Title: Factors Associated with Low Utilisation of Cervical Cancer Screening Among Urban
Women in Lilongwe, Malawi: A Cross Sectional Study
Version: 1 Date: 07 Apr 2021
Reviewer's report:
Thanks for the opportunity to review the manuscript. The paper is well-written on a topic of
public health importance. Below are my few comments/concerns that authors may address to
improve their work:
Abstract
- The first sentence in the abstract should be more specific; are these figures i.e., more than half
million women …etc global or in Africa?
- The 75.9 incidence is per what? 1000 or 100 000 persons?
- Abstract results: The last sentence in the result section “low participation” – this could also be
specific…low participation in what?
- Abstract conclusion: “addressing these factors will increase ….” – The statement sounds strong.
It’s not a guarantee that addressing these factors WILL increase participation, but “may” help
increase participation.
Keyword
- Should acetic acid be a keyword for this work?
Background
- Citations – there is a need to provide relevant citations to most sentences/claims the authors
have provided in the background section. For example
“Most women seek…”
Where authors are stating that Malawi has low screening levels etc
- Some English editing is needed for instance, remove “be” on the statement “men are also be
carriers”
-
- Authors have stated that “estimates based on modelling” – what kind of modelling is this? Are
these estimates global or in SSA?
-
- When mentioning incidence please specify per xxx population
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- 81 Health centers out of how many in Malawi? It would be important to provide a context to
know the accessibility of the screening services out of all the health centers available.
-
- I would recommend the authors to split the end part of the background section to clearly show
the aims of the study at the very end.
Methodology/Results
- Clearly state the name of the hospital in which the study was conducted.
- The methodology/Result sections could benefit from a well elaborated theoretical framework.
The authors seem to be presenting their work systematically using a Health Belief Model
however, there is no description of the HBM or any other model the authors want to use when
analysing their data. It would be important to elaborate on this in the methodology and clearly
what components of the model has been adopted in analysing and discussing their results. For
instance, through the observations, it is clear there were “Barriers to action” that were observed,
and this could be well explained from the theoretical framework point of view.
Discussion
- Under demographic characteristics of women, the statement that says “most women with
secondary education were coming for the cervical cancer screening services than the rest…” –
in as far as the data is showing this, it is important to note the study setting. The authors stated
that the study was conducted in a large urban hospital serving low-income community and its
not surprising that most participants are within the secondary and primary education levels. This
should be discussed to avoid misrepresentation of facts as the interpretation may be those with
secondary education attended screening more than those with tertiary…
- It would be great to write the discussion systematically based on the components of the
theoretical framework (HMB?) that has driven the analysis of this paper. In that way, it will be
easier to follow the discussion.
- The authors have stated about Mulanje, clearly state that this is a district in Southern Malawi.
- Limitations: Can the authors briefly explain how those that were not willing to participate in
the study could be a limitation and impact on their findings?