Date of Award


Degree Type


Degree Name

Master of Public Health (MPH)


Public Health

First Advisor

Dr. Richard Rothenberg

Second Advisor

Dr. Betty Lai

Third Advisor

Dr. Ike Okosun


Introduction: The use of antenatal care (ANC) services with programs for prevention of mother-to-child transmission (PMTCT) of HIV is vital in reducing maternal and infant mortality as well as reducing the rate of neonatal HIV infections. The objectives of this study were 1) to determine the knowledge that women have about HIV/AIDS as well as mother-to-child transmission (MTCT) of HIV, and 2) to identify factors that were associated with ANC attendance, timing of first ANC visit, HIV testing as part of an ANC visit, and place of delivery among women living in Cote D’Ivoire, a high HIV prevalent country in West Africa.

Methods: The 2011-2012 Demographic Health Surveys (DHS) for Cote D’Ivoire was used, with a focus on women who had a parity of at least 1 and/or are currently pregnant. The outcomes of interest were ANC attendance, timing of first ANC visit, being tested for HIV as part of ANC visit, and the place of delivery. The independent variables included age, education, marital status, wealth, type of residency, general knowledge of HIV/AIDS (transmission and prevention), attitudes towards people living with HIV/AIDS, general knowledge of mother-to-child transmission (MTCT) routes, and HIV pre-counseling during ANC visits. Chi-Square tests, univariate and multivariate logistic regression were conducted.

Results: There were a total of 7729 women who met the inclusion criteria, in which 4902 (90.9%) of them had at least one ANC visit, and 2340 (43.4%) had more than three ANC visits. More than half of the respondents went for their first ANC visit in their second trimester compared to 31.2% who went in their first trimester. Type of residence, wealth, attitudes towards people living with HIV/AIDS were associated with at least three of the outcomes. Women who did not receive counselling about testing for HIV during an ANC visit were more likely to not be tested for HIV (OR=24.65, 20.60 – 29.48; AOR= 22.21, 95% CI=16.82 – 29.31) compared to women who did receive counselling. Women less than 18 years were less likely to delivery in a health facility (OR= 1.76, 95% CI= 1.15 – 2.70) compared to women between the age of 25-29.

Conclusion: Even though approximately 91.0 % of the women in the study had at least one ANC visit, less than half of them met the World Health Organization (WHO) guidelines to have at least four ANC visits. The study shows that HIV pre-counseling is an effective intervention in engaging pregnant women in PMTCT programs. However, interventions need to take in consideration people living in rural areas as well as people with low income.