Identifying individual, community and country-level determinants of poor knowledge of mother-to-child transmission of HIV among women in sub-Saharan Africa: spatial and multilevel analysis

Background Mother-to-child transmission (MTCT) of HIV accounts for over 90% of new HIV infections among children. In 2018, a report from the World Health Organization showed that about 14.8 million children between the ages of 0 and 14 years were HIV-exposed globally, of which 13.2 million reside in sub-Saharan Africa (SSA). This study aimed to determine the spatial variation and identify factors of poor Knowledge of MTCT of HIV among women in SSA. Methods A cross-sectional study was conducted using secondary data of 318,354 women collected during a Demographic Health Survey (DHS) in SSA countries from the 2006-2024. Spatial cluster detection was conducted using SaTScan version 10.1, spatial mapping was performed in ArcGIS version 10.7, and statistical analyses were carried out using Stata version 17. Multilevel logistic regression was used to identify the associations of health and demographic variables with poor knowledge of MTCT. Results The spatial analysis revealed that poor knowledge of the MTCT of HIV among women of reproductive age significantly varied across countries. The spatial window analysis identified the primary clusters in Madagascar, the Congo Democratic Republic and parts of Angola. Overall, 46% of women had poor knowledge of MTCT of HIV. In multivariable analysis, age of 15 to 24 years (AOR: 1.11, 95% CI 1.04,1.18), no media exposure (AOR: 1.13, 95% CI 1.08, 1.19), being poorest (AOR: 1.17, 95% CI 1.06, 1.28), not working (AOR: 1.07, 95% CI 1.02, 1.12), never tested for HIV (AOR: 1.38, 95% CI 1.21, 1.57), lack of comprehensive knowledge (AOR: 1.16, 95% CI 1.10, 1.21), low community media exposure (AOR: 1.11, 95% CI 1.03, 1.19), Western Africa region (AOR: 1.27, 95% CI 1.20, 1.40), low income (AOR: 1.97, 95% CI 1.51, 2.56), and lower middle income (AOR: 1.53 95% CI 1.19, 1.95) were associated with poor knowledge of MTCT. Conclusion Spatial analysis demonstrated that poor knowledge of MTCT of HIV among women was unevenly distributed, with significant regional variation across the SSA countries. This study found that individual, community and country-level variables were significantly associated with poor knowledge of MTCT of HIV. The finding highlights the need for targeted, multilevel HIV education and testing programs that prioritize hotspot areas and address disparities in knowledge of MTCT of HIV across SSA.