Spatial variation and predictors of composite index of HIV/AIDS knowledge, attitude and behaviours among Ethiopian women: A spatial and multilevel analyses of the 2016 Demographic Health Survey
Authors: Habte Aklilu , Bizuayehu Habtamu Mellie , Haile Yosef , Mamo Daniel Niguse , Asgedom Yordanos Sisay 
Published: June 2024

Background
Although the dissemination of health information is one of the pillars of HIV prevention efforts in Ethiopia, a large segment of women in the country still lack adequate HIV/AIDS knowledge, attitude, and behaviours. Despite many studies being conducted in Ethiopia, they mostly focus on the level of women’s knowledge about HIV/AIDS, failing to examine composite index of knowledge, attitude, and behaviour (KAB) domains comprehensively. In addition, the previous studies overlooked individual and community-level, and spatial predictors. Hence, this study aimed to estimate the prevalence, geographical variation (Hotspots), spatial predictors, and multilevel correlates of inadequate HIV/AIDS-Knowledge, Attitude, and Behaviour (HIV/AIDS-KAB) among Ethiopian women.

Methods
The study conducted using the 2016 Ethiopian Demographic and Health Survey data, included 12,672 women of reproductive age group (15–49 years). A stratified, two-stage cluster sampling technique was used; a random selection of enumeration areas (clusters) followed by selecting households per cluster. Composite index of HIV/AIDS-KAB was assessed using 11 items encompassing HIV/AIDS prevention, transmission, and misconceptions. Spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran’s I) was used to determine the non-randomness of the spatial variation in inadequate knowledge about HIV/AIDS. Multilevel multivariable logistic regression was performed, with the measure of association reported using adjusted odds ratio (AOR) with its corresponding 95% CI.

Results
The prevalence of inadequate HIV/AIDS-KAB among Ethiopian women was 48.9% (95% CI: 48.1, 49.8), with significant spatial variations across regions (global Moran’s I = 0.64, p<0.001). Ten most likely significant SaTScan clusters were identified with a high proportion of women with inadequate KAB. Somali and most parts of Afar regions were identified as hot spots for women with inadequate HIV/AIDS-KAB. Higher odds of inadequate HIV/AIDS-KAB was observed among women living in the poorest wealth quintile (AOR = 1.63; 95% CI: 1.21, 2.18), rural residents (AOR = 1.62; 95% CI: 1.18, 2.22), having no formal education (AOR = 2.66; 95% CI: 2.04, 3.48), non-autonomous (AOR = 1.71; 95% CI: (1.43, 2.28), never listen to radio (AOR = 1.56; 95% CI: (1.02, 2.39), never watched television (AOR = 1.50; 95% CI: 1.17, 1.92), not having a mobile phone (AOR = 1.45; 95% CI: 1.27, 1.88), and not visiting health facilities (AOR = 1.46; 95% CI: 1.28, 1.72).

Conclusion
The level of inadequate HIV/AIDS-KAB in Ethiopia was high, with significant spatial variation across regions, and Somali, and Afar regions contributed much to this high prevalence. Thus, the government should work on integrating HIV/AIDS education and prevention efforts with existing reproductive health services, regular monitoring and evaluation, and collaboration and partnership to tackle this gap. Stakeholders in the health sector should strengthen their efforts to provide tailored health education, and information campaigns with an emphasis on women who lack formal education, live in rural areas, and poorest wealth quintile should be key measures to enhancing knowledge. enhanced effort is needed to increase women’s autonomy to empower women to access HIV/AIDS information. The media agencies could prioritise the dissemination of culturally sensitive HIV/AIDS information to women of reproductive age. The identified hot spots with relatively poor knowledge of HIV/AIDS should be targeted during resource allocation and interventions.