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Background: HIV/AIDS remains a major public health challenge, in Sub-Saharan Africa (SSA). In 2020, 16% of people living with HIV did not know their HIV status in SSA. Understanding the geospatial distribution of HIV infection, awareness status, and transmission knowledge is crucial for designing effective prevention and control strategies to end the HIV/AIDS pandemic by 2030. However, to the best of our literature searching the evidence of geospatial analysis and a machine learning algorithm, specifically a decision tree to decide on a Sustainability Development Goal (SDG), and to establish a clear pathway of HIV awareness status and HIV infection rates in each region of SSA is limited. Therefore, this study aims to determine HIV Infection, awareness status, and transmission knowledge among Adults in SSA using a machine learning approach and geospatial analysis., Methods: The study used demographic and health survey data from 2009 to 2019. Machine learning algorithms and geospatial analysis techniques were employed to determine HIV infection, awareness of HIV status, and HIV transmission knowledge., Results: The overall prevalence of HIV infection among adults in SSA from 2009 to 2019 is 4.96%. The machine learning algorithm (decision tree) indicates that infected individuals are unaware of their HIV infection, about half of them do not have HIV transmission knowledge, and more of them were found in Southern SSA. The spatial hotspots show that high HIV prevalence, low levels of HIV status awareness, and adequate transmission knowledge are specifically located in the Southern and some Eastern SSA., Conclusion: The machine learning algorithm (decision tree) revealed that the risk of HIV infection is high among individuals who are unaware of their HIV status and lack knowledge about HIV transmission in Southern and eastern parts of Sub-Saharan Africa. The spatial analysis revealed the high-risk areas of HIV infection with low HIV status awareness and HIV transmission knowledge were located in Southern and some Eastern SSA countries. Therefore public health strategies should focus on educating individuals about the importance of knowing their HIV status, transmission knowledge, and ensuring accessible testing options in these affected regions to address the observed spatial disparities in HIV infection, HIV status awareness, and HIV transmission knowledge to achieve the 2030 Sustainable Development Goal of ending the HIV/AIDS epidemic in Africa., Competing Interests: Declarations. Ethical approval: The utilized DHS data sets are publicly available, and the DHS program de-identifies all data before making them available to the public. The geospatial data (WorldPop) do not contain variables at the level of human subjects. Therefore, this work did not require ethical approval. Consent for publication: No consent to publish was needed for this study as we did not use any details, images, or videos related to individual participants. In addition, the data used are available in the public domain. Conflict of interest: The author declares no conflict of interest., (© 2024. The Author(s).)

Background: Antenatal care (ANC) is an important component of maternal and child health care. To reduce perinatal mortality and improve women's experience of care, the World Health Organization (WHO) recommends pregnant women should attend at least eight ANC visits. However, in Sub-Saharan Africa (SSA), the mean number of ANC visits among reproductive-age women using Demographic and Health Surveys (DHS) data following the new WHO recommendation is so far limited. Therefore, the study aimed to determine the mean number of ANC visits and its predictors among reproductive-age women in SSA., Method: Community-based cross-sectional study was conducted among 188,880 weighted reproductive-age women in SSA using a recent round of DHS data from 2017-2023. Zero-inflated negative binomial regression (ZINB) was conducted and statistical significance was declared at p-value <0.05 and adjusted incidence rate ratio(AIRR) for count model part and adjusted odds ratio for logit model inflated part of ZINBR with 95% confidence interval (CI) were reported., Result: The mean number of ANC visits among reproductive-age women in SSA was 4.08 with 95%CI [4.07, 4.09]. Among reproductive-age women who gave birth in the last five years before the survey, 7.3% had eight or more ANC visits during pregnancy. Age of women, maternal and husband educational status, types of pregnancy, birth order, household size, number of under-five children, and wealth index were associated with the numbers of ANC visits among reproductive-age women in Sub-Saharan., Conclusion: The mean number of ANC visits among reproductive-age women in SSA is too lower than the new WHO recommendation of ANC visits for a positive pregnancy experience. This study also highlights that the proportion of at least eight ANC visits is low and there are still disparities in the mean of ANC visits across different regions of SSA. The increasing maternal age, higher maternal and husband educational status, wanted pregnancy, the number of household members, the number of under-five children, and higher wealth index increase the number of ANC visits. Unwanted pregnancy, no more fertility desire, and rural residences were contributed for zero ANC visits in SSA. Therefore, efforts should be geared towards improving maternal and husband's educational status. We strongly recommend that the governments of SSA countries should empower women economically and educationally to achieve the goals of ANC as recommended by the WHO., Competing Interests: The authors declare that they have no competing interests., (Copyright: © 2024 Endawkie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)