Knowledge about prevention of mother-to-child transmission of HIV among reproductive-age women in Africa: a systematic review and meta-analysis

Human immunodeficiency virus (HIV) remains one of the most serious global public health challenges. While several studies have demonstrated that women’s knowledge is crucial for preventing mother-to-child transmission (PMTCT), consolidated evidence from Africa is still insufficient. This combined evidence informs policymakers and health professionals in designing and implementing effective strategies to fill knowledge gaps about PMTCT. Therefore, this review aimed to determine the overall estimate of knowledge about prevention of mother-to-child transmission of HIV among reproductive-age women in Africa. This study followed the Preferred Reporting Item Review and Meta-analysis (PRISMA) guidelines. The study protocol for this review was registered on PROSPERO (reference number CRD420251077063). A comprehensive and systematic literature search was conducted across multiple databases, including PubMed, Scopus, Embase, Web of Science, and HINARI, to identify relevant and eligible studies. In addition, relevant articles were identified through searches on Google Scholar. Extracted data from the included studies were analyzed using STATA version 17. The Joanna Briggs Institute (JBI) appraisal tool was employed to assess the methodological rigor of the eligible studies. A random-effects model with the Der Simonian–Laird method was applied to determine the pooled prevalence of women’s comprehensive knowledge about PMTCT of HIV. A funnel plot and Egger’s test were utilized to evaluate the presence of publication bias. Statistical heterogeneity was assessed using the I² statistic and Cochrane’s Q test. A total of 37 eligible studies, involving 466,995 reproductive-aged women, were included in the quantitative meta-analysis. The pooled estimate of women’s knowledge on prevention of mother-to-child transmission of HIV (PMTCT) was 56.97% (95% CI: 52.37%, 61.56%), indicating nearly half of reproductive-age women in Africa lacked adequate knowledge of PMTCT. Significant factors associated with higher knowledge of PMTCT included urban residence (AOR = 1.20; 95% CI: 1.12, 1.28), attainment of primary education (AOR = 1.32; 95% CI: 1.20, 1.44), secondary education (AOR = 1.66; 95% CI: 1.38, 2.01), tertiary or higher education (AOR = 1.98; 95% CI: 1.59, 2.46), being aged 25–34 (AOR = 1.36; 95% CI: 1.32, 1.41) or 35–49 (AOR = 1.78; 95% CI: 1.15, 3.36), exposure to mass media (AOR = 1.32; 95% CI: 1.20, 1.44), having adequate knowledge of HIV (AOR = 1.964; 95% CI: 1.45, 2.66), history of maternal HIV infection and HIV-infected child (AOR = 2.19; 95% CI: 1.04, 4.60), and higher women’s wealth index categories: poorer (AOR = 1.31; 95% CI: 1.05–1.62), middle-income (AOR = 1.29; 95% CI: 1.11, 1.50), and richer groups (AOR = 1.93; 95% CI: 1.32, 2.81). Despite substantial progress in HIV prevention efforts, knowledge of PMTCT among reproductive-age women in Africa remains suboptimal, with considerable disparities across settings. The findings highlight persistent inequalities related to education, socioeconomic status, age category, geographical location, and access to health information. Thus, strengthening PMTCT knowledge requires tailored, integrated, and context-specific strategies that expand women’s educational opportunities, improve access to reliable HIV-related information through media and comprehensive maternal health services, and prioritize underserved rural and socioeconomically disadvantaged populations. These proactive efforts are crucial to encouraging women for primary prevention of HIV, empowering women to make informed decisions, improving engagement with PMTCT services, and accelerating progress toward the elimination of mother-to-child transmission of HIV in Africa.