Spatial variability and determinants of cervical cancer screening among women of reproductive age in Mozambique
1
Department of Economics, University of Malawi, Zomba, Malawi
2
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Cervical Cancer (CxCa) is a public health burden in Mozambique, with incidence of 50.2 and a mortality of 38.7 per 100000 women. The Mozambican Government introduced CxCa screening, a proven secondary prevention method, in 2009. However, monitoring of uptake is limited. The study aimed to determine spatial distribution and factors influencing uptake of CxCa screening among women of reproductive age (WRA).
METHODS:
We analyzed data from the 2022 Mozambique Demographic Health Survey, a national cross-sectional survey. Data on self-reported CxCa screening was collected from women aged 15 to 49, alongside social demographic and other factors. A probit regression was fitted using Stata 18 to determine factors associated with screening uptake, while adjusting for the survey design. Spatial analysis was conducted using ArcGIS.
RESULTS:
A total of 33,177 WRA (mean age=34.8) were included in our analysis. Prevalence of cervical cancer screening was 11.02% (95% Confidence Interval, CI, 10.68–11.36%). At p-value <0.05 and 95% CI, probit regression results showed that women with employment, health insurance and higher education had increased screening likelihood by 1.96 (CI:0.64-3.27), 4.35 (CI:0.26-8.44) and 9.75 (CI:4.6-14.8) percentage points (PP) respectively. Wealthier women, urban residents, those who visited a health facility recently and old age increased screening likelihood by 5.81 (CI:3.36-8.27), 2.61 (CI:0.8-4.3), 3.66 (CI:2.19-5.08) and 0.21 (CI:0.12-0.29) PP. Radio access associated negatively, lowering screening likelihood by 1.24 (CI: -2.37-0.17) PP. Geographically, uptake was relatively higher in Maputo, Maputo city and Gaza, and lowest in Tete, Niassa and Cabo-Delgado provinces. A strong spatial autocorrelation was found (Moran’s Index =1.355, with z-score =3.782 and p-value <0.001), suggesting screening is unevenly distributed across Mozambique.
CONCLUSIONS:
Uptake of CxCa screening in Mozambique is low, and geographically inequitable. Therefore, interventions to improve uptake and scale up of CxCa screening should target specific social demographic factors, with special attention to the underserved provinces.
Cervical Cancer (CxCa) is a public health burden in Mozambique, with incidence of 50.2 and a mortality of 38.7 per 100000 women. The Mozambican Government introduced CxCa screening, a proven secondary prevention method, in 2009. However, monitoring of uptake is limited. The study aimed to determine spatial distribution and factors influencing uptake of CxCa screening among women of reproductive age (WRA).
METHODS:
We analyzed data from the 2022 Mozambique Demographic Health Survey, a national cross-sectional survey. Data on self-reported CxCa screening was collected from women aged 15 to 49, alongside social demographic and other factors. A probit regression was fitted using Stata 18 to determine factors associated with screening uptake, while adjusting for the survey design. Spatial analysis was conducted using ArcGIS.
RESULTS:
A total of 33,177 WRA (mean age=34.8) were included in our analysis. Prevalence of cervical cancer screening was 11.02% (95% Confidence Interval, CI, 10.68–11.36%). At p-value <0.05 and 95% CI, probit regression results showed that women with employment, health insurance and higher education had increased screening likelihood by 1.96 (CI:0.64-3.27), 4.35 (CI:0.26-8.44) and 9.75 (CI:4.6-14.8) percentage points (PP) respectively. Wealthier women, urban residents, those who visited a health facility recently and old age increased screening likelihood by 5.81 (CI:3.36-8.27), 2.61 (CI:0.8-4.3), 3.66 (CI:2.19-5.08) and 0.21 (CI:0.12-0.29) PP. Radio access associated negatively, lowering screening likelihood by 1.24 (CI: -2.37-0.17) PP. Geographically, uptake was relatively higher in Maputo, Maputo city and Gaza, and lowest in Tete, Niassa and Cabo-Delgado provinces. A strong spatial autocorrelation was found (Moran’s Index =1.355, with z-score =3.782 and p-value <0.001), suggesting screening is unevenly distributed across Mozambique.
CONCLUSIONS:
Uptake of CxCa screening in Mozambique is low, and geographically inequitable. Therefore, interventions to improve uptake and scale up of CxCa screening should target specific social demographic factors, with special attention to the underserved provinces.
| eISSN: | 2654-1459 |
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