www.idosr.

org Nabaasa
©IDOSR PUBLICATIONS
International Digital Organization for Scientific Research ISSN: 2579-0730
IDOSR JOURNAL OF BIOLOGY, CHEMISTRY AND PHARMACY 8(3)21-33, 2023.
https://doi.org/10.59298/IDOSR/JBCP/23/11.1113

Determinants Affecting the Utilization of Antenatal Care Services by

Women of Childbearing Age Visiting the Antenatal Care Clinic at
Kyabugimbi Health Centre IV, Bushenyi District

Nabaasa Brian

Faculty of Clinical Medicine and Dentistry Kampala International University Western

Campus Uganda

ABSTRACT
This research analyzed the utilization of antenatal care (ANC) services among pregnant
women at Kyabugimbi Health Centre IV in Bushenyi District, Uganda. The study found that
a significant percentage of women attended their first ANC visit late in their pregnancy,
with only 20% receiving ANC within the recommended 0-3 months. A majority of the
women had never heard about ANC or attended it in previous pregnancies. While 44% of the
women attended ANC four or more times, indicating awareness of the recommended ANC
frequency, 74% did not seek ANC at all. Most of the women with unplanned pregnancies did
not utilize ANC services. The study concluded that 51.9% of pregnant women experienced
delayed antenatal care, with 50.6% presenting between 4-6 months of gestation and 1.3%
presenting at 7-9 months. These findings highlight the need for improved awareness and
access to ANC services.
Keywords: Pregnant women; Antenatal Care; Mothers; Planned pregnancy; unplanned
pregnancy.

INTRODUCTION
Antenatal care (ANC) is the professional and vitamins). It also involves preparation
healthcare a pregnant woman receives for childbirth, including emergency
throughout her pregnancy, which helps readiness, access to bed nets, and
ensure the survival of pregnant women intermittent preventive therapy during
and newborn babies during pregnancy pregnancy [4–6].
and childbirth[1]. It refers to the care Prenatal care, also known as antenatal
given to an expectant mother from the care, is a type of preventive healthcare
confirmation of conception until the with the goal of providing regular check-
onset of labor. Antenatal care provides ups that allow doctors or midwives to
preventive and curative services during treat and prevent potential health
pregnancy, particularly during the first problems throughout the pregnancy while
visit [2, 3]. This includes essential promoting healthy lifestyles for both the
screening for health conditions such as mother and child [7, 8]. Globally,
HIV. For HIV-infected pregnant women, approximately 210 million women
the maximum benefit of antiretroviral become pregnant each year, but only 71%
therapy to prevent mother-to-child of them receive any ANC, resulting in 135
transmission (PMTCT) of HIV requires million live births. In Africa, about 30
early presentation to the health system, million women become pregnant each
screening for syphilis, diagnosis and year, with approximately 250,000
treatment of UTIs, tetanus toxoid maternal deaths related to pregnancy
administration, blood pressure checks, causes in sub-Saharan Africa in 2010 [9,
nutritional advice, and supplements (iron 10]. During that year, there were an

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estimated 162,000 maternal deaths, with maternal mortality had decreased by over
a maternal mortality rate (MMR) of 500 40% from 1990 levels, but maternal
per 100,000 live births. Receiving a mortality levels remain unacceptably high
sufficient number of timely ANC visits in sub-Saharan Africa (SSA)[20].
helps improve maternal health outcomes. Inadequate access to quality ANC
However, in sub-Saharan Africa, ANC contributes to these preventable maternal
utilization is low: 69% of pregnant women deaths. Approximately 303,000 women
have at least one ANC visit, 44% have at and adolescent girls died from pregnancy
least four ANC visits, and only 20% of and childbirth-related complications in
pregnant women receive ANC within 0-3 2015 [21]. In that same year, 2.6 million
months of pregnancy, which is low babies were stillborn. Almost all maternal
compared to other parts of the world [11, deaths (99%) and child deaths (98%)
12]. occurred in low- and middle-income
In Africa, there is the highest burden of countries. These maternal deaths could
maternal mortality in the world, with sub- have been prevented with access to
Saharan Africa responsible for quality antenatal care (ANC)[15]. Sixty
approximately 98% of maternal deaths in percent of stillbirths (1.46 million)
the region. The effects of antenatal care occurred during the antepartum period,
services on birth weight and the mainly due to untreated maternal
importance of model specification and infection, hypertension, and poor fetal
empirical procedures were used to growth [22]. Recent evidence suggests
estimate the marginal productivity of that the focused antenatal care (FANC)
health inputs [13, 14]. In 2016, the World model, developed in the 1990s, is
Health Organization (WHO) published associated with more perinatal deaths
Recommendations on Antenatal Care for a than ANC models comprising at least
Positive Pregnancy Experience, which eight contacts between the pregnant
outlines a new set of evidence-based woman or adolescent girl and the
global guidelines on recommended healthcare provider [15]. Furthermore, an
content and scheduling for antenatal care increase in perinatal mortality is more
[15]. These recommendations include likely due to an increase in stillbirths (The
eight contacts at specific times Cochrane Library, 2015). These findings
throughout the pregnancy, replacing the and other evidence informed the
term "visit" with "contact" to emphasize development of WHO's 2016 ANC
an active connection between a pregnant recommendations[15].
woman and a healthcare provider. This brief highlights the WHO's 2016 ANC
Additionally, ANC serves as the first recommendations and offers
contact with health facilities and is considerations for countries to adopt and
believed to increase the likelihood that implement these recommendations. The
mothers who attend more than one ANC recommendations include universal and
visit will give birth with the assistance of context-specific interventions, spanning
a skilled birth attendant [16]. ANC also five categories: routine antenatal
provides an opportunity for mothers to nutrition, maternal and fetal assessment,
receive information about HIV prevention preventive measures, interventions for
[17]. managing common physiological
Pregnancy and childbirth are significant symptoms in pregnancy, and health
events for women and their families, but system-level interventions to improve the
they also represent a period of heightened utilization and quality of ANC.
vulnerability for both women and their Researchers at the Overseas Development
unborn babies[18]. Each day, preventable Institute studied maternal health systems
causes related to pregnancy and in four apparently similar countries:
childbirth lead to the deaths of over 800 Rwanda, Malawi, Niger, and Uganda.
women, with 99% of these maternal Rwanda, in comparison to the other three
deaths occurring in low- and lower- countries, has a recent record of
middle-income countries[19]. By 2015, improving maternal death rates. Based on

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their investigation of these varying of utilization of ANC services in Bushenyi,
country case studies, they concluded that coupled with limited empirical data on
reviewing all maternal health-related factors influencing ANC utilization in
policies frequently to ensure internal Uganda as a whole, especially in rural
coherence, enforcing standards on areas. Therefore, this study intends to
providers of maternal health services, and investigate the socio-demographic
promoting local solutions to problems are factors, clinical factors, and the
key elements[13, 23]. proportion of pregnant women attending
Adequate ANC reduces the risk of mother- ANC at Kyabugimbi IV, which may
to-child transmission of HIV, anemia in influence utilization of the services
both mother and child and other negative among pregnant women in rural areas like
health outcomes [24-27]. However, there Bushenyi.
is no comprehensive study into the level
METHODOLOGY
Study designs Exclusion criteria
The research involved the use of a Women of reproductive age group do not
Descriptive Research Design where the consent.
instruments used to collect data were Sample Size Determination
Questionnaires (closed and structured) The sample size was determined using
and interviews (structured and focused). the formula; [28] for prevalence.
A quantitative data collection method was 𝑛=
(𝑧𝛼 +𝑧𝛽 )2 𝑥 𝑝(1−𝑝)
used. The interview was conducted in (𝑑)2
Runyankole and English languages that This formula is valid for a population ≥
are convenient. 10000
Area of Study Where;
The Research was conducted at n = Desired sample size
Kyabugimbi HC IV Igaara East HSD 𝑧𝛼 + 𝑧𝛽 =Z = Standard normal deviate at
Bushenyi district, about 9 km on 95% level of confidence; z= 1.96
Bushenyi-Buhweju Road, Southwestern P= already known prevalence from other
Uganda. The Health facility caters for studies (37% UBOS, 2007)
populations of the greater Bushenyi d = level of precision (in proportion of
Region, encompassing the districts of one, if 5% d=0.05)
Buhwenju, Sheema, Rubirizi and Mitooma Therefore, taking
and is a referral point for Health Centre Q=1-p,
IIs and IIIs in respective areas. The P=37/100=0.37,
services provided are General medical Q= 1-P (1-0.37),
care and some specialized clinics like Z=1.96, D=5% or 0.05
Antenatal care clinic and MCH, HIV/AIDs n=1.962*0.37*0.63
Care clinic, Dental clinics and surgical 0.052
services. It has a daily patient attendance n=0.89547696
population ranging from 400 to 800 0.0025
patients with a catchment population of Therefore; the sample size was
100,000. 358.190784mothers
Study population However, using the “Finite Population
The study population comprises of Correction for Proportions” formula
n1
women in the reproductive age group n= n1−1
1+[ ]
seeking antenatal care services at N

Kyabugimbi HC IV in Bushenyi District where N is the population size (for this

South Western Uganda. case 100 mothers attend ANC at KIU-TH
Inclusion Criteria per week) and n1 is the sample obtained
All women in the reproductive age group above;
attending ANC who consented. Sample size was; 358.190784
4.57190784
= 78.34602020324189

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Thus approximately; 80 mothers were collected. Quantitative data was
sampled. presented using frequency tables.
Sampling procedures Ethical Considerations
Consecutive Random sampling was used A research report was submitted and
where every individual in the inclusion approved, letter of introduction was
criteria has an equal chance of being part obtained from Dean School of Clinical
of the sample until the desired number is Medicine and Dentistry and endorsed by
achieved. IREC Kampala International University,
Data collection methods and Western Campus which was taken to the
management district health officer (DHO) and a copy to
The data collection involved a face-to-face the health facility In-charge and the in-
interview using a closed-structured charge of the Antenatal care clinic. The
Questionnaire. researcher obtained all the necessary
Data analysis permission from the health facility
Data analysis was conducted using SPSS administrators, other district authorities
(statistical package for social scientists). and other area authorities where the
Exploratory data techniques were used at research was carried out. But most
the initial stage of analysis and cover the importantly, the values and norms of the
structure of data and identify outliers or clients was studied well and respected to
unusual entered values. Quantitative data avoid any misconception. In addition,
was coded and processed using SPSS participants were asked for their consent
version 20. Descriptive statistics such as to participate in an interview and fill in a
frequencies was used to summarize, structured questionnaire.
organize and simplify the data that was
RESULTS
According to the study findings, the mothers were married and 19(24.4%)
majority, 35 (43.8%) of the mothers mothers had partners that are not
attained education up to primary level, 35 employed. Majority 59(76.6%) mothers
(43.8%) mothers attended up to secondary were Banyankole, 41(52.6%) mothers were
level, 7(8.8%) attended up to Post- catholic 26(32.5%) mothers were staying
secondary level, mostly 37(46.3%) in urban areas, while 53(67.5%) in Rural
mothers were housewives, and only areas.
4(5.0%) were civil servants. 65(81.3%)

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Table 1: Sociodemographic Characteristics of the Respondents of Pregnant Mothers

Attending ANC at Kyabugimbi HC IV, Bushenyi District
Variables Frequency Percentage
(n=80) (%)
Education level
Primary level 35 43.8
Secondary level 35 43.8
Post-secondary level 7 8.8
Never went to school 3 3.8
Occupation
Businesswoman 37 46.3
House wife 36 45.0
Peasant 3 3.8
Civil servant 4 5.0
Marital status
Single 12 15.0
Married 65 81.3
Widowed 1 1.3
Partner is employed
Yes 59 75.6
No 19 24.4
Tribe
Munyankole 62 79.5
Mukiga 4 5.1
Mutooro 2 2.6
Mukonjo 10 12.8
Religion
Catholic 41 52.6
Protestant 15 19.2
Pentecostal 12 15.4
Muslim 10 12.8
Area of residence
Urban 26 32.5
Rural 53 67.5

The proportion of women attending the 1st ANC with in the first Trimester among
pregnant women attending ANC clinic at Kyabugimbi HC IV

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ATTENDED 1ST ANC IN PREVIOUS PREGNANCY
Yes No

18.20%

81.80%

Figure 1: Proportion of women attending the 1st ANC with in the first Trimester
Table 2: Proportion of ANC visits among pregnant mothers at Kyabugimbi HC IV.
Variables Frequency Percentage
(n=80v cb uy6c c x) (%)
Ever heard about Antenatal Care before

Yes 65 84.4
No 10 13.0
Gestation age did you go for the 1st ANC visit
1-3 months 26 33.8
4-6 months 39 50.6
7-9 months 1 1.3
Number of previous pregnancies
1 21 27.3
2 15 19.5
3 6 7.8
4 4 5.2
Not applicable 31 40.3
The number of ANC attended
1 time 11 14.3
2-3 times 20 26.0
4 and more times 44 57.1

According to this study's findings, the pregnancies whereas 31(40.3%) mothers

majority 65(84.4%) of mothers had ever were prime-gravidas. More so, 44(57.1%)
heard about Antenatal Care, 66(81.2%) mothers attended ANC 4 times and more
mothers had attended 1st ANC, while times while 20(26.0%) mothers attended
14(18.2%) mothers generally never ANC 2-3 times and 11(14.3%) mothers
attended AN. Only 21(27.3%) mothers had attended one time. The majority of
attended ANC in one pregnancy, 15(19.5%) 44(57.1%) mothers were aware of the ANC
mothers had attended 1st ANC in two attendance recommendations.
pregnancies, 6(7.8%) mothers had
attended 1st ANC in three pregnancies and
4(5.2%) mothers had attended ANC in four

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The Socio-demographic factors to utilize the services, especially with
influencing the utilization of ANC employed partners48 (88.9%). However,
services among pregnant women all those 3(4.4%) who never went to school
attending the ANC clinic at Kyabugimbi had never utilized ANC as recommended
HC IV. and Being a housewife had a higher
According to the study findings, proportion 10(71.4%) of failing to utilize
education influenced good ANC ANC services whereas a similar and even
utilization with all those 7(13.0%) who worse trend was with rural residence
reached post-secondary efficiently 14(100.0%) never utilized ANC of the
utilizing the ANC services. Also, married 43(64.2%) from the rural area.
women were highly 46(85.2%) motivated

Table 3: Socio-demographic factors influencing utilization of ANC services among

pregnant women attending the ANC clinic at Kyabugimbi HC IV.
Variable Attended 1st ANC in a previous TOTAL
pregnancy N (%)
Yes [N (%)] No [N (%)]
Education level
Primary level 32(59.3%) 3(21.4%) 35(51.5%)
Secondary level 15(27.8%) 8(57.1%) 23(33.8%)
Post-secondary level 7(13.0%) 0(0.0%) 7(10.3%)
Never went to school 0(0.0%) 3(21.4%) 3(4.4%)
Occupation
Businesswoman 29(53.7%) 4(28.6%) 33(48.5%)
Housewife 18(33.3%) 10(71.4%) 28(41.2%)
Peasant 3(5.6%) 0(0.0%) 3(4.4%)
Civil servant 4(7.4%) 0(0.0%) 4(5.9%)
Marital status
Single 8(14.8%) 4(28.6%) 12(17.6%)
Married 46(85.2%) 10(71.4%) 56(82.4%)
Partner is employed
Yes 48(88.9%) 3(21.4%) 51(75.0%)
No 6(11.1%) 11(78.6%) 17(25.0%)
Area of residence
Urban 24(45.3%) 0(0.0%) 24(35.8%)
Rural 29(54.7%) 14(100.0%) 43(64.2%)

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The Obstetrical factors influencing utilization of ANC services among pregnant women
attending the ANC clinic at Kyabugimbi HC IV.

Attended 1st ANC in previous pregnancy

60.00%
50.00%
Percentage(%)

40.00%
30.00%
Yes
20.00%
No
10.00%
0.00%
Tetanus Toxoid Screening Health combination of
vaccine Services education the above
Services offered during the ANC Visit

Figure 2: Services during ANC services among pregnant women attending the ANC
clinic at Kyabugimbi HC IV.
According to the study findings, the OR=0.71(0.59-0.85), seeking 1st ANC
services at the clinic range from Tetanus services at <16 Weeks 21(30.9%) P-value=
toxoid vaccine, screening services health 0.031, OR= 7.65(1.00-62.92) and Services
education and a combination of many offered at the facility 30(56.6%) P-
other services. Of all these, health value=0.026, OR=1.23(1.06-1.44)
education and many other services were significantly affects utilization of ANC
reported to be lacking. However, it was services in Kyabugimbi HC IV. See Table
statistically found that; having planned a 4.
pregnancy 35(64.8%) P-Value= 0.009,

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Table 4: Obstetrical factors influencing utilization of ANC services among pregnant

women attending ANC clinic at Kyabugimbi HC IV
Variable Attended 1st ANC in TOTAL P- OR
previous pregnancy N (%) Value [95% C.I]
Yes [N (%)] No [N (%)]
Aware of recommended time for 1st ANC Visit
Yes 30(55.6%) 4(28.6%) 34(50.0%) 0.072 3.13(0.87-11.21)
No 24(44.4%) 10(71.4%) 34(50.0%) Ref. 1
Previous pregnancy Gestation age 1 st
ANC visit
<16 weeks 23(44.2%) 3(25.0%) 26(40.6%) 0.221 2.38(0.58-9.81)
≥16 16 weeks 29(55.8%) 9(75.0%) 38(59.4%) Ref. 1
Delivery place
Private health 20(37.7%) 3(21.4%) 23(34.3%) 0.253 2.22(0.55-8.94)
facility
Public health facility 33(62.3%) 11(78.6%) 44(65.7%) Ref. 1
Planned pregnancy
Yes 35(64.8%) 14(100.0%) 49(72.1%) 0.009 0.71(0.59-0.85)
No 19(35.2%) 0(0.0%) 19(27.9%) Ref. 1
Sought 1 ANC
st

<16 Weeks 20(37.0%) 1(7.1%) 21(30.9%) 0.031 7.65(1.00-62.92)

≥16 Weeks 34(63.0%) 13(92.9%) 47(69.1%) Ref. 1
Health facility is near home & easily accessed
Yes 38(71.7%) 7(50.0%) 45(67.2%) 0.124 2.53(0.76-8.46)
No 15(28.3%) 7(50.0%) 22(32.8%) Ref. 1
Services offered at the facility
Very poor 23(43.4%) 0(0.0%) 23(38.3%) 0.026 1.23(1.06-1.44)
Very good 30(56.6%) 7(100.0%) 37(61.7%) Ref. 1
*Statistically Significant, P-Value=<0.05 OR=Odds Ratios Ref=Reference category
DISCUSSION
The proportion of women attending the attended ANC in at least one
1st ANC with in the first Trimester pregnancy[29, 30]. However, this is still a
among pregnant women attending ANC low attendance compared to regions and a
clinic at Kyabugimbi HC IV low one in sub-Saharan Africa especially
According to this study findings, 84.4% in Congo. In Tanzania the antenatal visit
mothers had ever heard about Antenatal has gone up beyond 90% [31] to 98 %
Care and a bigger proportion 81.8% of TDHS-MIS, [31]. This could have been
them, had attended 1st ANC visit during because many were being told to come
pregnancy, while 18.2% mothers did not back later to initiate ANC after presenting
attend to ANC in their previous early and many were rural residents of
pregnancies. This complements previous low socio-economic status. Nonetheless,
studies in which the prevalence of for the mothers who attended ANC, 57.1%
antenatal visits varied among; attended more than 4 times while a
comparatively, 27.3% of mothers had considerable number still lags below at

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least 4 times yet currently 8 times (ANC housewife had a higher proportion
visits) are recommended. Similarly, only 10(71.4%) of failing to utilize ANC
55.6% who attended 1st ANC, 50.0% of services whereas a similar and even worse
mothers were aware of ANC trend was with rural residences where a
recommendations while the majorities considerable number never utilized ANC
were not thus majority of the mothers, of the 64.2% from the rural area.
50.6% attended ANC at a later time, and Obstetrical factors influencing
only 33.8% of mothers attended ANC as utilization of ANC services among
early as at 16 weeks or less. According to pregnant women attending ANC clinic at
TDHS-MIS [31], only 24% of pregnant Kyabugimbi HC IV
mothers reported to begin their ANC visit According to the study findings, the
during the first trimester as services at the clinic range from Tetanus
recommended [31]. toxoid vaccine, screening services, health
Socio-demographic factors influencing education and a combination of many
Utilization of ANC Services among other services. Of all these, health
Pregnant women attending the ANC education and many other services were
clinic at Kyabugimbi HC IV reported to be lacking. However, it was
According to the study findings, statistically found that; having planned a
education influenced good ANC pregnancy 35(64.8%) P-Value= 0.009,
utilization with all those 13.0% who OR=0.71(0.59-0.85), seeking 1st ANC
reached post-secondary efficiently services at <16 Weeks 21(30.9%) P-value=
utilizing the ANC services. Also, married 0.031, OR= 7.65(1.00-62.92) and Services
women were 85.2% motivated to utilize offered at the facility 30(56.6%) P-
the services, especially with employed value=0.026, OR=1.23(1.06-1.44)
partners 88.9%. However, all those 4.4% significantly affects utilization of ANC
who never went to school had never services in Kyabugimbi HC IV.
utilized ANC as recommended and being a
CONCLUSION
The research findings demonstrate a ANC attendance were identified as
significant prevalence of delayed significant determinants of ANC
antenatal care utilization among pregnant utilization. Notably, there is a need for
women in Kyabugimbi Health Centre IV. increased efforts to educate women about
While some women attended ANC the importance of early ANC visits and to
services, a considerable number did not provide better access to these services.
seek care until late in their pregnancies, Furthermore, addressing the issues of
which poses risks to maternal and child delayed care, especially among women
health. Factors such as knowledge about with unplanned pregnancies, is crucial for
ANC recommendations, pregnancy improving maternal and child health
planning, place of residence, and previous outcomes.
RECOMMENDATIONS
The recommendations aim to improve the Recommendations include disseminating
health and well-being of pregnant women recommended antenatal care guidelines,
in Bushenyi District by implementing promoting family planning services and
community-based interventions and education to reduce unplanned
health education programs to inform pregnancies associated with delayed ANC
pregnant women about the benefits of utilization. The quality of services offered
early antenatal care (ANC) visits and the at ANC clinics should be enhanced,
risks associated with delayed care. They including comprehensive care and
also suggest improving access to ANC addressing specific needs of pregnant
services by setting up outreach clinics or women. Further research on ANC
mobile clinics, particularly in rural areas. utilization and maternal health in the

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region is also recommended to identify evolving trends and challenges.
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CITE AS: Nabaasa Brian (2023). Determinants Affecting the Utilization of Antenatal
Care Services by Women of Childbearing Age Visiting the Antenatal Care Clinic at
Kyabugimbi Health Centre IV, Bushenyi District. IDOSR JOURNAL OF BIOLOGY,
CHEMISTRY AND PHARMACY 8 (3) 21-33.
https://doi.org/10.59298/IDOSR/JBCP/23/11.1113

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