Women’s decision-making capacity and its association with comprehensive knowledge of HIV/AIDS in 23 sub-Saharan African countries

Betregiorgis ZEGEYE, Felix Emeka ANYIAM, Bright Opoku AHINKORAH, Edward Kwabena AMEYAW, Eugene BUDU, Abdul Aziz SEIDU, Sanni YAYA*

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

8 Citations (Scopus)



Globally, Human Immunodeficiency Virus (HIV) that causes Acquired Immunodeficiency Syndrome (AIDS) remains a public health problem with a higher burden in sub-Saharan African countries. Though the coverage is low in sub-Saharan Africa (SSA), comprehensive knowledge about HIV is vital for preventing and controlling the transmission of the virus. Women’s decision-making power is significantly linked with the knowledge and use of healthcare services. However, there is no available evidence on women’s decision-making capacity and comprehensive knowledge of HIV. Therefore, this study investigated the association between women’s decision-making capacity within households and comprehensive knowledge of HIV/AIDS in SSA.


We derived data from the 2010 to 2020 Demographic and Health Surveys of 23 sub-Saharan African countries for the analysis. Using Stata version 14, both bivariate logistic regression and multivariate multilevel logistic regression analyses were used to examine the association between women’s decision-making capacity and comprehensive knowledge of HIV/AIDS at p ≤ 0.05. Results were reported using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI).


The pooled results show that comprehensive HIV/AIDS knowledge among married women in the studied countries was 35.5%, from 18.3% in Chad to 77.1% in Rwanda. Regarding sub-regional distribution, comprehensive knowledge of HIV/AIDS in Southern Africa was 73.2%, followed by East Africa (52.4%), West Africa (43.6%), and Central Africa (35.5%). The study showed higher odds of comprehensive knowledge of HIV/AIDS among married women who had decision making power (yes-aOR = 1.20, 95% CI; 1.16–1.25) compared to those who had no decision-making power. Age, women and partner’s level of education, place of residence, exposure to media, HIV testing status, community socio-economic status, parity, religion, and distance to health facilities also had significant association with comprehensive HIV/AIDS knowledge.


Comprehensive knowledge of HIV/AIDS in SSA is low but varies per country. Married women with decision-making capacity were more likely to have comprehensive knowledge of HIV compared to those with no decision-making capacity. Therefore, comprehensive knowledge of HIV/AIDS can be increased through enhancing women’s decision-making capacities, strengthening employment opportunities, socioeconomic capacities and creating awareness through media. Moreover, improving access to health care facilities working closely with religious leaders, can be considered to increase coverage of comprehensive knowledge of HIV among married women in SSA.

Original languageEnglish
Article number111
Number of pages16
JournalArchives of Public Health
Early online date6 Apr 2022
Publication statusPublished - 6 Apr 2022
Externally publishedYes

Bibliographical note

We acknowledge the Demographic and Health Surveys Program for making the DHS data available, and we thank the women who participated in the surveys.

© 2022. The Author(s).


  • DHS
  • Global health
  • Knowledge of HIV
  • Sub-Saharan Africa
  • Women’s decision-making


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