Reviewer’s report
Title: 
Model strategies to address barriers to cervical cancer treatment and
palliative care among women in Zimbabwe: A public health approach
Version: 
1 
Date: 
25 Feb 2021
Reviewer's report:
Thank you for the invitation to review the manuscript titled "Model strategies to
address barriers to cervical cancer treatment and palliative care among women in
Zimbabwe: A public health approach". The authors highlight an important topic
and I have included a few feedback points below that you may find helpful:
1. The title mentions that the article is to address barriers in cervical cancer
treatment and palliative care among women, however the article only describes
cervical cancer and not much emphasis in describing the palliative care aspect.
Palliative care is only mentioned once in the results section in one of the sub-
themes.
2. In the "Methods" section of the abstract, try to mention details on the
inclusion and exclusion criteria when selecting your 84 participants.
3. In the "Results" section of the abstract, mention the full term of "AIDS" and
then add the abbreviation next to it
4. When writing abbreviations throughout the manuscript (e.g. USA, HPV…
etc.), please mention the full word or term and then place the abbreviation in
brackets next to the word. You only need to do this once when you first mention
the term and then can use the abbreviation after that throughout the manuscript.
This is in addition to the list of abbreviations mentioned in the end.
5. In the Background section: 
a. Mention the ranking of cervical cancer among other cancers worldwide. Also,
mention the age group where most women are affected.
b. Describe where women in Zimbabwe rank among women around the globe in
the rate of cervical cancer and stage at diagnosis.
c. Should we assume that reference #1 is also referring to the statement "85% of
new diagnoses occur in less developed regions of the world"? If so, then all
looks good. 
d. Report where you got the annual numbers from. If the annual number of cases
of cervical cancer reported by the World Health Organization (WHO) then this
should be mentioned.
e. Mention what stage of cervical cancers are the commonest ones reported and
if the delay in attention and medical treatment causes the disease to advance to a
later stage in women. 
f. You mention that patients encounter a myriad of multi-dimensional barriers
but don't give examples. It would be helpful to describe a few examples. 
g. When mentioned the treatment barriers reported by researchers in the USA,
can you describe if any research has been conducted in Zimbabwe about this
topic and describe how the USA research was conducted or communicated and
what type of research studies were carried out.
h. When mentioning the affected women in Zimbabwe, can you mention more
details on the demographics of these ladies and how far their locations are from
medical centers.
i. Are you able to give more details on the medical centers in Zimbabwe and
their available services (hours of operation, specific costs, distance from the
communities (in Kilometres or Miles), the percentage of people who can afford
it, if public insurance is available to most). 
j. Can you briefly comment on the services available to moderate- and high-
income families and make a comparison of the treatment plans and available
options. A summarized table would be a good approach.
k. When mentioning that the healthcare workers are "ill-prepared", mention why
and what makes them underprepared. More description helps the reader better
understand the situation and provided a more targeted approach in finding
solutions to these targeted problems.
l. When describing the "Societal Barriers", can you please explain what you
mean by fear? If it that patients are afraid to be screened? Also, when mentioning
the "stigma" and "misconceptions", describe what you mean.
m. When describing an author (e.g Kuguyo), mention Kuguyo et al.
n. Do you have any information on other cities or communities in Zimbabwe
other than Harare? If so, then a quick comparison might be helpful.
6. In the Methods section:
a. Your study is a qualitative study, please talk a little bit about the quantitative
studies and what results were obtained. 
b. It's unclear how you determined participants to be "Key Informants" and it
might be best to use an alternative word to "Snowballing technique" when
describing the patient recruitment strategy.
c. Figure 1 is not visible.
7. In the Data Collection section:
a. Describe the "Research Question" after mentioning it.
b. The information provided in remainder of this section is appropriate and clear.
8. In the Data Analysis section:
a. Mention the name of the spoken language of the patients you interviewed. For
example, "Interviews and FGDs were transcribed verbatim and translated from
Shona/Chewa/Tsonga into the English language where applicable".
b. Mention that these interviews were confidential and that the patients' personal
information was handled appropriately at the end of the study to maintain
privacy.
c. Can you talk a bit more about the "Codes" and describe them for the readers.
9. In the Results section:
a. The information provided and the patient statements are very effective and
important.
b. Mention the sub-themes in numerical order and then add the details as you
have done so neatly in this section. It will help clarify to the reader how many
sub-themes to look forward to.
c. The patient age groups and locations can be placed in a table. It will also help
locate where most of the services are needed and if surrounding cities and
communities can travel an appropriate distance to receive adequate care.
d. When describing the 2 medical centers that treat cervical cancer, are you able
to comment about the number of medical centers that screen for the disease? And
the referral pathway to these 2 cancer treating centers? Are both centers in
Harare?
e. When participants describe places like "Bulawayo", it would be helpful to the
reader if you mentioned the distance travelled to reach the healthcare facilities.
10. In the Discussion section:
a. The summary of results in the beginning is clear.
b. When mentioning an author "Nyakabau", describe the author as "Nyakabau et
al".
c. Describe if health education on cervical cancer is taught in schools and
universities.
d. This section is well described.
11. In the References:
a. The number sequence of the references are not in numerical order. This is
throughout the entire manuscript. For example, reference #1 needs to be
followed by reference #2 and so on.
12. The list of Abbreviations does not include all the abbreviations mentioned in
the manuscript. Kindly review.
13. The "Figure" placed after the references is not described in the manuscript. Is
this "Figure 1" that was described in the manuscript?
14. The tables provided have abbreviations that need to be documented below
the table. For example "OT" needs to be documented under the table as "OT:
Occupational Therapist" to clarify to the readers who may not be aware or may
have missed in the manuscript.
15. Supplementary material briefly reviewed (files 1, 2, 3, 4).
16. File #4 is not mentioned in the manuscript but placed in the supplementary
material.
17. The article can benefit from a language review and grammatical review.
Please also review the punctuation and spacing errors throughout the manuscript.
Wishing you every success with your manuscript and publication.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes