Title: Knowledge, attitude, and uptake of human papillomavirus vaccine among adolescent
schoolgirls in Ethiopia: A systematic review and meta-analysis
Version: 0 Date: 21 Mar 2023
Reviewer's report:
Generally the authors address a good research area and an important public health issue. Here I
have include some comments and question to be included in the paper to increase its value.
Search results should be updated and checked
Google scholar search result= “"Knowledge" and "attitude" and "uptake"   and  "human
papilloma virus" and  "vaccine" and "associated factors"   and  "adolescent"  and "schoolgirls"
and  "Ethiopia"” ===== the result was 29
Abstract:
what is the need for using both fixed and random effect model? Which model does fit the research
question?
Methods: inclusion criteria: - your PICO is not clearly stated.
Study selection and quality assessment: indicate the company and location of software and
resources used
accessibility of full text: what measures did you take
relevance: what is irrelevant search result
outcome measures
knowledge: did all the included studies used similar tools?
Attitude: did all the included studies used similar method?
Data extraction:
data abstraction form: was it in Excel? Include details, and attach the sheet as supplementary file.
Figure 1: PRISMA flowchart is missing many details. Result from each database should be
indicated clearly, indicate “other sources” clearly,
eligibility: state the numbers for each rejection criteria (how many qualitative study, how many
with different population? Etc)
Result:
Characteristics of included studies: “All studies had a low risk of bias (Table 1)”: table 1 is not
an assessment tool for bias is a single cross-sectional study, what do you mean by this statement?
How did you assess the bias in the included studies?
Table 1: it is better to include data collection period. On study quality column: what does it
mean low risk?
Pooled estimate: there was high heterogeneity, there for random effect model used? Did you
used random effect model as a measure for high heterogeneity? What other measures did you
take to explain the heterogeneity?
It is now a common understanding that predictive interval should also be used in addition to I2,
so it is better to include it.
Figures: the figures in the manuscript are not of publication quality? Revise and present clear
figures.
Subgroup analysis: it is indicated that subgroup analysis was done based on  region, sample
size and publication status: what do you mean by region? What difference does they have with
respect to the research question? Publication status: study result may fail to be published for
several reasons, as long as it have used good quality tools it will not be source of heterogeneity.
What is the justification for sub-group analysis based on publication status?
Sub-group by sample size: it is better to do cumulative analysis than sub grouping based on
sample size and year of publications.
Sensitivity analysis: knowledge: - it is indicated that some studies were removed and analyses
was done again. What was the criteria to remove the studies?
Table 3: why is your analysis limited to removal of only one study?
Publication bias: it will be better to present the graphical representation of publication bias
factors associated with vaccine uptake: use of fixed effect model, it is indicated that the studies
are homogeneous, how is that possible while they are using different study groups?
Discussion: the finds were compared with pocket studies in different parts of the world. Your
data is not similar with those studies, it can’t be compared. It should be revised.