Determinants of utilization of cervical cancer screening among women in the age group of 30–49 years in Ambo Town, Central Ethiopia: A case-control study

Dereje Lemma; Mecha Aboma; Teka Girma; Abebe Dechesa

doi:10.1371/journal.pone.0270821

Peer Review History

Original SubmissionDecember 27, 2021
15 Mar 2022 Decision Letter - Desalegn Admassu Ayana, Editor PONE-D-21-40695Determinants of Utilization of Cervical Cancer Screening among Women in the Age group of 30-49 Years in Ambo Town, Central Ethiopia, a case-control studyPLOS ONE Dear Mecha Aboma, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Apr 29 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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List the grants or organizations that supported your study, including funding received from your institution. b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.” c) If any authors received a salary from any of your funders, please state which authors and which funders. d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.” Please include your amended statements within your cover letter; we will change the online submission form on your behalf. 4. Please include a separate caption for each figure in your manuscript [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Many grammatical errors are observed in the manuscript, the study is a case control study but in the conclusion section it is reported "Even though the facility of cervical cancer screening is available in almost all health facility levels but only a few of them utilized the services from existing data" this seems reporting prevalence of cervical cancer screening. Reviewer #2: The manuscript is reasonably sound, and the data support the conclusions presented. However, there are matters require revisions. The statistical analysis seems rigorous. The authors reported availability of data and promised that provide the data with reasonable request. The manuscript requires language revision. General comments: This article tried to address important research question that is relevant and an interesting. The manuscript is generally well written and structured. However, in my opinion the paper has few shortcomings. For instance, research gap that authors would attempt to address in their project is not boldly stated. It needs to show gap and must attempt to fill in some piece of information missed in the scientific literature. Otherwise, it is not novel research which is not contributing to the overall goals of science. Title: Determinants of Utilization of Cervical Cancer Screening among Women in the Age group of 30-49 Years in Ambo Town, Central Ethiopia: a case-control study. Why would you (authors) focus on this age group (30-49 years of age) as far as 15-49 years are also eligible? ABSTRACT: Background: What stated in this section might not be research gap. It seems effort attempted by government to facilitate cervical cancer screening. What were known and not known since guidelines and protocols endorsed by government of Ethiopia? Methods: “multivariate” should be edited and corrected as “Multivariable” Results: it would be clearer if the total number of study participants involved were mentioned. Line 20. Is grand multiparity appropriate instead of saying para 5 and above?? It is optional. Line 22: high level of knowledge can be merged to the list of variables showed association with CCS. No need of separate explanation. Conclusions: I think it needs revision. I must be based on main findings. Line 27: Why social media? Or would the authors say mass media? How many of women have access to social media? How feasible? INTRODUCTION: Line 31: It would be better if it changed to “introduction” than background. Because introduction consists of background and statement of the problem. Line 37-40: these statements are not aligning with the prior statements and subsequent paragraph. The first paragraph state prevalence and death attributed to cervical Ca. The middle statements talking about methods of screening while the subsequent paragraph talking about Cervical Ca incidence by regions. Similarly, lines 103-108 are not appropriate place for this paragraph. Check it. Line 111: Dire Dawa is not a city administration. Rather, it is simply Dire Dawa Administration since it has the numbers of rural woredas and kebeles. METHODS and MATERIALS: Study setting- was missed. This subtitle is important for what the authors stated from line 124-129. In addition, I personally want to incorporate other pertinent information such the numbers of health facilities, and trained health care providers who can provide CCS. Data collection tool and personnel Line 154-158: Here detail expiations about number of items used, response options, how composite scores made and relevant nature of tools, their validity are required. I suggest that merging and well synthesizing this section with operational definitions. Line 189: there is phrase “overall knowledge”. What does it mean? Did the knowledge items have dimensions or domains? If that is the case define overall and dimensions too. Data management & Analysis: add versions of software used (EpiData and SPSS) RESULTS: Line 215-216; Either median with IQR or mean with SD is enough based distribution of the data. Table 1: replace ‘’Socio-demographic characteristics of study participants (n=195)’’ with “variables”. Line 226 and 229: replace “have seen” with “saw” and “started” respectively. Line 234-235 remove “were” Line 237: replace “have” with “had” Table 2: variable “your husband has another wife”. It is not clear whether it is talking about polygamy or another wife or partner before she married him?? Table 2: “Number of partners”. It is not clear. Was it asking about number of partners in life or current number of partners? Knowledge related factors: Line 242-245: The statements are too long, and vague/not clear. It was also mentioned under operational definitions that authors followed Bloom’s cut-off point to determine levels of knowledge. The same is true in lines 249-251. Lines 255-265 need revision. Things already addressed in method section should be omitted. E.g., criteria set for candidacy to multivariable analysis. Lines 270, 273, and 275: The phrases “in the age group 30-49” are presented redundantly here and there unnecessarily. Since it was already mentioned in the title, no need of reporting them. Simply use “women who…….” Line 279: “Towns”- delete “s”. Similarly, delete February to march” since it was mentioned in line 125. Table 3: under monthly income (>3000ETB) the corresponding confidence interval was 0.4-4. But to maintain consistency use at least one digit after decimal point. The same is true for high level of knowledge (2-17). It would be better it 2.0-17.0 if appropriate or subsequent number. DISCUSSION: It would be appropriate if the first paragraph of discussion present summary of main findings. The main purpose of discussion is reporting findings one by one, interpreting, comparing with former findings and suggesting possible scientific justifications. In addition, explain newly emerged understandings from the current study. This section needs strict revision, and arguments. Line 292. It indicates misperception among younger women. Why that? Authors’ argument/ justifications should be scientific and strong enough to convince. Again, there are inconclusive findings? It is suggested that this must be exhaustively addressed and recommendations might be also required. Line 301-308: it is wonderful ways of discussion. Line 304: Add Tanzania, after Dare Salam. Lines 311-313: These kind of stating justifications might be so superficial. It would better if authors specify reasons for difference than crudely reporting difference was due to “socio-demographic or sample size, time gaps”. Please, look them further in terms of design, inclusion criteria, age, awareness level etc. CONCLUSIONS: The first 3 lines (331-333) are enough. Recommendations are not appropriately made based main findings. For instance, statements in line 334 and 335(availability of the service was not studied in the current study. Three paragraphs starting from line 336-348 have no importance. FIGURES: Figure 1: has no importance. I would suggest to omit it. Figure 3: has miss classification in relation to what operationally defined. REFERENCES: • There is inconsistent way of reference writing. Some lacks volume, numbers, years etc. • There are also old references published 10 years back. Unless special circumstances, it would better to use articles published since 2011 if guideline of journal allow. OTHERS: Minor editorial: punctuations, grammatical errors, inconsistent use terms NOTE: in conclusion, the findings of the manuscript are informative. But it requires moderate revision. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". 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Revision 1
8 Apr 2022 Author Response Author's response to Reviewers Comments Manuscript ID number: PONE-D-21-40695 Title of Manuscript: Determinants of Utilization of Cervical Cancer Screening among Women in the Age group of 30-49 Years in Ambo Town, Central Ethiopia, a case-control study Authors: 1. Dereje Lema 2. Mecha Aboma: Corresponding Author: abomamecha@gmail.com 3. Teka Girma 4. Ababe Dechasa Generally, in manuscript we used track change to incorporate or address the reviewers’ comments. A Point by Point Response to Reviewer Evaluation 1. Reviewer Question, #1: Many grammatical errors are observed in the manuscript, the study is a case control study but in the conclusion section it is reported "Even though the facility of cervical cancer screening is available in almost all health facility levels but only a few of them utilized the services from existing data" this seems reporting prevalence of cervical cancer screening. Answers from authors: The comment is accepted and corrected using track change and colored highlight throughout the manuscript, Line 407-4025 2. Reviewer Question, #2: The manuscript is reasonably sound, and the data support the conclusions presented. However, there are matters require revisions. The statistical analysis seems rigorous. The authors reported availability of data and promised that provide the data with reasonable request. The manuscript requires language revision. Answers from authors: It is alright. As you indicate there are many errors. Using language expert we tried to correct using track change and colored highlight throughout the manuscript 3. Reviewer Question, General comments: This article tried to address important research question that is relevant and an interesting. The manuscript is generally well written and structured. However, in my opinion the paper has few shortcomings. For instance, research gap that authors would attempt to address in their project is not boldly stated. It needs to show gap and must attempt to fill in some piece of information missed in the scientific literature. Otherwise, it is not novel research which is not contributing to the overall goals of science. Answers from authors: The comment is accepted and correction and revisions is made using track change and colored highlight throughout the manuscript. 4. Reviewer Question, Title: Determinants of Utilization of Cervical Cancer Screening among Women in the Age group of 30-49 Years in Ambo Town, Central Ethiopia: a case-control study. Why would you (authors) focus on this age group (30-49 years of age) as far as 15-49 years are also eligible? Answers from authors: The government of Ethiopia launched screening of cervical cancer in 2014 and the VIA recommended for those women between the age of 30-49 years within every five years (6). Currently in Ethiopia cervical cancer screening services are free of charge in the public health facilities and women of 30-49 can uses services through self-referral, referral by health extension workers, by referral of other health care professionals (nurses, midwives, doctors ,and public health professionals) , and opportunistic screening. 5. Reviewer Question, ABSTRACT: Background: What stated in this section might not be research gap. It seems effort attempted by government to facilitate cervical cancer screening. What were known and not known since guidelines and protocols endorsed by government of Ethiopia? Answers from authors: The comment is accepted and corrected, and indicated by track change and colored highlight, Line 11-16 6. Reviewer Question, Methods: “multivariate” should be edited and corrected as “Multivariable” Answers from authors: The comment is accepted and corrected as “Multivariable”, Line 20 7. Reviewer Question, Results: it would be clearer if the total number of study participants involved were mentioned. Answers from authors: The comment is accepted and corrected as ‘‘a total of 195 study participants, sixty-five cases and one hundred thirty controls, were participated in this study making a response rate of 100%’’, Line 22-23 8. Reviewer Question, Line 20. Is grand multiparty appropriate instead of saying Para 5 and above?? It is optional. Answers from authors: The comment is accepted 9. Reviewer Question, Line 22: high level of knowledge can be merged to the list of variables showed association with CCS. No need of separate explanation. Answers from authors: The comment is accepted and corrected and indicated by using track change and colored highlight Line 25-26 10. Reviewer Question, Conclusions: I think it needs revision. It must be based on main findings. Answers from authors: The comment is accepted and revision is made and indicated by using track change and colored highlight, Line 407-4025 11. Reviewer Question, Line 27: Why social media? Or would the authors say mass media? How many of women have access to social media? How feasible? Answers from authors: The comment is accepted and corrected as ‘‘Mass media’’ Line 31 INTRODUCTION: 12. Reviewer Question, Line 31: It would be better if it changed to “introduction” than background. Because introduction consists of background and statement of the problem. Answers from authors: The comment is accepted and corrected as ‘‘Introduction’’, Line 35 13. Reviewer Question, Line 37-40: these statements are not aligning with the prior statements and subsequent paragraph. The first paragraph state prevalence and death attributed to cervical Ca. The middle statements talking about methods of screening while the subsequent paragraph talking about Cervical Ca incidence by regions. Similarly, lines 103-108 are not appropriate place for this paragraph. Check it. Answers from authors: The comment is accepted and revision is made and indicated by using track change colored highlight throughout the manuscript 14. Reviewer Question, Line 111: Dire Dawa is not a city administration. Rather, it is simply Dire Dawa Administration since it has the numbers of rural woredas and kebeles. Answers from authors: The comment is accepted and corrected as ‘‘Dire Dawa Administration’’, Line 147 15. Reviewer Question, METHODS and MATERIALS: Study setting- was missed. This subtitle is important for what the authors stated from line 124-129. In addition, I personally want to incorporate other pertinent information such the numbers of health facilities, and trained health care providers who can provide CCS. Answers from authors: The comment is accepted and corrected as: - ‘‘The town has one referral hospital, one general hospital, two health centers, nine health posts, and twenty one private clinics. Ambo General Hospital was the only hospital providing cervical cancer screening during this study was conducted. Ambo General Hospital had 287 health care workers. Those were 8 special doctors, 19 general practitioners, 69 nurses, and other health care providers (30).’’ Line 168-172. And study setting is added. Line 62 Data collection tool and personnel 16. Reviewer Question, Line 154-158: Here detail expiations about number of items used, response options, how composite scores made and relevant nature of tools, their validity are required. I suggest that merging and well synthesizing this section with operational definitions. Answers from authors: The comment is accepted and revision is made and indicated by using track change and colored highlight. Number of items also addressed under operational definition., Line 198-204 17. Reviewer Question, Line 189: there is phrase “overall knowledge”. What does it mean? Did the knowledge items have dimensions or domains? If that is the case define overall and Dimensions too. Answers from authors: The comment is accepted and revision is made and indicated by using track change and colored highlighted, Line 235-239 18. Reviewer Question, Data management & Analysis: add versions of software used (EpiData and SPSS) Answers from authors: The comment is accepted and corrected as ‘‘EPI-Data 3.1 version SPSS software version 25’’, Line 2013-2014 RESULTS: 19. Reviewer Question, Line 215-216; Either median with IQR or mean with SD is enough based distribution of the data Answers from authors: The comment is accepted 20. Reviewer Question, Table 1: replace ‘’Socio-demographic characteristics of study participants (n=195)’’ with “variables”. Answers from authors: The comment is accepted and indicated by using track change and colored highlighted, and characteristics replaced with ‘‘variables’’ 21. Reviewer Question, Line 226 and 229: replace “have seen” with “saw” and “started” respectively. Answers from authors: The comment is accepted and indicated by using track change and colored highlighted, and “have seen” replaced with “saw” and “started” respectively.’’ Line 273, 276 22. Reviewer Question, Line 234-235 remove “were Answers from authors: The comment is accepted and corrected, and indicated by using track change and colored highlighted ‘’were’’ is removed, Line 281, 282 23. Reviewer Question, Line 237: replace “have” with “had” Answers from authors: The comment is accepted corrected, and indicated by using track change and colored highlighted, and “have” replaced with “had” , Line 284 24. Reviewer Question, Table 2: variable “your husband has another wife”. It is not clear whether it is talking about polygamy or another wife or partner before she married him?? Answers from authors: the comments accepted and corrected, and indicated by using track change and colored highlighted. It is talking about polygamy or currently having another wife 25. Reviewer Question, Table 2: “Number of partners”. It is not clear. Was it asking about number of partners in life time or current number of partners? Answers from authors: The comment is accepted and corrected, and indicated by using track change and colored highlighted. It is talking about number of partners in life time 26. Reviewer Question, Knowledge related factors: Line 242-245: The statements are too long, and vague/not clear. It was also mentioned under operational definitions that authors followed Bloom’s cut-off point to determine levels of knowledge. The same is true in lines 249-251. Answers from authors: The comment is accepted and correction is made and indicated by using track change and colored highlighted, Line 290-292, 296-298 27. Reviewer Question, Lines 255-265 need revision. Things already addressed in method section should be omitted. E.g., criteria set for candidacy to multivariable analysis. Answers from authors: The comment is accepted and correction is made and indicated by using track change and colored highlight, Line 302-3013 28. Reviewer Question, Lines 270, 273, and 275: The phrases “in the age group 30-49” are presented redundantly here and there unnecessarily. Since it was already mentioned in the title, no need of reporting them. Simply use “women who…….” Answers from authors: The comment is accepted and correction is made and indicated by using track change and colored highlight, Line 322, 324 29. Reviewer Question, Line 279: “Towns”- delete “s”. Similarly, delete February to march” since it was mentioned in line 125. Answers from authors: The comment is accepted and correction is made and indicated by using track change and colored highlight, Line 328 30. Reviewer Question, Table 3: under monthly income (>3000ETB) the corresponding confidence interval was 0.4-4. But to maintain consistency use at least one digit after decimal point. The same is true for high level of knowledge (2-17). It would be better it 2.0-17.0 if appropriate or subsequent number. Answers from authors: The comment is accepted and correction is made and indicated by using track change and colored highlight 31. Reviewer Question, DISCUSSION: It would be appropriate if the first paragraph of discussion present summary of main findings. The main purpose of discussion is reporting findings one by one, interpreting, comparing with former findings and suggesting possible scientific justifications. In addition, explain newly emerged understandings from the current study. Answers from authors: The comment is accepted and revision is made and indicated by using track change and colored highlight throughout the manuscript, Line 334-338 32. Reviewer Question, This section needs strict revision, and arguments. Line 292. It indicates misperception among younger women. Why that? Authors’ argument/ justifications should be scientific and strong enough to convince. Again, there are inconclusive findings? It is suggested that this must be exhaustively addressed and recommendations might be also required. Answers from authors: The comment is accepted and revision is made and indicated by using track change and colored highlight as follow: - ‘‘Similarly, the explanation for this could be that of the bimodal distribution of cervical cancer, one in their 30s and the other in their 60s. These two age groups represent the ages at which cervical lesions become symptomatic. Consequently, women see themselves as being at an increased risk of invasive cervical cancer as their age increases and seek health care and cervical cancer screening services. Additionally, in Ethiopia, the cervical cancer screening guideline promotes women aged 30–49 to be screened for cervical cancer, and women aged 40 and above might have better health-seeking behaviour and intention to be screened. Furthermore, this age group is more susceptible to giving birth at a productive age and has a chance of getting more gynecological examinations, giving birth, and getting more health information about sexual and reproductive health, including cervical cancer screening services. The other explanation might also be that increasing risk with women’s age leads the women to have more contact with healthcare facilities.’’ Line 346-459 33. Reviewer Question, Line 301-308: it is wonderful ways of discussion. Answers from authors: I thank you! 34. Reviewer Question, Line 304: Add Tanzania, after Dare Salam. Answers from authors: The comment is accepted and Tanzania is added after Dare Salam Line 369 35. Reviewer Question, Lines 311-313: These kinds of stating justifications might be so superficial. It would better if authors specify reasons for difference than crudely reporting difference was due to “socio-demographic or sample size, time gaps”. Please, look them further in terms of design, inclusion criteria, age, awareness level etc. Answers from authors: The comments accepted and revision is made and indicated by using track change and colored highlight as follow: Differences in respondents' ages, levels of awareness, access to information such as mass media and other social media, family, peers, cultural beliefs, sociodemographic status, women's autonomy, economic conditions, physical and financial accessibility, disease patterns, and health service issues, as well as differences in the study design, study area, study period, study populations, and sample size, all contribute to the variation. Line 377-383 36. Reviewer Question, CONCLUSIONS: The first 3 lines (331-333) are enough. Recommendations are not appropriately made based main findings. For instance, statements in line 334 and 335(availability of the service was not studied in the current study. Three paragraphs starting from line 336-348 have no importance. Answers from authors: The comment is accepted and correction is made and indicated by using track change and colored highlight, Line 405-425 FIGURES: 37. Reviewer Question, Figure 1: has no importance. I would suggest to omit it. Answers from authors: The comment is accepted and the figure is removed 38. Reviewer Question, Figure 3: has miss classification in relation to what operationally defined. Answers from authors: The comment is accepted but the score/ or response for negative attitude was zero because all of the study participants has positive and neutral attitudes, (according to their response indicated) 39. Reviewer Question, REFERENCES: • There is inconsistent way of reference writing. Some lacks volume, numbers, years etc. • There are also old references published 10 years back. Unless special circumstances, it would better to use articles published since 2011 if guideline of journal allow. Answers from authors: The comment is accepted, correction and revision is made and indicated by using track change and colored highlight 40. Reviewer Question, OTHERS: Minor editorial: punctuations, grammatical errors, inconsistent use terms Answers from authors: The comment is accepted, correction and revision is made and indicated by using track change and colored highlight throughout the manuscript 41. Reviewer Question, NOTE: in conclusion, the findings of the manuscript are informative. But it requires moderate revision. Answers from authors: The comment is accepted and revision is made and indicated by using track change and colored highlight throughout the manuscript. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0270821.r002
13 May 2022 Decision Letter - Desalegn Admassu Ayana, Editor PONE-D-21-40695R1Determinants of Utilization of Cervical Cancer Screening among Women in the Age Group of 30-49 Years in Ambo Town, Central Ethiopia: A Case-Control StudyPLOS ONE Dear Dr. Aboma, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Jun 27 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Desalegn Admassu Ayana, Ph.D Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. 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Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0270821.r003
Revision 2
20 May 2022 Author Response Author's response to Reviewers and Academic Editors Comments Manuscript ID number: PONE-D-21-40695 Title of Manuscript: Determinants of Utilization of Cervical Cancer Screening among Women in the Age group of 30-49 Years in Ambo Town, Central Ethiopia, a case-control study Authors: 1. Dereje Lema 2. Mecha Aboma: Corresponding Author: abomamecha@gmail.com 3. Teka Girma 4. Ababe Dechasa Generally, in manuscript we used track change to incorporate or address the reviewers’ comments. A Point by Point Response to academic editor and reviewer(s) Evaluation 1. Academic Editors Question, #1: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Answers from authors: The comment is accepted and corrected using track change and colored highlights throughout the manuscript. However, we didn’t use retracted and unpublished papers in the references, all of the references we used in this manuscript are available on Search Google or/and Google Scholars. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0270821.r004
21 Jun 2022 Decision Letter - Desalegn Admassu Ayana, Editor Determinants of Utilization of Cervical Cancer Screening among Women in the Age Group of 30-49 Years in Ambo Town, Central Ethiopia: A Case-Control Study PONE-D-21-40695R2 Dear Dr. Aboma, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Desalegn Admassu Ayana, Ph.D Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0270821.r005
Formally Accepted
30 Jun 2022 Acceptance Letter - Desalegn Admassu Ayana, Editor PONE-D-21-40695R2 Determinants of Utilization of Cervical Cancer Screening among Women in the Age Group of 30-49 Years in Ambo Town, Central Ethiopia: A Case-Control Study Dear Dr. Aboma: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Desalegn Admassu Ayana Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0270821.r006

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