Title: Factors associated with uptake of Human Papilloma Virus Vaccine among school girls
aged 9-14 years in Lira City northern Uganda: A cross-sectional study
Version: 1 Date: 19 Mar 2023
Reviewer:  Arthur Kiconco
Reviewer's report:
Abstract
Line 35: Use of the word ‘burden’ in the first line 35 makes the sentence loose meaning.
Line 37: Change the word adolescents to adolescent in line 37
Line 42: Use of the wording ‘Lira City, west northern Uganda’ in line 42 and onwards in unclear.
Should state whether it was western division, Lira City, Northern Uganda that they wanted to
refer to.
Line 48: Did you want to write ‘heard’ in line 48 instead of ‘had’?
Lines 52-52: Be consistent without starting with uppercase as done for individual factors. Also,
use conjunctions like and before the last statement i.e. … and having received healthworker….
In lines 51 and 52
Line 52: Report as p<0.001 instead of 0.00 in line 52
Lines 53-56: Since the main significant factors include hearing and being taught about the
vaccine? How about sustaining availability of vaccines at health facilities since it’s a major
finding
Study Background
Line 66: Missing word here, may be ‘of’ or ‘with’
Lines 69-73: second sentence: This was extracted from Lubeya  et al with minimal paraphrasing
but Lubeya et al also cite “ Bruni, L., Saura-Lázaro, A., Montoliu, A., Brotons, M., Alemany,
L., Diallo, M.S., Afsar, O.Z., LaMontagne, D.S., Mosina, L., Contreras, M. and Velandia-
González, M., 2021. HPV vaccination introduction worldwide and WHO and UNICEF estimates
of national HPV immunization coverage 2010–2019. Preventive medicine, 144, p.106399.”; it’s
better to refer to the original source and cite the original source after necessary paraphrasing.
Lines 72-73: This is a hanging sentence; did you mean to put a comma and continue with the
next sentence?
Line 83: Delete repeated word ‘Uganda’
Lines 91-92: Add that the effects were on service delivery otherwise someone may think that
COVID-19 increased risk for HPV infection.
Line 93: This order of words is confusing ‘Lira City West, northern Uganda’
Materials and methods
Line 99: previous comment
Lines 107-109: Break the second sentence into two to bring out clearly that there was parental
consent and children assent.
Sample size determination
Line 118: Maybe the statement would be clearer stating it as ‘the calculated sample size plus
10% of the non-response was 245 participants’ not as it is stated which looks like 245 is before
non-response adjustment. However, it seems after a 10% adjustment, it would come to 248.
Please stick to what was exactly done.
Data Collection Method and Tools
Lines 134-135: Why not the required three doses or given the number one had received determine
whether they had completed or failed to complete the dosage? Please justify the reason for your
consideration.
Data Collection Procedure
Lines 159-160: ‘convenience random sampling technique’ is non-existent. State random and
convenience sampling techniques’ instead.
Data Management and Analysis.
Line 157: ‘descriptive statistics’ Is this different from percentages and frequencies? It looks like
you had Mean and SD for continuous variables and percentages and frequencies for categorical
variables. Revise this section to make it more precise.
Line 159-160: Results from multivariable logistic regression are not presented yet stated here.
Results
Line 163: Mention the reason for dropping. The sample size was aprox. 248, why approach
260? Since the sample size plus 10% non-response would be 248, 245 is about 98%. Could you
please revise this.
Line 168: Reconcile this with the section on sample size calculation and the first part of results
stating a 95% response rate. It looks like you did 245 which does not include the non-response
adjustment. Stick to what you exactly did.
Lines 169-170: Too long sentence, break it into two.
Line 172: ‘Catholics and protestants’ OR ‘Catholics or protestants’ ?
Lines 179-180: Order of words as in comments above in Line 93
Line 276: Do you think there is still residual selection bias?
General comments and recommendations
Where are the results from the model to assess independent association of the factors to HPV
vaccine uptake? Given the absence of this, it may not be worse reviewing the discussion. Once
this is done, one table with factors independently associated with uptake of the vaccine should be
presented. The authors may consider assessing the vaccination status based on the stage each girl
is i.e., if one has taken necessary dosage and still waiting for completion or having completed
could be considered as vaccinated whereas those who have never vaccinated or are out of the
waiting period for next dose or completion be considered not vaccinated.