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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

1
Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 1130033, Japan.
2
Faculty of Medicine, Eduardo Mondlane University, PO Box 257, Maputo, Mozambique.
3
Division of Infectious Diseases, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA.
4
Human Research Protection Program, School of Medicine, University of California San Diego, San Diego, CA, USA.

Abstract

Context:

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.

Objective:

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.

Results:

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).

Conclusion:

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.

KEYWORDS:

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

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