Title: The practice of breast self-examination and associated factors among female healthcare
professionals working in selected hospitals in Kigali, Rwanda: A Cross Sectional Study
Version: 1 Date: 12 Aug 2023
Reviewer:  Chinomso Ugochukwu Nwozichi
Reviewer's report:
I wish to acknowledge the efforts of the authors for conducting the study and writing the
manuscript. Breast cancer and BSE among healthcare professionals are increasing gaining more
attention in the medical space and also in literature.
While I commend the efforts of the authors, there are areas of improvement identified as shown
below:
ABSTRACT
You cited a figure about the mortality rate of breast cancer in 2020. While the information gives
your work some justification, including it in your abstract without citing any reference is not fine.
BACKGROUND
Your background should begin with the descriptions about the global problem of cancer and then
specifically breast cancer.  Tell your readers how breast cancer affects communities globally
and then to Africa before resting on Rwanda.
Is there literature on breast cancer and BSE among healthcare professionals? Your background
focused on BSE in the general population how ever your paper is on BSE among healthcare
workers. Any literature gaps here? This section should be improved. Kindly indicate if there
is a paucity of literature on this subject matter. Any previous related study within or around
your study setting? What did they find? Generally, you should describe an undesirable gap
between the current-state level of BSE among healthcare workers and the desired future-state
level. Include absolute or relative measures of the problem that quantify that gap, but you should
not include possible causes or solutions.
METHOD
- A little more description of your study centers will be appreciated.
- How did you conduct the simple random sampling you documented in the manuscript?
- Why did you document the reliability coefficient of only the sub-scale on attitude? What of
the values for other sub-scales such as knowledge, practice etc?
- I am not sure why you compressed knowledge and awareness together. They seem to measure
different constructs that may be missing when muddled together.
- Please include some statements on ethical considerations in this study
RESULT
- You may need to define what healthcare workers mean in this study. Your result showed that
5% of the participants had only high school diploma. One begins to wonder the category of
healthcare workers that attained only high school diploma.
- In table 2 on page 11, you documented the average age at pregnancy? Did you exclude
participants who have never been pregnant?
- Nurses constituted 80.1% of your total sample size and doctors 4.5%. I am wondering why
majority (75.6%) of your participants claimed they had not received training on BSE. Do you
have any possible explanation that you may want to include in the discussion? Does it have
anything to do with the curriculum of health professionals in Rwanda? Any thoughts on this?
- Table 5 on page 15 needs to be edited. You indicated that 94 participants (42.5%) had ever
practiced BSE, however, the next question showed that 53 participants (53.4%) performed BSE
on monthly basis. The question here is how did 94 participants amount to 42.5% while 53 was
53.4%?  If you used only the 94 participants who had ever perfomed BSE to calculate the
percentage of monthly compliance, then indicate that the n=94.
DISCUSSION
The purpose of your discussion is to interpret and describe the significance of your findings in
light of what was already known about the research problem being investigated and to explain
any new understanding or insights that emerged as a result of your study of the problem.
Please your discussion should be a little bit more robust and not just to present similar studies/
references. Your discussion should be robust to make the reader understand how your work
contributes to the body of knowledge. you need to mention what makes your findings unique.
Identify your major findings and write a robust discussion on them in relation to what is known
or unknown about them.