Reviewer ’s report  
 
Title:  Characteristics of cervical disease among symptomatic women with histopathological 
sample at Hawassa University referral hospital, Southern Ethiopia  
 
Version: 1 Date: 16 Jun 2016 
 
Reviewer:  Alejandra  Castanon  
 
Reviewer’s report:  
 
Dear Editors,  
 
Please find below my review of the manuscript titled "Distribution of cervical cancer and other 
histopathological findings of cervical lesions in souther n Ethiopian women".  
 
I found the relevance of the manuscript difficult to assess as the authors have failed to provide 
the appropriate context and background information. Although they provide an overview of 
cervical cancer diagnosis and its causes they hav e not told us under what circumstances the 
biopsy samples reported in the manuscript were taken. Are women symptomatic? Is it a 
combination of screening setting with gynaecological clinics? Do the samples represent all taken 
in Hawassa? If they are, why do n't the authors report rates of disease?  
 
It is unclear why it is of interested to describe the non -cancerous lesions in detail. It is also 
unclear what the value of providing information of the differentiation of the cancerous lesions is.  
 
Further I was not  convinced that the literature quoted and compared to this study were a fair 
comparison and this may be due to the lack of background provided for this study population.  
 
I have made other detailed comments which I hope will prove useful to the authors.  
 
 
Background:  
 
Line 87. Please rephrase to give more detail of the Ethiopian studies (ref 13 and 14). Were they 
in a subset of women? Reference 14 seems more adequate as it represents Ethiopia as a whole 
while 13 is only in women with histological abnormalities so more likely to have HPV infection.  
 
Line 89: similarly re -word sentence to: "Knowledge about cervical cancer in Ethiopian 
population is poor (ref 15,16)."  
 
Add a sentence about screening in Ethiopia - presumably there is none based on the observed 
results  but I do not know this as a reader and it will influence the expected results.  
 
 
Aim:  
If I understand correctly the aim seems to be: "to assess the histopathological diagnosis of 
cervical samples over five years in southern Ethiopian women." Why is this of interest? Is it to 
inform service provision? Otherwise why not concentrate on those samples which show 
malignancy?  
 
Line 108: "Up on" reword "upon"  
 
 
Methods;  
 
Are all cervical cancers diagnosed in the region reported at this hospital? If so the paper would 
benefit from presenting rates. It would be of interest to find out what proportion of cancer in the 
region are reported without a histological sample.  
 
 
Results;  
 
Line 120 what does "cervical pathogen" mean?  
 
The authors classification of cervical disease is not helpful and says very little about the data. I 
suggest two section: neoplasia and non -neoplasia  
 
Show separately the cancer currently pooled in the 'others' category.  
 
Table 2. too many age groups  
 
Table 3 should come before table 2. I don't understand the relevance of presenting the non -
neoplasia results by age - what is the clinical relevance of these results?  
 
Sentence in 215 -126 these results are not reflected in table 1.  
 
Line 152: the authors assert t hat SCC accounts for 41.1% of all cases - this is misleading because 
what they show is that it accounts for 41.1% of all samples in the laboratory. This is why I 
suggest that the percentages in table 1 are restricted to the cancer outcomes.  
 
Line 154 they g o on to say this is a rate - which it is not. If screening is not wide spread in the 
region I find the proportion of cancers quite low.  
 
Line 157 - compared to a study in women with symptoms. Is this your study population? The 
comparison literature in gener al is not comparable or does not appear to be from what the authors 
have written.  
 
Lines 174 -181 do not explain why the differentiation is important.  
 
Are the methods appropriate and wel l described?  
If not, please specify what is required in your comments to the authors.  
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn ad equately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
Not relevant to this manuscript  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary fr om an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied f or patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the  above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
I declare that I have no competing in terests  
 
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