Anemia is a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which varies by age, sex, altitude, smoking, and pregnancy status [1]. Anemia is a global public health problem affecting both developing and developed countries with major consequences for human health as well as socio-economic development. It occurs at all stages of the life cycle but is more prevalent in pregnant women and young children [2]. In developing countries, the cause of anemia during pregnancy is multifactorial and includes nutritional deficiencies of iron, folate, and vitamin B₁₂ and parasitic diseases, such as malaria and hookworm. The relative contribution of each of these factors to anemia during pregnancy varies greatly by geographical location, season, and dietary practice [3]. During pregnancy, anemia is a major cause of morbidity and mortality of pregnant women in developing countries and has both maternal and fetal consequences [4–9]. It may also lead to premature births [10], low birth weight [11], fetal cognitive impairment, and death [12, 13]. According to the report of World Health Organization (WHO), the prevalence of anemia among pregnant women is 41.8%. The highest prevalence rate (61.3%) is found among pregnant women in Africa [14]. According to the Ethiopian Demographic Health Survey (EDHS) report, 17% women are estimated to be anemic and 22% of the pregnant women are anemic [15]. Because of different Socio-economic status, behavioral, geographical and methodological difference (design and methods) the national figure of EDHS could not represent the prevalence of anemia among pregnant women found in different part of Ethiopia. Thus, disclosing the burden and associated factor of anemia among pregnant women in the study area will help to develop evidence-based decision and intervention strategies to improve the health status of pregnant women. Furthermore, it will contribute to discount predisposing factors of anemia. Therefore, this study is aimed to determine the burden of anemia and associated risk factors among pregnant women attending Antenatal Care Clinic (ANC) follow up at Butajira General Hospital, Southern Ethiopia.

Anemia is a worldwide problem affecting all physiologic group. Pregnant women and children are the most vulnerable group for anemia. In the current study, the overall burden of anemia among pregnant women was 27.6%. The burden of anemia in the current study is in harmony with the study conducted by Ethiopian DHS 2005 (27.4%) and a cross-sectional study carried out in Southeast Ethiopia (27.9%) [18, 19]. However, our finding is slightly higher as compared to the finding from central Ethiopia, Addis Ababa (21.3%) [20], and from Northwest Ethiopia (21.6%) [21]. The burden of anemia in the current study is considerably lower than previous study reports from West Arsi Zone, Eastern part of Ethiopia (36.6%) [22], and Jimma Zone, Southwest part of Ethiopia (38.2-53.9%) [1, 23]. Such magnitude differences are due to geographical, economical, seasonal, dietary and behavioral variations [3, 20]. The presences and absences of malaria and intestinal parasitic infection are also among the contributing factors affecting the magnitude of anemia [24]. From multivariable logistic regression analysis, a significant association was found between anemia and residence, history of excess menstrual bleeding, ANC follow up, and interpregnancy interval. Anaemia among pregnant women who live in an urban setting is 0.167 times as likely as anemia among pregnant women who live rural setting. Association of rural residence with the occurrence of anemia has also been reported earlier [1, 19, 23]. The reason for a higher burden of anemia among pregnant women from rural areas may be related to inaccessibility of health care centers. Thus, they lack information on factors causing anemia and possible strategies to prevent the risk factors of anemia. Pregnant women with a history of heavy or excess menstrual cycle were more anemic than those with normal menstruation cycle [19, 23]. In the present finding, the odds of anemia among pregnant women with the normal menstrual cycle is 0.028 times the odds of anemia among pregnant women who had heavy or excess menstrual cycle. History of excessive bleeding can lead to anemia. The anemia may make her feel weak and tired, and she may also experience shortness of breath, rapid heart rate, and lightheadedness. The odds of anemia among pregnant women who had ANC follow up were 0.918 times less likely than anemia among pregnant women who didn’t have ANC follow up. This result is inconsistent with the study conducted in Addis Ababa [20]. Pregnant women who attend ANC follow up were supported by health professionals to prevent anemia. Antenatal care counseling helps in motivating pregnant women to take iron rich food and iron-folic acid tablets. The present study has shown a statistically significant association between interpregnancy interval and anemia. The odds of anemia among pregnant women who had a birth interval of greater than or equal to 2 years were 0.867 times lower than the odds of anemia among pregnant women who had less than 2 years’ birth interval. Appropriate time after each pregnancy for recovery and replenishment of nutrient stores requires 2–5 years. Pregnancy with a short birth interval leads to iron deficiency anemia as iron requirements are substantially higher than the average [25]. Similar finding has also been documented in the studies conducted at Addis Ababa [20], Jimma Hospital [23], and Nigeria [26]. In this particular study, malaria and intestinal parasitic infection, parity, trimester, age, educational status, occupation and income did not show significant association with anemia among pregnant women but found to be significant by other studies [14, 19–22, 27].

Because of the limited fund we had, a number of potential confounding factors such as vitamin B₁₂ and/or folate levels, hemoglobinopathies, HIV/AIDS infection, and food frequency, along with a C-reactive protein test for inflammation, were not measured.

The prevalence of anemia among pregnant women in this study was 27.6%. Living in a rural residence, having a history of excess bleeding during the menstrual cycle, ANC follow up and interpregnancy interval were identified as predictors of anemia among the study participants. Therefore, working in the identified gaps could reduce the current burden of anemia among pregnant women in the study area.