Reviewer’s report
Title:  Socio-Demographic  Characteristics  and  Associated  Factors  Influencing  Cervical  Cancer
Screening among Women Attending in St. Paul ’s Teaching and Referral Hospital, Ethiopia
Version: 0 Date: 23 Apr 2019
Reviewer: Mona Saraiya
Reviewer's report:
This manuscript describes the relationship between cervical screening and various socio-demographic
characteristics of women aged 18-49 attending St. Paul's Teaching and Referral Hospital in Addis
Ababa, Ethiopia. It lays out the need for increased screening in low income countries, such as Ethiopia
in order to decrease the burden of cervical cancer, and seeks to identify factors that may be contributing
to reduced screening rates in the country. This study identifies rural residence, younger age, low
monthly income, and lack of knowledge as variables associated with decreased screening. This paper
was poorly written but the study was conducted appropriately and contributes important information to
the field. 
It is unclear what guidelines Ethiopia is following and why one would be examining practices from
women under 25/30 given WHO guidelines are recommending staying away from Pap testing and not
starting to screen till age 30 (unless HIV +).  It is also unclear if its is appropriate to  use statistical
interpretations with a prevalence odds ratio
Overall: 
*Clear question is being asked: What effect do socioeconomic factors in Addis Ababa, Ethopia
have on the low rate of screening?
*Important  question  with  few  other  studies  providing  information  on  this  topic.  Especially
among the general populations of women of reproductive age. 
*Conclusions are consistent with existing data.
*Figures could include the demographics for those who did not receive screening within the last
3 years.
*Multiple grammatical errors and areas that need clarification.
*Paper could be made more concise. 
Abstract: 
*Line 31: clarify what purposefully selected means
*Line  38-39:  consider  rephrasing  if  these  aren't  all  significantly associated  with  uptake  of
screening.
Introduction:
*Article does a good job of setting up the argument
*Could use more concise language 
*Should focus more on the disparities in Ethiopia, as this is the area of interest
*Could highlight the gaps in research in this area better. 
*Define what type of screening is being discussed.
*Line 52: rephrase for clarity
*Line 58-59: reference?
*Line 62-64: rephrase
*Line 76-77: Rephrase, focus more on statistics in Ethiopia to build case for study
Materials and Methods: 
*Sample size/power is sufficient and methods appear to be reproducible. Inclusion and exclusion
data should be clarified.
*Uses validated questionnaire
*How were women recruited? 
*How were translations of questionnaires performed?
*Line 90-95: Clarify sample size determination. Rephrase.
*Line 95-98: Clarify if purposeful sampling was choosing women based off the inclusion criteria
listed. Were women randomly sampled?
*Line  101-103:  Define  outcome  variables  and  predictive  variables  more  precisely.  Was  all
cervical cancer screening included? Define income groups, etc.
*Line 114-115: Why was a p-value of 0.2 used
*Line 115-116: What were odds ratios adjusted for? 
Results: 
*Line 120-121: clarify "under the age range from 30-39", does this include that age group?
*Line 148: spell out abbreviations
*Line 147: Is pills referring to birth control pills?
*Line 153: clarify what is meant by "had information about cervical cancer" 
*Line 170-171: clarify.
Discussion: 
*Could be made more concise.
*Study findings are comparable to those in other studies
*Line 173: rephrase. 
*Line 173-178: make more concise, repetition of the introduction
*Line 179-180: this should go in results. Discussion should summarize these findings.
*Line 182-184: Could be due to some selection bias because participants were chosen in a
hospital setting
*Line 184-188: are there any other similar studies in Ethiopia that this study can be compared
against?
*Line 210: Clarify? Is this factual?
*Line 217-219: clarify
*Line 220: Lower monthly income was associated with lower uptake 
*Line 228-229: reference. Were these barriers identified in this study?
*Line 244: clarify
*Line 251: was religion or belief in destiny mentioned in the questionnaire? 
*Line 260: Could address other limitations; for example, recall bias from surveys, selection bias?
*Generalizability of study population to population in Ethiopia?
Conclusion: 
*Good summation of the paper
*Could add on some potential solutions/targets for either expanding screening or expanding
awareness.
Figures:
*Add demographics table with whole population
*Add demographics of those who were not screened.
*Clarify some of the terms/questions in the table 
.
Are the methods appropriate and well described?
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.
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 the 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
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 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 details below.
I have no competing interests
I agree to the open peer review policy of the journal. I understand that my name will be included on my
report to the authors and, if the manuscript is accepted for publication, my named report including any 
attachments I upload will be posted on the website along with the authors' responses. I agree for my 
report to be made available under an Open Access Creative Commons CC-BY license 
(http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments which I do not wish to 
be included in my named report can be included as confidential comments to the editors, which will not
be published.
I agree to the open peer review policy of the journal