The Prevalence and Associated Risk Factors of Anemia among Pregnant Women Attending ANC in Public Health Facilities: The Case of Assosa Zone, Benishangul Gumuz Regional State, Ethiopia

Background Anemia during pregnancy is a major global public health problem associated with adverse maternal and fetal outcomes, particularly in low-resource countries. Understanding local prevalence and risk factors is crucial for effective intervention. Objective To determine anemia prevalence and associated risk factors among pregnant women attending Antenatal Care (ANC) in public health facilities in Benishangul, Ethiopia. Methods This institutional cross-sectional study included 809 laboring women admitted between October and November 2021. Data on socio-demographics, obstetric history, health behaviors, and diet were collected via patient records and questionnaires. Anemia status was determined from clinical records. Binary logistic regression identified predictors. Results Anemia prevalence was 35.7% (95% CI: 32.4%-39.1%). Factors significantly increasing anemia odds included pre-existing anemia (AOR = 2.48, 95% CI: 1.69–3.65), history of successive menstrual bleeding (AOR = 1.68, 95% CI: 1.18–2.40), miscarriage history (AOR = 3.39, 95% CI: 2.18–5.32), malaria during pregnancy (AOR = 2.99, 95% CI: 1.78–5.11), chronic disease (AOR = 5.44, 95% CI: 3.62–8.28), and fasting during pregnancy (AOR = 2.95, 95% CI: 2.04–4.29). Factors associated with lower odds were folic acid supplementation (AOR = 0.51, 95% CI: 0.36–0.73), being divorced versus married (AOR = 0.34, 95% CI: 0.14–0.74), and consuming fruit daily relative to weekly (AOR = 0.64, 95% CI: 0.41–0.99). The model showed good fit the data and excellent discrimination (AUC = 0.852). Conclusion Anemia prevalence among pregnant women in Benishangul is multifactorial, associated with reproductive history, infections, chronic conditions, and nutritional factors. Findings necessitate targeted ANC interventions, including strengthened malaria control, chronic disease management, folic acid promotion, and context-specific nutritional counseling.