PONE-D-23-29440Understanding cervical cancer awareness in hard-to-reach areas of Bangladesh: a cross-sectional study involving women and household decisionmakersPLOS ONE

Dear Dr. Nazrul,

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PLOS ONE

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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: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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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: No

Reviewer #2: Yes

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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: Yes

Reviewer #2: Yes

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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: Few issues required further revision:

Method:

1. The inclusion criteria appear to be unclear, particularly regarding the justification for including "husbands" in the study. Authors are encouraged to provide a more explicit rationale for this inclusion.

2. The decision to limit the study to women aged 30-60 raises questions. If this restriction aligns with national guidelines for cervical screening, it would be beneficial for the authors to elucidate. Additionally, considering a broader age range might enhance the study's generalizability.

3. The inclusion of 400 women, 400 husbands, and 400 household decision-makers needs clarification. The rationale behind separating these three groups should be justified.

4. The term "household decision-maker" lacks clarity and requires a more detailed definition. Authors are advised to provide explanation to avoid confusion, specifying whether it exclusively refers to husbands or includes others.

5. The study originally calculated a required sample size of 400 for each arm, but the final sample collected was 600. Authors should address this discrepancy and provide a clear explanation for the deviation from the initially determined sample size.

6. The statement that "a total of 1800 respondents were interviewed" raises concerns about its coherence. Authors are encouraged to revise and provide a more accurate representation of the study's participant recruitment and response rates.

Results:

1. The use of "family expenditure" rather than "household income" needs clarification. Authors should justify this choice to ensure a clear understanding of the financial metric employed.

2. Tables 4 and 5 present results that are causing confusion. Authors should elucidate the reasons for selecting specific parameters as references, such as age 30-39, education below primary, and expenditure 0-5000, to enhance the interpretability of the findings.

Reviewer #2: Reported study is a cross-sectional survey conducted in five districts in Bangladesh among women aged between 30 and 60 years, their husbands and their mothers-in-law from April to September 2022.

Lines 64-65: Need more clarity.

Results of multivariate analysis could be interpreted and reported in a better way to identify the determinants of good knowledge or identification of symptoms etc.

Discussion part please mention the other studies along with the year it was conducted.eg. the study conducted in India and Zimbawe

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Reviewer #1: No

Reviewer #2: Yes: Gauravi Ashish Mishra

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Understanding cervical cancer awareness in hard-to-reach areas of Bangladesh: a cross-sectional study involving women and household decisionmakers

PONE-D-23-29440R1

Dear Dr. Naheed Nazrul

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.

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Kind regards,

Adu Appiah-Kubi, MBChB, CEMBA, FGCS

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #3: (No Response)

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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 #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: Yes

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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. 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 #3: Yes

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5. 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 #3: Yes

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6. 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 #3: It is excellent how the writers have succinctly and clearly presented their findings. There is straightforward presentation and interpretation of the results in the methods section, which is written with ease of comprehension. The results are well-positioned within the larger body of research by the discussion section, and the conclusions are reasonable and solidly backed by the evidence. As a whole, the manuscript is skillfully composed and constructed.

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7. 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 #3: Yes: Michael Yaw Amoh

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