Title: Prevalence and associated factors of baseline anemia among cervical cancer patients in
Tikur Anbesa Specialized Hospital, Ethiopia.
Version: 3 Date: 18 Nov 2020
Reviewer's report:
General comments:
# There are a lot of grammatical errors and, lengthy sentences difficult to understand; which all
need s rigorous editing’s.
# There is inconsistency of wordings: Please consistently use “Cancer of cervix” instead of
cervix cancer or cervical cancer or cervical carcinoma
# Abbreviations and or Acronyms were not written as per the BMC women’s health author guide.
# Use patients instead of participants throughout your text.
Abstract
1. Modify the background and conclusion section.  Both are very long and seems a copy of the
body of the manuscript.
Background
1. Cervical cancer ranks fourth for both incidence (6.6%) and mortality (7.5%)[1]. The ranking,
is it among woman or from overall cancer?
2. Paragraph 7: “Black Lion Specialized Hospital”;  Replace it with “Tikur Anbessa Specialized
Hospital”
3. Paragraph 7; was not properly cited [11, 12] and seams a direct copy of reference number “11”,
almost a similar study conducted at “Tikur Anbessa Specialized Hospital, your study setting, in
2019” …and is confusing between the two references
Generally, how common is the pre-treatment anemia/baseline anemia in other parts of the world?
This needs your attention, in particular for your discussion/comparison. However, most of the
references entitled with general anemia prevalence.
Methods:
1. What do you mean complain therapy?
2. Are you sure TASH is the only center in Ethiopia?  What about Hawassa, Jimma, Gondar,
Ayder…. Etc.?
3. The source and study population were those patients treated from January 1, 2014 to December
31, 2016. Why?  What about the new those patients from December 31, 2016 till December
31, 2019 at least? Can we say this is an outdated data? Does this represent the current anemia
prevalence?
4. Total numbers of medical records screened were 1227 and, only 634 were included for the
study.  Means you excluded about 593 patients, why? Please specify the reasons why? Instead
of merely saying incomplete data/medical record? Does it have its impact on the generalizability
of your finding? You almost excluded 50% of your study participants?
5. Why don’t you go for sample size calculation, and then go for systematic random sampling
technique?
6. Substance use definition is for mental health, not for anemia. What about caffeine use? Is
there any relationship between the stated substance use and anemia? Please include these on the
background section of the manuscript.
7. Provide a detailed Hosmer and Lemeshow test results of your model.  The cut off point for
p-value>0.05, is it correct? Provide your reference.
8. Remove citation [19] on the method section of your manuscript. It is totally unrelated.
Results
Correct the inconsistent description of the results.
1. Table 1: More than half (56%) of the participants came from….better to put like.. More than
half (n=355) of the participants….follow the same for others.
2. All tables: Instead of “no” to represent number, use capital or small letter “N” or “n”. It is
confusing with the word “No”
3. All tables: Use consistent decimal places either one or two decimal place.
4. Table 1: regarding occupation Who are the “others”? specify as a foot note.
5. Table 2: About two third (65.1%) of study participants presented at advanced stages. What
do you mean advanced stage? Specify and correct the manuscript accordingly.
6. Sub title: “Prevalence of “base line” anemia in cervical cancer patients” …use the one word
“baseline”
7.  Table 3: legend….(634)..make it (n=634)
8. The table 4:  logistic regression result interpretation is not well interpreted and needs major
revision.
Discussion
It needs major revision.
# Spelling and grammatical errors.
# The findings are not well discussed
Paragraph 2: The one cited as the Ethiopian study is not studied among Ethiopian patients. It
is the Korean study. Besides, the justifications given are not scientific. Study time difference
variation, healthcare delivery differences, etc. What is the relationship between anemia and these
points?
Paragraph 4: which chemicals in the substance are associated with the stated mechanism?
Reference number [22], Semba, R.D., et al., High prevalence of iron deficiency and anemia
among female injection drug users with and without HIV infection. Journal of acquired immune
deficiency syndromes (1999), 2002. 29(2): p. 142-144; cited as a justification is studied among
injection drug users not on Khat, cigarette and Alcohol as per your operation definition  of
substance users.
Paragraph 5: An other….its one word ”another”
Discuss: why being divorced is protective for anemia? Present appropriate literatures supporting
the same.
Conclusion:
In addition, it is better to expanded cervical cancer early screening and treatment options. Do
you have evidences to say cervical screening is a gap? I found one article published in the
area for your attention which I guess compliment your suggestion if cited properly: https://
bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-01008-3
Ethical clearance
Write the protocol number and provide scanned copy of ethical clearance letter issued by the
Institutional Review Board of school of nursing and midwifery, Addis Ababa University.
What is the relationship between the authors, the current affiliation of authors and Tikur Anbessa
Specialized Hospital, Addis Ababa University?
References
Referencing style is consistent. All the references must be edited as per the BMC women’s
health journal requirement.