Prevalence and factors associated with anemia among pregnant women in Nakfa district, Eritrea: A cross-sectional study

Prevalence and factors associated with anemia among pregnant women in Nakfa district, Eritrea: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and factors associated with anemia among pregnant women in Nakfa district, Eritrea: A cross-sectional study Meron Tesfay Kahsay, Oliver Okotch Achila, Huruy Tesfahiwet, Hermon Haile Alem, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8599815/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: Anemia in pregnancy is a fairly common public health problem with major implications for fetal and maternal health. Despite its importance, data on pregnancy-related anemia is hard to obtain for countries in Sub-Saharan Africa. In this study, we aimed to determine the prevalence of anemia and associated risk factors in women attending Antenatal clinic of Nakfa hospital, Nakfa sub-zone, Eritrea. Methods: Hospital based cross-sectional study was conducted from 1 st May – 31 st August of 2024. In total, 283 women, visiting Nakfa hospital Antenatal Care clinic, were enrolled. Relevant metadata was collected via researcher administered questionnaire and medical records. In addition, standard phlebotomy techniques were employed to collect specimen for diagnosis of anemia. To identify and categorize anemia, the WHO criteria was employed. Data were analyzed using SPSS software version 26. Result: The median age of the participants was 25 years [IQR: 22-28 years] with minimum and maximum age of 18 and 42 years, respectively. The overall, prevalence of anemia was 43% (95% CI: 38.9 – 48.7) with a mean hemoglobin concentration of 11.09 gm/dl (±1.64 SD). Among patients with anemia, 25% had moderate anemia and 17.6% had mild anemia. Factors associated with anemia in the bivariate analysis included level of education of mother and husband, mode of transport; and trimester. Protective factors included consumption of meat, poultry or diary; dark green vegetables; and fresh fruits. However, anemia was higher among the participants who took Iron-Folate than those who did not take (63% Vs 10%, p<0.01 ). In the multivariate analysis age was negatively associated with anemia (AOR=0.9, 95% CI: 0.8-0.9, p=0.03 ). Those who traveled by animal carrier or car (AOR=2.3, 95% CI:1.2-4.7, p=0.01 ), women in third trimester (AOR=2.7, CI:1.5-5.1, p=0.001 ), those who did not consume dark green vegetable (AOR=2.1, 95% CI:1.1-4, p=0.002 ) and participants with more than four children (AOR=3, CI:1.01-9.2, p= 0.048 ) had higher rate of anemia. Conclusion: This study demonstrated that the prevalence of anemia is high among pregnant women attending Nakfa hospital’s ANC clinic. The findings underscore the urgent need for improved ANC monitoring along with relevant public health strategies directed at addressing the problem. In addition, expanded research on anemia etiology is warranted. prevalence Anemia pregnancy Eritrea Nakfa predictors Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Pregnancy is a physiological condition characterized by a multiplicity of adoptive changes in response to the presence of then growing fetus [ 1 ]. One of the most consequential changes includes differential increase in plasma volume and red cell mass. These changes, lead, ultimately to reduction in hematocrit (HCT), particularly in the 2nd trimester [ 1 , 2 ]. Related to these changes is an increase in the likelihood of anemia – defined by the World Health Organization (WHO) as a hemoglobin concentration < 11g/dL; in pregnant women [ 3 ]. The high likelihood of anemia among pregnant women is reflected in real world data. For example, a recent WHO report noted that the prevalence of anemia in non-pregnant women was 29.6% whereas the prevalence in pregnant women was 36.5% [ 4 ]. Others have noted that the prevalence of anemia is higher in developing countries – 18% vs 56% in developed countries [ 5 , 6 ]. Anemia during pregnancy is of great concern because it contributes significantly to increased risk of maternal death during the prenatal period. It increases the risk of postpartum hemorrhage, pregnancy-induced hypertension, placenta Previa, hemorrhage and cardiac failure [ 7 ]. In Africa where the prevalence of anemia among pregnant women is disproportionately high; adverse health outcomes for both mother and infant like maternal mortality, perinatal mortality, growth restriction and low birth weight have been reported [ 8 ]. Annually, approximately 510,000 maternal deaths occur due to complications related to pregnancy and childbirth, with nearly 20% of these deaths occurring in developing countries, often attributable to anemia [ 9 ]. To mitigate the impact of pregnancy - related anemia in developing countries; the WHO recommends day-to-day supplementation of 30–60 mg/d elemental iron (+ 400µg) and folic acid to reduce its public health impacts [ 10 ]. In terms of etiology, reports indicate that pregnancy – related anemia is associated with a multiplicity of factors including iron deficiency (resulting from prolonged negative iron balance) [ 11 ]; gestational age (more prevalence in the 3rd trimester) [ 12 , 13 ]; not taking iron-folate supplementation; and a diet that is not diverse [ 13 ]. Other reports have linked it to increased nutritional demand and unmet need for micronutrients; intestinal helminthic infections, malaria, and chronic illnesses, among others [ 14 ]. In part, these constellation of factors explain of disproportionate burden of pregnancy-related anemia in developing countries where underprivileged citizens often have poor socioeconomic status, excess parity, inadequate spacing, poor alimentation, and high rate of infectious diseases. Moreover, they have poor access to medical care and preventive measures – factors which augment the risk of developing anemia [ 15 ]. Despite its importance, data on pregnancy-related anemia is hard to obtain for countries in Sub-Saharan Africa. In Eritrea, for instance, a population survey conducted in 2010, reported a prevalence of 23.8% [ 16 ]. In the interim, no studies were undertaken – an outcome which has left a significant gap in our knowledge on the prevalence of anemia among pregnant women in the country. Additional concerns with the now dated study were the fact that factors associated with anemia were not explored. At the same time, disaggregation of data with respect to the various sub-regions within the country was not undertaken. In this study, we aimed to determine the prevalence and factors associated with anemia among pregnant women in Nakfa district, Eritrea. Methodology Study design and setting Hospital based cross-sectional study was done in Nakfa hospital from May 1 up to July 31 of 2024. Nakfa is found 225km from the capital Asmara and it is located in latitude and longitude of 16 .66 o and 38.4 o respectively, in an elevation of about 1700 meters (5,577feet) above sea level. The subzone has 11 administration regions and in 2024 the estimated population was 54,684 in Nakfa sub-zone and 26,593 in Nakfa town. Most of the people are farmers with nomadic and seminomadic life style; the rough topography of the region is the main reason of the poor transportation system there. The sub- zone has three health stations and one hospital (only the hospital has laboratory service). The hospital provides outpatient and inpatient service with: adult ward, pediatric ward, MHC ward (Maternal Health Care) and one OR (operation room) for cesarean section. It also serves as a referral hospital for the sub-zone and other nearby subzones (Adobha and karora subzones). According data from the hospital, first ANC visit rate was 104.6% in 2024 with total visit of 1122 women. Sample size determination Our source population was all pregnant mothers in Nakfa sub-zone. The sample size\(\:\:\)was estimated using the Cochran formula. Where: N = Sample size, Z = The z-score that corresponds with 95% confidence interval (1.96), P = According to the Eritrean population and health survey, prevalence of anemia in pregnancy was 23.8% [16], therefore, we considered p as 0.23, e = margin of error was taken as 5%. We calculated the minimum sample size of 278 women. Study Population, inclusion and exclusion criteria All pregnant women who visited the facility within the stated period (May 1 up to July 31 of 2024) were enrolled in the study. 305 participants were recruited, however, 9 (2.9%) and 13(4.2%) were excluded due to lack of co-operation and absence of critical data respectively. Ultimately, 283 participants were included in the study(fig-1). Inclusion criteria Pregnant women, 18 and above years old, who come to the ANC clinic of Nakfa hospital at the time of data collection, with no clinical emergency and consented to participate was eligible for the study. Exclusion criteria Pregnant mothers younger than 18 years, severely ill, mentally disabled, who had history of blood transfusion in the past one month and those who failed to consent were excluded. Data collection tools and procedures The questionnaire was developed based on the key indicators of the study and some variables that have been identified in earlier studies across developing countries [17, 18, 19]. The developed questionnaire was with 29 questions partitioned in to socio-demographic characteristics, obstetric history, medical history and nutritional history. It was originally prepared in English then it was translated in to Tigre (local language) and back translated in to English to ensure its’ consistency. Validation Two weeks before data collection, pre-testing was done on 20 ANC attendants with similar characteristics as the actual participants. The questionnaire was then assessed robustly and modified accordingly. Variable definition Outcome variable The dependent variable is hemoglobin value of mothers at the time of data collection. Anemia is defined as hemoglobin level of less than 11 g/dl: it is further categorized into mild, moderate, and severe anemia with a hemoglobin range of 10 − 10.9 g/dl, 7–9.9 g/dl, and < 7 g/dl, respectively [12]. Dependent Variables Socio-demographic questions include age, mothers educational level (illiterate, literate), mothers occupation (Not employed, Military recruit, others), residence (Nakfa, outside Nakfa), marital status(Married, single mom), husbands educational level( illiterate ,literate), mothers care taker (Husband or family, Relative or adopted, Single), occupation of care taker (unemployed, daily laborers, farmer, government worker, merchant, and working abroad) and mode of transport to the hospital (by animal carrier or by car, on foot) . Obstetric and medical history includes mother’s gravidity, history of abortion (yes, no), gestational age (first trimester, second trimester, third trimester), anemia in previous pregnancy (yes, no), number of ANC visits(once,2–3 times,>3 times), current child spacing(≤ 2 years,>2 years), use of family planning (yes, no), history of neonatal death (yes, no), history of still birth (yes, no), presence of any chronic illness (yes, no), single or multiple pregnancy( single, multiple), history of vaginal bleeding (yes, no), use of family planning (yes, no) and history of malaria infection(yes, no) during this pregnancy. Nutritional and medication history includes consumption of nuts and seeds, consumption of meat, poultry or diary, consumption of dark green vegetables and fruits in a weekly basis. Iron-folate supplementation history in preconception and during period of gestation. Data collection Initially to ensure uniformity of the process, the data collectors were given orientation on how to explain the study objectives, obtain informed consent and conduct data collection. The two data collectors in the study were: one mid wife nurse and one nurse assistant trained and certified on ANC. Two supervisors and one project manager oversaw the data collection process. Data collectors conducted researcher administered questionnaire-based interview with the participants after routine ANC service. The interview was held in private ANC room and to ensure strict confidentiality, only one participant was allowed to do the interview at any one time. Average time needed to fill one questionnaire was 15 minutes. Uncertain answers were left unfilled and uncooperative subjects were excluded from the study. The Collected questionnaires were evaluated for its completeness and reliability daily by the supervisors. After the interview, the participants were referred to the laboratory for specimen collection. Hemoglobin measurement Hemoglobin levels were assessed using HemoCue 301 AB, SE 262 city, Sweden. Capillary blood sample, drawn using finger prick procedure, was used in this analysis. Before the sample collection date, quality control of the HemoCue machine was done at the National Health Laboratory (NHL). In addition, daily quality control was undertaken using standardized samples from the NHL. Statistical analysis Data was entered into CsPro version 7.1 and exported to Statistical Package for the Social Science (SPSS) version 26 for analysis. After cleaning, data was analyzed using descriptive statistics. Briefly, continuous data was analyzed using mean (standard deviation (SD), median (IQR)). Categorical variables were summarized into frequencies and proportions. Continuous variables such as age were categorized into age groups and hemoglobin values were categorized in to mild anemia (Hb 10–10.9 g/dl), moderate anemia (7–9.9 g/dl) and severe anemia (Hb < 7 g/dl). Pearson’s Chi square test was used for evaluating the association between categorical variables. Variables with p-value of ≤ 0.25 in the bivariate analysis and with no significant collinearity were subjected in to Binary logistic regression for multivariate analysis. Statistical significance was declared at p < 0.05. Result Socio-demographic characteristics of participants The median age of the participants was 25 [IQR: 22–28] with minimum and maximum age of 18 and 42 respectively. While, the middle aged (25–34 years old) participants were the most 151 (53.2%), the older age group (> 34 years old) holds only 12(4.2%) participants. Two third of the mothers were from out-side Nakfa town and most were traveled on foot to the hospital 205(72.2%). Furthermore, majority mothers were not employed 255(89.8%), married 266(93.7%) and under care of their husband or family 253(89.1%). As per formal education, 158(55.6%) of women and142 (50%) of their husbands were illiterate, and relatively higher number of their care takers were farmers 102(36%) (Table-1). Obstetric history and other relevant information of participants Majority of our participants were on second 134(48.9%) and third 124(45.3%) trimester with 2–4 children 124(44%). Family planning was not practiced by the greatest portion of our study participants 232(89.2%) and the study also revealed child spacing from the previous pregnancy was < 2 years in majority of our participants142(72.1%). History of previous abortion or neonatal death was low among the women, 46(16.5%) and 11(4.6%) respectively. Third of our study participants reported that they had anemia in the previous pregnancy, 95(34.3%). The data also show that most of the participants are with: no previous history of still birth 264(93%), having no chronic illness 278(98% of them with no either of diabetes, hypertension, cardiac problem or convulsion or epilepsy), single pregnancy 266(94%), no history of vaginal bleeding 241(85%) and with no history of malaria attack 266(94%) (Table-2). Table-1 Socio-demographic characteristics of study participants in Nakfa sub-zone, Eritrea, 2024. Characteristics Frequency (%) N = 283 Age category 18–24 120(42.3) 25–34 151(53.2) >34 12(4.2) Residence Nakfa 93(32.7) Outside Nakfa 187(65.8) Mode of transport to the hospital On foot 205(72.2) By animal carrier or car 67(23.6) Mothers educational status Illiterate 158(55.6) Literate 123(43.3) Mothers occupation Not employed 255(89.8) Military recruit 6(2.1) Others 11(3.9) Mothers marital Married 266(93.7) Single mom 7(2.5) Mothers care taker Family or Husband 253(89.1) Relative or adopted 9(3.2) None 9(3.2) Occupation of care taker Daily laborer 42(14.8) Farmer 102(36) Government worker 55(19.4) Merchant 18(6.4) Working abroad 48(17) Others 8(2.8) Husbands educational level Illiterate 131(46.1) Literate 142(50) Table-2 Obstetric history and relevant information of study participants in Nakfa sub-zone, Eritrea, 2024 Characteristics Frequency (%) N = 283 Gestational age First trimester 16(5.8) Second trimester 134(48.9) Third trimester 124(45.3) Gravidity Gravida-one 75(26.6) Gravida 2–4 124(44) Gravida > 4 83(29.4) Use of family planning? Yes 28(10.8) No 232(89.2) Duration from previous pregnancy ≤ 2(years) 142(72.1) >2(years) 55(27.9) History of abortion Yes 46(16.4) No 235(83.6) History of neonatal death Yes 11(4.6) No 225(95.4) Anemia in previous pregnancy Yes 95(34.3) No 182(65.7) Number of ANC visits 1 140(50.5) 2–3 88(31.8) >3 49(17.7) Nutritional and medication parameters of participants Nutritional assessment was done based on the consumption of specific diet on weekly bases. Protein rich diets like Meat, poultry or diary was consumed by most of the participants 191(67%). Consumption of Eggs and dark green vegetables were moderate, 114(40.1%) and 130(45.8%) respectively. While, consumption of Seeds and Nuts 37(13.1%) and consumption of fruits 72(25.4%) were relatively low. Besides, Iron-Folate supplementation rate was 177(62.5%) among our study participants (table-3). Table-3 Nutritional and medication history of study participants in Nakfa subzone, Eritrea, 2024 (N = 283). Characteristics Count(%) Nuts and seeds consumption at least once a week Yes 37(13.1) No 231(81.6) Meat, poultry or diary consumption at least once a week Yes 191(67.3) No 86(30.3) Egg consumption at least once a week Yes 114(40.1) No 155(54.6) Dark green vegetables consumption at least once a week Yes 130(45.8) No 150(53.6) Fruits consumption at least once a week Yes 72(25.4) No 164(57.7) Iron-folate supplementation during this pregnancy Yes 177(62.5) No 106(37.5) Iron-Folate supplementation across period of gestation The overall Iron-Folate supplementation rate of our participants was 177(62.5%), with 7.7% (N = 22) of them took more than once. Trend of iron-folate supplementation reached its’ peak value in the second trimester of the gestation (37.5%). The consumption rate during first trimester and preconception was relatively low, accounted for 6.3% and 0.4% respectively (fig-2). Distribution of participant’s mode of transport across residency Most of the participants traveled on foot 205(72.3%) to the hospital at the time of data collection and participants from outside Nakfa used mostly animal carrier or car to travel to the hospital 65 (97%) (fig-3). Utilization of Antenatal Care (ANC) Service of participants In regard to ANC visit rate, 101(75%) of women in second trimester attended their first ANC visit and only one person attended four and more times. Further, only 48(39%) of the mothers in the third trimester visited ≥ 4 times to the hospital and 23(19%) had one visit rate in third trimester (table-4). Table-4 Number of ANC visit of participants with respect to their gestational age, in Nakfa sub-zone, Eritrea, 2024. Gestational age Frequency of ANC visit 1 visit, N (%) 2–3 visit, N (%) ≥4 visit, N (%) First trimester 14(87.5) 2(12.5) 0(0) Second trimester 101(75.4) 32(23.9) 1(0.7) Third trimester 23(19) 51(41.9) 48(39.3) ANC : Antenatal care Prevalence of Anemia in the study participants The prevalence of anemia in our study is 122(43%, 95% CI: 38.9–48.7) and the mean hemoglobin concentration of our study participants is 11.09 gm/dl (± SD1.64). Minimum and maximum hemoglobin values recorded was 7.2gm/dl and 15gm/dl respectively. Although, 72(25%) of our participants were in the moderate anemia category, no participant with severe anemia appeared in our study(fig-4). Factors associated with anemia: bivariate analysis The result of bivariate analysis showed, women illiteracy ( p = 0.018 ), husband illiteracy( p = 0.013 ) being traveled by animal carrier or car ( p = 0.004 ), and being in third trimester ( p < 0.01 ) showed statistically significant association with higher prevalence of anemia. Those who had more than 4 children was also vulnerable to anemia with close to significance (p = 0.05) . As of the nutritional factors, not consuming: meat, poultry or diary (p = 0.03) , dark green vegetables (p = 0.02) and fresh fruits ( p = 0.04 ) per week were associated with higher rate of anemia. Furthermore, Anemia was higher among the participants who took Iron-Folate (63% Vs 10%, p < 0.01 ) (table-5). Table-5 Bivariate analysis of factors associated with anemia in pregnant mothers in Nakfa sub zone, Eritrea, 2024. Characteristics Anemia category p-value Anemic count (%) Not Anemic count (%) Median Age(IQR) 25(22–28) 25(22–29) 0.5 Residence Nakfa 34(37) 58(63) 0.17 Outside Nakfa 85(45.5) 102(54.5) Mothers Educational level Literate 43(35.2) 79(64.8) 0.018 Illiterate 78(48.4) 80(50.6) Husband’s educational level Literate 51(35.9) 91(64.1) 0.013 Illiterate 66(50.8) 64(49.2) Mode of transport to health facility On foot 75(36.8) 129(63.2) 0.004 By animal carrier or car 38(56.7)) 29(43.3) Occupation of care taker? Daily laborer 16(38.1) 26(61.9) 0.2 Farmer 49(48) 53(52) Government worker 19(34.5) 36(65.5) Working abroad 22(45.8) 26(54.2) Merchant 4(23.5) 13(76.5) Gravidity Gravida 1 29(39.2) 45(60.8) 0.05 Gravida 2–4 47(37.9) 77(62.1) Gravida >4 45(54.2) 38(45.8) Had Abortion Yes 22(47.8) 24(52.2) 0.4 No 98(41.9) 136(58.1) Gestational age First and second trimester 49(32.9) 100(67.1) 0.001 Third trimester 66(53.2) 58(46.8) Anemia in previous pregnancy? Yes 46(48.4) 49(51.6) 0.19 No 73(40.3) 108(59.7) Number of ANC visit in the current pregnancy 1 51(36.7) 88(63.3) 0.1 2–3 42(47.7) 46(52.3) >3 25(51) 24(49) Time gap from the previous pregnancy (years) ≤ 2 59(41.5) 83(58.5) 0.3 >2 27(49.1) 28(50.9) Use of family planning? Yes 8(28.6) 20(71.4) 0.09 No 105(45.3) 127(54.7) Previous history of neonatal death? Yes 4(40) 6(60) 0.9 No 95(41.9) 132(58.1) Consumption of Nuts and seeds at least once a week Yes 16(44.4) 20(55.6) 0.8 No 99(42.9) 132(57.1) Consumption of meat, poultry or diary at least once a week Yes 74(38.9) 116(61.1) 0.03 No 45(52.3) 41(47.7) Consumption Egg at least once a week Yes 45(39.8) 68(60.2) 0.3 No 70(45.2) 85(54.8) Consumption of Dark green vegetables Yes 46(35.7) 83(64.3) 0.02 No 74(49.3) 76(50.7) Consumption of Fruits at least once a week Yes 23(32.4) 48(67.6) 0.04 No 76(46.3) 78(53.7) Iron-Folate supplementation Yes 111(63.1) 65(36.9) < 0.001 No 11(10.4) 95(89.6) Factors associated with anemia: multivariate analysis Multivariate analysis showed that age was negatively associated with anemia in pregnancy (AOR=0.9, 95% CI: 0.8-0.9, p=0.03 ). Those who traveled by animal carrier or car to the hospital had 2.3 times odds of having anemia as compared to those who traveled on foot (AOR=2.3, 95% CI:1.2-4.7, p=0.01 ) and mothers in third trimester had 2.7 times odds of having anemia as compared to in first or second trimester (AOR=2.7, CI:1.5-5.1, p=0.001 ). Another noteworthy finding was, those who did not consume dark green vegetables had higher odds of anemia (AOR=2.1, 95% CI:1.1-4, p=0.002 ). Furthermore, participants with more than four children had higher odds of anemia as compared to women in their primary pregnancy (AOR=3, CI:1.01-9.2, p= 0.048 ) (Table-6). Table-6 Multivariate analysis of factors associated with anemia in pregnancy in Nakfa sub-zone, Eritrea, 2024. Characteristics CIR (95% CI) p-value AOR (95% CI) p-value Age 0.9(0.8–0.9) 0.045 0.9(0.8–0.9) 0.03 Residence Nakfa town 1(ref) Outside Nakfa town 0.4(0.1–1.1) 0.08 Mothers Educational level Literate 1(ref) Illiterate 1.4(0.7–3.1) 0.3 Mode of transport to health facility On foot 1(ref) 1(ref) By animal carrier or by car 3(1.3–6.6) 0.006 2.3(1.2–4.7) 0.01 Occupation of care taker? Merchant 1(ref) Working abroad 1.9(0.4–9.1) 0.3 Government worker 1.3(0.3–5.7) 0.7 Farmer 1.7(0.4–7.7) 0.4 Daily laborer 1.3(0.2–6.3) 0.7 Gravidity Gravida 1 1(ref) 1(ref) Gravida 2–4 0.8(0.3-2) 0.6 1.09(0.4–2.5) 0.8 Gravida > 4 2.3(0.6–7.7) 0.1 3(1.01–9.2) 0.048 Gestational age First and second trimester 1(ref) 1(ref) Third trimester 2.3(1.04–5.3) 0.03 2.7(1.5–5.1) 0.001 Anemia in previous pregnancy? Yes 1(ref) No 0.5(0.2–1.2) 0.14 Number of ANC visit in the current pregnancy 1 0.8(0.2–2.3) 0.7 0.5 2–3 1.3(0.5–3.5) >3 1(ref) Consumption of meat, poultry or diary at least once a week Yes 1(ref) 0.2 No 1.5(0.7–3.07) Consumption of Dark green vegetables at least once a week Yes 1(ref) 0.04 1(ref) No 2.1(1.03–4.5) 2.1(1.1-4) 0.02 Consumption of Fruits at least once a week Yes 1(ref) 0.8 No 1.1(0.4–2.6) CIR= Crude Incidence Ratio, AOR= Adjusted Odds Ration, CI= Confidence Interval P- Values highlighted in bold indicates statistically significant (< 0.05). Discussion Anemia remains a major public health concern with important implications for both maternal and fetal outcomes. According to the WHO, anemia is classified as a condition of moderate public health significance [ 3 ]. This study assessed the prevalence of anemia and its associated factors among pregnant women in the Nakfa sub-zone, Eritrea. Women aged over 34 years accounted for the smallest proportion of participants (4.2%). This finding may be explained by the widespread practice of early marriage in the region, which contributes to higher fertility at younger ages. A comparable age distribution was reported in a study conducted in Asmara, Eritrea, where 13.1% of participants were aged over 34 years [ 20 ]. These findings suggest similarities in socioeconomic and cultural contexts across the country. In the present study, most participants traveled on foot to attend ANC services (72.2%), which likely explains most of our participants resided close to Nakfa town. This supports the assumption that proximity to healthcare facilities influences ANC attendance. At the time of data collection, 75% of women in their second trimester were attending for the first time to the ANC service, moreover only 39% of women in the third trimester had completed four or more ANC visits. The WHO recommends a minimum of eight antenatal contacts during pregnancy [ 21 ] to ensure timely detection and management of maternal and fetal complications. ANC attendance in this study was lower than that reported in Asmara, where 24.6% of women initiated ANC during the second month of pregnancy [ 20 ]. Improved accessibility in urban settings, including shorter travel times to health facilities, may account for this difference. Nevertheless, the ANC utilization pattern observed in this study is consistent with findings from Ghana [ 22 ]. Daily iron–folate supplementation throughout pregnancy is recommended by the Ministry of Health of Eritrea in accordance with WHO guidelines [ 10 , 20 ]. However, only 63% of participants in this study reported receiving iron–folate supplements. Enhancing ANC attendance and strengthening supplementation programs are therefore essential. Although the supplementation coverage observed in this study was lower than reported in Cameroon and Tanzania, where coverage exceeded 90% [ 23 , 24 ], it was higher than that reported in Uganda [ 7 ]. The variation in supplementation coverage across countries likely reflects differences in health system capacity, supply chain management, and program implementation. The prevalence of anemia among pregnant women in this study was 43%, which is classified as a severe public health problem according to WHO criteria [ 25 ]. This prevalence is higher than reports from sub-Saharan Africa overall (35.6%) [ 13 ], Northern Uganda (24.7%) [ 26 ], the Mbeya region of Tanzania (25.5%) [ 27 ], Tigray in northern Ethiopia (7.9%) [ 12 ], and Ethiopia at the national level (26.3%) [ 14 ]. Conversely, it is lower than the prevalence reported in West Gonja District, Ghana (55.8%) [ 22 ], Somaliland (50.6%) [ 9 ], Sudan (53.0%) [ 28 ], and Bangladesh (58.9%) [ 29 ]. Such variation may be attributed to differences in socioeconomic conditions, dietary practices, geographic settings, and national health policies. Although 25% of participants were classified as having moderate anemia, no cases of severe anemia were identified. This finding is consistent with reports from other studies [ 8 , 17 ], but contrasts with findings from Somaliland, where 12.1% of pregnant women had severe anemia [ 9 ]. The absence of severe anemia in the present study may reflect the positive role of ANC services in Eritrea in early identification and management of anemia. In the bivariate analysis, a higher prevalence of anemia was observed among women who reported iron–folate supplementation compared with those who did not (64% vs. 36%). This association should be interpreted cautiously, as the cross-sectional design precludes causal inference. Iron–folate supplementation may have been initiated as a therapeutic intervention among women already diagnosed with anemia. Additionally, suboptimal adherence to supplementation could limit its effectiveness. Inconsistencies with our finding have been reported elsewhere [ 14 , 30 ], underscoring the need for longitudinal studies to clarify the relationship between supplementation and anemia. Multivariable analysis demonstrated a negative association between maternal age and anemia, indicating a higher burden among younger women. This finding contrasts with results from Cameroon [ 23 ]. Women who traveled to health facilities by car or animal carrier had 2.3 times higher odds of anemia compared with those who traveled on foot. Notably, in our study, 97% of women who used car or animal transport resided outside Nakfa town(fig-3), suggesting that longer travel distance may contribute to increased anemia risk. Women in their third trimester had 2.7 times higher odds of anemia compared with those in the first or second trimester, consistent with findings from previous studies [ 9 , 14 , 17 ]. Increased physiological demand for iron and folate during late pregnancy may partly explain this association. Reduced dietary intake in the third trimester, particularly of nutrient-rich foods [ 24 ], may further exacerbate anemia risk. In this study, women who did not consume dark green leafy vegetables had a significantly higher risk of anemia (adjusted odds ratio [AOR] = 2.1, 95% CI: 1.1–4.0). Similar associations have been reported in Tanzania and other settings [ 24 , 27 ]. Parity was also significantly associated with anemia. Women with more than four children had threefold higher odds of anemia (AOR = 3.0, 95% CI: 1.01–9.2), consistent with findings from other studies [ 9 , 14 ]. Limitation and strength of the study One of the major drawbacks of this study is, the outcome we found is sensitive to any inaccuracy of the response from the study subjects. Secondly, given that this study is a cross-sectional study, it cannot conclude causal relationship. Larger sample size with additional variables like: stool examination, blood cell morphology evaluation and assessment of adherence to Iron-Folate supplementation would have also given this research broader insight. However, considering the study is inclusive in terms of representation, it reflects the burden of anemia in pregnancy in the region. Conclusion The magnitude of anemia in Nakfa sub-zone is comparatively high (43%), which may have profound negative effect in the health of mother and child. Factors that are associated with anemia in pregnancy in the present study are; younger age, being traveled by car or animal carrier, being in the third trimester and not consuming dark green vegetables often times. Therefore, we suggest that greater effort should be applied in reducing this burden by improving dietary practices, giving more attention to the pregnant mothers in the third trimester and providing better health care facility and transport system to the remote sites of the region. Finally, our recommendation is further robust study to be done. Abbreviations ANC Antenatal Care WHO World Health Organization NHL National Health Laboratory CI Confidence Interval COR Crude Odds Ratio AOR Adjusted Odds Ratio Vs Versus Declarations Ethics approval and consent to participate Permission was sought from the Health Research Ethics and Protocol Review Committee of the Eritrean Ministry of Health (Letter of reference 29/02/2023) and from the administration of study hospital. An official consent form was signed by every participant before data collection and full confidentiality of the participants were strictly respected. Consent for publication Not applicable. Data availability The data set supporting the conclusions of this article is available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding No funding obtained for this study. Authors Contribution MTK, STM, GGG conceived the study and formulated the study design and participated in data collection. MTK, GGG supervised the data collection process and performed other administrative functions. MTK, OOA, GGG, HT, HHA, STM and AFT did the statistical analysis and data presentation. MTK, OOA, GGG, HT, HHA, STM and AFT wrote and edited the first draft of the manuscript. All authors read and approved the final manuscript. Acknowledgement The authors thank Zahra Mohammed for her great assistance in the data collection and all Nakfa Hospital staff who supported us throughout study. References Flick AA, Kahn DA. Maternal Physiology during pregnancy and Fetal and Early Neonatal Physiology. Current Obstetrics and Gynecologic Diagnosis and Treatment. 11th ed. New York: McGrawHill; 2013. p. 16379. Marya RK. Medical Physiology. 3rd ed. New Delhi: CBS Publishers and Distributors Ltd.; 2010. World Health Organization. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity (No. WHO/NMH/NHD/MNM/11.1). 2011. World Health Organization. Anemias. Geneva: World Health Organization. Available from: https://www.who.int/healthtopics/anaemia [Last accessed on 2022 may 10]. WHO. Iron Deficiency Anemia: Assessment, Prevention and Control: A Guide for Program Managers. Geneva, Switzerland: UNICEF, United Nations University, WHO; 2001. Murphy JF. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Geneva: World Health Organization (2011). M. A. Mbule, Y. B. Byaruhanga, M. Kabahenda, and A. Lubowa. Determinants of anemia among pregnant women in rural Uganda, Rural and Remote Health. vol. 13, no. 2, p. 2259, 2013. Lebso M, Anato A, Loha E (2017) Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study. PLoS ONE 12(12): e0188783. https://doi.org/10.1371/ journal.pone.0188783 Mohamed Mussa Abdilahi, Jonah Kiruja, Badra Osman Farah , Farduus Mohamed Abdirahman , Ahmed Ismail Mohamed , Jama Mohamed and Abdeta Muktar Ahmed. Prevalence of anemia and associated factors among pregnant women at Hargeisa Group Hospital, Somaliland. BMC Pregnancy and Childbirth (2024) 24:332 https://doi.org/10.1186/s12884-024-06539-3 WHO. Global prevalence of anemia in 2011. Geneva: Health organization; 2011. Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Peña-Rosas JP, Bhutta ZA, Ezzati M, Group NIMS. Global, regional, and national trends in hemoglobin concentration and prevalence of total and severe anemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(1): e16–25. Brhane Berhe , Fitsum Mardu, Haftom Legese, Aderajew Gebrewahd, Guesh Gebremariam, Kebede Tesfay, Getachew Kahsu, Hadush Negash and Gebre Adhanom. Prevalence of anemia and associated factors among pregnant women in Adigrat General Hospital, Tigrai, northern Ethiopia, 2018. BMC Res Notes (2019) 12:310 https://doi.org/10.1186/s13104-019-4347-4 Meseret Belete Fite, Nega Assefa and Bizatu Mengiste. Prevalence and determinants of Anemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis. Archives of Public Health (2021) 79:219. https://doi.org/10.1186/s13690-021-00711-3 Geta TG, Gebremedhin S, Omigbodun AO (2022). Prevalence and predictors of anemia among pregnant women in Ethiopia: Systematic review and meta-analysis. PLoS ONE 17(7): e0267005. https://doi.org/10.1371/journal. pone.0267005 Ashraf MA Hussain, Qais Ismaeel kadhem, Nibras Alaa Hussain. Prevalence of anemia in a sample of pregnant women in Babylon Governorate, Iraq . Revista Latinoamericana de Hipertensión. Vol. 15 - Nº 4,2020. National Statistics Office (NSO) [Eritrea] and Fafo AIS. 2013. Eritrea Population and Health Survey 2010. Asmara, Eritrea: National Statistics Office and Fafo Institute for Applied International Studies. Anthony Wemakor. Prevalence and determinants of anemia in pregnant women receiving antenatal care at a tertiary referral hospital in Northern Ghana. BMC Pregnancy and Childbirth (2019) 19:495. https://doi.org/10.1186/s12884-019-2644-5 Abel Gebre and Afework Mulugeta.Prevalence of Anemia and Associated Factors among Pregnant Women in North Western Zone of Tigray, Northern Ethiopia: A Cross-Sectional Study. Hindawi Publishing Corporation Journal of Nutrition and Metabolism Volume 2015, Article ID 165430, 7 pages http://dx.doi.org/10.1155/2015/165430 Mekdemariam Getachew, Mebrahtu Abay, Hiwet Zelalem, Tirhas Gebremedhin, Teklit Grum and Alemayehu Bayray. Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia. BMC Pregnancy and Childbirth (2018) 18:83 https://doi.org/10.1186/s12884-018-1716-2 Meron Berhe Tsegai1, Abiel Habtom Berhe, Semhar Berhane Tesfaezgi, Dawit G Weldemariam, Kifleyesus Tedla Petros, Hana Bereket Weldetinsae, Eyasu H Tesfamariam. Knowledge, Attitude, and Practice Regarding Supplemental Iron and Folic Acid Amongst Women Delivering in Edaga-Hamus Community Hospital: A Cross-Sectional Study in Asmara, Eritrea, International Journal of Women’s Health 2023:15 1593–1609 WHO recommendations on antenatal care for a positive pregnancy experience. World health organization,Geneva,2016.http://www.who.int/reprodctivehealth/publications/maternal_perinatal_health/anc-positive-pregncncy-experience/en/(Accesed on December01, 2016). Basil Addayire Tibambuya, John Kuumuori Ganle &, Muslim Ibrahim. Anaemia at antenatal care initiation and associated factors among pregnant women in West Gonja District, Ghana: a cross-sectional study . The Pan African Medical Journal. 2019; 33:325. doi:10.11604/pamj.2019.33.325.17924 Henri, E., Valere, M.K., Lucas, E.E., Calixte, P.I., Ngalame, C.M., Grâce, T.T., Ekobo, A.S. and Moukoko, C.E.E. (2019). Hematological Profile and Risk Factors of Anemia in Pregnant Women: A Cross Sectional Descriptive and Analytical Study in Douala Cameroon. Open Journal of Obstetrics and Gynecology, 9, 968-980. https://doi.org/10.4236/ojog.2019.97094 Lema EJ, Seif SA. Prevalence of anemia and its associated factors among pregnant women in Ilala Municipality - Tanzania: Analytical cross-sectional study. Medicine 2023; 102:23 (e33944). World Health Organization, worldwide prevalence of anemia 1993-2005: WHO global database on anemia, 2008. Samson Udhoa, Joyce Nankumbib , Mariam Namutebib , David Mukunyac,d, Grace Ndeezie and James K Tumwine. Prevalence of anemia in pregnancy and associated factors in northern Uganda: a cross-sectional study. South African Journal of Clinical Nutrition 2023; 36(4):136–141 https://doi.org/10.1080/16070658.2022.2148909 Abdallah F, John SE, Hancy A, Paulo HA, Sanga A, Noor R, et al. (2022). Prevalence and factors associated with anemia among pregnant women attending reproductive and child health clinics in Mbeya region, Tanzania. PLOS Glob Public Health 2(10): e0000280. https://doi.org/ 10.1371/journal.pgph.0000280 Ishag Adam, Yassin Ibrahim and Osama Elhardello, Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC Hematology (2018) 18:31. https://doi.org/10.1186/s12878-018-0124-1 Ahmed, S., Al Mamun, Md.A., Mahmud, N., Farzana, N., Sathi, M.S.A., Biswas, B.K., Datta, A. and Ahmad, T. (2019). Prevalence and Associated Factors of Anemia among Pregnant Women Receiving Antenatal Care (ANC) at Fatima Hospital in Jashore, Bangladesh: A Cross-Sectional Study. Food and Nutrition Sciences,10,1056-1071.https://doi.org/10.4236/fns.2019.109076 Berrick Otieno, Cyrus Mutie, Salwa Elmawi, Marttin Kyania Mulala, Makorani Y’Dhidha-a-Mjidho, Isaac Kyalo1, Mwaswere Juma, and Osman Abdullahi. Prevalence and Predictors of Anaemia in Pregnant Women Receiving Antenatal Care at Kilifi County Referral Hospital, Kenya. African Journal of Health Sciences Volume 36, Issue No.5, September – October 2023 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8599815","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":604530430,"identity":"bfd75850-c823-4b0c-addc-df243b75ccd1","order_by":0,"name":"Meron Tesfay Kahsay","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYJCCD3DWAwYbIMnYeACfch6gihlwXgJDGkhLA0laDoNpvFrs2dsfNvxs2yZn3t578EPCn/N2a9sPA22psYnGaQvPGcPG3rbbxjJnziVLJLbdTt52JhGo5VhabgMuLRI57A94224nzpDIMWNIbLidbHYAqIWx4TBuLfLPHzb+bbtdD9aS8Odcstn5hwS0SDAYNgNtSZAAa2E7YGd2g5AtZ3IMm2XO3TacwXPGGOiX5ASzG0BbEvD4hb39+MPGN2W35SXYeww/fPhjZ292Pv3hgw81Nji1gAEjG4KdCFaZgE85GPxBMO0JKh4Fo2AUjIIRBwCok2ZG6+klSQAAAABJRU5ErkJggg==","orcid":"","institution":"National Health Laboratory, Eritrea","correspondingAuthor":true,"prefix":"","firstName":"Meron","middleName":"Tesfay","lastName":"Kahsay","suffix":""},{"id":604530434,"identity":"3a7b15aa-299b-415a-9c82-7a4d5c010206","order_by":1,"name":"Oliver Okotch Achila","email":"","orcid":"","institution":"Orotta college of medicine and health sciences","correspondingAuthor":false,"prefix":"","firstName":"Oliver","middleName":"Okotch","lastName":"Achila","suffix":""},{"id":604530435,"identity":"1fb9592b-b676-4e87-b24c-b8cc9f3aaa8a","order_by":2,"name":"Huruy Tesfahiwet","email":"","orcid":"","institution":"National Health Laboratory, Eritrea","correspondingAuthor":false,"prefix":"","firstName":"Huruy","middleName":"","lastName":"Tesfahiwet","suffix":""},{"id":604530439,"identity":"c29ce3e0-e3cc-4ff1-847f-f0b02d9c770d","order_by":3,"name":"Hermon Haile Alem","email":"","orcid":"","institution":"Orotta national referral hospital","correspondingAuthor":false,"prefix":"","firstName":"Hermon","middleName":"Haile","lastName":"Alem","suffix":""},{"id":604530442,"identity":"40399792-37f0-4f82-a14b-a15f8e655c2f","order_by":4,"name":"Ghirmay Ghebrekidan Ghebremeskel","email":"","orcid":"","institution":"Nakfa hospital","correspondingAuthor":false,"prefix":"","firstName":"Ghirmay","middleName":"Ghebrekidan","lastName":"Ghebremeskel","suffix":""},{"id":604530445,"identity":"7acda35c-5417-406e-b0f9-eb7cf029c296","order_by":5,"name":"Samuel Tekle Mengstu","email":"","orcid":"","institution":"Nakfa hospital","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"Tekle","lastName":"Mengstu","suffix":""},{"id":604530452,"identity":"0afeb119-ff58-40d4-baca-d3e97a013033","order_by":6,"name":"Abiel Fessehaie Tesfazion","email":"","orcid":"","institution":"National Health Laboratory, Eritrea","correspondingAuthor":false,"prefix":"","firstName":"Abiel","middleName":"Fessehaie","lastName":"Tesfazion","suffix":""}],"badges":[],"createdAt":"2026-01-14 09:08:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8599815/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8599815/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104581957,"identity":"b2c01a76-8b47-42e2-9c46-8818a2cb5acb","added_by":"auto","created_at":"2026-03-13 15:11:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33942,"visible":true,"origin":"","legend":"\u003cp\u003eFlow diagram of participant recruitment for the study in Nakfa sub-zone, Eritrea, 2024.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8599815/v1/283dc6cb5c1788805ad27b49.png"},{"id":104582018,"identity":"61860eda-e854-4414-aac1-a4e51128a521","added_by":"auto","created_at":"2026-03-13 15:11:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33866,"visible":true,"origin":"","legend":"\u003cp\u003eTrends of Iron-Folate supplementation across months of gestation among women in Nakfa sub-zone, Eritrea, 2024.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8599815/v1/4e55ea118daf304a5b6afb9b.png"},{"id":104582060,"identity":"0346be27-5d0a-4635-970f-9c783ab70536","added_by":"auto","created_at":"2026-03-13 15:11:43","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":14846,"visible":true,"origin":"","legend":"\u003cp\u003eMode of transport of women with respect to their residence in Nakfa sub-zone, Eritrea, 2024.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8599815/v1/17ec1cdd71c31bb52f89aa64.png"},{"id":104581951,"identity":"e1291a13-6f65-4d9a-9ab6-5514342a23dd","added_by":"auto","created_at":"2026-03-13 15:11:25","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":83656,"visible":true,"origin":"","legend":"\u003cp\u003eprevalence of anemia in Nakfa sub-zone, Eritrea, 2024. The pi-chart shows the proportion of mild anemia (hemoglobin value,10-10.9 g/dl), moderate anemia (hemoglobin value,7-9.9 g/dl) and not anemic (hemoglobin value, ≥11g/dl) in our participants.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8599815/v1/2faacd173116ef9820a2e832.png"},{"id":104582328,"identity":"298ecc61-d1f4-4412-9643-7bf976cc662e","added_by":"auto","created_at":"2026-03-13 15:12:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2403619,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8599815/v1/982f2ea5-fa75-468a-b556-089205f524cd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and factors associated with anemia among pregnant women in Nakfa district, Eritrea: A cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePregnancy is a physiological condition characterized by a multiplicity of adoptive changes in response to the presence of then growing fetus [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. One of the most consequential changes includes differential increase in plasma volume and red cell mass. These changes, lead, ultimately to reduction in hematocrit (HCT), particularly in the 2nd trimester [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Related to these changes is an increase in the likelihood of anemia \u0026ndash; defined by the World Health Organization (WHO) as a hemoglobin concentration\u0026thinsp;\u0026lt;\u0026thinsp;11g/dL; in pregnant women [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The high likelihood of anemia among pregnant women is reflected in real world data. For example, a recent WHO report noted that the prevalence of anemia in non-pregnant women was 29.6% whereas the prevalence in pregnant women was 36.5% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Others have noted that the prevalence of anemia is higher in developing countries \u0026ndash; 18% vs 56% in developed countries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnemia during pregnancy is of great concern because it contributes significantly to increased risk of maternal death during the prenatal period. It increases the risk of postpartum hemorrhage, pregnancy-induced hypertension, placenta Previa, hemorrhage and cardiac failure [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Africa where the prevalence of anemia among pregnant women is disproportionately high; adverse health outcomes for both mother and infant like maternal mortality, perinatal mortality, growth restriction and low birth weight have been reported [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Annually, approximately 510,000 maternal deaths occur due to complications related to pregnancy and childbirth, with nearly 20% of these deaths occurring in developing countries, often attributable to anemia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. To mitigate the impact of pregnancy - related anemia in developing countries; the WHO recommends day-to-day supplementation of 30\u0026ndash;60 mg/d elemental iron (+\u0026thinsp;400\u0026micro;g) and folic acid to reduce its public health impacts [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of etiology, reports indicate that pregnancy \u0026ndash; related anemia is associated with a multiplicity of factors including iron deficiency (resulting from prolonged negative iron balance) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]; gestational age (more prevalence in the 3rd trimester) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]; not taking iron-folate supplementation; and a diet that is not diverse [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Other reports have linked it to increased nutritional demand and unmet need for micronutrients; intestinal helminthic infections, malaria, and chronic illnesses, among others [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In part, these constellation of factors explain of disproportionate burden of pregnancy-related anemia in developing countries where underprivileged citizens often have poor socioeconomic status, excess parity, inadequate spacing, poor alimentation, and high rate of infectious diseases. Moreover, they have poor access to medical care and preventive measures \u0026ndash; factors which augment the risk of developing anemia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite its importance, data on pregnancy-related anemia is hard to obtain for countries in Sub-Saharan Africa. In Eritrea, for instance, a population survey conducted in 2010, reported a prevalence of 23.8% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In the interim, no studies were undertaken \u0026ndash; an outcome which has left a significant gap in our knowledge on the prevalence of anemia among pregnant women in the country. Additional concerns with the now dated study were the fact that factors associated with anemia were not explored. At the same time, disaggregation of data with respect to the various sub-regions within the country was not undertaken. In this study, we aimed to determine the prevalence and factors associated with anemia among pregnant women in Nakfa district, Eritrea.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cdiv\u003e\n \u003ch2\u003eStudy design and setting\u003c/h2\u003e\n \u003cp\u003eHospital based cross-sectional study was done in Nakfa hospital from May 1 up to July 31 of 2024. Nakfa is found 225km from the capital Asmara and it is located in latitude and longitude of 16 .66 \u003csup\u003e\u003cstrong\u003eo\u003c/strong\u003e\u003c/sup\u003e and 38.4\u003csup\u003e\u003cstrong\u003eo\u003c/strong\u003e\u003c/sup\u003e respectively, in an elevation of about 1700 meters (5,577feet) above sea level. The subzone has 11 administration regions and in 2024 the estimated population was 54,684 in Nakfa sub-zone and 26,593 in Nakfa town. Most of the people are farmers with nomadic and seminomadic life style; the rough topography of the region is the main reason of the poor transportation system there. The sub- zone has three health stations and one hospital (only the hospital has laboratory service). The hospital provides outpatient and inpatient service with: adult ward, pediatric ward, MHC ward (Maternal Health Care) and one OR (operation room) for cesarean section. It also serves as a referral hospital for the sub-zone and other nearby subzones (Adobha and karora subzones). According data from the hospital, first ANC visit rate was 104.6% in 2024 with total visit of 1122 women.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eOur source population was all pregnant mothers in Nakfa sub-zone. The sample size\\(\\:\\:\\)was estimated using the Cochran formula.\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003eWhere:\u003c/p\u003e\n\u003cp\u003eN\u0026thinsp;=\u0026thinsp;Sample size, Z\u0026thinsp;=\u0026thinsp;The z-score that corresponds with 95% confidence interval (1.96), P\u0026thinsp;=\u0026thinsp;According to the Eritrean population and health survey, prevalence of anemia in pregnancy was 23.8% [16], therefore, we considered p as 0.23, e\u0026thinsp;=\u0026thinsp;margin of error was taken as 5%. We calculated the minimum sample size of 278 women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population, inclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll pregnant women who visited the facility within the stated period (May 1 up to July 31 of 2024) were enrolled in the study. 305 participants were recruited, however, 9 (2.9%) and 13(4.2%) were excluded due to lack of co-operation and absence of critical data respectively. Ultimately, 283 participants were included in the study(fig-1).\u003c/p\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cp\u003ePregnant women, 18 and above years old, who come to the ANC clinic of Nakfa hospital at the time of data collection, with no clinical emergency and consented to participate was eligible for the study.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria\u003c/h3\u003e\n\u003cp\u003ePregnant mothers younger than 18 years, severely ill, mentally disabled, who had history of blood transfusion in the past one month and those who failed to consent were excluded.\u003c/p\u003e\n\u003ch3\u003eData collection tools and procedures\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was developed based on the key indicators of the study and some variables that have been identified in earlier studies across developing countries [17, 18, 19]. The developed questionnaire was with 29 questions partitioned in to socio-demographic characteristics, obstetric history, medical history and nutritional history. It was originally prepared in English then it was translated in to Tigre (local language) and back translated in to English to ensure its\u0026rsquo; consistency.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ch2\u003eValidation\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cp\u003eTwo weeks before data collection, pre-testing was done on 20 ANC attendants with similar characteristics as the actual participants. The questionnaire was then assessed robustly and modified accordingly.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003eVariable definition\u003c/h3\u003e\n\u003cdiv\u003e\n \u003ch2\u003eOutcome variable\u003c/h2\u003e\n \u003cp\u003eThe dependent variable is hemoglobin value of mothers at the time of data collection. Anemia is defined as hemoglobin level of less than 11 g/dl: it is further categorized into mild, moderate, and severe anemia with a hemoglobin range of 10 \u0026minus;\u0026thinsp;10.9 g/dl, 7\u0026ndash;9.9 g/dl, and \u0026lt;\u0026thinsp;7 g/dl, respectively [12].\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ch2\u003eDependent Variables\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eSocio-demographic questions include\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eage, mothers educational level (illiterate, literate), mothers occupation (Not employed, Military recruit, others), residence (Nakfa, outside Nakfa), marital status(Married, single mom), husbands educational level( illiterate ,literate), mothers care taker (Husband or family, Relative or adopted, Single), occupation of care taker (unemployed, daily laborers, farmer, government worker, merchant, and working abroad) and mode of transport to the hospital (by animal carrier or by car, on foot) .\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eObstetric and medical history includes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003emother\u0026rsquo;s gravidity, history of abortion (yes, no), gestational age (first trimester, second trimester, third trimester), anemia in previous pregnancy (yes, no), number of ANC visits(once,2\u0026ndash;3 times,\u0026gt;3 times), current child spacing(\u0026le;\u0026thinsp;2 years,\u0026gt;2 years), use of family planning (yes, no), history of neonatal death (yes, no), history of still birth (yes, no), presence of any chronic illness (yes, no), single or multiple pregnancy( single, multiple), history of vaginal bleeding (yes, no), use of family planning (yes, no) and history of malaria infection(yes, no) during this pregnancy.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNutritional and medication history includes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003econsumption of nuts and seeds, consumption of meat, poultry or diary, consumption of dark green vegetables and fruits in a weekly basis. Iron-folate supplementation history in preconception and during period of gestation.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ch2\u003eData collection\u003c/h2\u003e\n \u003cdiv\u003e\n \u003cp\u003eInitially to ensure uniformity of the process, the data collectors were given orientation on how to explain the study objectives, obtain informed consent and conduct data collection. The two data collectors in the study were: one mid wife nurse and one nurse assistant trained and certified on ANC. Two supervisors and one project manager oversaw the data collection process. Data collectors conducted researcher administered questionnaire-based interview with the participants after routine ANC service. The interview was held in private ANC room and to ensure strict confidentiality, only one participant was allowed to do the interview at any one time. Average time needed to fill one questionnaire was 15 minutes. Uncertain answers were left unfilled and uncooperative subjects were excluded from the study. The Collected questionnaires were evaluated for its completeness and reliability daily by the supervisors. After the interview, the participants were referred to the laboratory for specimen collection.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ch2\u003eHemoglobin measurement\u003c/h2\u003e\n \u003cp\u003eHemoglobin levels were assessed using HemoCue 301 AB, SE 262 city, Sweden. Capillary blood sample, drawn using finger prick procedure, was used in this analysis. Before the sample collection date, quality control of the HemoCue machine was done at the National Health Laboratory (NHL). In addition, daily quality control was undertaken using standardized samples from the NHL.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ch2\u003eStatistical analysis\u003c/h2\u003e\n \u003cp\u003eData was entered into CsPro version 7.1 and exported to Statistical Package for the Social Science (SPSS) version 26 for analysis. After cleaning, data was analyzed using descriptive statistics. Briefly, continuous data was analyzed using mean (standard deviation (SD), median (IQR)). Categorical variables were summarized into frequencies and proportions. Continuous variables such as age were categorized into age groups and hemoglobin values were categorized in to mild anemia (Hb 10\u0026ndash;10.9 g/dl), moderate anemia (7\u0026ndash;9.9 g/dl) and severe anemia (Hb\u0026thinsp;\u0026lt;\u0026thinsp;7 g/dl). Pearson\u0026rsquo;s Chi square test was used for evaluating the association between categorical variables. Variables with \u003cem\u003ep-value\u003c/em\u003e of \u0026le;\u0026thinsp;0.25 in the bivariate analysis and with no significant collinearity were subjected in to Binary logistic regression for multivariate analysis. Statistical significance was declared at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Result ","content":"\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003cdiv id=\"Sec16\" class=\"Section3\"\u003e\n \u003ch2\u003eSocio-demographic characteristics of participants\u003c/h2\u003e\n \u003cp\u003eThe median age of the participants was 25 [IQR: 22\u0026ndash;28] with minimum and maximum age of 18 and 42 respectively. While, the middle aged (25\u0026ndash;34 years old) participants were the most 151 (53.2%), the older age group (\u0026gt;\u0026thinsp;34 years old) holds only 12(4.2%) participants. Two third of the mothers were from out-side Nakfa town and most were traveled on foot to the hospital 205(72.2%). Furthermore, majority mothers were not employed 255(89.8%), married 266(93.7%) and under care of their husband or family 253(89.1%). As per formal education, 158(55.6%) of women and142 (50%) of their husbands were illiterate, and relatively higher number of their care takers were farmers 102(36%) (Table-1).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eObstetric history and other relevant information of participants\u003c/h2\u003e\n \u003cp\u003eMajority of our participants were on second 134(48.9%) and third 124(45.3%) trimester with 2\u0026ndash;4 children 124(44%). Family planning was not practiced by the greatest portion of our study participants 232(89.2%) and the study also revealed child spacing from the previous pregnancy was \u0026lt;\u0026thinsp;2 years in majority of our participants142(72.1%). History of previous abortion or neonatal death was low among the women, 46(16.5%) and 11(4.6%) respectively. Third of our study participants reported that they had anemia in the previous pregnancy, 95(34.3%). The data also show that most of the participants are with: no previous history of still birth 264(93%), having no chronic illness 278(98% of them with no either of diabetes, hypertension, cardiac problem or convulsion or epilepsy), single pregnancy 266(94%), no history of vaginal bleeding 241(85%) and with no history of malaria attack 266(94%) (Table-2).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable-1\u003c/strong\u003e Socio-demographic characteristics of study participants in Nakfa sub-zone, Eritrea, 2024.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency (%) N\u0026thinsp;=\u0026thinsp;283\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge category\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e120(42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e151(53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNakfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93(32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutside Nakfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e187(65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of transport to the hospital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOn foot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e205(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBy animal carrier or car\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers educational status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e158(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123(43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers occupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e255(89.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMilitary recruit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers marital\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e266(93.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle mom\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers care taker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily or Husband\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e253(89.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelative or adopted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation of care taker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaily laborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102(36)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorking abroad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHusbands educational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e131(46.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e142(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eTable-2\u003c/strong\u003e Obstetric history and relevant information of study participants in Nakfa sub-zone, Eritrea, 2024\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabb\" border=\"1\"\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency (%) N\u0026thinsp;=\u0026thinsp;283\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGestational age\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e134(48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124(45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida-one\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75(26.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida 2\u0026ndash;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124(44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida\u0026thinsp;\u0026gt;\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of family planning?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e232(89.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration from previous pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le; 2(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e142(72.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;2(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55(27.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of abortion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e235(83.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHistory of neonatal death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e225(95.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia in previous pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95(34.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e182(65.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of ANC visits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140(50.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88(31.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49(17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eNutritional and medication parameters of participants\u003c/h2\u003e\n \u003cp\u003eNutritional assessment was done based on the consumption of specific diet on weekly bases. Protein rich diets like Meat, poultry or diary was consumed by most of the participants 191(67%). Consumption of Eggs and dark green vegetables were moderate, 114(40.1%) and 130(45.8%) respectively. While, consumption of Seeds and Nuts 37(13.1%) and consumption of fruits 72(25.4%) were relatively low. Besides, Iron-Folate supplementation rate was 177(62.5%) among our study participants (table-3).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable-3\u003c/strong\u003e Nutritional and medication history of study participants in Nakfa subzone, Eritrea, 2024 (N\u0026thinsp;=\u0026thinsp;283).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabc\" border=\"1\"\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCount(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNuts and seeds consumption at least once a week\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37(13.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e231(81.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeat, poultry or diary consumption at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e191(67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEgg consumption at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e114(40.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e155(54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDark green vegetables consumption at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e130(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e150(53.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFruits consumption at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e72(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e164(57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIron-folate supplementation during this pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e177(62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e106(37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eIron-Folate supplementation across period of gestation\u003c/h2\u003e\n \u003cp\u003eThe overall Iron-Folate supplementation rate of our participants was 177(62.5%), with 7.7% (N\u0026thinsp;=\u0026thinsp;22) of them took more than once. Trend of iron-folate supplementation reached its\u0026rsquo; peak value in the second trimester of the gestation (37.5%). The consumption rate during first trimester and preconception was relatively low, accounted for 6.3% and 0.4% respectively (fig-2).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003eDistribution of participant\u0026rsquo;s mode of transport across residency\u003c/h2\u003e\n \u003cp\u003eMost of the participants traveled on foot 205(72.3%) to the hospital at the time of data collection and participants from outside Nakfa used mostly animal carrier or car to travel to the hospital 65 (97%) (fig-3).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\n \u003ch2\u003eUtilization of Antenatal Care (ANC) Service of participants\u003c/h2\u003e\n \u003cp\u003eIn regard to ANC visit rate, 101(75%) of women in second trimester attended their first ANC visit and only one person attended four and more times. Further, only 48(39%) of the mothers in the third trimester visited\u0026thinsp;\u0026ge;\u0026thinsp;4 times to the hospital and 23(19%) had one visit rate in third trimester (table-4).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable-4\u003c/strong\u003e Number of ANC visit of participants with respect to their gestational age, in Nakfa sub-zone, Eritrea, 2024.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabd\" border=\"1\"\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGestational age\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eFrequency of ANC visit\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1 visit, N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;3 visit, N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026ge;4 visit, N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFirst trimester\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14(87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecond trimester\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e101(75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32(23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eThird trimester\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eANC\u003c/strong\u003e: Antenatal care\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e\n \u003ch2\u003ePrevalence of Anemia in the study participants\u003c/h2\u003e\n \u003cp\u003eThe prevalence of anemia in our study is 122(43%, 95% CI: 38.9\u0026ndash;48.7) and the mean hemoglobin concentration of our study participants is 11.09 gm/dl (\u0026plusmn;\u0026thinsp;SD1.64). Minimum and maximum hemoglobin values recorded was 7.2gm/dl and 15gm/dl respectively. Although, 72(25%) of our participants were in the moderate anemia category, no participant with severe anemia appeared in our study(fig-4).\u003c/p\u003e\n \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e\n \u003ch2\u003eFactors associated with anemia: bivariate analysis\u003c/h2\u003e\n \u003cp\u003eThe result of bivariate analysis showed, women illiteracy (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.018\u003c/em\u003e), husband illiteracy(\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.013\u003c/em\u003e) being traveled by animal carrier or car (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.004\u003c/em\u003e), and being in third trimester (\u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/em\u003e) showed statistically significant association with higher prevalence of anemia. Those who had more than 4 children was also vulnerable to anemia with close to significance \u003cem\u003e(p\u0026thinsp;=\u0026thinsp;0.05)\u003c/em\u003e. As of the nutritional factors, not consuming: meat, poultry or diary \u003cem\u003e(p\u0026thinsp;=\u0026thinsp;0.03)\u003c/em\u003e, dark green vegetables \u003cem\u003e(p\u0026thinsp;=\u0026thinsp;0.02)\u003c/em\u003e and fresh fruits (\u003cem\u003ep\u0026thinsp;=\u0026thinsp;0.04\u003c/em\u003e) per week were associated with higher rate of anemia. Furthermore, Anemia was higher among the participants who took Iron-Folate (63% Vs 10%, \u003cem\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/em\u003e) (table-5).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable-5\u003c/strong\u003e Bivariate analysis of factors associated with anemia in pregnant mothers in Nakfa sub zone, Eritrea, 2024.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabe\" border=\"1\"\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAnemia category\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAnemic count (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNot Anemic count (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian Age(IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(22\u0026ndash;28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(22\u0026ndash;29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNakfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutside Nakfa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85(45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102(54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers Educational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79(64.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80(50.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHusband\u0026rsquo;s educational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51(35.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91(64.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(50.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64(49.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of transport to health facility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOn foot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75(36.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129(63.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBy animal carrier or car\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38(56.7))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29(43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation of care taker?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaily laborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49(48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53(52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36(65.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorking abroad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(76.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29(39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(60.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida 2\u0026ndash;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77(62.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida \u0026gt;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(54.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHad Abortion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(47.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(52.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136(58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst and second trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49(32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100(67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66(53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58(46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia in previous pregnancy?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(48.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73(40.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108(59.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of ANC visit in the current pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51(36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88(63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42(47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime gap from the previous pregnancy (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le; 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e59(41.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83(58.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(49.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28(50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of family planning?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105(45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e127(54.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious history of neonatal death?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95(41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132(58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption of Nuts and seeds at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16(44.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption of meat, poultry or diary at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74(38.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116(61.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(52.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41(47.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption Egg at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68(60.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70(45.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85(54.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption of Dark green vegetables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46(35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74(49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76(50.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption of Fruits at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23(32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48(67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76(46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78(53.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eIron-Folate supplementation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111(63.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65(36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11(10.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95(89.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e\n \u003ch2\u003eFactors associated with anemia: multivariate analysis\u003c/h2\u003e\n \u003cdiv class=\"gridtable\"\u003eMultivariate analysis showed that age was negatively associated with anemia in pregnancy (AOR=0.9, 95% CI: 0.8-0.9, \u003cem\u003ep=0.03\u003c/em\u003e). Those who traveled by animal carrier or car to the hospital had 2.3 times odds of having anemia as compared to those who traveled on foot (AOR=2.3, 95% CI:1.2-4.7, \u003cem\u003ep=0.01\u003c/em\u003e) and mothers in third trimester had 2.7 times odds of having anemia as compared to in first or second trimester (AOR=2.7, CI:1.5-5.1,\u003cem\u003e\u0026nbsp;p=0.001\u003c/em\u003e). Another noteworthy finding was, those who did not consume dark green vegetables had higher odds of anemia (AOR=2.1, 95% CI:1.1-4, \u003cem\u003ep=0.002\u003c/em\u003e). Furthermore, participants with more than four children had higher odds of anemia as compared to women in their primary pregnancy (AOR=3, CI:1.01-9.2, \u003cem\u003ep= 0.048\u003c/em\u003e) (Table-6).\u003c/div\u003e\n \u003cp\u003e\u003cstrong\u003eTable-6\u003c/strong\u003e Multivariate analysis of factors associated with anemia in pregnancy in Nakfa sub-zone, Eritrea, 2024.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tabg\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCIR\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003cp\u003e(95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9(0.8\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.045\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9(0.8\u0026ndash;0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNakfa town\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOutside Nakfa town\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.4(0.1\u0026ndash;1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMothers Educational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.4(0.7\u0026ndash;3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMode of transport to health facility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOn foot\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBy animal carrier or by car\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(1.3\u0026ndash;6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3(1.2\u0026ndash;4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation of care taker?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWorking abroad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.9(0.4\u0026ndash;9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3(0.3\u0026ndash;5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.7(0.4\u0026ndash;7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDaily laborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3(0.2\u0026ndash;6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGravidity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida 2\u0026ndash;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8(0.3-2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.09(0.4\u0026ndash;2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida\u0026thinsp;\u0026gt;\u0026thinsp;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3(0.6\u0026ndash;7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(1.01\u0026ndash;9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.048\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst and second trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.3(1.04\u0026ndash;5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.03\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.7(1.5\u0026ndash;5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnemia in previous pregnancy?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5(0.2\u0026ndash;1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of ANC visit in the current pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8(0.2\u0026ndash;2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3(0.5\u0026ndash;3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption of meat, poultry or diary at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5(0.7\u0026ndash;3.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption of Dark green vegetables at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.04\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1(1.03\u0026ndash;4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.1(1.1-4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eConsumption of Fruits at least once a week\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(ref)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1(0.4\u0026ndash;2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eCIR= Crude Incidence Ratio, AOR= Adjusted Odds Ration, CI= Confidence Interval\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eP- Values highlighted in bold indicates statistically significant (\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAnemia remains a major public health concern with important implications for both maternal and fetal outcomes. According to the WHO, anemia is classified as a condition of moderate public health significance [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This study assessed the prevalence of anemia and its associated factors among pregnant women in the Nakfa sub-zone, Eritrea.\u003c/p\u003e \u003cp\u003eWomen aged over 34 years accounted for the smallest proportion of participants (4.2%). This finding may be explained by the widespread practice of early marriage in the region, which contributes to higher fertility at younger ages. A comparable age distribution was reported in a study conducted in Asmara, Eritrea, where 13.1% of participants were aged over 34 years [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These findings suggest similarities in socioeconomic and cultural contexts across the country. In the present study, most participants traveled on foot to attend ANC services (72.2%), which likely explains most of our participants resided close to Nakfa town. This supports the assumption that proximity to healthcare facilities influences ANC attendance.\u003c/p\u003e \u003cp\u003eAt the time of data collection, 75% of women in their second trimester were attending for the first time to the ANC service, moreover only 39% of women in the third trimester had completed four or more ANC visits. The WHO recommends a minimum of eight antenatal contacts during pregnancy [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] to ensure timely detection and management of maternal and fetal complications. ANC attendance in this study was lower than that reported in Asmara, where 24.6% of women initiated ANC during the second month of pregnancy [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Improved accessibility in urban settings, including shorter travel times to health facilities, may account for this difference. Nevertheless, the ANC utilization pattern observed in this study is consistent with findings from Ghana [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDaily iron\u0026ndash;folate supplementation throughout pregnancy is recommended by the Ministry of Health of Eritrea in accordance with WHO guidelines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, only 63% of participants in this study reported receiving iron\u0026ndash;folate supplements. Enhancing ANC attendance and strengthening supplementation programs are therefore essential. Although the supplementation coverage observed in this study was lower than reported in Cameroon and Tanzania, where coverage exceeded 90% [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], it was higher than that reported in Uganda [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The variation in supplementation coverage across countries likely reflects differences in health system capacity, supply chain management, and program implementation.\u003c/p\u003e \u003cp\u003eThe prevalence of anemia among pregnant women in this study was 43%, which is classified as a severe public health problem according to WHO criteria [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This prevalence is higher than reports from sub-Saharan Africa overall (35.6%) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], Northern Uganda (24.7%) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], the Mbeya region of Tanzania (25.5%) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], Tigray in northern Ethiopia (7.9%) [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], and Ethiopia at the national level (26.3%) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Conversely, it is lower than the prevalence reported in West Gonja District, Ghana (55.8%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], Somaliland (50.6%) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], Sudan (53.0%) [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], and Bangladesh (58.9%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Such variation may be attributed to differences in socioeconomic conditions, dietary practices, geographic settings, and national health policies.\u003c/p\u003e \u003cp\u003eAlthough 25% of participants were classified as having moderate anemia, no cases of severe anemia were identified. This finding is consistent with reports from other studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], but contrasts with findings from Somaliland, where 12.1% of pregnant women had severe anemia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The absence of severe anemia in the present study may reflect the positive role of ANC services in Eritrea in early identification and management of anemia.\u003c/p\u003e \u003cp\u003eIn the bivariate analysis, a higher prevalence of anemia was observed among women who reported iron\u0026ndash;folate supplementation compared with those who did not (64% vs. 36%). This association should be interpreted cautiously, as the cross-sectional design precludes causal inference. Iron\u0026ndash;folate supplementation may have been initiated as a therapeutic intervention among women already diagnosed with anemia. Additionally, suboptimal adherence to supplementation could limit its effectiveness. Inconsistencies with our finding have been reported elsewhere [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], underscoring the need for longitudinal studies to clarify the relationship between supplementation and anemia.\u003c/p\u003e \u003cp\u003eMultivariable analysis demonstrated a negative association between maternal age and anemia, indicating a higher burden among younger women. This finding contrasts with results from Cameroon [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Women who traveled to health facilities by car or animal carrier had 2.3 times higher odds of anemia compared with those who traveled on foot. Notably, in our study, 97% of women who used car or animal transport resided outside Nakfa town(fig-3), suggesting that longer travel distance may contribute to increased anemia risk.\u003c/p\u003e \u003cp\u003eWomen in their third trimester had 2.7 times higher odds of anemia compared with those in the first or second trimester, consistent with findings from previous studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Increased physiological demand for iron and folate during late pregnancy may partly explain this association. Reduced dietary intake in the third trimester, particularly of nutrient-rich foods [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], may further exacerbate anemia risk.\u003c/p\u003e \u003cp\u003eIn this study, women who did not consume dark green leafy vegetables had a significantly higher risk of anemia (adjusted odds ratio [AOR]\u0026thinsp;=\u0026thinsp;2.1, 95% CI: 1.1\u0026ndash;4.0). Similar associations have been reported in Tanzania and other settings [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Parity was also significantly associated with anemia. Women with more than four children had threefold higher odds of anemia (AOR\u0026thinsp;=\u0026thinsp;3.0, 95% CI: 1.01\u0026ndash;9.2), consistent with findings from other studies [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eLimitation and strength of the study\u003c/h2\u003e \u003cp\u003eOne of the major drawbacks of this study is, the outcome we found is sensitive to any inaccuracy of the response from the study subjects. Secondly, given that this study is a cross-sectional study, it cannot conclude causal relationship. Larger sample size with additional variables like: stool examination, blood cell morphology evaluation and assessment of adherence to Iron-Folate supplementation would have also given this research broader insight. However, considering the study is inclusive in terms of representation, it reflects the burden of anemia in pregnancy in the region.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe magnitude of anemia in Nakfa sub-zone is comparatively high (43%), which may have profound negative effect in the health of mother and child. Factors that are associated with anemia in pregnancy in the present study are; younger age, being traveled by car or animal carrier, being in the third trimester and not consuming dark green vegetables often times. Therefore, we suggest that greater effort should be applied in reducing this burden by improving dietary practices, giving more attention to the pregnant mothers in the third trimester and providing better health care facility and transport system to the remote sites of the region. Finally, our recommendation is further robust study to be done.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eANC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntenatal Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Laboratory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCrude Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAdjusted Odds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eVs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eVersus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePermission was sought from the\u0026nbsp;Health Research Ethics and Protocol Review\u0026nbsp;Committee of the Eritrean Ministry of Health (Letter of reference 29/02/2023)\u0026nbsp;and from the administration of study hospital. \u0026nbsp;An official consent form was signed by every participant before data collection and full confidentiality of the participants were strictly respected.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data set supporting the conclusions of this article is available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u003c/strong\u003eNo funding obtained for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMTK, STM, GGG conceived the study and formulated the study design and participated in data collection. MTK, GGG supervised the data collection process and performed other administrative functions. MTK, OOA, GGG, HT, HHA, STM and AFT did the statistical analysis and data presentation. MTK, OOA, GGG, HT, HHA, STM and AFT wrote and edited the first draft of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Zahra Mohammed for her great assistance in the data collection and all Nakfa Hospital staff who supported us throughout study. \u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFlick AA, Kahn DA. Maternal Physiology during pregnancy and Fetal and Early Neonatal Physiology. Current Obstetrics and Gynecologic Diagnosis and Treatment. 11th ed. New York: McGrawHill; 2013. p. 16379.\u003c/li\u003e\n\u003cli\u003eMarya RK. Medical Physiology. 3rd ed. New Delhi: CBS Publishers and Distributors Ltd.; 2010.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity (No. WHO/NMH/NHD/MNM/11.1). 2011.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Anemias. Geneva: World Health Organization. Available from: https://www.who.int/healthtopics/anaemia [Last accessed on 2022 may 10].\u003c/li\u003e\n\u003cli\u003eWHO. Iron Deficiency Anemia: Assessment, Prevention and Control: A Guide for Program Managers. Geneva, Switzerland: UNICEF, United Nations University, WHO; 2001.\u003c/li\u003e\n\u003cli\u003eMurphy JF. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and mineral nutrition information system. Geneva: World Health Organization (2011).\u003c/li\u003e\n\u003cli\u003eM. A. Mbule, Y. B. Byaruhanga, M. Kabahenda, and A. Lubowa. Determinants of anemia among pregnant women in rural Uganda, Rural and Remote Health. vol. 13, no. 2, p. 2259, 2013.\u003c/li\u003e\n\u003cli\u003eLebso M, Anato A, Loha E (2017) Prevalence of anemia and associated factors among pregnant women in Southern Ethiopia: A community based cross-sectional study. PLoS ONE 12(12): e0188783. https://doi.org/10.1371/ journal.pone.0188783\u003c/li\u003e\n\u003cli\u003eMohamed Mussa Abdilahi, Jonah Kiruja, Badra Osman Farah , Farduus Mohamed Abdirahman , Ahmed Ismail Mohamed , Jama Mohamed and Abdeta Muktar Ahmed. Prevalence of anemia and associated factors among pregnant women at Hargeisa Group Hospital, Somaliland. BMC Pregnancy and Childbirth (2024) 24:332 https://doi.org/10.1186/s12884-024-06539-3\u003c/li\u003e\n\u003cli\u003eWHO. Global prevalence of anemia in 2011. Geneva: Health organization; 2011.\u003c/li\u003e\n\u003cli\u003eStevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, Pe\u0026ntilde;a-Rosas JP, Bhutta ZA, Ezzati M, Group NIMS. Global, regional, and national trends in hemoglobin concentration and prevalence of total and severe anemia in children and pregnant and non-pregnant women for 1995\u0026ndash;2011: a systematic analysis of population-representative data. Lancet Glob Health. 2013;1(1): e16\u0026ndash;25.\u003c/li\u003e\n\u003cli\u003eBrhane Berhe , Fitsum Mardu, Haftom Legese, Aderajew Gebrewahd, Guesh Gebremariam, Kebede Tesfay, Getachew Kahsu, Hadush Negash and Gebre Adhanom. Prevalence of anemia\u003cem\u003e \u003c/em\u003eand associated factors among pregnant women in Adigrat General Hospital, Tigrai, northern Ethiopia, 2018. BMC Res Notes (2019) 12:310 https://doi.org/10.1186/s13104-019-4347-4\u003c/li\u003e\n\u003cli\u003eMeseret Belete Fite, Nega Assefa and Bizatu Mengiste. Prevalence and determinants of\u003cem\u003e \u003c/em\u003eAnemia among pregnant women in sub-Saharan Africa: a systematic review and Meta-analysis. Archives of Public Health (2021) 79:219. https://doi.org/10.1186/s13690-021-00711-3\u003c/li\u003e\n\u003cli\u003eGeta TG, Gebremedhin S, Omigbodun AO (2022). Prevalence and predictors of anemia among pregnant women in Ethiopia: Systematic review and meta-analysis. PLoS ONE 17(7): e0267005. https://doi.org/10.1371/journal. pone.0267005\u003c/li\u003e\n\u003cli\u003eAshraf MA Hussain, Qais Ismaeel kadhem, Nibras Alaa Hussain. Prevalence of anemia in a sample of pregnant women in Babylon Governorate, Iraq\u003cem\u003e. \u003c/em\u003eRevista Latinoamericana de Hipertensi\u0026oacute;n. Vol. 15 - N\u0026ordm; 4,2020.\u003c/li\u003e\n\u003cli\u003eNational Statistics Office (NSO) [Eritrea] and Fafo AIS. 2013. Eritrea Population and Health Survey 2010. Asmara, Eritrea: National Statistics Office and Fafo Institute for Applied International Studies.\u003c/li\u003e\n\u003cli\u003eAnthony Wemakor. Prevalence and determinants of anemia in pregnant women receiving antenatal care at a tertiary referral hospital in Northern Ghana. BMC Pregnancy and Childbirth (2019) 19:495. https://doi.org/10.1186/s12884-019-2644-5 \u003c/li\u003e\n\u003cli\u003eAbel Gebre and Afework Mulugeta.Prevalence of Anemia and Associated Factors among Pregnant Women in North Western Zone of Tigray, Northern Ethiopia: A Cross-Sectional Study. Hindawi Publishing Corporation Journal of Nutrition and Metabolism Volume 2015, Article ID 165430, 7 pages http://dx.doi.org/10.1155/2015/165430\u003c/li\u003e\n\u003cli\u003eMekdemariam Getachew, Mebrahtu Abay, Hiwet Zelalem, Tirhas Gebremedhin, Teklit Grum and Alemayehu Bayray. Magnitude and factors associated with adherence to Iron-folic acid supplementation among pregnant women in Eritrean refugee camps, northern Ethiopia. BMC Pregnancy and Childbirth (2018) 18:83 https://doi.org/10.1186/s12884-018-1716-2\u003c/li\u003e\n\u003cli\u003eMeron Berhe Tsegai1, Abiel Habtom Berhe, Semhar Berhane Tesfaezgi, Dawit G Weldemariam, Kifleyesus Tedla Petros, Hana Bereket Weldetinsae, Eyasu H Tesfamariam. Knowledge, Attitude, and Practice Regarding Supplemental Iron and Folic Acid Amongst Women Delivering in Edaga-Hamus Community Hospital: A Cross-Sectional Study in Asmara, Eritrea, International Journal of Women\u0026rsquo;s Health 2023:15 1593\u0026ndash;1609\u003c/li\u003e\n\u003cli\u003eWHO recommendations on antenatal care for a positive pregnancy experience. World health organization,Geneva,2016.http://www.who.int/reprodctivehealth/publications/maternal_perinatal_health/anc-positive-pregncncy-experience/en/(Accesed on December01, 2016).\u003c/li\u003e\n\u003cli\u003eBasil Addayire Tibambuya, John Kuumuori Ganle \u0026amp;, Muslim Ibrahim. Anaemia at antenatal care initiation and associated factors among pregnant women in West Gonja District, Ghana:\u003cem\u003e \u003c/em\u003ea cross-sectional study\u003cem\u003e.\u003c/em\u003e The Pan African Medical Journal. 2019; 33:325. doi:10.11604/pamj.2019.33.325.17924\u003c/li\u003e\n\u003cli\u003eHenri, E., Valere, M.K., Lucas, E.E., Calixte, P.I., Ngalame, C.M., Gr\u0026acirc;ce, T.T., Ekobo, A.S. and Moukoko, C.E.E. (2019). Hematological Profile and Risk Factors of Anemia in Pregnant Women: A Cross Sectional Descriptive and Analytical Study in Douala Cameroon. Open Journal of Obstetrics and Gynecology, 9, 968-980. https://doi.org/10.4236/ojog.2019.97094\u003c/li\u003e\n\u003cli\u003eLema EJ, Seif SA. Prevalence of anemia and its associated factors among pregnant women in Ilala Municipality - Tanzania: Analytical cross-sectional study. Medicine 2023; 102:23 (e33944).\u003c/li\u003e\n\u003cli\u003eWorld Health Organization, worldwide prevalence of anemia 1993-2005: WHO global database on anemia, 2008.\u003c/li\u003e\n\u003cli\u003eSamson Udhoa, Joyce Nankumbib , Mariam Namutebib , David Mukunyac,d, Grace Ndeezie and James K Tumwine. Prevalence of anemia in pregnancy and associated factors in northern Uganda: a cross-sectional study.\u003cem\u003e \u003c/em\u003eSouth African Journal of Clinical Nutrition 2023; 36(4):136\u0026ndash;141 https://doi.org/10.1080/16070658.2022.2148909\u003c/li\u003e\n\u003cli\u003eAbdallah F, John SE, Hancy A, Paulo HA, Sanga A, Noor R, et al. (2022). Prevalence and factors associated with anemia among pregnant women attending reproductive and child health clinics in Mbeya region, Tanzania. PLOS Glob Public Health 2(10): e0000280. https://doi.org/ 10.1371/journal.pgph.0000280\u003c/li\u003e\n\u003cli\u003eIshag Adam, Yassin Ibrahim and Osama Elhardello, Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC Hematology (2018) 18:31. https://doi.org/10.1186/s12878-018-0124-1\u003c/li\u003e\n\u003cli\u003eAhmed, S., Al Mamun, Md.A., Mahmud, N., Farzana, N., Sathi, M.S.A., Biswas, B.K., Datta, A. and Ahmad, T. (2019). Prevalence and Associated Factors of Anemia among Pregnant Women Receiving Antenatal Care (ANC) at Fatima Hospital in Jashore, Bangladesh: A Cross-Sectional Study. Food and Nutrition Sciences,10,1056-1071.https://doi.org/10.4236/fns.2019.109076 \u003c/li\u003e\n\u003cli\u003eBerrick Otieno, Cyrus Mutie, Salwa Elmawi, Marttin Kyania Mulala, Makorani Y\u0026rsquo;Dhidha-a-Mjidho, Isaac Kyalo1, Mwaswere Juma, and Osman Abdullahi. Prevalence and Predictors of Anaemia in Pregnant Women Receiving Antenatal Care at Kilifi County Referral Hospital, Kenya. \u003cem\u003eAfrican Journal of Health Sciences Volume 36, Issue No.5, September \u0026ndash; October 2023\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"prevalence, Anemia, pregnancy, Eritrea, Nakfa, predictors","lastPublishedDoi":"10.21203/rs.3.rs-8599815/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8599815/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Anemia in pregnancy is a fairly common public health problem with major implications for fetal and maternal health. Despite its importance, data on pregnancy-related anemia is hard to obtain for countries in Sub-Saharan Africa. In this study, we aimed to determine the prevalence of anemia and associated risk factors in women attending Antenatal clinic of Nakfa hospital, Nakfa sub-zone, Eritrea.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Hospital based cross-sectional study was conducted from 1\u003csup\u003est\u003c/sup\u003e May – 31\u003csup\u003est\u003c/sup\u003e August of 2024. In total, 283 women, visiting Nakfa hospital Antenatal Care clinic, were enrolled. Relevant metadata was collected via researcher administered questionnaire and medical records. In addition, standard phlebotomy techniques were employed to collect specimen for diagnosis of anemia. To identify and categorize anemia, the WHO criteria was employed. Data were analyzed using SPSS software version 26.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e The median age of the participants was 25 years [IQR: 22-28 years] with minimum and maximum age of 18 and 42 years, respectively. The overall, prevalence of anemia was 43% (95% CI: 38.9 – 48.7) with a mean hemoglobin concentration of 11.09 gm/dl (±1.64 SD). Among patients with anemia, 25% had moderate anemia and 17.6% had mild anemia. Factors associated with anemia in the bivariate analysis included level of education of mother and husband, mode of transport; and trimester. Protective factors included consumption of meat, poultry or diary; dark green vegetables; and fresh fruits. However, anemia was higher among the participants who took Iron-Folate than those who did not take (63% Vs 10%, \u003cem\u003ep\u0026lt;0.01\u003c/em\u003e). In the multivariate analysis age was negatively associated with anemia (AOR=0.9, 95% CI: 0.8-0.9, \u003cem\u003ep=0.03\u003c/em\u003e). Those who traveled by animal carrier or car (AOR=2.3, 95% CI:1.2-4.7, \u003cem\u003ep=0.01\u003c/em\u003e), women in third trimester (AOR=2.7, CI:1.5-5.1, \u003cem\u003ep=0.001\u003c/em\u003e), those who did not consume dark green vegetable (AOR=2.1, 95% CI:1.1-4, \u003cem\u003ep=0.002\u003c/em\u003e) and participants with more than four children (AOR=3, CI:1.01-9.2, \u003cem\u003ep= 0.048\u003c/em\u003e) had higher rate of anemia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study demonstrated that the prevalence of anemia is high among pregnant women attending Nakfa hospital’s ANC clinic. The findings underscore the urgent need for improved ANC monitoring along with relevant public health strategies directed at addressing the problem. In addition, expanded research on anemia etiology is warranted.\u0026nbsp;\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Prevalence and factors associated with anemia among pregnant women in Nakfa district, Eritrea: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-13 15:09:13","doi":"10.21203/rs.3.rs-8599815/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-22T10:09:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-02T05:52:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"35939704120376006032495375832144768013","date":"2026-03-28T05:01:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321715094930977406936454017226092391888","date":"2026-03-26T05:05:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-21T04:42:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"296870959190698815883041087175771193633","date":"2026-03-11T14:37:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211642339725643768977986322277533876024","date":"2026-03-09T17:11:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-09T14:07:15+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-27T07:26:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-24T07:37:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-24T07:37:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-01-14T08:52:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2561ff95-6a7c-4a11-ba99-f53d4886caab","owner":[],"postedDate":"March 13th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T15:09:13+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-13 15:09:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8599815","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8599815","identity":"rs-8599815","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}