 
programs in Uganda. The study found that most women were knowledgeable about cervical 
cancer symptoms, prevention measures and risk -factors, which is consistent with findings from a 
similar study from northern Uganda. While this is a generally favo rable outcome, the belief that 
nothing can be done once one is diagnosed with cervical cancer was common, and this might 
hinder women from seeking screening services for fear of a positive diagnosis. This study 
provides valuable information about the knowl edge and attitudes of women about cervical cancer 
and screening.  
 
Major comments  
1. When presenting AOR, include the 95% confidence intervals. A p -value may also be 
provided for emphasis, but is not necessary; 95% confidence intervals are sufficient.  
2. The phrase "having ever tested for HIV" is confusing. Does this mean having tested positive 
for HIV, or does it mean just having been tested at some point? I think it means having been 
tested at some point, regardless of if the result was positive or negativ e. Please clarify this, 
throughout the manuscript where this phrase is used.  
3. Line 105, Please define how often "periodic" screening services is, and include that this is 
cervical cancer screening.  
4. One of the results of the study was that having lower  income leads to higher levels of 
knowledge. While the authors list other studies that look at various associations between 
income and cervical cancer screening in the discussion, the authors should also discuss 
possible reasons for this association. One w ould intuitively expect that higher income level 
would lead to higher level of knowledge, and the finding that the opposite is true is quite 
interesting.  
 
Minor comments  
1. Include "a" in the abstract, methods section: It was a cross -sectional community based 
survey.  
2. When saying "the majority", it's not correct to immediately put numbers after this. Rather, 
the numbers should be in parentheses. For example, the followin g sentences in the abstract 
should read: …cervical cancer; the majority (557; 70.2%) received information from radio 
and 120 (15.1%) from health facilities. Most (743; 82.6%) knew…" These sentences should 
be updated, and all other similar sentences should also be updated.  
3. Define AOR at first use.  
4. Line 56 should read "lack of information about the disease and lack of screening services"  
5. Line 60 -61 should read "…human papillomavirus, a necessary cause of cervical cancer, 
and…" because papillomavirus is one word and "a main cause" should be strengthened to say 
that HPV is a necessary cause of cervical cancer.  
6. Line 73 should read "…diagnosis and treatment of pre -cancerous and cancerous lesions 
detected."  
7. Line 76, "…women had ever been screened…"  
8. Line 86 -87 should read "This study determined women's…"  
9. Line 114 should read "A multi -stage sampling technique was used: five…"  
10. Line 141, if there were 10 questions, each worth 1 point, the maximum possible should be 10 
and not 20. Please clarify this. 
11. Lines 170 and 173, "majority" should be changed to "the majority." This should also be done 
for any other places where "majority" is used.  
12. Line 201, "knowledge on cervical cancer" should be changed to "knowledge about cervical 
cancer". This s hould also be changed in other places where "knowledge on cervical cancer" 
is used.  
13. Lines 204 -208, I suggest removing the "four times", "two times", etc more likely. The AOR 
are the most informative, and it's unnecessary to include the "four times more  likely", etc. 
comments.  
14. Table 1 and Table 4, include the time period of the household income. Is it monthly 
household income?  
15. Line 426, "its" should not have an apostrophe.  
16. Figure 1 does not need to be a figure; the data can be depicted just a s well (and possibly 
better) in a table, like the rest of the data for this  manuscript.  
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which contr ols 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.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recomme nd 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 am able to assess the statistics  
 
Quality of written English  
Please indicate t he 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 past five year s received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose  
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?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this p aper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comme nts 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal