Reviewer’s report
Title: 
THE STATE OF CERVICAL CANCER SCREENING IN IMPRISONED
WOMEN IN MALAWI: A CASE OF MAULA PRISON.
Version: 
1 
Date: 
17 Sep 2022
Reviewer's report:
Reviewer Comments
Overall Comments
Cervical cancer is an important public health issue in Malawi. Therefore, the
findings of this study have the potential to make a significant contribution to the
development of interventions to improve access to cervical cancer screening and
treatment. You choose to study a population that is often not included in
research. Therefore, that is a unique aspect of the study. Please review the
following suggestions for strengthening the manuscript. 
Areas for Improvement:
* Abstract
o Please at a time period to the following sentence. For example, is this referring
to 10% of women being screened annually?
 Less than ten percent of women screened for cervical cancer.
o Findings should not be discussed in the abstract.
o The methods section was well written
o & should not be used
o The conclusion goes beyond the scope of cervical cancer. The conclusion
should summarize and highlight the implications of the study.
* Background
o The statistics included are outdated. 
o The first four sentences are not necessary. Focus on the impact of cervical
cancer in Malawi.
o The findings should not be discussed in the background section.
o 
* Methods
o The timeframe of the study is not clear. You indicated that the study began in
2018 but you go on to provide the number of incarcerated women only for 2020.
When were the interviews and focus groups conducted. Based on the information
about the sample size, it appears that the participants were selected at one time
and divided into the interview group and the focus group group.
o The paragraph about the sample selection needs to be written more clearly.
The following statement does not make sense. The sentence about the sampling
method, "purposively and conveniently sampled" does not make sense.
o The statement about "convenient sampling due to their convenient accessibility
and proximity" does not make sense.
o The last 2 sentences provide redundant information
o The rationale for the sample size is illogical.
o What is the theoretical framework?
o There are inconsistencies in the type of analysis that are being reported. The
abstract stated that you conducted thematic analysis, but the methods state that
you conducted inductive content analysis.
o There is no mentioned of how you ensured the reliability and validity of the
data analysis.
* Results
o More details about the participants demographic characteristics are needed or
put m more descriptors after the quotes. One particular characteristic that will
help add context to the participants quotes is the length of time they had been
incarcerated at the time they participated in the study. The views of a woman
who has been incarcerated for 1 month will be vastly different from the views of
a woman who has been incarcerated for 16 months.
o Also, screen history, cancer history and HIV status. The fact that at least one
of your participants had cervical cancer is significant and should have been
highlighted in the demographics section. Also, the fact that at least one of your
participants was HIV positive is significant because cervical cancer is an AIDS-
related malignancy.
o The punction marks in the quotes are not consistently format, with extraneous
quotations marks in some quotes. For example:
 There was a time I was suspecting that I have cancer of the cervix. I was
bleeding but yet I have already reached menopause. I was also experiencing
sharp back and abdominal pain. This was during the time I was already here in
prison." I reported to the clinic to request for screening, the clinic was unable to
do so, but they arranged for me to go for a check-up at Central hospital". (IDI
participant 7).
General comments:
* Please review spelling, grammar and consistency with the capitalization of
terms and correct errors that are throughout the manuscript. For example, the
correct term is focus group discussions, not focused group discussions.
* Make sure all numbers are formatted correctly. For example, in the
introduction 100 000 should be 100,000.
* Sentences should not begin with numerals.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes