Reviewer ’s report  
 
Title: Cervical cancer screening service utilization and associated factors among age -eligible 
women in Jimma Town using health belief model, so uth west Ethiopia  
 
Version: 0 Date: 24 Jun 2019  
 
Reviewer: Alejandra Castanon  
 
Reviewer's report:  
 
Dear editor,  
 
I appreciate the opportunity to review the manuscript by Nigussie Tola et al. This is a qualitative 
study to assess factors related to cervical screening service utilization in the town of Jimma, 
Ethiopia.  
The manuscript needs extensive editoria l input to improve the English prior to publication. Many 
of my comments may stem from lack of understanding the text, however I hope the authors will 
find them useful in improving their manuscript.  
 
Major comments  
1) Sample size. I would like a much more d etailed explanation of the assumption that 
screening uptake would be 19.8% with a 3% error margin. This seems high, especially given the 
figures quoted in the background (1 -3% uptake).  
2) Data analysis. Authors should specify which variables met the 0.25 p -value cut off to be 
included in the multivariate analysis. The inclusion of 19 variables in the multivariate analysis 
seems excessive and is probably due to the very high threshold for the bivariate p -value cut -off 
point. Given the small number of women s creened the inclusion of so many covariates in the 
model will have resulted in a significant loss of power hence the very large confidence intervals.  
3) How do the authors explain the difference in screening uptake in this study (15%) and 
that in the liter ature (1 -3%)? It would be more useful to the reader to have an explanation of the 
Mekele zone study in the background as the sample size appears to be based on the finding in 
that study.  
4) When talking about the Ethiopian federal ministry of health effort s. Can you specify what 
proportion of the population was screened as part of the effort? Did this population include 
Jimma?  Is this how the authors justify the higher screening uptake?  
Given the reservations I have about the power of the study and the num ber of co -variates 
included in the multivariate regression I have not commented on the discussion at this time.  
Minor comments  
Table 4 - the percentage should be calculated in columns not rows.  
Figure 1 - is restricted to those with good knowledge of cervi cal cancer. The title should say so. 
How many of these women are actually screened? Can we compare to those with poor 
knowledge?  
 
Background  
4th paragraph - "the study from Addis Ababa…" which study? Should it say 'a study' and then 
have reference 6. You s ay this study found 5,293 cases, from what size population? Showing the 
rate would be better.  
When was the cancer registry finalized? Why is this important to this study?  
Sample size: the reference to the Mekele zone study is wrong here. Authors state refe rence 18 
but it should be 17. Authors should check all references in the manuscript.  
Are the methods appropriate and well 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.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in t he manuscript:  
 
Not suitable for publication unless extensively edited  
 
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 from an 
organisatio n 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 for patents relati ng 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 interests  
 
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to the editors, which wi ll not be published.  
 
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