Association between antenatal care utilization, preeclampsia, and neonatal Apgar scores among postnatal women in Eswatini: an analytical cross-sectional study

BACKGROUND: Preeclampsia is a hypertensive disorder that occurs during pregnancy significantly associated with maternal morbidity and mortality worldwide. It is associated with complications for both mothers and babies although 10 - 20% may be prevented through proper antenatal care (ANC) utilization. In Eswatini, despite high ANC coverage, there has been an increase in maternal and neonatal deaths with limited evidence of the associated factors. Therefore, this study examined the utilization of ANC services, prevalence, and factors associated with pre-eclampsia and low Apgar Score among Postnatal Women in Eswatini. METHOD: A hospital-based cross-sectional analytical study among 216 postnatal women was conducted in Eswatini between April and June 2024. Data were collected through face-to-face interviews using a validated questionnaire and by extracting data from hospital records. Multivariate logistic regression was used to determine the association between ANC service utilization, preeclampsia, Apgar score, and other factors (socio-demographic and obstetric characteristics). Results presenting a p-value < 0.05 were considered significant. RESULTS: The mean age of participants was 26.78 ± 6.7 years. All participants had attended ANC services, and over half, 20.4% (n = 44) of the women, booked early. Only about two percent (1.9%, n = 4) of postnatal women had greater than 8 ANC service utilization. Among all women, 19.0% (n = 41) were diagnosed with preeclampsia: 16.7% (n = 36) during ANC visits and 2.3% (n = 5) during postpartum care. Among neonates, 17.3% (n = 37) had a low Apgar score. The mean Apgar score among them was 8.4 ± 1.8. Adequate ANC frequency was associated with 42% lower odds of preeclampsia (AOR: 0.58, 95% CI: 0.76, 0.90) and 71% lower odds of low Apgar score (AOR: 0.29, 95% CI: 0.09, 0.55). Gestational age was another factor associated with lower odds of both pre-eclampsia and low Apgar score (AOR: 0.05, 95% CI: 0.02,0.15) and (AOR: 0.22, 95% CI: 0.08, 0.62), respectively. CONCLUSION: The study highlights that adequate utilization of ANC services reduces the odds of pre-eclampsia and low Apgar scores. The findings are consistent and confirm the previous studies, but provide the first nationally relevant estimates from Eswatini, offering important insights for improving ANC quality and reducing maternal and neonatal morbidity. We recommend a community intervention in Eswatini to create awareness about the importance of ANC utilization.