Do dietary habits and iron-folic acid intake make a difference? Factors associated with anemia in pregnancy: a multi-center cross-sectional study

Abstract

Background: Anemia in pregnancy impacts the well-being of the women and the conception. Anemia is associated with increased risks of maternal mortality. In Ethiopia, three in ten pregnant women were affected by either mild, moderate, or severe anemia. The recent evidence was limited in the study locations of southern Ethiopia and needs to be updated. No report of anemia as relation to dietary factors observed in the region. This study therefore aimed to assess factors associated with anemia in pregnancy in the region.

Methods: A multicenter, cross-sectional study was conducted from January 2 to 30, 2025, in five selected public health facilities in Arba Minch district, South Ethiopia.

Results: A total of 476 (96%) respondents had participated in the survey. Explanatory variables were modeled in logistic regression to test for statistical associations at a P value of <0.05. The study participants were in the age range of 18 to 40 years. Of the respondents who completed the survey, 103 (21.6%, 95%CI 18.2-25.6%) were diagnosed as anemic. Participants who received iron-folic acid during the current pregnancy were 66% less likely to be anemic, AOR (95% CI), 0.34 (0.19, 0.61). Participants with high education status, sleeping under insecticide-treated bed nets (ITN), not being infected with malaria in the current pregnancy, and age category between 20-29 years were less likely to experience anemia in pregnancy. Evidence was limited to support association of women dietary diversity score (WDDS) and anemia in pregnancy, AOR (95%CI), 0.83 (0.49, 1.40).

Conclusions and recommendations: Anemia prevalence was a moderate public health problem in the study area. Healthcare workers should encourage antenatal women to receive iron and sleep under insecticide-treated bed nets (ITN) for anemia protection during pregnancy.

Keywords: anemia; iron folic acid; pregnancy; risk factors; south Ethiopia.

Figure 1

The participant recruitment and selection flowchart. N, total population of antenatal women in a month; n, sample population; HC, health center; AMGH, arbaminch general hospital; DFH, dil fana primary hospital; PSU, primary sampling unit; SSU, secondary sampling unit.

Figure 2

Percentage of the women who consumed foods in the last 24 h before the day of the survey vs. anemia status, Arba Minch district, South Ethiopia, January 2025.