Title: Utilization of cervical cancer screening and its associated factors among women of child-
bearing age in Mangochi district, Malawi: a facility-based cross-sectional study
Version: 0 Date: 11 Apr 2023
Reviewer:  Dalau Mukadi Nkamba
Reviewer's report:
This manuscript addresses a very relevant public health issue in LMIC. Here are my comment:
Abstract
Result.
The auhtors should provide the magnitude of CCS uptake in the general sample before starting
any subgroup comparison.
Line 25, 27,29, and 31, and 33 : add « , » just after ] and remove  « Significantly higher » so
to avoid redundancy.
The main manuscript
Background
Line 78 : Can the authors precise when the programme phased out ?
Line 85 : The authors say « The National Cervical Cancer Control Strategy also confirms that
lack of awareness  of the disease by general public … ». Was this derived from a study ? So I
suggest they mention the primary source of this statement.
Materials and methods
Study participants
Line 132 : The athors say they have described study particpants elsewere. We recommand that
the authors described very briefly participants.
Sample and procedures :
We recommand that the authors described very briefly sampling procedure as this has been
described extensively elsewhere.
Source of CC information
Is there any reason why for the authors to claissify radio as a stand alone source and then list
television in the category named other ?
Level of belief toward ccs
The authors said a list of cc risk factors was read out to the respondents, which runs the risk of
women giving socially desirable responses. Why did the authors not identify this as a limitation?
And how did they minimize the related information bias?
Statistical analysis
Authors should indicate why they used Fisher’s exact tests. In the table, they have presented
proportions without announcing them in statistical analysis section.
Results
Table 1 : Authors said 63 women uptook cervical cancer screening, but 3 of these women have
never heard of cervical cancer, so how did they know that screening was for cervical cancer ? So
I think the « ever cervical cancer screening uptake » question should apply only to those women
who have ever heard of cervical cancer. The author should check.
The authors have stratified women based on a number of scores, they should in addition consider
presenting the distribution of each individual element that compose the scores.
The authors mention N=60, N=201, N=261 but they have not mentionned why these N are
different from the one stated above in the same table. They should make some marks aside the
N and explain on the foot of the table that these questions were asked only to those who have
ever heard of cervical cancer.
Line 265, 267,270, and 292: we suggest to remove  « Significantly higher » so to avoid
redundancy.
Table 2 : Recommandations for CCS given by health wokers should apply only to women who
have ever heard of cervical cancer, not to all women.
Discussion
Line 328 to 332 : Authors say 3 women have never heard of cc but have undergone ccs. How
was this information collected ? was data collected using tablets or paper based questionnaire ?
How did authors take into account skip patterns ? What was the background of data collectors ?
All this information needs to be clarified in method section. It may also be that these women
just reponded yes to a yes/no question without knowing what ccs was.