Knowledge of reproductive age women on prevention of mother to child transmission of human immunodeficiency virus and associated factors at Mecha district, Northwest Ethiopia: A community based cross sectional study

Objective: To asses knowledge of reproductive age women on prevention of mother to child of HIV and associated factors at Mecha Result: About 22.4% of the respondents were knowledgeable on prevention of mother to child transmission (PMTCT) of HIV. Having knowledge on PMTCT of HIV was significantly associated with urban residence (AOR =2.486, 95%CI= 1.160-5.328), education level of secondary and above (AOR =5.445, 95%CI=2.698-10.986), those having history of antenatal care followup (AOR =4.430, 95%CI=1.471-13.340), those with history of institutional delivery (AOR=4.766, 95%CI = 2.004-11.334), those having comprehensive knowledge on HIV/AIDS (AOR=1.697, 95%CI = 1.011-2.846), women who were knowledgeable about mother to child transmission of HIV (AOR =2.203, 95% CI =1.37-3.54), and women who held discussions with their husband regarding HIV/AIDS, (AOR= 2.700, 95%CI =1.658-4.396).


Introduction
Vertical transmission of Human Immunodeficiency Virus (HIV) during pregnancy, delivery and breast feeding period continues to be a major public health problem and constitutes the most important cause of HIV infection in children less than 15 years old in the world (1). Over 90% of new infections of human immunodeficiency virus in infants and young children occur through mother-to-child transmission (2). In Ethiopia it is estimated that 109,133 children less than 15 years were living with HIV in 2016 and there were an estimated of 2,420 new infections each year due to mother-to-child transmission (3).
Knowledge of reproductive age women on prevention of mother-to-child transmission (MTCT) of HIV plays a major role in limiting the number of children being infected by HIV. With timely interventions like testing for HIV during pregnancy, safe delivery practices, preventive anti-retroviral (ARV) drugs, and modified infant feeding practices the risk of a baby getting HIV infection from an infected mother can be reduced from 20%-45% to 2-5% (4-6).
Even though there were some institution based studies conducted, there was no study done at the community level in Ethiopia.Therefore this study was conducted to identify knowledge of reproductive 3 age women on PMTCT of HIV and associated factors at the community level.

Study design and Setting
Community based cross sectional study was conducted from July 1-30/2016 in Mecha district, Ethiopia.The district has an estimated population size of 383,861 among whom 82,506 were reproductive age group in 2016.

Participants
The source population were all reproductive age women in Mecha districtand and the study population was reproductive age women living in selected kebeles in Mecha district during study period.

Sample size determination and sampling procedure
Sample size was determined by using single population proportion formula with the assumptions of 95% level of confidence, 50% proportion, 5% of margin of error and design effect of two. Finally, considering a nonresponse rate of 10%, the total sample size was 853. Multi-stage sampling technique was used to select the study participants.

Data collection tools and techniques
Data were collected by using pretested interviewer administered questionnaire. The collected data was reviewed and checked for completeness before data entry.

Variables
The dependent variablewasknowledge on PMTCT of HIV and the independent variableswere;sociodemographic characteristics, reproductive characteristics, comprehensive knowledge of HIV/AIDS and knowledge on MTCT of HIV/AIDS

Operational definition
The women who scored above or equal to the mean of the responses of knowledge assessment questions were considered as knowledgeable on PMTCT and the women who identified correctly the three different periods of MTCT of HIV considered as knowledgeable on MTCT.

Data analysis
4 The data were analyzed by using SPSS version 20.Bivariate analysis was done for all explanatory variables and those variables with P < 0.2 were entered into multivariable logistic regression.
Adjusted odds ratio with 95 % confidence interval was computed and P-value less than 0.05 considered as a significant value.

Ethical clearance
Ethical clearance was obtained from ethical review committee of university of Gondar and permission was obtained from Mecha woreda health office. Written informed consent and assent (for participants aged less than 18 rear old) was obtained prior to data collection.

Result
From the total of 853 reproductive age women included in the study, 830 of them responded the question correctly making the response rate of 97.3%.

Socio demographic characteristics
The mean (+ SD) age of the respondents were 28.5+ 8.02 and 210 (25.3%) of the women were within the age group of 20-24 years. Majority 640 (77.1%) of the study population were from rural area (Table 1).

Reproductive health characteristics
Concerning the reproductive status of the women, 389 (46.9%) were multipara. About 84.9%, 82.5% and 61.3% of the respondents had history of using family planning, ANC follow up and institutional delivery respectively.

Comprehensive knowledge of the women about HIV/AIDS
Four hundred six (48.9%) of the respondents had comprehensive knowledge about HIV/AIDS. Nearly one fifth, 19.2% and 6.5 % of the respondents described that HIV can be transmitted by mosquitos and by super natural powers respectively. Most 757(91.2%) of them knew that healthy-looking person may have AIDS virus. About 73.3% of the respondents knew that someone can prevent from HIV by consistent condom use and limiting sex partners.

Knowledge of the women on MTCT
Six hundred sixty one (79.6%) knew that HIV could be transmitted from an infected mother to her baby. Concerning the time of transmission of the virus from the infected mother to her child, 77.9%, 50.2% and 49.9% responded that MTCT could be through breast feeding, during delivery and during pregnancy respectively. Over all 221(26.6%) of the respondents were knowledgeable on MTCT of HIV.

Knowledge of the Women on PMTCT
More than three fourths, 636 (76.6%) of the respondents had heard about PMTCT of HIV of whom 186 (22.4%) of the respondents were knowledgeable on PMTCT of HIV. (Table 2). Women who had discussions with their husband about HIV/AIDS, MTCT and its prevention were 2.7 times (AOR = 2.700, 95%CI = 1.658, 4.396) more likely to be knowledgeable than those who had not (Table 3).

Discussion
In this community based cross sectional study about 22.4% of the respondents were knowledgeable on PMTCT of HIV.This finding is less than the study conducted at Gondar (83.5%) (7), Hawasa referral hospital (82.3%) (8) and Southern Nigeria (91.4 %,) (9). This discrepancy might be due to the study setting and source population difference. 6 Those women residing in urban areas were 2.5 times (AOR = 2.5, 95%CI = 1.16-5.33) more likely to be knowledgeable when compared to the rural residents. This finding is in line with studies conducted at Hawassa referral hospital, Gondar and Tanzania (7,8,10). It might be due to the urban location geographical accessibility and availability of nearby health services and greater media exposure compared with rural areas.
In this study education level of secondary and above were 5.4 times (AOR = 5.4, 95%CI = 2.69-10.98) more likely to be knowledgeable on PMTCT of HIV than those with no formal education. This explanation is in line with the study done in, Addis Ababa,Hawassa and Tanzania (8,11,12). This could be because when the women become educated their health seeking behavior and access to information might be increased.
Women who had history of ANC follow up were about 4.4times (AOR = 4.4, 95%CI = 1.47-13.34) more likely to be knowledgeable on PMTCT of HIV/AIDS than those who hadn't ANC followup. This finding is consistent with the study conducted at Hawassa referral hospital (8). It could be due to women who had history of ANC follow up might get the chance to learn from health professionals and this information may enhance women's knowledge about PMTCT.
Women who had history of institutional delivery were more knowledgeable about PMTCT (AOR= 4.77, 95%CI = 2.00-11.33) than those who had not. This finding is also consistent with the study conducted at Hawassa referral hospital (8). It could be due to women who had history of institutional delivery might get the chance of PMTCT service at the health institution from health professionals.
Women who had comprehensive knowledge on HIV/AIDS were 1.7 times (AOR = 1.7, 95%CI = 1.01 -2.85) more likely to be knowledgeable on PMTCT of HIV than non-knowledgeable counter parts. This finding was consistent with a study conducted in Gondar and Assosa, Ethiopia (7,13). The possible interpretation for this positive association is that those women with comprehensive knowledge on HIV may appreciate the prevention strategies of mother to child transmission of HIV Women who were knowledgeable on MTCT of HIV were 2.2 times (AOR = 2.20, 95% CI = 1.37-3.54) more knowledgeable on PMTCT of HIV than those who did not have. This finding is in agreement with previous study done at Assosa town, Ethiopia (13).This might be due to women with knowledgeable on 7 MTCT of HIV might have greater understanding on prevention possibilities.
Women who had discussions with their husband about HIV/AIDS, MTCT and its prevention were 2.7 times (AOR = 2.700, 95%CI = 1.7, 4.4) more likely to be knowledgeable than those who had not. This finding is inline with the study done on Mekele and Southern Ethiopia (13,14). This might be explained due to women having discussion with their husband regarding HIV/AIDS will help to share the information and increase her level of understanding which enhances her PMTCT knowledge.

Conclusion
Knowledge on PMTCT among women was found to be low. Residence, education level ANC follow up,

Ethics Approval and consent to participate
This study was approved by ethical review committee of university of Gondar and permission was obtained from Mecha woreda health office. Then informed written consent and assent were taken from the study participants.

Availability of data and material
The datasets generated during the current study are available from the corresponding author on reasonable request.

Funding
The authors have no support or funding to report Acknowledgement 8 We would like to acknowledge University of Gondar for giving a chance to undertake this study.We are also thankful to all data collectors and supervisors for their commitment and research participants for their time. We also extend our gratitude to the study participants for sharing the information.

Competing interests
We, the authors declare that we didn't have competing interests.