Knowledge of reproductive-age women about mother-to-child transmission of HIV and associated factors: a systematic review and meta-analysis

Abstract

Introduction

Despite significant efforts to manage and prevent HIV, knowledge gaps persist regarding mother-to-child transmission of HIV among women of reproductive age. Previous studies, limited in scope and producing inconsistent findings, have hindered the development of effective policies and interventions. This study aims to provide updated information on MTCT knowledge among women of reproductive age and identify associated factors globally.

Method

A systematic search was conducted across four databases (PubMed, Scopus, Web of Science, and Cochrane Central Library). The quality of the included studies was assessed using the JBI tool. Extracted data characteristics were presented in tables and forest plots. The random effects model was applied, and statistical heterogeneity was assessed using Higgins I² statistics. Subgroup and sensitivity analyses were performed to examine variation in estimates and the impact of individual studies on the pooled result. Publication bias was evaluated using a funnel plot and Egger’s regression test.

Result

A total of 37 studies meeting the eligibility criteria were included in this systematic review and meta-analysis. The pooled knowledge of women regarding mother-to-child transmission of HIV was 52% (45%, 59%). Subgroup analysis by study year showed lower knowledge in studies conducted before 2015 compared to those after. Egger’s test indicated no publication bias and sensitivity analysis confirmed no single study impact on the pooled estimate. Significant factors associated with knowledge included place of residence, education, wealth status, media exposure, antenatal visits, and HIV testing history.

Conclusion

Knowledge of mother-to-child transmission of HIV among reproductive-age women globally remains insufficient. Our findings show that urban residence, higher education, wealth status, media exposure, antenatal care visits, and HIV testing are significantly linked to better knowledge. Targeted interventions for rural, uneducated, and socioeconomically disadvantaged women are needed to improve awareness and prevent MTCT of HIV.

Systematic review registration

PROSPERO CRD42024620895

Supplementary Information

The online version contains supplementary material available at 10.1186/s13643-026-03099-9.

Introduction

In 2023, UNAIDS reported that approximately 39.9 million individuals worldwide are living with HIV, including 1.4 million children. Additionally, there were 1.3 million new infections and 630,000 deaths related to AIDS [1, 2]. Although the epidemic is decelerating, considerable challenges persist, especially in sub-Saharan Africa, South Asia, Southeast Asia, and Eastern Europe [3]. Worldwide, 3100 new HIV infections occurred in sub-Saharan Africa in 2023, and an estimated 4000 infections occurred each week among females aged 15–24 [2, 4, 5].

Notwithstanding significant endeavors to diminish new infections and AIDS-related fatalities in several regions, the worldwide objectives for 2020 have remained unachieved [6]. Initiatives to eradicate new HIV infections in children have stagnated, leading to a concerning increase in HIV diagnoses among adolescent girls and young women annually [5]. In 2020, children accounted for 5% of the global HIV population and 15% of all AIDS-related fatalities [7]. According to UNICEF, the elimination of mother-to-child transmission program has played a crucial role in preventing child HIV infections. Between 2000 and 2023, approximately 4 million infections were averted through the prevention of mother-to-child transmission (PMTCT) program, which the Super-Fast-Track Framework supports to end AIDS. In 2022 alone, the program successfully reduced new child HIV infections to 120,000, significantly lower than the estimated 350,000 that would have occurred without intervention. It is noteworthy that 92% of the averted cases were predominantly located in the Eastern and Southern African regions, 79%, and the West and Central African regions, 13% [8].

Despite significant progress in the prevention of mother-to-child transmission (PMTCT) of HIV, considerable efforts are still required to achieve the goal of zero new HIV infections by 2030. A substantial proportion of vertical transmissions result from mothers not receiving antiretroviral therapy (ART), discontinuing ART, or acquiring the infection during pregnancy and breastfeeding [9]. A key contributing factor to these issues is insufficient awareness and knowledge regarding PMTCT of HIV [10]. There are still many gaps in the understanding of the effectiveness of the prevention and treatment of HIV and the mother-to-child transmission of HIV among women of reproductive age in many countries [11]. A study in sub-Saharan Africa revealed that only 56.21% of women are aware of MTCT and its prevention measures [12]. Similarly, research in Ethiopia showed that only 41.1% of women had the right knowledge on mother–child transmission of HIV and there was a difference based on the region and the socioeconomic status of the women [13]. Other research also shows that 59.41% of women of reproductive age in East Africa have good knowledge of the parent-to-child transmission of HIV and its prevention [14]. Further, a study conducted in Nigeria and India showed that although pregnant women had knowledge about HIV/AIDS, their knowledge of MTCT was inadequate [15, 16].

The following are the variables that have been found to affect women’s knowledge and understanding of the MTCT of HIV/AIDS. The socioeconomic characteristics, including urban residency, older age, higher level of education, wealth, exposure to mass media, and having at least one child, are all positively related to knowledge [12, 17]. In addition, women with adequate knowledge of HIV, and those who have no stigma and prejudice towards people living with HIV, are more likely to have a good understanding of the MTCT of HIV [18]. Notwithstanding considerable endeavors to combat MTCT of HIV, huge information deficits persist across diverse countries, accompanied by several myths about the transmission of the virus. Although so many studies were done previously, they were limited in scope, focusing on small areas. Further, their inconsistent findings have hindered the development of effective policies and intervention programs. Therefore, this study aims to provide updated information on the knowledge level regarding MTCT of HIV among women of reproductive age and to identify associated factors on a global scale. The results aim to augment current programs and guide policy-making initiatives to elevate knowledge of HIV MTCT among women.

Methods

Protocol and registration

This systematic review and meta-analysis adheres to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [19]. The protocol of the systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with an ID of CRD42024620895 (https://www.crd.york.ac.uk/prospero/#myprospero). For the dissemination of our results, we adhered to the PRISMA guidelines (Supplementary Table S1).

Data sources and search strategies

A compressive search was conducted from 08/11/2024 to 11/11/2024 in four databases (PubMed, Scopus, Web of Science, and Cochrane Central Library), and we included articles published up until the inception of the study. Further, a systematic search was done on Google, Google Scholar, and institutional repositories to access grey literature from sources such as the World Health Organization (WHO), Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Children’s Fund (UNICEF), and the Centers for Disease Control and Prevention (CDC). A combination of keywords and controlled vocabularies like Medical Subject Headings (MeSH) in PubMed and Cochrane was used in the search process. The terms (knowledge, awareness, factor*, determinant*, cause*, risk*, “risk factor*”, “determinant factor*”, “associated factor*”, “Prevention of mother to child transmission of HIV”, “mother to child transmission of HIV”, “prevention of vertical transmission of HIV”, “vertical transmission of HIV”, “fetomaternal infection”, “fetomaternal infection transmission”, “maternal–fetal infection”, “maternal–fetal infection transmission”, “PMTCT”, “MTCT”) with Boolean operators (OR, AND), field codes, wildcards, braces, and quotation marks were used for searching in each database (Supplementary Table S2).

Eligibility criteria

Inclusion criterias

Study design, language, and year of publication

We included articles with a cross-sectional, case-control, and cohort study design that were published in the English language. There was no restriction in the year of publication.

Population

All reproductive-age women aged 15–49, including pregnant, non-pregnant, HIV-negative, and those living with HIV, were included in this review.

Outcome

Knowledge level of women about MTCT and associated factors. The knowledge of women about MTCT was assessed using different criteria among different studies. But we stick to those studies that use the following three criteria for the knowledge level: is HIV transmitted from mother to child during pregnancy, delivery, or breastfeeding? Most of the studies classified women who responded “yes” to all three questions as having “good knowledge,” while those who did not as having “poor knowledge.” Some studies used the mean/median knowledge level as a cutoff point.

Exclusion criterias

We excluded studies that did not report on the knowledge of women regarding mother-to-child transmission (MTCT) of HIV, those lacking sufficient data to extract the outcome of interest, review articles, editorials, commentaries, case reports, conference abstracts without full texts, and studies not conducted among reproductive-age women (15–49 years).

Study selection

We used Covidence, an online systematic review management platform, to manage the review process including removing duplications, title abstract and full-text screening, and data extraction [20]. Each title and abstract was independently screened by two reviewers from our author pool, who selected all potentially eligible articles for full-text review. Two reviewers independently reviewed full texts for eligibility, with disagreement resolved through discussion with a third reviewer. The reason for studies excluded in the full-text review is presented in Supplementary Table S3.

Data extraction and study quality assessment

Data were extracted independently by two reviewers using a standardized form, and discrepancies were resolved by consensus. Risk of bias of included studies was assessed independently by two reviewers using the appropriate JBI (the Joanna Briggs Institute) critical appraisal tools [21], with disagreements resolved through discussion. The tool has 8, 10, and 11 items to measure the quality of cross-sectional, case-control, and cohort studies respectively. An article with a total JBI quality score of more than 50% was considered as having a low risk of bias and included in our data analysis [22] (Supplementary Table S4).

Data synthesis and analysis

The extracted data were exported to Stata version 18 for data synthesis and statistical analysis. The characteristics of the extracted data were presented in the table, and a summary of the pooled estimate was presented graphically in a forest plot. The random effect model was used as there is a high level of heterogeneity between studies. The presence of statistical heterogeneity across the included studies was determined using Higgins I² statistics and considered low when it is less than 50%, moderate when it is between 50 and 75%, and high when it is greater than 75% [23]. Additionally, subgroup analysis was done by geographic regions, sample size, and study year to see the variation of estimates among the categories, and sensitivity analysis to check a single study effect on the overall pooled estimate was done. The Freeman–Tukey double arcsine transformation was used to generate the knowledge level with a 95% confidence interval and to stabilize the variance of each study’s proportion [24, 25]. Publication bias was checked graphically using a funnel plot and statistically by Egger’s regression test.

Results

Search results

A total of 2099 studies were retrieved from four databases and 200 papers from the first 20 pages of Google Scholar. Of these, 968 were identified as duplicates by the COVIDENCE software, and 1331 studies proceeded to title and abstract screening. During this screening, 1251 studies were excluded for being irrelevant, leaving 80 studies for full-text screening. Ultimately, 37 studies were included in the systematic review and meta-analysis, while the remaining 43 were excluded based on the eligibility criteria (Fig. 1).

Fig. 1.

Preferred reporting items for systematic review and meta-analysis (PRISMA) flow chart

Study characteristics

Of the total studies included in this study, 33 studies were conducted in Africa (Zimbabwe, Tanzania, Sudan, Kenya, Ethiopia, Nigeria, South Africa, Rwanda, Cameroon, Congo, Malawi, and Ghana), while 4 studies were from Asia (Indonesia, India, Pakistan, and Vietnam). All the studies were cross-sectional. The studies focused on women of reproductive age, ranging from 15 to 49 years, with sample sizes varying from 123 to 350,888, totaling a population of 824,230 (Table 1).

Table 1.

Summary of the characteristics of the studies included in the systematic review and meta-analysis (global, 2024)

No.	Study	Study year	Study setting (country)	Study design	Population	Sample size	case	MTCT knowledge
1	Masaka 2019 [26]	2015	Zimbabwe	Cross-sectional	Reproductive age Women	9603	6770	70.50%
2	Ngadaya 2021 [27]	2011–2013	Tanzania	Cross-sectional	Pregnant women	159	87	54.70%
3	Lejeng 2020 [28]	2019	Sudan	Cross-sectional	Women living with HIV	304	122	40%
4	Buston 2023 [29]	2023	Indonesia	Cross-sectional	Reproductive age Women	9600	6360	66.25%
5	Rogers 2006 [30]	2004	India	Cross-sectional	Pregnant women	202	91	45%
6	Omwega 2006 [31]	2006	Kenya	Cross-sectional	Reproductive age Women	123	47	38.20%
7	Moges 2011 [32]	2008	Ethiopia	Mixed Cross-sectional	Pregnant women	418	177	42.30%
8	Malaju 2012 [33]	2012	Ethiopia	Cross-sectional	Pregnant women	400	354	88.5
9	Asefa 2013 [34]	2013	Ethiopia	Cross-sectional	Pregnant women	1325	152	11.5%
10	Deressa 2014 [35]	2014	Ethiopia	Cross-sectional	Pregnant women	843	219	26%
11	Birhane 2015 [36]	2014	Ethiopia	Cross-sectional	Pregnant	542	103	19%
12	Haile 2016 [37]	2011 and 2012	Tanzania	Cross-sectional	Reproductive age women	10,967	5045	46%
13	Abtew 2016 [38]	2014	Ethiopia	Cross-sectional	Pregnant women	386	222	57.5%
14	Alemu 2017 [39]	2013	Ethiopia	Cross-sectional	Pregnant women	416	165	39.6%
15	Luba 2017 [40]	2011	Ethiopia	Cross-sectional	Reproductive age Women	16,515	5648	34.20%
16	Alemu 2018 [41]	2017	Ethiopia	Cross-sectional	Pregnant women	416	216	52%
17	Gizaw 2018 [42]	2014	Ethiopia	Cross-sectional	Pregnant women	504	215	42.65%
18	Irfan 2019 [43]	2018	Pakistan	Cross-sectional	Pregnant women	350	52	14.8%
19	VoHoang 2020 [44]	2000–2014	Vietnam	Cross-sectional	Reproductive age women	40,213	18,576	46.20%
20	Liyeh 2020 [45]	2016	Ethiopia	Cross-sectional	Reproductive age women	830	221	26.60%
21	Liyeh 2020 [46]	2017	Ethiopia	Cross-sectional	Reproductive age women	510	160	31.40%
22	Teshale 2021 [12]	2008/2009–2018/2019	Sub-Saharan Africa	Cross-sectional	Reproductive age women	350,888	197,234	56.21%
23	Olopha 2021 [47]	2018	Nigeria	Cross-sectional	Reproductive age women	34,837	20,624	59.20%
24	Gizaw 2021 [48]	2020	Ethiopia	Cross-sectional	Pregnant women	798	510	63.90%
25	Gebremedin 2021 [49]	2016	Ethiopia	Cross-sectional	Reproductive age women	4081	2130	52.2%
26	DartehEKM 2021 [50]	2016	South Africa	Cross-sectional	Reproductive age women	7861	7185	91.4%
27	Gebre 2021 [11]	2016	Ethiopia	Cross-sectional	Reproductive age women	15,683	6446	41.10%
28	Balis 2022 [51]	2019	Ethiopia	Cross-sectional	Reproductive age women	422	397	94.10%
29	Deynu 2023 [52]	2020	Rwanda	Cross-sectional	Reproductive age women	14,634	11,649	79.60%
30	Dhillon 2023 [53]	2018	Cameroon	Cross-sectional	Reproductive age women	6337	4246	67%
31	Mudji 2023 [54]	2021	Congo	Cross-sectional	Pregnant women	460	140	30.40%
32	Eshetu 2023 [55]	2023	Eight African countries*	Cross-sectional	Reproductive age women	97,130	56,229	57.89%
33	Afaya 2024 [56]	2017	Indonesia	Cross-sectional	Reproductive age women	39,735	28,609	72%
34	Antabe 2024 [18]	2015–2016	Malawi	Cross-sectional	Women living with HIV	858	644	75%
35	Mohammed 2024 [57]	2024	Ghana	Cross-sectional	Reproductive age women	9106	6320	69.41%
36	Terefe 2024 [58]	2011 to 2022	East Africa	Cross-sectional	Reproductive age women	133,724	79,445	59.41%
37	Andargie 2024 [59]	2005–2016	Ethiopia	Cross-sectional	Pregnant women	13,020	5629	43.23%

^*Equatorial Guinea, Malawi, Zambia, Mozambique, Namibia, Zimbabwe, South Africa, and Lesotho

Knowledge level of reproductive-age women about mother-to-child transmission of HIV

Thirty-seven studies were used to estimate the knowledge level of reproductive-age women about mother-to-child transmission of HIV. The pooled knowledge was 52% (45%, 59%). There was a statistically significant higher degree of heterogeneity among the studies (I² = 99.97%, P < 0.001) (Fig. 2).

Fig. 2.

Forest plot of the knowledge levels of reproductive-age women about MTCT of HIV: a systematic review and meta-analysis (Global, 2024)

Sub-group analysis and meta-regression

Subgroup analysis was conducted based on geographic regions (Africa, Asia), sample size, and study year (before 2015, 2015, and later). A statistically significant difference was found based on the study year. The pooled prevalence of women’s knowledge about MTCT was lower in studies conducted before 2015 compared to those conducted in 2015 and later (Fig. 3). Additionally, a meta-regression was performed to examine the impact of covariates on the pooled estimates. It was found that only the study year significantly influenced the pooled estimates. Studies conducted after 2015 showed a positive association with the pooled estimates, with a coefficient of 0.31618 and a P-value of 0.028.

Fig. 3.

Subgroup analysis of the knowledge levels of reproductive-age women about MTCT of HIV based on the year of study: a systematic review and meta-analysis (Global, 2024)

Publication bias and sensitivity analysis

Publication bias was evaluated using a funnel plot and Egger’s test. Although asymmetry was observed in the funnel plot (Fig. 4), Egger’s test indicated no significant publication bias (P = 0.1289). A sensitivity analysis was conducted using a leave-one-out meta-analysis to assess the impact of individual studies on the pooled estimates. The results showed that no single study significantly influenced the pooled estimates of reproductive-age women’s knowledge about MTCT (Fig. 5).

Fig. 4.

Funnel plot to evaluate publication bias in studies examining the knowledge level of reproductive-age women about MTCT of HIV: a systematic review and meta-analysis (Global, 2024)

Fig. 5.

Sensitivity analysis of the studies included in the systematic review and meta-analysis (Global, 2024)

Factors associated with the knowledge level of reproductive-age women about MTCT of HIV

Residence

The pooled estimates from 14 studies suggest that women living in urban areas have better knowledge of MTCT of HIV compared to those residing in rural areas, with a pooled OR of 1.47 (95% CI 1.24–1.74) (Supplementary Fig. S1).

Level of education

The pooled estimates from 14 studies indicate that women with primary education had a better understanding of MTCT of HIV (OR 1.38, 95% CI 1.22–1.56), while those with secondary education demonstrated even greater knowledge (OR 1.79, 95% CI 1.36–2.35). Additionally, women with higher education, based on 8 studies, exhibited the highest level of knowledge (OR 1.63, 95% CI 1.00–2.67) compared to women with no education (Supplementary Fig. S2a, S2b, S2c).

Wealth

A pooled estimate from 7 studies indicated that women from poorer household wealth status had better knowledge of MTCT of HIV (pooled OR 1.06, 95% CI 1.02–1.09). Women from middle-income households, based on 10 studies, showed even better knowledge (pooled OR 1.11, 95% CI 1.07–1.15). Furthermore, women from richer households (7 studies) had a pooled OR of 1.16 (95% CI 1.09–1.22), while those from the richest households (10 studies) demonstrated the highest level of knowledge (pooled OR 1.22, 95% CI 1.06–1.39) compared to women from the poorest households (Supplementary Fig. S3a, 3b, 3c, 3 d).

Media exposure

The combined prevalence from 11 studies shows that women with media exposure had a better understanding of the mother-to-child transmission (MTCT) of HIV as compared to those with no media exposure, with a pooled odds ratio of 1.15 (1.04, 1.27) (Supplementary Fig. S4).

Antenatal care

The pooled estimates from 3 studies show that women with a history of ANC visits had better knowledge of MTCT of HIV compared to those without a history of ANC, with a pooled OR of 2.18 (95% CI 1.01–4.71) (Supplementary Fig. S5).

Ever tested for HIV

The pooled estimates from 6 studies indicate that women who have ever been tested for HIV had better knowledge of MTCT of HIV compared to those who have not been tested, with a pooled OR of 1.45 (95% CI 1.00–2.11) (Supplementary Fig. S6).

Discussion

Transmission of HIV from mother to child mainly takes place during pregnancy, delivery, and breastfeeding, and these modes of transmission are responsible for almost all new HIV infections in children aged 0–14 years [56]. However, the risk of transmission can be significantly decreased through targeted interventions aimed at enhancing the knowledge of reproductive-aged women regarding maternal transmission of HIV. Therefore, the aim of this study is to provide updated insights into the level of knowledge about MTCT of HIV globally among reproductive-age women.

Our study found that pooled knowledge of MTCT among the study participants stands at 52% (45%, 59%). This finding is lower than those reported from studies conducted in Indonesia, which reported 72% [56], in East Africa 59.4% [58], in eight HIV/AIDS prevalent countries using the DHS dataset 57.98% [55], and in Sub-Saharan Africa (SSA) 56% [12]. Conversely, our finding was higher than previous research from Tanzania at 46% [37], Pakistan at 14.3% [43], Ethiopia at 34.9% [40], South Africa at 30.8% [60], Mecha district in Ethiopia at 31.4% [45], and Vietnam at 46.87% [44]. This discrepancy in the levels of knowledge may be attributed to variations in study populations, sampling methods, or the timing of the studies. Differences in public health initiatives, community awareness campaigns, and access to healthcare resources across various regions may also explain the discrepancies. Furthermore, our pooled estimate is lower than that reported in the previous systematic review and meta-analysis conducted in Ethiopia, which found a pooled knowledge level of 62% [61]. This discrepancy may be attributed to several factors, including differences in methodological approaches, particularly in the definitions and measurements of the outcome. Moreover, the scope of our review is broader, encompassing studies from multiple countries across various regions, whereas the previous review was restricted to Ethiopia. Consequently, the lower overall estimate observed in our review may reflect greater heterogeneity in study populations, health system capacities, and the reach and effectiveness of HIV-related awareness and prevention programs across diverse global contexts.

The pooled prevalence of women’s understanding of MTCT in the studies showed a notable increase after 2015 in comparison to the period before 2015. Moreover, the meta-regression analysis highlighted significant differences and suggested that the study year was a key factor influencing the pooled estimate. Research conducted post-2015 demonstrated a positive association with knowledge regarding MTCT. The improvements can be ascribed to the expanded global health initiatives focused on eliminating MTCT, including programs led by the World Health Organization (WHO) and the United Nations’ Sustainable Development Goals (SDGs), which have emphasized maternal and child health in recent years, likely contributing significantly to the good trend in knowledge about MTCT [62, 63]. However, discussing HIV remains taboo in some cultural contexts, and there is resistance worldwide to undermine HIV education, with the issue being particularly prevalent in low- and middle-income countries (LMICs) [64].

Our research revealed that variables such as place of residence, level of education, wealth, media exposure, participation in antenatal care, and history of HIV testing impacted reproductive-aged women’s understanding of mother-to-child transmission (MTCT) of HIV.

The association between residence and knowledge of mother-to-child transmission (MTCT) of HIV was assessed. Women residing in urban regions exhibited superior knowledge of MTCT compared to their rural counterparts, with a pooled odds ratio (OR) of 1.47 (95% CI 1.24–1.74). This finding is consistent with earlier research conducted in Ethiopia [4, 12, 30, 31], which reported that women dwelling in urban areas have better knowledge than those residing in rural areas. The disparities between rural and urban areas can be ascribed to variations in access to and quality of HIV-related information and resources. Additionally, urban residents often have greater exposure to HIV-related information compared to rural women, who frequently encounter barriers to accessing prevention of mother-to-child transmission (PMTCT) services [52].

Similarly, women from the richest households demonstrated the highest level of knowledge (pooled OR 1.22, 95% CI 1.06–1.39) compared to women from the poorest households. This aligns with findings from studies in Ethiopia, Tanzania, and Vietnam [11, 37, 44], which reported that women from the richest households have better knowledge than those from the poorest households. One possible reason for this observation is that women with lower socioeconomic status may face financial barriers that limit their access to healthcare services and facilities, potentially preventing them from obtaining important health information [65]. As a result, this may affect their ability to receive essential maternal health services, such as antenatal care [56]. Conversely, women from higher socioeconomic backgrounds are more likely to have greater access to various resources, including education, healthcare, and social media, which enables them to acquire information about MTCT of HIV [11, 37, 56, 66].

Research shows that obtaining higher education is a significant factor associated with an improved knowledge of HIV transmission and maternal health education [56, 67]. This study found that women with primary, secondary, or higher education possessed more understanding regarding mother-to-child transmission (MTCT) of HIV than those without formal education. This aligns with prior studies [40, 46, 47, 54]. This emphasizes the importance of education for increasing awareness and its influence on health knowledge and behaviors [55].

Further, women with media exposure were more likely to possess better knowledge regarding mother-to-child transmission (MTCT) of HIV than those without such exposure. This finding is consistent with previous research conducted in Africa [11, 40, 68] and Asia [29, 44], highlighting that media exposure influences better knowledge about mother-to-child transmission of HIV. The relationship may be ascribed to the influence of health education campaigns disseminated via media channels, especially radio, which has demonstrated effectiveness in conveying health information in local languages to specific populations [69]. The results emphasize the positive impact of targeted media campaigns as a strategic approach to augment knowledge and understanding of MTCT prevention methods.

Women with a history of attending antenatal care (ANC) visits displayed better knowledge regarding mother-to-child transmission (MTCT) of HIV compared to those who did not attend ANC. This might be associated with the knowledge that counselors impart during sessions. This result aligns with research conducted in Zimbabwe [26] and Rwanda [52]. Moreover, women who had participated in HIV testing exhibited a higher understanding of mother-to-child transmission (MTCT). This may result from post-test counseling that frequently encompasses education on preventing mother-to-child transmission (MTCT) of HIV. This result highlights the essential function of HIV testing in improving knowledge and awareness of MTCT among pregnant women, consistent with findings from a study in sub-Saharan Africa [55].

While the strength of our systematic review and meta-analysis (SRMA) lies in its global scope, providing valuable insights for policymakers to inform interventions, it is not without limitations. One key limitation is the variation in the methodologies used across the included studies to assess knowledge levels. These inconsistencies in measurement approaches may introduce bias, affect the reliability of the pooled results, and may influence the conclusions drawn from the analysis.

Conclusion

Knowledge about MTCT of HIV among reproductive-age women globally remains suboptimal. Our findings highlighted that urban residence, higher education level, wealth, media exposure, antenatal care visits, and ever tested for HIV are significantly associated with higher odds of knowledge about MTCT among reproductive-age women. Targeted interventions are essential for improving knowledge and addressing disparities among rural, uneducated, and socioeconomically disadvantaged women. Strengthening health education initiatives through media, incorporating PMTCT into maternal health services, and addressing barriers to healthcare access will be essential to reducing HIV transmission from mother to child. These efforts should be tailored to align with the diverse socio-cultural practices, values, and norms that influence health behaviors, beliefs, and healthcare-seeking patterns across different communities and countries. Ensuring cultural sensitivity and community engagement will be crucial for enhancing the effectiveness, acceptance, and sustainability of interventions aimed at reducing mother-to-child HIV transmission.

Abbreviations

ANC

Antenatal care

MTCT

Mother-to-Child Transmission

OR

Odd Ratio

PMTCT

Prevention of Mother to Child Transmission

SRMA

Systematic Review and Meta-Analysis

SSA

Sub-Saharan Africa

Authors’ contributions

Conceptualization: Abebe Gedefaw and Mulugeta Shegaze. Data extraction: Abebe Gedefaw, Yalemzer Agegnehu, Yenus Ibrahim, and Tsehanew Kassie. Formal analysis: Abebe Gedefaw and Mulugeta Shegaze. Methodology: Abebe Gedefaw, Mulugeta Shegaze, Yalem Tsegay, Lovel Fornah, Abakundana Nsenga Ariston Gabriel, Getahun Koira, Gerard Bikorimana, and Wei Ma. Supervision: Mulugeta Shegaze, Getahun Koira, Gerard Bikorimana, Yalem Tsegay, Lovel Fornah, Abakundana Nsenga Ariston Gabriel and Wei Ma. Writing: Abebe Gedefaw, Mulugeta Shegaze, Lovel Fornah, and Abakundana Nsenga Ariston Gabriel.

Funding

There is no funding obtained for this study.

Data availability

The datasets used during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.