Reviewer ’s report  
 
Title: Cervical cancer knowledge, attitudes, beliefs and practices of women aged at least 25 
years in Harare, Zimbabwe  
 
Version: 3 Date: 17 Jun 2019  
 
Reviewer: Amos Mwaka  
Reviewer's report:  
Dear Authors,  
 
I highly appreciate the improvement in the manuscript. Congratulations.  
 
I have only a few issues for you to revise at this point.  
1. It is critical that the findings are interpreted in light of the direction of the effect measures 
and size, given the reference category in the logistic regression model. This is not quite clear 
in some instances. For example, in the abstract, watching TV daily is associated with lower 
likelihood of having correct knowledge (OR<1.0), table 3. Association can be in either 
positive o r negative direction -the expected reporting direction is dictated perhaps by the 
research question and intended message!  
2. Conclusion in the abstract that ". . . associated with high socioeconomic status" requires 
stating the direction of the association ; both "no household income" and "middle wealth 
quintiles" show association. The no household income person is a poor one I guess, while the 
middle quintile person has some money and better placed socioeconomically!  
So what is the measure of socioeconomic status? Also having and watching TV maybe measures 
of socioeconomic status. So, you may want to refine and give the specific message you wish we 
the readers should consume.  
The issue of socioeconomic status features again prominently in lines 307/308. Plea se qualify 
what direction the association is: is it associated with low or high socioeconomic status?  
3. Are there any key findings from the qualitative arm that could go into the abstract - just in 
case space allows. To clearly bring out the fact that imp ortant findings came from both 
approaches, hence the need for the mixed methods design. This is really not a requirement if 
there are no very key issues from the qualitative segment you feel need to be captured in the 
abstract.  
 
4. Line 316: ". . . reporte d age as . . ." is it younger age or older age? And importantly, you do 
not provide the age group you used as reference age in the regression analyses. That makes it 
difficult to make a clear statement on whether the younger or older are or are not likely to be 
associated with the outcome of interest.  
5. Line 337 "… cervical cancer, (80%) ..." If 80% is considered suboptimal, what percentage 
would cohere with optimal knowledge? Please make this clear for readers to contextualize 
the message you are providin g in this regard.  
Lines 375 - 378. You seem to suggest that 95% of the patients were diagnosed on the basis of 
screening - particularly in line 377 "…meaning that 5% presented with advanced disease that did 
not require screening". Please make this clear. M ore than 83% of cervical cancer patients in sub 
Saharan Africa are known to be diagnosed in advanced stages.  
Your tool seems to have asked "Have you ever screened for cervical cancer?" - Table 2, last 
segment. So, let us interpret what the tool measured ra ther than something else.  
One becomes interested in seeing the stage distribution of the cancers at diagnoses in your table 
1. What proportion of patients were in stage I/II and stage III/IV?  
6. Lines 416/417:  "Lastly, … generalizable beyond the study set tings" could be deleted. Is it 
really the case that qualitative inquiry are inherently prone to bias, and perhaps by extension, 
to mean that quantitative are not prone to bias? And in qualitative inquiries interests are not 
on generalization beyond study s etting, but rather whether the findings can be transferable to 
other settings similar to the one where the study has been conducted. So, transferability, not 
generalizability is the issue in qualitative inquiries. I would delete this sentence since under 
methods you had strongly justified the need for a qualitative arm to explain findings from the 
quantitative arm.  
7. Lines 434: Where are these coming from? They seemed not to have been explored in this 
study and seemingly no direct connections between them and the findings in this study to 
warrant them appearing in the conclusion.  
Kind Regards  
Are the methods appropriate and well descri bed?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately 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.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interes ts 
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 
organisation that may in any way gain or lose financially from the publ ication 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 current ly 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 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 det ails below.  
 
'I declare that I have no competing interests'  
 
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