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J Glob Infect Dis. 2018 Jul-Sep;10(3):152-158. doi: 10.4103/jgid.jgid_165_17.

Impact of Per Capita Income on the Effectiveness of School-Based Health Education Programs to Promote Cervical Cancer Screening Uptake in Southern Mozambique.

Author information

Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
Faculty of Medicine, Eduardo Mondlane University, PO Box 257, Maputo, Mozambique.
Division of Infectious Diseases, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
Human Research Protection Program, School of Medicine, University of California San Diego, San Diego, CA, USA.



In the face of rising mortality rates from cervical cancer (CC) among women of reproductive age, a nationwide screening program based on visual inspection with acetic acid was introduced in Mozambique in 2009.


The objective of the study is to examine the impact of per capita income on the effectiveness of school-based health education programs to promote the utilization of CC screening services.

Materials and Methods:

We conducted a cross-sectional study in 2013 involving 105 women randomly selected from households of different economic backgrounds. Marginal effect estimates derived from a logit model were used to explore the patterns in the effectiveness of school-based health education to promote CC screening uptake according to household per capita income, based on purchasing power parity.


We found a CC screening uptake of 16.1% (95% confidence interval [CI], 9.7%-24.6%) even though 64.6% (95% CI, 54.2%-74.1%) of women had heard of it. There are important economic differentials in the effectiveness of school-based health education to influence women's decision to receive CC screening. Among women with primary school or less, the probability of accessing CC screening services increases with increasing income (P < 0.05). However, income significantly reduces the effect that school-based health education has on the probability of screening uptake among those women with more than 7 years of educational attainment (P = 0.02).


These results show that CC screening programs in resource-constrained settings need approaches tailored to different segments of women with respect to education and income to achieve equitable improvement in the levels of screening uptake.


Cancer screening; Mozambique; Sub-Saharan Africa; cervical cancer; economic inequalities; health education; human papillomavirus

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