Reviewer’s report
Title: 
THE STATE OF CERVICAL CANCER SCREENING IN IMPRISONED
WOMEN IN MALAWI: A CASE OF MAULA PRISON.
Version: 
2 
Date: 
10 Jan 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are minor issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: Authors have partly addressed the concerns I have
raised on the manuscript.
REQUESTED REVISIONS: 
There are still some weaknesses in the study population description. I asked, "It
is mandatory to add a diagram flow of patients starting with the total number of
imprisoned women" authors answered as follows:
The current revisions of the manuscript indicate that the study used purposive
sampling, which does not require the presentation of information in a diagram. I
am not an expert enough to say whether purposive sampling requires or does not
require the display of information on a graph. What I do know is that to me is
still unclear the inclusion criteria they used (in fact, the exclusion criteria are the
opposite of the inclusion criteria, which is incorrect). To have a good overview
of the studied population, authors must write the inclusion and exclusion criteria
and present a diagram or a table with the main characteristics (age, primary
education, previous screening) of the 81 (total) 40 that wanted to participate and
the 31 that indeed attended. Moreover, as the study is presented, the conclusions
are unsupported because they are based on a very particular population of
women and cannot be applied to all female prisoners of Malawi. As such, the
study is biased because they only include the women that had previous screening
and have primary education. The first paragraph of the discussion is
contradictory 
"While lack of knowledge of screening programs is the most
common reason for not being screened for cervical cancer among women in the
society [17,18], the situation is not different among imprisoned women at Maula
Prison. In this study, lack of information did not come out as a hindrance to
screening at all. If the authors disagree with my suggestion, the conclusion
should be changed to clearly state that this only reflects the subpopulation of
imprisoned women of reproductive age that had previous screening and had
primary education.
ADDITIONAL REQUESTS/SUGGESTIONS: 
Optional but desirable. A short sentence describing how are the 30 prisons and
why study selected the Maula prison.
Declaration of competing interests
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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?
No
Are the methods sufficiently described to allow the study to be repeated?
No
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
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No