Reviewer’s Comments

(A) The four countries – Kenya, Cameroon, Namibia and Zimbabwe…what are the reasons you pick them for study? (Please state the justification)

(B) Understand ICC and follow the definition as follows:
The intra-cluster correlation coefficient (ICC), or ρ (the Greek rho), is a measure of the relatedness of clustered data. It accounts for the relatedness of clustered data by comparing the variance within clusters with the variance between clusters.

An intraclass correlation coefficient (ICC) is used to measure the reliability of ratings in studies where there are two or more raters. The value of an ICC can range from 0 to 1, with 0 indicating no reliability among raters and 1 indicating perfect reliability among raters.

What does good intraclass correlation mean?: The ICC is a value between 0 and 1, where values below 0.5 indicate poor reliability, between 0.5 and 0.75 moderate reliability, between 0.75 and 0.9 good reliability, and any value above 0.9 indicates excellent reliability

What does low intraclass correlation mean? A high Intraclass Correlation Coefficient (ICC) close to 1 indicates high similarity between values from the same group. A low ICC close to zero means that values from the same group are not similar.

(C) Explain each of the model in Table 3 and Table 4

(D) Explain the ICC and look at the articles I attached to this email to see how ICC are reported for each country (Kenya, Namibia, Cameroon and Zimbabwe)

(E) Let your ICC reporting be reflected in your recommendations, discussion and conclusions

(F) Include in Table 1 the unweighted sample size for women

(G) Convert the operational definition to Variables measurements and construct a table to illustrate how you measure the explanatory (independent) variables

(H) Look at line 9 to Line 16 and remove one of the repetitions

(I) Your manuscript should be drafted well and be free from errors

(J) Try to re-write your introduction in order to capture the title and your object and
research problem should be stated clearly in the introduction aspect. Please, give us information of cervical cancer morbidity and mortality as well as Pap smear uptake across few countries in West Africa, Central Africa, Southern Africa and Eastern Africa including North Africa (as recently there is a call for the awareness on cervical cancer morbidity and mortality among women in North Africa – I attended a Webinar on this)

(K) Put your introduction aspect very well in line with the format of this journal and also in a clarity form

(L) Put your Results very well in line with the format of this journal and also in a clarity form
(M) Arrange your discussions with your objectives step by step with each paragraph for an objective. Read articles in line with your findings and support or against the outcomes of your findings in your discussion section.

(N) Finally, send the manuscript to a very good Language Editor for proofreading

Read these following articles on intracluster (ICC)
1. Killip, S., Mahfoud, Z., & Pearce, K. (2004). What is an intracluster correlation coefficient? Crucial concepts for primary care researchers. Annals of family medicine, 2(3), 204–208. https://doi.org/10.1370/afm.141.
2. Colin K Macleod, Robin L Bailey, Michael Dejene, Oumer Shafi, Biruck Kebede, Nebiyu Negussu, Caleb Mpyet, Nicholas Olobio, Joel Alada, Mariamo Abdala, Rebecca Willis, Richard Hayes, Anthony W Solomon, Estimating the Intracluster Correlation Coefficient for the Clinical Sign “Trachomatous Inflammation—Follicular” in Population-Based Trachoma Prevalence Surveys: Results From a Meta-Regression Analysis of 261 Standardized Preintervention Surveys Carried Out in Ethiopia, Mozambique, and Nigeria, American Journal of Epidemiology, Volume 189, Issue 1, January 2020, Pages 68–76, https://doi.org/10.1093/aje/kwz196

3.https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-epidemiology/clustered-data

1. Akokuwebe, M.E.; Idemudia, E.S. Multilevel Analysis of Urban–Rural Variations of Body
   Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey. Int. J. Environ. Res. Public Health 2022, 19, 125.
   https://doi.org/10.3390/ijerph19010125 (Look at this article to report your ICC in your work)

2. Liljequist D, Elfving B, Skavberg Roaldsen K (2019) Intraclass correlation – A discussion and demonstration of basic features. PLoS ONE 14(7): e0219854. https://doi.org/10.1371/ journal.pone.0219854

3. Bobak, C., Barr, P. & O’Malley, A. Estimation of an inter-rater intra-class correlation coefficient that overcomes common assumption violations in the assessment of health measurement scales. BMC Med Res Methodol 18, 93 (2018). https://doi.org/10.1186/s128 74-018-0550-6

4. Koo, T. K., & Li, M. Y. (2016). A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of chiropractic medicine, 15(2), 155–163. https://doi.org/10.1016/j.jcm.2016.02.012

5. Ba, D. M., Ssentongo, P., Musa, J., Agbese, E., Diakite, B., Traore, C. B., Wang, S., & Maiga, M. (2021). Prevalence and determinants of cervical cancer screening in five sub-Saharan African countries: A population-based study. Cancer epidemiology, 72, 101930. https://doi.org/10.1016/j.canep.2021.101930

6. Barrow, A., Onikan, A., Nzoputam, C.I. et al. Prevalence and determinants of cervical cancer awareness among women of reproductive age: evidence from Benin and Zimbabwe population-based data. Appl Cancer Res 40, 8 (2020). https://doi.org/10.1186/s41241-020-00092-z

7. Djibril M. Ba, Paddy Ssentongo, Jonah Musa, Edeanya Agbese, Brehima Diakite, Cheick Bougadari Traore, Steve Wang, Mamoudou Maiga, Prevalence and determinants of cervical cancer screening in five sub-Saharan African countries: A population-based study, Cancer Epidemiology, 2021, Volume 72, 101930,

8. Tekalign T, Teshome M (2022) Prevalence and determinants of late-stage presentation among cervical cancer patients, a systematic review and meta-analysis. PLoS ONE 17(4): e0267571. https://doi.org/10.1371/journal.pone.0267571.

9. Mboumba Bouassa RS, Prazuck T, Lethu T, Jenabian MA, Meye JF, Bélec L. Cervical cancer in sub-Saharan Africa: a preventable noncommunicable disease. Expert Rev Anti Infect Ther. 2017; 15(6):613-627. doi:10.1080/14787210.2017.1322902.

10. Akokuwebe ME, Idemudia ES, Lekulo AM, Motlogeloa OW. Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016. BMC Public Health. 2021; 21(1):2013. Published 2021 Nov 5. doi: 10.1186/s12889-021-12020-z

Reviewer comments
The topic is a topical issue that has attracted several campaigns and debates. The prevalence of cancer morbidity and mortality is increasing, and women are more affected. However, for this work to be in a better form, the authors need to affect all comments raised on the manuscript.
Minor comments
1. All comments raised on the main manuscript must be attended to and be affected.
2. Tables must be in one page and in small font size
3. The age group used for this study must be explain why it was used. Give justification for 1 = 30-40 and 2 = 40+
4. All previous comments from other prior reviewers must be attended and to be affected.
5. Look at the following published papers to rebuild your entire work before editing and cite them if you choose:

i. Akokuwebe, M.E., Idemudia, E.S., Lekulo, A.M. et al. Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016. BMC Public Health 21, 2013 (2021). https://doi.org/10.1186/s12889-021-12020-z.

ii. Ncane Z, Faleni M, Pulido-Estrada G, Apalata TR, Mabunda SA, Chitha W, Nomatshila SC. Knowledge on Cervical Cancer Services and Associated Risk Factors by Health Workers in the Eastern Cape Province. Healthcare. 2023; 11(3):325. https://doi.org/10.3390/healthcare11030325.

iii. Aga SS, Yasmeen N, and Khan MA. Cervical Cancer and Its Screening: Assessing the Knowledge, Awareness, and Perception among Health and Allied Students. Hindawi Education Research International, Volume 2022, Article ID 4608643, 17 pages. https://doi.org/10.1155/2022/4608643.

iv. Ngwu CN, Iwuagwu AO, Ebimgbo SO, Igboeli EE, Eyang BO, Ogar LE. Perception and Practice of Cervical Cancer Screening Services and the Role of Social Workers in Facilitating Screening Uptake in Enugu State, Nigeria. Asian Pac J Cancer Prev. 2022 Jul 1;23(7):2271-2277. doi: 10.31557/APJCP.2022. 23.7.2271.

v. Bano R, Kumari R. Acceptance of cervical cancer screening among women: global and Indian scenario. Int J Community Med Public Health. 2022 Nov; 9 (11): 4260-4267. DOI: https://dx.doi.org/10.18203/23946040.ijcmph20222 924.

Major correction
1. This manuscript must be sent to a Professional English Editor that will entirely edit this paper to be in a better form. This is very important and must be adhered to.
2. The authors should not use Grammarly or other social media editing platforms to edit this paper, as that was what the authors used before, and the entire manuscript is not readable or so long sentences, etc.
3. The authors must stick to Britain English only.

None for now