Factors associated with the utilization of antenatal care services among pregnant women in Eswatini - A cross-sectional study

Zama Mkhonta, Yu-Ying Lu, Shu-Chen Kuo, Chieh-Yu Liu


The study aimed to assess the utilization of antenatal care services and its associated factors among pregnant women in Eswatini. A cross-sectional study was adopted. Convenience sampling was conducted in a public referral hospital in central Eswatini from 1 st of August to the 30 of September 2021. A total of 400 newly delivered women who met the inclusion criteria were recruited. SPSS version 22.0 was used to analyze data including descriptive and bivariate analysis. Results indicated that only 13% of pregnant women booked their first ANC in the first trimester and 24.8% of them attended less than four ANC visits. Maternal education, gestational age, gravity, pregnant-related complications, medical history, and maternal health literacy were significantly associated with the utilization of ANC services (p< .05). To increase the utilization of ANC service, healthcare professionals should pay special attention to pregnant women with tertiary education, gave birth below 38 weeks, multi-gravities, medical history, and poor maternal health literacy. (Afr J Reprod Health 2022; 26[12]: 67-77).

Full Text:



Mamba N and Tagutanazvo OB. First-time mothers'

experiences of the first stage of labour in hospitals in

the HhoHho region, Eswatini. Afr J Midwifery

Womens Health 2021; 15(1): 1-8.

Taheri S, Tavousi M, Momenimovahed Z, DirekvandMoghadam A, Tiznobaik A, Suhrabi Z and

Taghizadeh Z. Development and psychometric

properties of maternal health literacy inventory in

pregnancy. PloS One 2020; 15(6): e0234305.

Eswatini Ministry of Health (2017). Sexual and

Reproductive Health (SRH) Program Annual Report.

USAID, Mbabane, Eswatini. Retrieved from


Eswatini Ministry of Health (2018). The Kingdom of

Eswatini Antenatal Care Guidelines. Mbabane,


WHO (2016). WHO recommendations on antenatal care for

a positive pregnancy experience. Retrieved from



Benova L, Owolabi O, Radovich E, Wong KLM, Macleod

D, Langlois EV and Campbell OMR. Provision of

postpartum care to women giving birth in health

facilities in sub-Saharan Africa: A cross-sectional

study using demographic and health survey data from

countries. PLoS Med 2019; 16(10): e1002943.

Lael-Monfared E, Tehrani H, Moghaddam ZE, Ferns GA,

Tatari M and Jafari A. Health literacy, knowledge

and self-care behaviors to take care of diabetic foot

in low-income individuals: Application of extended

parallel process model. Diabetes Metab Syndr 2019;

(2): 1535-1541.

Phommachanh S, Essink DR, Wright PE, Broerse J and

Mayxay M. Maternal health literacy on mother and

child health care: A community cluster survey in two

southern provinces in Laos. PloS One 2021; 16(3):


Ani PN, Ibeanu V, Umeakuka CC and Umeakuka OP.

Maternal literacy and anthropometric indices of

under-five children in a Unviersty Town south east,

Nigeria. Indian J Nutr Diet 2018; 39: 114-121.

Neter E and Brainin E. Association between health literacy,

e health literacy, and health outcomes among patients

with long-term conditions. Eur Psychol 2019; 24: 68-

Olander EK, Smith DM and Darwin Z. Health behaviour

and pregnancy: a time for change. J Reprod Infant

Psychol 2018; 36(1): 1-3.

Eswatini Nazarene Health Institution. (2019). The Eswatini

Nazarene Health Institution Annual Report.

Retrieved from https://enhicare.com.cutestat.com/

Taheri S, Tavousi M, Momenimovahed Z, DirekvandMoghadam A, Rezaei N, Sharifi N and Taghizadeh

Z. Determining health literacy level and its related

factors among pregnant women referred to medical

and health centers of Tehran in 2019: A crosssectional study. Shiraz E-Med J 2021; 22(10):


Abubakari A, Agbozo F and Abiiro GA. Factors associated

with optimal antenatal care use in Northern region,

Ghana. Women Health 2018; 58(8): 942-954.

Simelane L. (2020). Pregnant women’s perceptions and

understanding of the barriers to early antenatal care

booking in the Shiselweni region in Swaziland.

Bellville, Republic of South Africa: Master’s thesis,

University of the Western Cape. Retrieved from


Gulema H and Berhane Y. Timing of first antenatal care

visit and its associated factors among pregnant

women attending public health facilities in Addis

Ababa, Ethiopia. Ethiop J Health Sci 2017; 27(2):


Islam MM and Masud MS. Determinants of frequency and

contents of antenatal care visits in Bangladesh:

Assessing the extent of compliance with the WHO

recommendations. PloS One 2018; 13(9): e0204752.

Ebonwu J, Mumbauer A, Uys M, Wainberg ML and

Medina-Marino A. Determinants of late antenatal

care presentation in rural and peri-urban

communities in South Africa: A cross-sectional

study. PloS One 2018; 13(3): e0191903.

Dlamini LP, Shongwe MC, Simelane MS, Chemhaka GB

and Magagula FN. Factors associated with poor

maternal health care services utilization in Eswatini:

A secondary analysis of a nationally representative

household survey. Midwifery 2022; 106: 103250.

Wilunda C, Scanagatta C, Putoto G, Montalbetti F,

Segafredo G, Takahashi R, Mizerero SA and Betrán

AP. Barriers to utilisation of antenatal care services

in South Sudan: a qualitative study in Rumbek North

County. Reprod Health 2017; 14 (65): 1-10.

Tufa G, Tsegaye R and Seyoum D. Factors Associated with

Timely Antenatal Care Booking Among Pregnant

Women in Remote Area of Bule Hora District, Southern Ethiopia. Int J Womens Health 2020; 12:


Umar AS. The use of maternal health services in Nigeria:

does ethnicity and religious beliefs matter? MOJ

Public Health 2017; 6(6): 442-447.

Vikram K and Vanneman R. Maternal education and the

multidimensionality of child health outcomes in

India. J Biosoc Sci 2020; 52(1): 57-77.

Worku AG, Yalew AW and Afework MF. Factors affecting

utilization of skilled maternal care in Northwest

Ethiopia: a multilevel analysis. BMC Int Health Hum

Rights 2013; 13: 20.

Benova L, Tunçalp Ö, Moran AC and Campbell OMR. Not

just a number: examining coverage and content of

antenatal care in low-income and middle-income

countries. BMJ Glob Health 2018; 3: e000779.

Exavery A, Kanté AM, Njozi M, Tani K, Doctor HV,

Hingora A and Phillips JF. Predictors of mistimed,

and unwanted pregnancies among women of

childbearing age in Rufiji, Kilombero, and Ulanga

districts of Tanzania. Reprod Health 2014; 11: 63.

Njiku F, Wella H, Sariah A and Protas J. Prevalence and

factors associated with late antenatal care visit

among pregnant women in Lushoto, Tanzania.

Tanzan J Health Res 2017; 19(3): 1-6.

Dodzo RC, Ogunsakin RE and Ginindza TG. Prevalence

and associated risk factors for anaemia amongst

pregnant women attending three antenatal clinics in

Eswatini. Afr J Prim Health Care Fam Med 2022;

(1): e1-e9.

Kpienbaareh D, Kofinti RE, Konkor I, Amoak D, Kansanga

MM and Luginaah I. Knowledge of pregnancy

complications and utilization of antenatal care

services in Rwanda. Int J Health Plann Manage 2022;

(3): 1680-1693.

McKinn S, Linh DT, Foster K and McCaffery K.

Distributed health literacy in the maternal health

context in Vietnam. Health Lit Res Pract 2019; 3(1):


Milkowska-Shibata MA, Aye TT, Yi SM, Oo KT, Khaing

K, Than M, Win T, Myo SY, Toe SY, West HS,

Ringstad KM, Galarza L, Meng C and Shibata T.

Understanding barriers and facilitators of maternal

health care utilization in central Myanmar. Int J

Environ Res 2020; 17(5): 1464.

Chorongo D, Okinda FM, Kariuki EJ, Mulewa E, Ibinda F,

Muhula S, Kimathi G and Muga R. Factors

influencing the utilization of focused antenatal care

services in Malindi and Magarini sub-counties of

Kilifi county, Kenya. Pan Afr Med J 2016; 25(Suppl

: 14


  • There are currently no refbacks.