Pre-delivery anaemia and associated factors among women in Kikuube District, Uganda: a cross-sectional study

Anaemia in pregnancy is a global public health concern, especially in low and middle-income countries, where it is linked to adverse maternal and neonatal outcomes. Despite various antenatal care interventions to prevent anaemia in pregnancy, a considerable proportion of pregnant women still present with anaemia at delivery. This study aimed to determine the prevalence, severity, and factors associated with pre-delivery anaemia among women at Kyangwali Health Centre IV (KHCIV).

A health facility-based cross-sectional analytical study was conducted. A simple random sampling technique was used to select 422 pregnant mothers at ≥ 28 weeks of gestation admitted for delivery. Data on socio-demographic, medical, and obstetric characteristics were collected using an interviewer-administered semi-structured questionnaire and analyzed using STATA version 15. Anaemia was defined as a hemoglobin (Hb) level less than 11 g/dl. We performed a modified Poisson regression analysis to determine the factors associated with pre-delivery anaemia at a 95% confidence level and 5% statistical significance using multivariable analysis.

The overall prevalence of pre-delivery anaemia was 30.1% (95% CI, 29.90-30.27%). The prevalence of mild, moderate, and severe anaemia was 71.7%, 22.8%, and 5.5%, respectively. Attendance of more than four Antenatal Care (ANC) visits (APR = 0.42, 95% CI: 0.24-0.73, p = 0.003), malaria prevention with Fansidar (APR = 0.16, 95% CI: 0.04-0.54, p = 0.004), and prior use of contraceptives (APR = 0.50, 95% CI: 0.34-0.74, p < 0.001) were associated with a lower prevalence of pre-delivery anaemia. On the contrary, treatment for malaria during pregnancy was associated with a higher prevalence of pre-delivery anaemia (APR = 1.53, 95% CI: 1.08-2.46, p < 0.015).

Anaemia remains a significant maternal health burden. A third of the pregnant women admitted for delivery in Kyangwali HCIV had pre-delivery anaemia, albeit the majority had mild anaemia. The findings highlight the protective role of ANC attendance and use of antimalarial chemoprevention during pregnancy, and prior contraceptive use in reducing the risk of anaemia. However, a history of malaria treatment during pregnancy was associated with increased anaemia, suggestive of inadequate prevention, underscoring the need for additional malaria preventive strategies. Strengthening ANC services to ensure uptake of a comprehensive package of preventive interventions may help reduce the prevalence of pre-delivery anaemia.