OBJECTIVES:: To determine magnitude and reasons of loss to programme and poor antiretroviral prophylaxis coverage in prevention of mother to child transmission (PMTCT) programmes in sub Saharan Africa. DESIGN:: Systematic review and meta analysis. METHODS:: We searched PubMed and Embase databases for PMTCT studies in sub Saharan Africa published between January 2002 and March 2012. Outcomes were the percentage of pregnant women (i) tested for HIV (ii) initiating antiretroviral prophylaxis (iii) having a CD4 cell count measured and (iv) initiating antiretroviral combination therapy (cART) if eligible. In children outcomes were (v) early infant diagnosis for HIV and (vi) cART initiation. We combined data using random effects meta analysis and identified predictors of uptake of interventions. RESULTS:: Forty four studies from 15 countries including 75172 HIV infected pregnant women were analyzed. HIV testing uptake at antenatal care services was 94 (95 confidence intervals [CI] 92 95) for opt out and 58 (95 CI 40 75) for opt in testing. Coverage with any antiretroviral prophylaxis was 70 (95 CI 64 76) and 62 (95 CI 50 73) of pregnant women eligible for cART received treatment. Sixty four percent (95 CI 48 81) of HIV exposed infants had early diagnosis performed and 55 (95 CI 36 74) were tested between 12 and 18 months. Uptake of PMTCT interventions was improved if cART was provided at the antenatal clinic and if the male partner was involved. CONCLUSIONS:: In sub Saharan Africa uptake of PMTCT interventions and early infant diagnosis is unsatisfactory. An integrated family centered approach seems to improve retention.