Abstract:
Background: Limited literacy skills are common in the United States (US) and are related to lower HIV knowledge and worse
health behaviors and outcomes. The extent of these associations is unknown in countries like Mozambique, where no
rigorously validated literacy and numeracy measures exist.
Methods: A validated measure of literacy and numeracy, the Wide Range Achievement Test, version 3 (WRAT-3) was
translated into Portuguese, adapted for a Mozambican context, and administered to a cross-section of female heads-of-
household during a provincially representative survey conducted from August 8 to September 25, 2010. Construct validity
of each subscale was examined by testing associations with education, income, and possession of socioeconomic assets,
stratified by Portuguese speaking ability. Multivariable regression models estimated the association among literacy/
numeracy and HIV knowledge, self-reported HIV testing, and utilization of prenatal care.
Results: Data from 3,557 women were analyzed; 1,110 (37.9%) reported speaking Portuguese. Respondents’ mean age was
31.2; 44.6% lacked formal education, and 34.3% reported no income. Illiteracy was common (50.4% of Portuguese speakers,
93.7% of non-Portuguese speakers) and the mean numeracy score (10.4) corresponded to US kindergarten-level skills.
Literacy or numeracy was associated (p,0.01) with education, income, age, and other socioeconomic assets. Literacy and
numeracy skills were associated with HIV knowledge in adjusted models, but not with HIV testing or receipt of clinic-based
prenatal care.
Conclusion: The adapted literacy and numeracy subscales are valid for use with rural Mozambican women. Limited literacy
and numeracy skills were common and associated with lower HIV knowledge. Further study is needed to determine the
extent to which addressing literacy/numeracy will lead to improved health outcomes.
