University of Gondar

College of Medicine and Health Science

Institute of Public Health
Department of Epidemiology

Levels of knowledge of mother to child transmission of HIV/AIDS, its prevention, and

associated factors among pregnant women in sub-Saharan Africa: Evidence from 14
countries recent Demographic and Health Surveys

Name of investigators

1 Andargachew Alemante

2 Zemikael Melese
 Acknowledgement
We would like to give our special indebtedness for the almighty God. next, our deepest gratitude goes to
our advisor Mr. Assefa Admasu (assistant professor) for his invaluable commitment, support and
guidance during the entire process of this thesis writing. We greatly acknowledge MEASURE DHS
program for granting access to the Demographic and Health Surveys data. We greatly acknowledge
MEASURE DHS program for granting access to the Demographic and Health Surveys data.
Abbreviations/acronyms
AIDS Acquired Immune Deficiency Syndrome
AOR Adjusted Odds Ratio
ART Antiretroviral Therapy
CI Confidence Interval
DHS Demographic and Health Survey
EMTCT Elimination of Mother To Child Transmission
HIV Human immunodeficiency Virus
ICC Intraclass Correlation Coefficient
MTCT Mother To Child Transmission
PMTCT Prevention of Mother To Child Transmission
PCV Percentage change in Variance
SSA Sub-Saharan Africa
WHO World Health Organization
UNAIDs United States Agency for International Development
Table of contents

Contents
Acknowledgement.......................................................................................................................................i
Abbreviations/acronyms...........................................................................................................................ii
List of Tables.............................................................................................................................................iv
Abstract......................................................................................................................................................v
1 Introduction............................................................................................................................................1
1.1 Statement of the problem...................................................................................................................1
1.2 Literature review...............................................................................................................................2
1.2.1 Knowledge about MTCT of HIV/AIDS and its prevention........................................................2
1.2.2 Factors associated with Knowledge about MTCT of HIV/AIDS and its prevention...................2
1.3 Justification.......................................................................................................................................5
2. Objectives...............................................................................................................................................5
2.1 General objective...............................................................................................................................5
2.2 Specific objectives.............................................................................................................................5
3 Methods...................................................................................................................................................6
3.1 Data source and study population......................................................................................................6
3.2 Study variables..................................................................................................................................7
3.2.1 Outcome variable........................................................................................................................7
3.2.2 Independent variables.................................................................................................................7
3.3 Eligibility...........................................................................................................................................7
3.4 Operational definitions......................................................................................................................7
3.5 Data Management and Analysis........................................................................................................8
3.6 Ethical consideration.........................................................................................................................8
4 Result.......................................................................................................................................................9
4.1 Socioeconomic characteristics of participants...................................................................................9
4.2 The Pooled Prevalence of knowledge about MTCT of HIV/AIDS and its prevention in SSA.........10
4.3 Factors associated with knowledge about MTCT of HIV/AIDS and its prevention in SSA............10
5. Discussion.............................................................................................................................................15
6. Strength and limitation of the study...................................................................................................16
7 Conclusion and recommendations.......................................................................................................17
8. References............................................................................................................................................18

List of Figures

Figure 1; Factors associated with knowledge about MTCT of HIV/AIDS and its prevention 4

Figure 2: The pooled prevalence of knowledge about MTCT of HIV/AIDS and its prevention in SSA....11

List of Tables
Table 1 : Sampling distribution and countries.............................................................................................6
Table 2: Sociodemographic characteristics of participants..........................................................................9
Table 3: Random effect analysis and model comparison in the assessment of factors associated with
knowledge about MTCT of HIV/AIDS and its prevention in SSA............................................................12
Table 4: Factors associated with knowledge about MTCT of HIV/AIDS and its prevention in SSA........13
Abstract

Background: In developing countries, particularly in sub-Saharan Africa (SSA), the burden of mother to
child transmission (MTCT) of HIV is higher. Although the Joint United Nations programme on
HIV/AIDS (UNAIDS) and other organizations are working to eliminate MTCT, knowledge of MTCT of
HIV and its prevention is low in most African countries. therefore, this study aimed to assess knowledge
of MTCT of HIV and its prevention among pregnant women in SSA.
Method: The recent SSA countries’ Demographic and Health Surveys (DHS), which were conducted
from 2015 to 2021, was our data source. We appended 14 countries’ DHS data for our analysis. For our
study, a total weighted sample of 100175 pregnant women was used. A multilevel logistic regression
analysis was used due to the hierarchical structure of the DHS data. To determine whether there was a
clustering, the Interclass Correlation Coefficient (ICC) was determined. Model comparison was
conducted using deviance (−2LL).

Result: The Pooled Prevalence of adequate knowledge about MTCT of HIV/AIDS and its prevention in
SSA countries was 50.96 (95%CI: 40.37-61.56). In the multilevel logistic regression analysis: being in
the older age group, employed mothers, multiparity, owning mobile, having mass media exposure, health
facility delivery, having ANC follow up, having comprehensive HIV knowledge and knowing a place to
get HIV test were associated with higher odds of knowledge about MTCT of HIV/AIDS and its
prevention. However, better education level was associated with lower odds of knowledge about MTCT
of HIV/AIDS and its prevention.
Conclusion: This study showed that the prevalence of knowledge about MTCT of HIV/AIDS and its
prevention in SSA countries is low. Thus, improved access and utilization of antenatal care, intervene by
targeting younger women, unemployed mothers, and other significant factors this study revealed can be
an effective strategy to reduce MTCT of HIV.

6
Introduction

Globally, Human Immunodeficiency Virus (HIV) infection has been a major public health
problem to nations and territories most especially in Lower and Middle-Income Countries
(LMICs)(1). Despite the continuing progress in preventing new HIV infections through the
introduction of antiretroviral (ARVs), and elimination of mother-to-child transmission of HIV
(EMTCT) services(2). The global burden of HIV was 39 million with over 1.3 million new
infections and with 630,000 deaths in 2022. Sub-Saharan Africa disproportionately carries a
highest burden of HIV accounting for more than 70% of the global burden of the infection. More
than two-third of the estimated 6000 new HIV infections that occur globally each day occurs in
sub-Saharan Africa where young women disproportionately bear the highest burden of the
disease. East and Southern Africa is the most affected region in the world and is home to the
largest number of people living with HIV(3, 4). As more women become infected, mother-to-
child transmission (MTCT) of HIV continues to be a major challenge(5).

The transmission of HIV from an HIV-positive mother to her child during pregnancy, labor,
delivery, or breastfeeding is called mother-to-child transmission (MTCT). The rate of
transmission of HIV from an HIV-positive mother to her baby ranges from 15 percent to 45
percent in the absence of intervention and can be reduced to below 5 percent with an effective
intervention. The global burden of pediatric HIV infection was 1.5 million children under 15
years with associated 84 000 mortalities in 2022. In sub-Saharan Africa, an estimated 180,000
new HIV infections occurred in 2017 among children aged 0–14 years predominantly during
breastfeeding(6, 7).

The global community has committed to eliminating MTCT of HIV as a public health
priority through a harmonized and integrated approach to improve the health outcomes of
mothers and their children(8). The World Health Organization (WHO) recommendations to
reducing MTCT includes; prevention of HIV among women of reproductive age, prevention of
unintended pregnancies among women living with HIV, and provision of antiretroviral therapy

7
(ARTs) to mothers living with HIV(1). The Joint United Nations Program on HIV/AIDS had
launched a global plan in 2011 which covered all low-and middle-income countries with due
focuses on 22 countries where 90% of all pregnant women living with HIV reside to eliminate
new HIV infections among children by 2015 and keeping their mothers alive. The program had
also adopted a new strategy in October 2015 to end the AIDS epidemic as a public health threat
by 2030 with an interim goal of 95% coverage with antiretroviral therapy among pregnant
women and less than 20 000 new pediatric HIV infections by 2020, and gained tremendous
achievements(5, 9).Remarkable efforts have been made by countries towards the elimination of
MTCT of HIV through implementation and utilization of ART, and prevention of MTCT of HIV
programs(10).

However, even though there is promising progress in the HIV response, the existing pieces of
evidence have depicted that the disease is still devastating the lives of many children. The 2020
UNICEF report showed that, of the estimated 38.0 million people living with HIV worldwide in
2019, 2.8 million were children aged 0–19 years. The same report showed that approximately
880 and 310 children became infected with and died from AIDS-related causes respectively on
each day in 2019, mostly because of inadequate access to HIV prevention, care, and treatment
services.(6)

Maternal knowledge about MTCT of HIV/AIDS and its prevention is a cornerstone for
elimination of MTCT of HIV(2). This is because childbearing women with adequate knowledge
on HIV and PMTCT tend to protect themselves and their families from HIV infection and are
highly likely to seek testing and treatment compared to those who have less knowledge on
MTCT(16).

Even though the PMTCT of HIV services were proven effective in preventing the vertical
transmission of HIV from mother-to-child, it was evidenced that a large proportion of
reproductive-age women do not know about vertical transmission of HIV. The different studies
done in the different countries of SSA have evinced that 34.9% - 61% of the reproductive-age
women have knowledge of MTCT of HIV/AIDS and its prevention(11, 12, 17).

According to various studies done elsewhere, knowledge about MTCT and PMTCT of HIV/AIDS
is correlated with factors such as maternal age, maternal education, employment, marital status,

8
wealth status, parity, owning mobile, mass media exposure, distance from health facility,
residence, place of delivery, ANC follow up, comprehensive HIV knowledge, ever been tested
for HIV and knowing a place to get HIV test. (11-12,17-19,24) Although the majority of the
population in SSA are lived in rural areas with restricted availability and accessibility of health
facilities, most of the studies on knowledge about MTCT of HIV/AIDS and its prevention were
conducted among available women, such as those who came to the health facility for their
antenatal care follow up(12, 13). Though there is a study conducted using nationally
representative data (using the recent DHS surveys) at the SSA scale(6). Some important factors
such as ever been tested for HIV, comprehensive knowledge of HIV and place of delivery were
not included. Therefore, this study aimed to assess knowledge of MTCT of HIV/AIDS, its
prevention (PMTCT), and associated factors among pregnant women in 14 SSA countries.

Methods
Data source and study population
This cross-sectional study used recent Demographic and Health Surveys (DHS) data (2015–
2021) to examine knowledge of pregnant women about MTCT of HIV/AIDS and its prevention
in SSA. DHS is a nationally representative survey collected every five years across low- and
middle-income countries. There were 18 countries DHS conducted in the study period. However,
we appended 14 countries’ DHS data for our analysis since the one country (Burkina Faso) and
three countries (Nigeria, Tanzania ad South Africa) DHS had no observation regarding our
outcome variable and independent variables respectively. The study sample was, thus, a
weighted sample of 100175 women (Table 1). Details on the sampling methodology and data
collection used by the DHS are published elsewhere.

Study variables
Outcome variable
The outcome variable in this study was knowledge about MTCT of HIV/AIDS and its prevention
(PMTCT). It was a composite score of four different questions; Can HIV be transmitted from
mother to her baby during pregnancy?, Can HIV be transmitted from the mother to her baby
during delivery?, Can HIV be transmitted from the mother to her baby during breastfeeding?,
Are there any special drug or medicines that a doctor or a nurse can give to a woman infected
with HIV to reduce the risk of transmission to the baby?. Responses to each of these questions
were coded as 1 if the respondent answered “yes” and 0 if the respondent answered “no”. An
aggregate score was then computed and a score of (4) meant the respondent had adequate
knowledge on MTCT and PMTCT of HIV whilst a score less than (4) by a respondent was

9
considered as having inadequate knowledge on MTCT and PMTCT of HIV. A binary variable
was therefore created based on the aggregate scores.

Table 1 : Sampling distribution and countries

Country Year of survey Weighted sample Unweighted sample

(%) (%)

Angola 2015 8495(8.48) 8947(8.93)

Benin 2017/18 9031(9.01) 8994(8.98)

Burundi 2016/17 8941(8.93) 8660(8.65)

Cameroon 2018 6613(6.60) 6463(6.45)

Ethiopia 2016 7590(7.58) 7193(7.18)

Gambia 2019/20 5372(5.36) 5799(5.79)

Guinea 2018 5488(5.48) 5530(5.52)

Liberia 2019/20 4026(4.02) 4267(4.26)

Madagascar 2021 9232(9.23) 9315(9.30)

Mali 2018 6623(6.61) 6368(6.36)

Rwanda 2020 6302(6.29) 6167(6.16)

Uganda 2016 10152(10.13) 10263(10.25)

Zambia 2018 7325(7.31) 7372(7.36)

Zimbabwe 2016 4988(4.98) 4833(4.82)

Total 100175 100171

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Independent variables
Both individual level and community level independent variables were incorporated in assessing
factors associated with knowledge about MTCT of HIV/AIDS and its prevention among
pregnant women in SSA.

Individual-level variables: maternal age, maternal education, current marital status, household
wealth status, employment, own mobile, media exposure, parity, distance from the health
facility, ANC visit, place of delivery, comprehensive knowledge about HIV, ever been tested for
HIV, know a place to get HIV test were incorporated as individual-level factors.

Community-level variables: Residence.

Operational definitions
Inadequate knowledge of mother-to-child transmission; If the scores of the four measurement
questions of MTCT and PMTCT of HIV sum ranges from 0 to 3(6).

Adequate knowledge of mother-to-child transmission: If the scores of the four measurement

questions of MTCT of HIV summed to ‘4’ that is if they answered the four questions
correctly(6).

Having comprehensive knowledge about HIV/AIDS: is regarded as knowing HIV prevention

methods (using a condom and restricting sex partners to one uninfected faithful partner), being
aware that any healthy-looking person can have the virus, and rejecting two most common local
misconceptions (i.e., HIV can be transmitted through mosquito bites, and by sharing food with
HIV positive person). All questions had binary “yes” or “no” response. Those who answered all
the five questions coded “1”, otherwise “0”.

Media exposure: a composite variable obtained by combining whether a respondent reads

newspaper/magazine, listen to the radio, and watch television with a value of “0” if a woman
were not exposed to at least one of the three media, and “1” if a woman has access/exposure to at
least one of the three media.

Data Management and Analysis

Before any statistical analysis, the data were weighted to restore the representativeness of the
data and to achieve an accurate estimate. Stata version 14 was used to extract, recode, and
analyze data. A multilevel logistic regression analysis was used due to the hierarchical structure
of the DHS data, which violates the independent assumptions of the standard logistic regression
model. Four models were incorporated: the null model-a model without explanatory variables,
model I-a model with individual-level variables, model II-a model with community-level
variables, and model III-a model with individual and community-level variables. The Interclass
Correlation Coefficient (ICC) was calculated to determine whether clustering was occurred or

11
not. Deviance and percentage change in variation (PCV) were used to compare models. Among
these models, Model III was selected as the best-fit model because it had the lowest deviance.
Both bi-variable and multivariate multi-level logistic regression was performed. Variables with a
p-value of less than 0.2 were considered for multivariable analysis. In the multivariable analysis
Variables with a P-value, lower than 0.05 were considered as the statistically significant factors
associated with knowledge of MTCT and PMTCT of HIV among pregnant women.

Ethical consideration
Since we were using publicly accessible data, ethical approval was not needed. However, by
registering or online requesting we have accessed the data set from the DHS website
(https://dhsprogram.com).

Result
Socioeconomic characteristics of participants
For the final analysis, we used a total weighted sample of 100175 pregnant women who gave
birth in the last five years preceding each survey. Most of the study participants (10.13%) were
from Uganda (Table 1). The median age of participants was 28 years with IQR = 23–34 years.
The majority (35.72%) of respondents had no formal education. The majority (84.02%) of
respondents was currently in union and 67.01% were employed. The majority (62.10%) of
respondents did not perceive distance from the health facility as a big problem. Regarding place
of residence, most (67.68%) of respondents was from rural areas. (Table 2)

The Pooled Prevalence of knowledge about MTCT of HIV/AIDS and its

prevention in SSA
The Pooled Prevalence of adequate knowledge about MTCT of HIV/AIDS and its prevention in
SSA countries was 50.96 (95%CI: 40.37-61.56), with the highest in Zimbabwe (75.60) and the
lowest in Madagascar (19.20). (Figure 1)

Factors associated with knowledge about MTCT of HIV/AIDS and its

prevention in SSA

Random effect

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In the null model, the ICC was 3.3%, which showed that 3.3% of the variation on knowledge
about MTCT and PMTCT of HIV/AIDS in SSA was attributed due to differences between
clusters or communities. In addition, the proportional change in variance (PCV) in the final
model revealed that about 4.2% of the variation of knowledge about MTCT of HIV/AIDS and its
prevention in SSA was explained by both individual and community-level factors. Regarding
model comparison, the fourth model (Model 3) was the best-fitted model since it had the lowest
deviance (119576.0). (Table 3)

Table 2: Sociodemographic characteristics of participants

Variables Category Number (N = Percent (%)

100175)

Age 15-19 7717 7.70

20-24 22451 22.41

25-29 25433 25.39

30-34 20113 20.08

35-39 14701 14.68

40-44 7419 7.41

45-49 2341 2.34

Educational status No formal education 35778 35.72

Primary education 35342 35.40

Secondary education 25364 25.32

Higher education 3571 3.56

Employment Not Employed 33048 32.99

Employed 67127 67.01

Marital status Currently Not in union 15993 15.97

13
 Currently in union 84182 84.03

Parity Primiparous 21418 21.38

Multiparous 48185 48.10

Grand multiparous 30572 30.52

Wealth index Poorest 21503 21.47

Poorer 20959 20.92

Middle 20025 19.99

Richer 19764 19.73

Richest 17924 17.89

Distance from health A big problem 37962 37.90

facility

Not a big problem 62213 62.10

Own mobile No 53660 53.57

Yes 46515 46.43

Media exposure No 35833 35.77

Yes 64342 64.23

Residence Urban 32375 32.32

Rural 67800 67.68

Fixed effect analysis

In the bi-variable analysis all factors except marital status (p=0.25) were eligible (had p<0.20)
for the multivariable analysis. In the multivariable multilevel analysis, maternal age, maternal
education, employment, parity, owning mobile, mass media exposure, place of delivery, ANC
follow up, comprehensive HIV knowledge and knowing a place to get HIV test were found to be
significant factors associated with knowledge about MTCT of HIV/AIDS and its prevention
among pregnant women in SSA. (Table 4)

14
Mothers aged 20-24, 25-29, 30-34, 35-39, and 40-44 years had 1.10 (AOR = 1.10; 95%CI: 1.04-
1.17), 1.16 (AOR = 1.16; 95%CI: 1.09-1.24), 1.13 (AOR = 1.13; 95%CI: 1.05-1.21) , 1.14 (AOR
= 1.14; 95%CI: 1.06-1.23), 1.12 (AOR = 1.12; 95%CI: 1.03-1.23) higher odds of knowledge
about MTCT of HIV/AIDS and its prevention respectively compared to women aged 15–19
years.

year of Effect %
country survey sample (95% CI) Weight

Angola 2015 8947 40.90 (40.89, 40.91) 7.14

Burkina Faso 2017/18 8994 74.40 (74.39, 74.41) 7.14
Burundi 2016/17 8660 71.60 (71.59, 71.61) 7.14
Cameroon 2018 6463 60.10 (60.09, 60.11) 7.14
Ethiopia 2016 7193 34.60 (34.59, 34.61) 7.14
Gambia 2019/20 5799 48.50 (48.49, 48.51) 7.14
Guinea 2018 5530 27.60 (27.59, 27.61) 7.14
Liberia 2019/20 4267 45.00 (44.99, 45.01) 7.14
Madagascar 2021 9315 19.20 (19.19, 19.21) 7.14
Mali 2018 6368 29.70 (29.69, 29.71) 7.14
Rwanda 2020 6167 68.40 (68.39, 68.41) 7.14
Uganda 2016 10263 57.80 (57.79, 57.81) 7.14
Zambia 2018 7372 60.10 (60.09, 60.11) 7.14
Zimbabwe 2016 4833 75.60 (75.59, 75.61) 7.14
Overall, DL 50.96 (40.37, 61.56) 100.00

-100 0 100

Figure 1: The pooled prevalence of knowledge about MTCT of HIV/AIDS and its prevention in SSA

15
Table 3: Random effect analysis and model comparison in the assessment of factors associated with
knowledge about MTCT of HIV/AIDS and its prevention in SSA

Parameter Null model Model 1 Model 2 Model 3

Community level 0.113 0.071 0.103 0.071

variance

ICC 0.033 0.021 0.030 0.021

PCV (%) REFF 4.2 1.0 4.2

Deviance 137413.8 119576.6 136801.8 119576.0

ICC: intraclass correlation coefficient, PCV: percentage change in variance

Mothers who had primary education, secondary education, and higher education had 5% (AOR =
0.95; 95%CI: 0.92–0.98), 8% (AOR = 0.92; 95%CI: 0.88–0.96), and 31% (AOR = 0.69; 95%CI:
0.64–0.75) lower odds of knowledge about MTCT of HIV/AIDS and its prevention respectively
as compared to those who did not attend formal education. The odds of having knowledge about
MTCT of HIV/AIDS and its prevention was 1.09 (AOR = 1.09; 95%CI: 1.06-1.12), times higher
among employed mothers as compared to unemployed mothers. The odds of having knowledge
about MTCT of HIV/AIDS and its prevention was 1.09 (AOR = 1.09; 95%CI: 1.04–1.14), and
1.11 (AOR = 1.11; 95%CI: 1.05–1.18) times higher among multiparous, and grand multiparous
mothers respectively as compared to Primiparous mothers.

Mothers who owned mobile had 1.07 (AOR = 1.07; 95%CI: (1.03-1.10) times higher odds of
knowledge about MTCT of HIV/ AIDS and its prevention as compared to those who did not.
Mothers who had media exposure had 1.08 (AOR = 1.08; 95%CI: 1.04–1.12) times higher odds
of knowledge about MTCT of HIV/AIDS and its prevention as compared to their counterparts.

The odds of having knowledge about MTCT of HIV/AIDS and its prevention was 1.50 (AOR =
1.50; 95%CI: 1.45–1.56), and 1.48 (AOR = 1.48; 95%CI: 1.31–1.67) times higher among
mothers who gave birth at health institution and other respectively as compared to those who
gave birth at home. The odds of having knowledge about MTCT of HIV/AIDS and its prevention
was 1.21 (AOR = 1.21; 95%CI: 1.14–1.28) times higher among mothers who had ANC follow
up as compared to those who did not have.

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 The odds of having knowledge about MTCT of HIV/AIDS and its prevention was 1.98 (AOR =
1.98; 95%CI: 1.92–2.04) times higher among mothers who had comprehensive knowledge about
HIV/AIDS as compared to their counterparts. Mothers who knew a place to get HIV test had
5.22 (AOR = 5.22; 95%CI: 4.97–5.50) times higher odds of knowledge about MTCT of
HIV/AIDS and its prevention as compared to those who did not know.

Table 4: Factors associated with knowledge about MTCT of HIV/AIDS and its prevention
in SSA

Variables Models fitted

Null model Model 1 Model 2 Model 3

AOR (95%CI) AOR (95%CI) AOR (95%CI)

Age

15-19 1.00 1.00

20-24 1.10(1.04,1.17) 1.10(1.04,1.17) *

25-29 1.16(1.09,1.24) 1.16(1.09,1.24) *

30-34 1.13(1.05,1.21) 1.13(1.05,1.21) *

35-39 1.14(1.05,1.23) 1.14(1.06,1.23) *

40-44 1.12(1.03,1.23) 1.12(1.03,1.23) *

45-49 1.08(0.96,1.22) 1.08(0.96,1.22)

Education status

No formal education 1.00 1.00

Primary education 0.95(0.92,0.98) 0.95(0.92,0.98) *

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 Secondary education 0.92(0.88,0.96) 0.92(0.88,0.96) *

Higher education 0.69(0.64,0.76) 0.69(0.64,0.75) *

Employment

Not Employed 1.00 1.00

Employed 1.09(1.06,1.12) 1.09(1.06,1.12) *

Parity

Primiparous 1.00 1.00

Multiparous 1.09 (1.05,1.14) 1.09 (1.04,1.14) *

Grand multiparous 1.11(1.05,1.18) 1.11(1.05,1.18) *

Wealth

Poorest 1.00 1.00

Poorer 1.02(0.97,1.06) 1.02(0.97,1.06)

Middle 1.04(1.01,1.09) 1.04(1.01,1.09) *

Richer 1.04(1.01,1.10) 1.04(0.99,1.09)

Richest 1.04(0.98,1.10) 1.03(0.97,1.09)

Distance from health facility

Big problem 1.00 1.00

Not big problem 0.97(0.94,1.01) 0.97(0.94,1.01)

Own mobile

No 1.00 1.00

Yes 1.07(1.04,1.11) 1.07(1.03,1.10) *

Media exposure

No 1.00 1.00

Yes 1.08(1.04,1.12) 1.08(1.04,1.12) *

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Place of delivery

Home 1.00 1.00

Health facility 1.50(1.45,1.56) 1.50(1.45,1.56) *

Other 1.48(1.31,1.67) 1.48(1.31,1.67) *

ANC visit

No 1.00 1.00

Yes 1.21(1.14,1.28) 1.21(1.14,1.28) *

Comprehensive knowledge of
HIV

No 1.00 1.00

Yes 1.98(1.92,2.04) 1.98(1.92,2.04) *

Ever been tested for HIV

No 1.00 1.00

Yes 1.01(0.97,1.05) 1.01(0.97,1.05)

Know a place to get HIV test

No 1.00 1.00

Yes 5.23(4.97,5.50) 5.22(4.97,5.50) *

Residence

Rural 1.00 1.00

Urban 1.43(1.39,1.47) 1.01(0.97,1.05)

* p value < 0.05

Discussion

In SSA, the prevalence of knowledge about MTCT of HIV/AIDS and its prevention was 50.96( 95%CI:
40.37-61.56). This finding is lower than a study done in Zimbabwe and Rwanda(2, 19). However, the

19
finding of our study is higher than a study done in Ethiopia(17). The possible explanation could be due to
the difference in the study period and sample size.

The odds of having knowledge about MTCT of HIV/AIDS and its prevention were higher among mothers
of older age groups compared to women of younger age groups (15–19). This is in line with a study done
in Zimbabwe and Cameroon(1, 2). This might be explained by, as the age of the mother increases; they
might have better knowledge and understanding about MTCT of HIV/AIDS and its prevention due to the
proximity of older women during their consecutive pregnancy to various maternal health service.

Educated mothers had lower odds of knowledge about MTCT of HIV/AIDS and its prevention compared
to those who had no formal education. This is consistent with a study done in Rwanda(19). However, this
finding is in contrast with those reported in Nigeria(10) and Tanzania(11) where women with primary or
higher levels of education have increased odds of having knowledge on MTCT. This may be
because women with higher education may not necessarily access health services at government
hospitals but rather at private health facilities where these EMTCT protocols and guidelines may
not be fully implemented or followed. Additionally, unlike government or state-owned health
facilities, the private medical facilities may not organize health education and promotion sessions
where information on EMTCT is disseminated. The women even-though highly educated may
have limited information and knowledge on MTCT of HIV and its prevention.

The odds of having knowledge about MTCT of HIV/AIDS and its prevention were higher among
employed mothers compared to unemployed. This is in concordance with a study done in
malawi(25) This could be because working mothers make their income so that they can utilize
optimal ANC services through which the get health education about MTCT of HIV/AIDS and its
prevention(20).

In this study, multiparous women had higher odds of knowledge about MTCT of HIV/AIDS and
its prevention compared to primiparous. This finding was not agreed with Addis Ababa study
which indicated mothers who have many children (>5 children) were found to be less
knowledgeable about PMTCT than those that had lesser numbers of children(26). On the other
hand, this finding was Consistent with other studies(6, 11). This may be because multiparous
women may have a higher chance of exposure to maternal health services, including HIV testing
and counseling services, during their consecutive pregnancy

20
In this study, owning mobile telephones was also significantly associated with MTCT of HIV-
related knowledge and its prevention. The odds of having knowledge about MTCT of HIV/AIDS
and its prevention were higher among those who had mobile phones compared to those who did
not have. This is congruent with a study done in Ethiopia(18). This might be because mothers
who owned mobile phones have greater likelihood of linking health workers and getting
information about health-related issues through social media platforms. (27) In addition, we
found that mothers who had media exposure had higher odds of knowledge about HIV/AIDS and
its prevention compared to their counterparts. This is concordant with the result of the study done
in Ethiopia where exposure to mass media was significantly associated with the knowledge of
the MTCT of HIV(17) and the cross-sectional study done in the SSA where exposure to mass
media had shown a potential effect on HIV-related knowledge(21). Other Studies have also
shown that access to media increases utilization of ANC services through which mothers get
counseling about MTCT of HIV(22, 23)

This study revealed that the odds of having knowledge about MTCT of HIV/AIDS and its
prevention were higher among mothers who gave birth at health facility compared to their
counterparts. Besides mothers who had ANC follow up had higher odds of knowledge about
MTCT of HIV/AIDS and its prevention compared to those who did not have. This is in line with
a study done in Ethiopia(24). This may be due to the fact that those mothers who deliver at
health institutions and utilize ANC services have better access to health education, information
and knowledge on MTCT is likely higher.

This study has shown that mothers who had comprehensive knowledge of HIV had higher odds
of knowledge about MTCT of HIV/AIDS and its prevention compared to those who did not
have. In addition, the odds of having knowledge about MTCT of HIV/AIDS and its prevention
were higher among mothers who knew a place to get HIV test compared to their counterparts.
This is consistent with a study done in Tanzania(11). This might be justified by people with a
good understanding of HIV/AIDS including its transmission and preventive measures may also
know about MTCT of HIV/AIDS and its prevention.

Strength and limitation of the study

This study has several strengths. First, the study was based on weighted nationally representative
data from 14 SSA countries with large sample size. Second, since it is based on the national
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survey data the study has the potential to give insight for policymakers to design appropriate
intervention strategies at national levels. Moreover, on this study we tried to assess the effect of
some important predictors like comprehensive HIV knowledge, place of delivery and ANC
follow up which were not include on previous studies(6, 18, 19) conducted at national
representative data.

As a limitation, since the study used cross-sectional data, a causal relationship cannot be
established. Furthermore, we used DHS conducted during the previous seven years and hence it
may not reflect adequately the current situation. Therefore, caution is required during the
interpretation of the study results.

Conclusion and recommendations

With high disparity among countries, knowledge about MTCT of HIV/AIDS and its prevention
in SSA countries was low. In the multilevel analysis maternal age, maternal education,
employment, parity, owning mobile, mass media exposure, distance from the health facility,
place of delivery, ANC follow up, comprehensive HIV knowledge and knowing a place to get
HIV test were associated with higher odds of knowledge about MTCT of HIV/AIDS and its
prevention. Therefore, giving special attention for those groups of women who are at higher risks
of not having knowledge about MTCT of HIV/AIDS and its prevention such as younger mothers
and mothers who did not know a place to get HIV test could reduce MTCT.

22
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