Title: Knowledge and practice of cervical cancer prevention and associated factors among
commercial sex workers in Shashemene town, west Arsi, Oromia region, Ethiopia:
Version: 4 Date: 17 Apr 2022
Reviewer:  Rene H. M. Verheijen
Reviewer's report:
GENERAL COMMENTS
The language of the paper needs considerable adjustment, rephrasing and correction.
Please refrain from decimals to a too high degree (although they will be provided by your
computer program). So e.g. better 29.3 +/- 5.5, rather than 29.29 +/- 5.468.
MAJOR COMMENTS
p. 2 Background should not be a childish tekst book summary. Please, rather refer to to size of
the problem, unmet needs etc.
p.3 Hence leave out first paragraph of the paper.
p.3. Your explanation that the ‘peak time for acquiring infection was after menopause’ should
surely be a misinterpretation of the WHO Guide. Please state the correct age of peak incidence.
p.3 Please specify the screening methods (tests) that are currently used in Ethiopia.
p.4. Please provide some information on what constitutes a ‘family guidance association clinic’,
for what reason(s) and how commercial sex-workers were attending this clinic.
As a non-statistician I cannot say whether or not your sample size calculation is justified and/
or correct.
p.12 Significantly the issue of HIV and its importance with respect to cervical cancer is not
mentioned before the Discussion section and without discussion. The history and (current)
incidence of HIV infection should have been addressed in the study questionnaire, if only
because cervical carcinoma is an HIV-related disease.
p.12 Without saying so, implicitly the bias of sex workers that visit a clinic is mentioned here.
However, it is not explained why this study did not try to also contact sex workers that would
not visit a family association clinic. This bias should be specified in the ‘Limitation’ section
(which should be rephrased anyhow to make this section comprehensible.
p.13 In this study the determinant for participation in cervical cancer screening was ‘practice
of screening’. Why did this study not check e.g. the age at first screening, the frequency of
screening to compare this actual ‘practice’ with the level of knowledge ?
MINOR COMMENTS
p.2  Please rephrase last sentence of ‘Conclusions’ to make this statement comprehensible.
p.3 Please specify amongst what/where/when cervical cancer ‘is most common’.
p.3 By ‘America’ presumably is meant ACOG, so please site their full name.
p.3 Presumably the study period was from 01/06/20-01/01/21.
p.3 Presumably the town ‘is’ (still) located 267.8 km from Addis Ababa. In general please use
the present sense to indicate a current/existing situation/event.
p.5 Apparently (from the result section) the questionnaire tool results in a score. Please explain
somewhere how the score is determined, what is the p;otential range and whether this is a
validated scoring system.
p.6 Table 1. Please specify the level of education more understandable, i.e. primary, secondary
and higher education. Please note that in the US ‘preparatory school’ refers to secondary
education, whereas in the UK it refers to ‘primary education’. To which one do your prep-schools
belong and could you merge the numbers with the correct level ?
Also, are there no sex workers under 20 in Ethiopia, or has that age group been left out of this
study ?
p.7 Table 2 The median age, rather than the mean age would better reflect the fact that the
majority of women had their first sex encounter at or under the age of 21.
p.9 Table 5 What means ‘I have issued more than this’ ?
p.11 What is the meaning and the reliability of ‘number of sexual partners’ in this group of sex
workers ?!