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Background: Maternal knowledge on mother-to-child transmission (MTCT) and its prevention has been identified to enhance maternal testing and adherence to antiretroviral therapy (ART) regimen. Examining prevalence and associated factors on MTCT and its prevention among women provides empirical evidence for design and implementation of health strategies aimed at increasing MTCT knowledge and its elimination. This study therefore examined women’s comprehensive knowledge and associated factors on MTCT and its prevention among childbearing women in Rwanda. Methods: Analysis was conducted on a weighted sample of 14,634 women from the 2020 Rwanda Demographic and Health Survey (RDHS). Dataset cleaning and missing value analysis was conducted. Chi square, bivariate and multivariable regression was then conducted in complex samples in SPSS. Alpha level set at p < 0.05 and at 95% Confidence Interval (95% CI). All analysis were adjusted for unequal probability sampling using survey weights. Bivariate and multivariable results were reported with crude and adjusted odds ratios. Results: The mean age was 29.2 years, SD-9.1. Prevalence of HIV testing and comprehensive knowledge on MTCT and its prevention among women in Rwanda was 79.6% and 65.1% respectively. Findings from this study showed that married women have higher odds (aOR = 1.18, 95% CI = 1.04–1.35) of comprehensive knowledge on MTCT and its prevention compared to those unmarried. Women who were living in southern (aOR = 1.23, 95%CI = 1.02–1.48) and eastern (aOR = 1.37, 95% CI = 1.13–1.66) parts of Rwanda were more likely to have adequate knowledge on MTCT of HIV and its prevention than those in Kigali. Also, women who received post-test counselling (aOR = 1.26, 95% CI = 1.01–2.11) have increased knowledge on MTCT than those who did not. Women with access to radio (aOR = 1.18, 95% CI = 1.06–1.32) and television (aOR = 1.25, 95% CI = 1.07–1.45) at least once a week were more likely to have adequate knowledge on MTCT and its prevention compared to those who do not in Rwanda. Conclusion: There is inadequate knowledge on MTCT and its elimination among women of reproductive age in Rwanda. Strategies to enhance knowledge on MTCT and its prevention among childbearing women should be adopted through rigorous educational sensitization campaigns using local media such as radio and television. Health services that focus on prevention of MTCT must emphasize post-test counselling.
This is secondary data analysis of a cross sectional study carried out on women of reproductive age 15–49 years in Rwanda. The data was extracted from the 2020 Rwandan Demographic and Health Surveys (RDHS) conducted from November 2019-July 2020. The 2020 RDHS was a follow up to the previous 2014/2015 RDHS [25]. Its primary objective was to provide up-to-date estimates of basic demographic and health indicators including information on fertility levels and preferences, contraceptive use, maternal and child health, infant, child and neonatal mortality levels, maternal mortality, gender, nutrition, awareness about HIV/AIDS, self-reported Sexually Transmitted Infections (STIs) and other health indicators that are relevant to the attainment of the Sustainable Development Goals (SDGs) [25]. The survey respondents in the 2020 RDHS were representatively selected from the five (5) regions of Rwanda. The 2020 RDHS followed a two-stage sample design that allows estimates of key indicators at the national level as well as for urban and rural areas, five regions or provinces. The first stage involved the selection of sample points (clusters) consisting of Enumeration Areas (EAs). A total of 500 clusters were selected, 112 in urban and 388 in rural areas. The second stage involved systematic sampling of households within the selected clusters providing a sampling frame from where the households were randomly selected from all the clusters to provide estimates for key indicators. A total sample size of 14,634 women aged 15–49 years were interviewed in the 2020 RDHS. Therefore, sample size analyzed in this study was 14,634 respondents. The detailed description of the methodology of the survey design, survey tools used, methodology and the data collection methods for the 2020 RDHS has been described in the RDHS report [26]. This study was conducted in Republic of Rwanda, a landlocked country located in the Great Rift Valley of Eastern-Central Africa. It has a total area of 26 338 sq. km and bounded to the north by Uganda, to the east by Tanzania, and the west by Democratic Republic of Congo with an estimated population of 13 256 000 in 2022. It has five provinces namely North, East, West, South and Kigali (Capital). The main outcome variable in this study is reproductive women’s comprehensive knowledge on MTCT and EMTCT of HIV in Rwanda. It is a composite score of five [5] different questions that were similar to those in previous studies [2, 4, 8, 10, 14]. The questions included (i) “Now I would like to talk about something else, have you ever heard of HIV/AIDS?”, (ii) “Can HIV be transmitted from mother to her baby during pregnancy?”, (iii) “Can HIV be transmitted from the mother to her baby during delivery?”, (iv) “Can HIV be transmitted from the mother to her baby during breastfeeding?”, (v) “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 (5) meant the respondent had adequate knowledge on MTCT and EMTCT of HIV whilst a score less than (5) by a respondent was considered as having inadequate knowledge on MTCT and EMTCT of HIV. A binary variable was therefore created based on the aggregate scores. The Social Cognitive Theory [18] and the Information Motivation Behavioral Skills Theory (IMB) [19] and previous literature [1, 2, 4, 8, 10, 11] provided the theoretical foundation and guided selection of the independent predictors analyzed in this study respectively. The independent predictors have been categorized into Individual level factors such as Respondents age (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49), Marital status (recoded into Never in union/Not Married, Married/Living with partner, Divorced/Separated/Widowed), Highest educational level (No education, Primary, Secondary, Higher), Religion (Catholics, Protestants, Adventists, Muslim, Traditional & Others), Frequency of reading newspaper/magazine (Not at all, Less than once a week, At least once a week), Frequency of listening to radio (Not at all, Less than once a week, At least once a week), Frequency of watching Television (Not at all, Less than once a week, At least once a week), Wealth Index Combined (Poorest, Poorer, Middle, Richer, Richest), Currently pregnant (No or Unsure, Yes), Visited health facility last 12 months (No, Yes), Covered by Health Insurance (No, Yes), Respondent currently working/Employment status (Employed, Unemployed). The Community level variables included Region of residence (Kigali, South, West, North, and East) and Type of Place of residence (Urban, Rural). Others included HIV related knowledge variables; Ever been tested for HIV in last 12 months prior to the survey (No, Yes), Knows a place to get HIV test (No, Yes), Knowledge and use of HIV self-test kits (Never heard of HIV test kits, Knows and self-tested), Tested for HIV as part of ANC visit (No, Yes), Got results for HIV as part of ANC visit (No, Yes), Received counselling after being tested for HIV as part of ANC visit (No, Yes), Received results for last HIV test (No, Yes). The data in the current study was analyzed through dataset cleaning and integrity checks to ensure completeness and consistency of the dataset. Univariate analysis as well as missing data analysis was conducted. Bivariate and multivariable regression analysis was then conducted using IBM Statistical Software for Social Sciences (SPSS) version 26, level of significance set at p < 0.05 and at 95% Confidence Interval (95%CI). Survey characteristics were described using frequencies and percentages. Pearson’s Chi square was then performed to investigate the associations between the dependent variable and the predictors of MTCT and EMTCT of HIV. The multivariable logistic regression model was then fitted with the independent variables to identify the determining factors of comprehensive MTCT and EMTCT of HIV knowledge. This was to adjust for confounders [27, 28]. The multivariable analysis was conducted through a three-stage modelling to understand the factors that influence comprehensive MTCT and EMTCT of HIV Knowledge. The first model involved the sociodemographic or individual level characteristics of the survey respondents. The second modeling entailed both individual level factors and community level factors. The third modelling involved the second model and HIV related knowledge factors to produce adjusted odds ratios that are independently associated with reproductive women’s knowledge on MTCT and EMTCT of HIV. The bivariate analysis results were reported in crude odds ratios (COR) whilst the multivariable results were reported with adjusted odds ratios (aOR) at 95% Confident Intervals (95%CI). Sample weights were applied to account for sampling biases. All analysis were conducted through the complex samples analysis in SPSS after the Complex Samples Analysis Plan (CS Plan) was generated in SPSS using the weight, cluster and strata variables in the Rwanda DHS. This allowed for the adjustment of weight, stratification and clustering of the sampling design in order to produce national estimates that are representative of the general population taking into account the weights for under or over sampling of specific groups in Rwanda [26, 29–31]. The study was performed in accordance with the Declaration of Helsinki and approved by appropriate ethics committee. Ethical clearance was obtained from the Rwanda National Ethics Committee and the ICF Institutional Review Board. Informed consents were obtained from participants prior to data collection. We obtained permission from the DHS program to use the 2020 RDHS for our study at https://dhsprogram.com/data/available-datasets.cfm. All data were anonymized before the authors received the data. All methods were performed in accordance with the relevant guidelines and regulations.
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