Abstract
Introduction:
Preconception care involves measures to enhance a woman’s physical, psychological, and nutritional health before pregnancy. Despite various observational studies assessing healthcare practitioners’ knowledge of preconception care in East Africa, the overall pooled knowledge level remains unclear, and the studies often report inconsistent associated factors. This systematic review and meta-analysis aimed to determine the aggregated knowledge of preconception care among healthcare providers in East Africa and identify influencing factors.
Method:
We searched studies using PubMed, Scopus, Embase, and Google Scholar that were published between January 01, 2018 and November 30, 2024. This study used the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The quality of studies was evaluated using the modified Newcastle-Ottawa quality assessment tool. The data were extracted by two authors independently using Microsoft Excel and analyzed by Stata version 17. A random effects model was applied to calculate the pooled level of knowledge and its associated factors. The International Prospective Register of Systematic Review registration number for the review was CRD42024608878.
Results:
A total of 12 studies comprising 4892 participants were involved in this meta-analysis. The pooled knowledge of preconception care among healthcare providers was 56% (95% CI: 45%–66%). This study showed that gender (odds ratio (OR) = 1.35), educational level (OR = 3.52), monthly salary (OR), work experience (OR = 1.77), Internet access (OR = 3.41), ever read the preconception care guideline (OR = 2.77), having Smartphone (OR = 1.70), working institution (OR = 2.05), Training on HIV testing and management (OR = 4.28), training on providing alcohol or tobacco cessation service (OR = 1.14), the presence of a library in a working health facility (OR = 1.98), taking training on preconception care education and counseling (OR = 3.44) were significant factors associated with knowledge of preconception care.
Conclusion:
The findings indicate that healthcare providers in East Africa have limited knowledge of preconception care. Gender, educational level, monthly salary, previous work experience, internet connection, awareness of preconception care policy, smartphone possession, type of work schedule, prior HIV testing, and management training, library access in healthcare facilities, and involvement in preconception care training meetings and counseling sessions are significant factors of the knowledge of preconception care among healthcare providers.
Keywords: Knowledge, preconception care, healthcare providers, east Africa, systematic review, meta-analysis
Introduction
Preconception care (PCC) is an anticipatory intervention focused on the optimization of health before conception to reduce adverse maternal and infant health consequences. PCC for pregnancy consists of multiple vital components targeted at improving health before conception. The necessary components of PCC consist of health evaluations and dietary instructions in addition to the ongoing management of persistent diseases combined with vaccination updates alongside genetic assessment along with behavioral changes, emotional support, and educational counseling. The collaboration between these factors creates enhanced wellness for individuals which prepares them for a wholesome pregnancy. 1 Although appreciating the significance of PCC calls for health providers to have a sound understanding of principles thereof, especially in areas such as East Africa which has fairly big challenges in reproductive health. 2 Enhancing the knowledge of health practitioners is one of the strategies for offering the correct PCC to women of reproductive potential before the occurrence of pregnancy with excellent health status and controlling the risks occurring during childbirth by risk assessment. 3
PCC is now gaining international acceptance as a critical component of maternal and child health enhancement through health promotion activities such as health counseling for women of childbearing age and those with chronic diseases. 4 Still, its implementation and awareness are patchy, more so in low-resource environments. In Africa, it is even worse, with high rates of maternal mortality; according to WHO, Africa is entirely responsible for nearly 66% of the total deaths of women, mostly in the Sub-Saharan region. 5 In Sub-Saharan Africa, healthcare providers’ adequate knowledge of PCC is alarmingly low, with studies showing rates between 20% and 50%. 6 Factors such as limited training access, insufficient educational resources, and low engagement with current guidelines contribute to this gap, resulting in missed opportunities for critical counseling and services for women of reproductive age. 7
In East Africa, some studies show that more than half of healthcare providers have poor knowledge,8–10 and more than 85% of healthcare providers are practicing poorly. 11 Moreover, previous studies have identified different factors for healthcare providers’ knowledge and practice on PCC, including sociodemographic characteristics, training, attitude toward PCC, availability of policy or protocol on PCC, availability of internet access, and library in the working facility.8–18
The preconception healthcare systems in East Africa summarize education services and screenings and comprehensive health solutions for each country. Healthcare facilities in Kenya offer reproductive health counseling with family planning information to patients and their communities are supported through outreach activities conducted by community health workers. 19 Uganda puts emphasis on reproductive health education together with family planning service access. 20 The PCC in Tanzania is part of its maternal and child health programs which use community engagement as a main focus. 20 Despite facing resource constraints Burundi operates health education services to support prenatal care. 20 The healthcare system of South Sudan works on developing its PCC framework to enhance maternal health and nutritional services. 20 Different countries in the region are actively pursuing enhancements to PCC services and quality.
Different factors in each East African country determine the general lack of PCC understanding. Kenyan culture combines with the urban-rural divide to keep people uninformed while Tanzanian patients face barriers to healthcare provider access alongside language communication difficulties. 20 The combination of poor education and economic difficulties makes Ugandan society unaware of reproductive health information. 14 The political instability in Burundi causes dysfunction in healthcare systems, which generates wrong information and South Sudan’s nascent healthcare system faces difficulties because of its ongoing conflicts and people being displaced from their homes. Individual solutions need to be developed to fight the specific difficulties that exist within each situation.11,15,21,22
As a result, improving healthcare providers’ acceptance of evidence-based information helps to better overall health for mothers and newborns in East Africa, as well as answers to other continent-wide challenges. This study supports the Sustainable development goals (SDGs), particularly SDG 3: Good Health and Well-Being. By raising knowledge of PCC by 2030, we will help to enhance women’s and children’s health.
However, there is still no consensus on whether modifiable factors impact healthcare providers’ knowledge of PCC, owing mostly to disparities in sampling, methodologies, and context. Therefore, this systematic review and meta-analysis assess the current literature regarding the healthcare providers’ knowledge of PCC. By synthesizing findings from various studies, we intend to identify misconceptions, assess the effectiveness of educational interventions, and examine the demographic factors that influence knowledge levels. In addition, this study seeks to determine the overall level of PCC knowledge among healthcare providers in East Africa and the associated factors.
Methods
Study protocol and registration
This study was conducted on the knowledge of PCC and associated factors among healthcare providers in East Africa, and conducted following guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The study has been registered on the International Prospective Register of Systematic Review (PROSPERO), with registration number CRD42024608878.
Searching strategies and sources of information
We searched studies that were published between January 01, 2018 to November 31, 2024 using electronic databases such as PubMed, Scopus, Embase, Google Scholar, and other sources. We chose a 7-year time frame for the meta-analysis to include relevant, contemporary publications that represent current trends and methodology. Keywords such as knowledge, PCC, healthcare providers, determinants, and East Africa with their corresponding Medical Subject Headings terms were used to search by combining Boolean operators (AND, OR, NOT; Supplemental Table S1).
Inclusion and exclusion criteria
Inclusion criteria: This meta-analysis included studies that fulfilled the following criteria: research carried out only in East Africa, full-text articles, abstracts, and thesis or dissertations that were written only in English, peer-reviewed studies that assess knowledge among healthcare providers regarding PCC, studies involving various healthcare professionals, including doctors, nurses, and midwives, all observational studies that report the knowledge of PCC among healthcare providers, and the publication year between January 01, 2018 and November 31, 2024 were included in the analysis.
Exclusion criteria: Studies with different outcomes of interest, data from letters and meeting abstracts, duplicated or redundant studies, and research done in languages other than English. Studies that do not provide quantitative or qualitative data on healthcare providers’ knowledge, research focusing solely on patient perspectives without provider involvement, and studies conducted before January 01, 2018, and after November 31, 2024 were excluded from this study. For more information look (Supplemental Table S3).
Study selection and quality assessment
All explored studies were exported to Endnote 21 software. After duplicates were removed, studies were assessed for eligibility criteria by two authors (AKB and BYW) individually, and disagreements were settled by involving a third author (BAT). Finally, studies that fulfilled the inclusion criteria were included. The quality of the studies was evaluated using modified Newcastle-Ottawa quality assessment tools that are adopted for cross-sectional data and cohort studies. 23 The quality of the studies was evaluated independently by two authors (BGY and MKM), and disagreements were settled by involving a third author (BAT). Finally, our study included high-quality studies that received at least 8 out of a possible 9 points for all studies (Supplemental Table S2).
The outcome of the study
The outcomes of this study are expected to provide a comprehensive understanding of healthcare providers’ knowledge regarding PCC in East Africa. This includes quantifying knowledge levels, identifying gaps, and evaluating the impact of educational interventions, the study aims to inform policy decisions, shape educational strategies, and ultimately improve reproductive health services in the region.
Data extraction process
Two authors (BAT and AKB) extract all relevant data using data extraction form. This form was prepared in Microsoft Excel and contains the following variables: The author’s name, publication year, country, study period, study design, sample size, percentage of knowledge of PCC among healthcare providers, and adjusted odds ratio with a 95% confidence interval for associated factors of knowledge of PCC among healthcare providers were extracted.
Statistical analysis
The data were analyzed using Stata version 17. The combined prevalence of adequate knowledge and its associated factors among healthcare providers across multiple studies was examined using a random effects model. 24 Subgroup analysis and sensitivity analyses were performed to identify the source of heterogeneity across the studies. Heterogeneity was assessed by I2 statistic. The value of the I2 statistic was an indication of variation across studies, and values of 25%, 50%, and 75% were indications of low, medium, and high presence of heterogeneity. 25 Finally, the funnel plot, Egger’s regression test, and Begg’s test were used to check the presence of publication bias across the studies. 26
Results
Search outcomes and characteristics of included studies
A total of 356 articles were retrieved from different databases and all studies about the knowledge of PCC among healthcare providers were included. Then the data was exported to Endnote 21 Reference Manager for screening and a total of 344 studies were excluded from the analysis because of irrelevant (unrelated) titles, duplicate findings, and different outcomes of interest. Finally, 12 studies with a total of 4842 healthcare providers that fulfilled the inclusion criteria were included for systematic and meta-analysis Figure 1.
Figure 1.
PRISMA flowchart of data extraction process for systematic reviews and meta-analysis searches of databases, registers, and other sources about knowledge of preconception care among healthcare providers in East Africa.
Characteristics of included studies
A total of 12 studies were included to estimate the pooled knowledge of PCC among healthcare providers. The studies were conducted in East African countries between 2018 and 2024. The minimum number of healthcare providers who participated in the single study was 104 and the maximum number was 781 Table 1.
Table 1.
Summary statistics for the number of healthcare providers in the study.
| Variable | N | Mean | SD | Min | Max | Total |
|---|---|---|---|---|---|---|
| Size | 12 | 403.5 | 227.60 | 104 | 781 | 4842 |
Concerning publication year, from a total of 12 studies, 5 (58.33%) were in 2024, 2 (16.67%) in 2020 and 2021, whereas 1 (8.33%) were in 2018, 2019, 2022, and 2023 individually. In the case of Counties, 8 (66.67%) of the studies were conducted in Ethiopia, 2 (16.67%) in Kenya, and 1 (8.33%) in Sudan, and Zambia each country Table 2.
Table 2.
Characteristics of included studies.
| Group | Number of studies | % |
|---|---|---|
| Year | ||
| 2018 | 1 | 8.33 |
| 2019 | 1 | 8.33 |
| 2020 | 2 | 16.67 |
| 2021 | 1 | 16.67 |
| 2022 | 1 | 8.33 |
| 2023 | 1 | 8.33 |
| 2024 | 5 | 58.33 |
| Country | ||
| Ethiopia | 8 | 66.67 |
| Kenya | 2 | 16.67 |
| Sudan | 1 | 8.33 |
| Zambia | 1 | 8.33 |
Pooled knowledge of PCC among healthcare providers in East Africa
From a total of 12 studies, the overall pooled level of knowledge of PCC among healthcare providers in East Africa showed 56% (95% CI: 45%–66%), with observed heterogeneity (I2 = 93.6%; p-value < 0.000) of healthcare providers have good knowledge about PCC Figure 2.
Figure 2.
Forest plot for pooled level of knowledge of PCC among healthcare providers in East Africa.
Source of heterogeneity and handling
Subgroup analysis
Table 3 depicts the knowledge of PCC among healthcare providers based on the year of publication and country. Regarding publication year, the knowledge of PCC ranged from 31.2% to 69.2%, with the highest knowledge recorded in 2019. Here, the highest heterogeneity was observed in studies conducted in 2024 (I2 = 95.3%).
Table 3.
Subgroup analysis for the year of publication and country.
| Group | Number of studies | Pooled knowledge% (95% CI) | Z | I2 (%) | p-Value |
|---|---|---|---|---|---|
| Year | |||||
| 2018 | 1 | 0.312 (0.221–0.403) | 6.734 | 0 | 0.000 |
| 2019 | 1 | 0.692 (0.602–0.782) | 14.989 | 0 | 0.000 |
| 2020 | 2 | 0.506 (0.436–0.575) | 14.305 | 0 | 0.000 |
| 2021 | 1 | 0.602 (0.506–0.698) | 12.299 | 0 | 0.000 |
| 2022 | 1 | 0.661 (0.568–0.754) | 13.964 | 0 | 0.000 |
| 2023 | 1 | 0.370 (0.275–0.465) | 7.664 | 0 | 0.000 |
| 2024 | 5 | 0.606 (0.425–0.787) | 6.568 | 95.3 | 0.000 |
| Total | 12 | 0.557 (0.453–0.661) | 10.543 | 93.6 | 0.000 |
| Country | |||||
| Ethiopia | 8 | 0.540 (0.454–0.626) | 12.309 | 84.7 | 0.000 |
| Kenya | 2 | 0.502 (0.243–0.760) | 9.248 | 93.3 | 0.000 |
| Sudan | 1 | 0.461 (0.363–0.559) | 11.679 | 0 | 0.000 |
| Zambia | 1 | 0.888 (0.826–0.950) | 28.158 | 0 | 0.000 |
| Total | 12 | 0.557 (0.453–0.661) | 10.543 | 93.6 | 0.000 |
I2 = 0.0%: implies there was a single study in that specific category so that I2 was not calculated.
When examining the study setting, the knowledge of PCC among healthcare providers was highest in Zambia at 88.8% (95% CI: 82.6%–95%) and lowest in Sudan at 46.1% (95% CI: 36.3%–55.9%). The highest heterogeneity (I2 = 93.3%) was observed in studies conducted in Kenya.
Sensitivity analysis
The influence of individual studies on the pooled knowledge of PCC among healthcare providers was evaluated using sensitivity analysis. The result showed that there is no single study whose value lies outside the 95% CI of the overall estimate or pooled knowledge of PCC Figure 3.
Figure 3.
Sensitivity analysis for knowledge of preconception care among healthcare providers in East Africa.
Publication bias or small-study effects
The Egger’s test and the funnel plot were used to assess the presence of small-study effects or publication bias across the studies. The funnel plot shows an asymmetric distribution of the data points, with more on the right side, and the pseudo 95% confidence limits are not symmetrical, suggesting potential publication bias toward larger, positive effect sizes. However, an egg test is needed to confirm the presence and extent of this bias Figure 4.
Figure 4.
Funnel plot of knowledge of preconception care with standard error.
Egger’s regression analysis indicates a significant positive slope and negative bias, implying smaller studies report lower effect sizes. The low p-value provides strong evidence against the null hypothesis of no small-study effects, suggesting publication bias may be present in this meta-analysis Table 4.
Table 4.
Egger test.
| Std_eff | Coefficient | Std. err. | T | p > t | 95% CI | |
|---|---|---|---|---|---|---|
| Slope | 1.539466 | 0.2333695 | 6.60 | 0.000 | 1.019486 | 2.059445 |
| Bias | −20.84953 | 5.074094 | −4.11 | 0.001 | −32.15532 | −9.543748 |
This publication bias can be influenced by different factors, such as journals may tend to publish studies that show significant results, editors and reviewers may have a bias toward accepting studies with positive results, researchers may manipulate data to determine significant findings, and many more factors leading to publication bias.
As the asymmetry was detected using the funnel plot and Egger’s test; the trim-and-fill method Figure 5 was used to re-estimate the pooled effect size by removing the outlying effect sizes, and then adding them back into the funnel plot and mirroring the opposite side to identify the best estimate of the unbiased pooled effect size.
Figure 5.
Trim-and-fill plot level of knowledge with standard error.
Factors associated with knowledge of preconception among healthcare providers in East Africa
According to Table 5 the meta-analysis results, it was established that the following factors could predict the knowledge of PCC among healthcare providers in East Africa.
Table 5.
Factors associated with the knowledge of PCC among healthcare providers.
| Associated factor | Category | No. of studies | Pooled odds ratio | p-Value | I2 (%) |
|---|---|---|---|---|---|
| Gender | Male | 3 | 1.35 (1.08, 1.68) | 0.008 | 0.0 |
| Female (reference) | |||||
| Educational level | Degree and above | 4 | 3.52 (2.26, 5.49) | 0.000 | 58.8 |
| Diploma (reference) | |||||
| Profession | Doctor | 3 | 2.21 (0.94, 5.18) | 0.068 | 78.0 |
| Nurse | 0.82 (0.14, 4.83) | 0.825 | 95 | ||
| Midwifery | 0.61 (0.05, 7.73) | 0.701 | 96.5 | ||
| Health officer | 1.01 (0.16, 6.53) | 0.990 | 89.1 | ||
| Pharmacy (reference) | |||||
| Marital status | Married | 2 | 1.62 (0.22, 11.89) | 0.635 | 88.1 |
| Single (reference) | |||||
| Monthly salary | 4000–5000 birr | 3 | 2.32 (1.13, 4.76) | 0.021 | 37.1 |
| >5000 birr | 1.83 (1.18, 2.84) | 0.007 | 19.2 | ||
| <4000 (reference) | |||||
| Work experience | ⩾5 year | 3 | 1.77 (1.06, 2.97) | 0.030 | 64.9 |
| ⩽5 year (reference) | |||||
| Internet access (ref no) | Yes | 2 | 3.41 (2.12, 5.47) | 0.000 | 0.0 |
| No (reference) | |||||
| Ever read the PCC guideline | Yes | 6 | 2.77 (1.94, 3.96) | 0.000 | 57.9 |
| No (reference) | |||||
| Having smartphone | Yes | 5 | 1.70 (1.10, 2.63) | 0.017 | 66.0 |
| No (reference) | |||||
| Working institution | Hospital | 5 | 2.05 (1.62, 2.60) | 0.000 | 0.00 |
| Private (reference) | |||||
| Training on HIV testing and management | Yes | 2 | 4.28 (2.92, 6.28) | 0.000 | 0.00 |
| No (reference) | |||||
| Training on providing alcohol or tobacco cessation services | Yes | 2 | 1.14 (0.68, 1.93) | 0.620 | 0.0 |
| No (reference) | |||||
| The presence of a library in a working health facility | Yes | 4 | 1.98 (1.50, 2.59) | 0.000 | 13.3 |
| No (reference) | |||||
| Taking training on PCC education and counseling | Yes | 3 | 3.44 (2.45, 4.84) | 0.000 | 0.0 |
| No (reference) |
Gender emerged as a predictor of an increased proportion of proficient understanding of PCC; male providers had a 1.35 times higher probability of being proficient than comparable female providers (p = 0.008). This study can be expected to generate new concerns when it comes to gender inequalities in education and training in preconception practices.
The level of education is a key precondition affecting the level of awareness of PCC among the population. Healthcare providers with a degree or higher demonstrated substantially better PCC knowledge than those with only a diploma, with an odds ratio of 3.52 (95% CI: 2.79–4.48, p < 0.001). This brings out the need for enhancement of training to assist practicing caregivers in grasping provisions liable to enhance practice on PCC.
In terms of profession, this meta-analysis revealed that doctors were 2.21 times more likely to have greater PCC knowledge than pharmacists, although this difference was statistically significant (p = 0.068). When comparing nurses, midwives, health officials, and pharmacists, the statistical analysis revealed no significant difference in odds. This suggests that medical training and curriculum may limit PCC for particular health fields.
The monthly salaries of healthcare practitioners were also associated with their PCC knowledge. Practitioners earning between 4000 and 5000 birr had 2.32 times higher odds (p = 0.021) of demonstrating stronger PCC knowledge compared to those earning less than 4000 birr. Similarly, those earning more than 5000 birr had 1.83 times greater odds (p = 0.007) of exhibiting better PCC knowledge. This relationship between higher salary and improved PCC knowledge may be linked to factors such as access to resources, opportunities for professional development, and overall job satisfaction. In addition, years of experience of the healthcare practitioners also determine the PCC knowledge, the healthcare practitioners who have served for above or equal to 5 years had 1.77 times better PCC knowledge compared to the healthcare practitioners who served for 5 years or below (95% CI: 1.28–2.44; p = 0.000). This aggrandizes the notion that experience improves their understanding of PCC.
Having internet access substantially increases the likelihood of improved PCC knowledge by 3.41 times compared to those without access (OR: 3.41, p < 0.001), emphasizing the value of digital resources. Furthermore, providers who have interacted with PCC recommendations had 2.77 times better chances of enhanced understanding than those who have not (OR: 2.77, p < 0.001), highlighting the importance of acquaintance with these principles. Furthermore, the presence of a smartphone is linked to PCC knowledge, with healthcare providers who own a smartphone having 1.70 times higher odds of possessing superior PCC knowledge (OR: 1.70, p = 0.017) compared to those without one. This illustrates how mobile technology enhances access to information. Similarly, those working in hospital settings have 2.05 times higher chances of improved PCC knowledge compared to those in private institutions (OR: 2.05, p < 0.001). In addition, providers who have undergone HIV testing and management training are more likely to have superior PCC knowledge related to HIV (OR: 4.28, p < 0.001) compared to those who have not received such training, emphasizing the relevance of specialized training.
Access to a workplace library is linked to PCC. Having access to a library boosts PCC knowledge by 1.98 times (OR: 1.98, p < 0.001) compared to those without access, highlighting the importance of adequate resources. Similarly, in this study, participants who have undergone PCC education and counseling had 3.44 times more likelihood of improved knowledge (OR: 3.44, p < 0.001) as compared to the participants who did not have such training. This implies that training that is centered yields improved PCC comprehension.
Discussion of results
The primary goal of this study was to assess the overall level of knowledge regarding PCC and its causes among healthcare practitioners in East Africa. Our final meta-analysis included 12 papers that recruited 4842 healthcare providers, 56% of whom indicated good PCC knowledge. This finding aligns with previous studies18,27,28 and suggests that while there is a foundational level of understanding, it remains lower than findings reported in Sub-Saharan Africa (62%), 14 West Africa (70%), 29 and South Africa (65%), 29 but higher than those reported in studies.10,11,18 This discrepancy may arise from differences in the quality of educational programs, healthcare infrastructure, cultural beliefs, research methodologies, and the experience of healthcare providers across regions. 1
The research findings about factors affecting PCC knowledge among healthcare workers validate existing literature in this field. Male healthcare providers demonstrate higher odds than female providers to possess PCC knowledge according to the pooled results. Multiple research investigations from Nigeria and other areas have shown that male medical providers may have access to better training opportunities than their female colleagues. 30 Some previous research studies27,31 found no significant gender disparities when measuring healthcare knowledge levels among healthcare providers. The observed divergence exists because of cultural expectations about male engagement in particular training programs, together with their superior resource availability and organizational dynamics that promote male activity.
The level of education also confirmed a significant correlation with PCC knowledge, with higher education having 3.52 OR (p = 0.000). This accords with a meta-analysis conducted in South Africa, which showed that first-line care facilitators with higher degrees had improved knowledge of maternal health practices.31,32 The significant relationship between the level of education and enhanced PCC knowledge supports the results of prior research 33 reported that healthcare providers with a degree or postgraduate qualification had significantly better knowledge of PCC compared to those with lower educational levels. This emphasizes the importance of comprehensive and targeted training in PCC within healthcare professionals’ education curricula.34,35
Furthermore, our results indicate that higher levels of income have been associated with better PCC knowledge, a fact corroborated by a Nigerian study by Ezegwui et al., 36 which established that healthcare providers with a higher income level had sufficient knowledge of PCC. This could be explained by better availability of professional development or continuing education, and professional sources of information among higher-paid healthcare workers. The correlation between work experience and PCC knowledge supports the findings of a systematic review by Poels et al., 37 which compared the knowledge and skills of healthcare professionals with years of clinical practice and found that healthcare professionals who had spent more years in practice had better knowledge in PCC. This is why there is a need for constant on-the-job training and coaching especially for mid-career health providers.
The significant association between internet access and knowledge reflects the critical role of digital resources in modern healthcare education. This result is in line with studies in South Africa and Uganda that have shown that healthcare providers with internet access are more likely to stay updated on clinical guidelines and best practices.32,38 Similarly, our results reveal a strong positive relationship between reading PCC guidelines and knowledge points to the need for understanding guidelines. This is supported by research done across different countries, that healthcare providers who interact with clinical guidelines show better understanding and compliance with care practices.39,40 Moreover, PCC education training has a significant relationship with the increase in knowledge, as also revealed by the systematic review of the impact of structured training programs in enhancing the knowledge and confidence of providers.40,41
Generally, a comprehensive review of PCC knowledge acquisitions by East African healthcare professionals exists in this meta-analysis study. The analysis of education along with socioeconomic, and experiential variables leads to a greater understanding of PCC knowledge enhancement for the East African region.
Strengths and limitations of the study
This study has several important strengths: The systematic review and meta-analysis involved the use of various studies to establish major gaps in knowledge about PCC among healthcare providers in East Africa. It defines determinants of knowledge, including gender or education level, on which interventions can be based. Nonetheless, there are some drawbacks: variability in the study quality; the problem of possible publication bias; and the fact that all researched studies come from East Africa only, which may affect the generalization of results. Moreover, a large number of the included studies have a cross-sectional study design, which limits establishing causality and investigating temporal changes. Such strengths and limitations can help inform future research on this important aspect of maternal health.
Conclusion and recommendation
This systematic review and meta-analysis show that there are knowledge deficits of PCC among healthcare providers in East Africa. The knowledge levels in pooled groups, measuring real-life understanding of PCC are relatively poor in comparison to the WHO standards. Gender, educational level, monthly salary, previous work experience, internet connection, awareness of PCC policy, smartphone possession, type of work schedule, prior HIV testing and management training, library access in healthcare facilities, and involvement in PCC training meetings and counseling sessions all make up the control variables for the knowledge of PCC contents.
The findings of this study suggest specific directions for further development of educational courses aimed at harmonization of PCC interventions provided by all personnel of a healthcare organization and wherein both female and male employees should have equal access to training. Equal representation of women in professional development or leadership positions will enhance the capacity of the female providers. Further, an increase in the carrying of educational materials, guidelines, and Internet resources in healthcare facilities for continual learning will be useful. More studies are needed to explore the reasons for the knowledge gap, especially as it relates to culture and institutions. Last, proper advocacy for the promotion of PCC in the community may enhance practice by providers and those they serve. When implemented, the recommendations will increase knowledge and practice of PCC in healthcare facilities and in turn improve women’s and family health.
Supplemental Material
Supplemental material, sj-docx-1-smo-10.1177_20503121251345598 for Knowledge of healthcare providers on preconception care in east Africa: Systematic review and meta-analysis by Birhan Ambachew Taye, Belyu Yehualashet Weldearegay, Muluemebet Kassa Mezen, Bantie Getnet Yirsaw, Fasiledes Fetene Asfaw, Shumye Tamrie Yerie and Aychew Kassa Belete in SAGE Open Medicine
Acknowledgments
The authors of the primary studies that were included in this review were acknowledged.
Footnotes
ORCID iD: Birhan Ambachew Taye 
https://orcid.org/0000-0002-2789-9963
Ethical considerations: Ethical approval was not sought for the present study because. As the study used existing public recorded studies; hence, ethical approval was not necessary for this study, and there are no names of individuals or household addresses in the data file.
Consent to participate: Informed consent was not sought for the present study because we analyzed existing data from published studies, which have already received ethical approval.
Consent for publication: Not applicable.
Author contributions: Conceptualization: BAT, AKB, BYW, and BGY. Methodology: BAT, BGY, and FFA. Data Curation: BAT, AKB, MKM, BYW, and STY. Writing: BAT, AKB, BYW, and BGY. Review and Editing: BAT, AKB, BGY, BYW, and STY. Supervision: BAT, AKB, MKM, BGY, BYW, and FFA.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data availability statement: The data is available from the corresponding author and can be available upon request.
Trial registration: International Prospective Register of Systematic Review (PROSPERO), with registration number CRD42024608878.
Supplemental material: Supplemental material for this article is available online.
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Supplementary Materials
Supplemental material, sj-docx-1-smo-10.1177_20503121251345598 for Knowledge of healthcare providers on preconception care in east Africa: Systematic review and meta-analysis by Birhan Ambachew Taye, Belyu Yehualashet Weldearegay, Muluemebet Kassa Mezen, Bantie Getnet Yirsaw, Fasiledes Fetene Asfaw, Shumye Tamrie Yerie and Aychew Kassa Belete in SAGE Open Medicine