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Abstract

Background:

Anaemia in pregnancy is a major public health concern in Tanzania, affecting maternal and neonatal outcomes. This scoping review synthesises existing evidence on the prevalence, risk factors, and perinatal outcomes to inform policy and programmes.

Methods:

A systematic search was conducted across EMBASE, PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and ScienceDirect for studies published between 2010 and 2025 on anaemia among pregnant women in Tanzania. Eligible studies reported on prevalence and/or associated factors. Two reviewers independently screened, extracted data, and assessed study quality using PRISMA guidelines. A narrative synthesis was used to thematically group and interpret the findings.

Results:

Sixteen studies met the inclusion criteria, with anaemia prevalence ranging from 20% to 83.5% and a pooled estimate of 52.6% (95% CI: 41.6–63.4). Key risk factors included young maternal age, low education and socioeconomic status, high gravidity, poor dietary diversity, short inter-pregnancy intervals, inadequate ANC attendance, and maternal infections such as HIV and malaria. Protective factors included being married, higher education, adequate ANC visits, facility delivery, and use of anti-malarial drugs, health insurance, food security, and a positive attitude towards anaemia prevention. Anaemia was linked to adverse outcomes such as preterm birth, low birth weight, and reduced newborn anthropometric indices, though some studies found no significant association.

Conclusion:

Anaemia in pregnancy in Tanzania exceeds the WHO threshold of 40%, representing a serious public health problem that requires targeted interventions, including improved nutrition, antenatal care, and maternal health education, to reduce adverse maternal and neonatal outcomes.

Keywords

prevalence anaemia in pregnancy risk factors maternal anaemia Tanzania scoping review

Introduction

Anaemia during pregnancy is a global problem linked to adverse perinatal outcomes.¹ Anaemia in pregnancy is a condition where the body lacks sufficient healthy red blood cells or haemoglobin to deliver oxygen to the mother and baby.² The WHO defines it as haemoglobin levels below 11 g/dL, classified as mild (9.0–10.9 g/dL), moderate (7.0–8.9 g/dL), and severe (<7.0 g/dL).³

Several factors have been outlined to cause anaemia, with Iron deficiency being considered the major factor. Untreated Iron deficiency anaemia during pregnancy is associated with negative maternal and newborn health outcomes, including a higher risk of maternal and perinatal morbidity and mortality, preterm birth, intrauterine foetal death (IUFD), intrauterine growth retardation (IUGR), and low birth weight (LBW).^3,4 Anaemia affects 38% of pregnant women and 29% of non-pregnant women internationally, accounting for 20% of all maternal fatalities and being a substantial health problem worldwide.⁵

The prevalence of anaemia among pregnant women is disproportionately high in Africa, with the World Health Organization reporting a rate of 61.3%, compared to 52.5% in Southeast Asia and a global average of 41.8%.⁶ Sub-Saharan Africa (SSA) alone accounts for approximately 30% of global anaemia cases among pregnant women, affecting an estimated 17.2 million women.⁶ In low- and middle-income countries, iron deficiency is the leading cause, responsible for up to 75% of cases.⁷ This trend is further reflected in regional studies, such as one from Ghana, which reported a pregnancy anaemia prevalence of 78.5%, underscoring the persistent burden of the condition across the continent.⁸

Despite modest progress reflected in the Tanzania Demographic and Health Surveys, which show a slight decline in anaemia prevalence among pregnant women from 57% in 2016/2017 to 56% in 2022/2023,⁹ the burden remains unacceptably high. Regional studies continue to report prevalence rates of up to 83.5% among women attending antenatal care (ANC) clinics.¹⁰ This persistent challenge exists despite the wide implementation of preventive interventions, including the use of insecticide-treated nets, malaria prophylaxis, deworming, and iron–folic acid supplementation.¹¹ Given the inconsistencies across studies and the limited synthesis of evidence on risk factors and maternal–neonatal outcomes, a comprehensive review is warranted. This scoping review aims to synthesise existing evidence on the prevalence, risk factors, and birth outcomes of anaemia among pregnant women in Tanzania, within the context of current antenatal interventions. The findings are intended to inform targeted public health strategies, guide future research, and strengthen maternal health programmes to reduce anaemia and improve pregnancy outcomes in Tanzania.

Methods and materials

Search strategy

This scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines,¹² and the completed checklist is provided as Supplemental File: PRISMA-ScR Fillable Checklist. A comprehensive literature search was performed across multiple electronic databases, including Medline, EMBASE, PubMed, CINAHL, Web of Science, Scopus, PsycINFO, and ScienceDirect. In addition, grey literature sources, such as unpublished PhD dissertations and master’s theses, were manually searched to capture relevant unpublished studies. The search covered studies published between January 2010 and May 2025. A combination of keywords and Boolean operators was used to ensure a broad search strategy, including: “anemia” OR “anaemia” AND “pregnancy” AND “prevalence” AND “risk factors” AND “perinatal outcomes” AND “Tanzania.” Furthermore, reference lists of all included articles were manually screened to identify additional relevant studies, ensuring a thorough review of the literature.

Inclusion criteria

Studies were conducted specifically among pregnant women in Tanzania. Only studies published between January 2010 and May 2025 were considered. Eligible articles needed to report on the prevalence, risk factors, or perinatal outcomes of anaemia in pregnancy. Furthermore, only full-text articles published in English were included, encompassing both peer-reviewed publications and relevant grey literature such as PhD dissertations and master’s theses.

Exclusion criteria

The exclusion criteria for this review included interventional studies, reviews, editorials, and case reports, as they did not align with the observational focus of the study. Studies that lacked sufficient data on the prevalence, risk factors, or perinatal outcomes of anaemia in pregnancy were also excluded. Additionally, duplicate studies and abstracts without accessible full-text versions were not considered for inclusion.

Selection of the studies

A comprehensive search was conducted to identify studies reporting on the prevalence, associating factors, and perinatal outcomes of anaemia among pregnant women in Tanzania. Observational studies (cross-sectional, cohort, or case-control) published in English between 2010 and 2025 were eligible. All search results were imported into Zotero version 7.0.17, where duplicates were removed. Two authors (S.MM. and C.DE.) independently screened titles and abstracts using a structured checklist based on the Participants, Interventions/Exposure, Comparison, Outcomes, and Study Setting (PICOS) framework, capturing key variables such as study aim, design, sample size, data collection methods, anaemia prevalence, and associated factors. Full-text articles were retrieved and assessed for final inclusion based on relevance, methodological quality, and outcome measures. Discrepancies were resolved through discussion. Reference lists of included studies were also reviewed to identify additional relevant publications. Due to heterogeneity and variations in study design, data were summarised narratively rather than quantitatively. Meta-biases, including publication bias and selective reporting, were evaluated where feasible. Finally, the overall strength and certainty of the cumulative evidence were assessed using the GRADE approach to provide transparent and actionable conclusions for policy and practice. The study selection process is summarised using a PRISMA flow diagram (Figure 1).

Figure 1.

Illustration of the procedure for selection. Adopted from the PRISMA Guideline.¹²

Data extraction and quality assessment

The authors participated in the data extraction process. A data extraction template was developed in advance, including key variables such as author name, year of publication, study location, sample size, odds ratio, confidence intervals, and p-values. Each author independently extracted data using the template, after which the results were cross-checked and compared for consistency. Any discrepancies or partialities observed were discussed collectively, and a consensus was reached. The quality of the included studies was assessed using the Modified Newcastle-Ottawa Scale.¹³ This tool assigns a maximum of nine stars, with studies considered high quality if they scored 7 or more, and medium quality if they scored at least 5.¹³

Registration

This review was not registered with PROSPERO, as it was conducted as part of an academic research project that had already received institutional review. Despite the lack of registration, the study adhered to PRISMA-ScR guidelines to ensure methodological rigour and transparent reporting.

Data analysis

Data from the included studies were extracted and managed using Microsoft Excel and STATA version 17. Given the objectives of this scoping review, only pooled prevalence estimates of anaemia were calculated. Estimates were summarised descriptively, with 95% confidence intervals reported where available. Subgroup analyses were performed by grouping studies into geographic region, and year of publication, to explore variations in anaemia prevalence. Sensitivity analysis assessed the influence of study quality by comparing pooled prevalence from studies with higher versus lower risk of bias. Results from pooled, subgroup, and sensitivity analyses were presented in figures to enhance transparency and facilitate interpretation. Publication bias was assessed qualitatively using funnel plots and Egger’s regression test, with interpretation being cautious due to the descriptive nature of the review.

Results

A total of 1238 potential articles were identified: 991 from electronic databases (Scopus, Web of Science, PubMed, and Cochrane Library), 247 from Google Scholar, and 1 grey literature source (a Master’s thesis from Muhimbili University). After removing 796 duplicates, 442 unique records were screened by title and abstract, with 312 excluded for not meeting the review objectives. Of the 130 full-text articles assessed, 114 were excluded, leaving 16 studies for final analysis. This selection process ensured the inclusion of high-quality and diverse evidence, including academic theses often overlooked (Figure 1).

Study characteristics

A review of 16 studies (2011–2025)^{3,4,10,11,14–25} shows anaemia prevalence among pregnant women in Tanzania ranging from 20.0% to 83.5%, with higher rates in coastal and island regions (Pwani, Unguja, Kibaha)^10,15,16,26 and lower in central and northern areas (Dodoma, Kilimanjaro).^3,23 Most were facility-based cross-sectional studies with sample sizes ranging from 233 to 2654 (Table 1).

Table 1.

Characteristics of included studies on anaemia prevalence among pregnant women in Tanzania.

Authors/year	Region/study site	Study design	Statistical analysis	Sample size	Prevalence (%)
Konje 2022	Mwanza	FBC	Descriptive/multivariate	768	68.8
Abdallah 2022	Mbeya	FBC	Descriptive/multivariate	420	25.5
Ngimbudzi 2021	Pwani	FBC	Descriptive/multivariate	418	83.5
Lema 2023	Dar es Salaam	FBC	Descriptive/multivariate	367	57.2
Sunguya 2021	Whole Tanzania	PBS	Descriptive/multivariate	2194	57
Stephen 2018	Kilimanjaro	FBC	Descriptive/multivariate	539	20
Gibore 2021	Unguja Island	FBC	Descriptive/multivariate	338	80.8
Margwe 2018	Mbulu-Manyara	FBC	Descriptive/multivariate	354	46.3
Nyagawa 2025	Dodoma	FBC	Descriptive/multivariate	396	33.3
Msuya 2011	Moshi-Tanzania	FBC	Descriptive/multivariate	2654	47.4
Marwa 2025	Kibaha-Pwani	FBC	Descriptive/multivariate	233	46.8
Kara 2020	Mtwara	FBC	Descriptive/multivariate	356	46.3
Schmiegelow 2024	Tanga	Cohort study	Descriptive/multivariate	346	31.8
Ali 2019	Unguja Island	FBC	Descriptive/multivariate	388	80.8
John 2023	Mbeya	FBC	Descriptive/multivariate	420	37.8
Mlugu 2020	Kibiti-Pwani	FBC	Descriptive/multivariate	819	68.5

FBC: facility-based cross-sectional study; PBS: population-based study.

Pooled prevalence of anaemia

Figure 2 presents the pooled prevalence of anaemia among pregnant women in Tanzania, estimated at 52.6% (95% CI: 41.6–63.4), with very high between-study heterogeneity (I² > 90%, p < 0.001). Subgroup analyses revealed variation by year of publication, with studies from 2011 to 2015 (n = 1) reporting 47.4% (I² = 0%), 2016–2020 (n = 5) 53.9% (I² = 82%), and 2021–2025 (n = 10) 54.1% (I² = 87%), indicating an increasing trend over time (Figure 3). Regional differences were also observed, with the highest pooled prevalence in the Coastal zone (60.1%, I² = 82%), followed by Lake (68.8%, single study), Northern (44.0%), Central (33.3%), and Southern Highlands (32.0%; Figure 4). Sensitivity analyses showed that the pooled estimate was robust to exclusion of individual studies, and publication bias assessment indicated no substantial small study effects. Overall, heterogeneity reflects true epidemiological variation across regions and study settings rather than bias.

Figure 2.

Pooled prevalence of anaemia in Tanzania.

Figure 3.

Pooled anaemia prevalence among pregnant women in Tanzania by geographic zone.

Figure 4.

Pooled anaemia prevalence among pregnant women in Tanzania by year of publication.

Table 2 summarises key risk and protective factors for anaemia in pregnancy in Tanzania, with common risks including low socioeconomic status, poor dietary diversity, young maternal age, low education, and short birth intervals. Few studies reported perinatal outcomes, but anaemia was associated with preterm birth and LBW.

Table 2.

Summary of associated factors for anaemia in Tanzanian pregnant women.

Author/year	Key risk factors	Key protective factors	Perinatal outcomes
Konje, 2022	-	-	-
Abdallah, 2022	Lower socio-economic status; Lack of daily consumption of dark green leafy vegetables; Use of vegetable liquid cooking oil	-	-
Ngimbudzi, 2021	Being in the third trimester; Not consuming specific foods (vegetables, meat, eggs, fish); Inadequate minimum dietary diversity	-	-
Lema, 2023	Primary education level; Short inter-pregnancy interval (<18 months); Being in the third trimester; Not taking IPT; Not taking iron/folic acid supplements; Low dietary diversity	Moderate appetite	-
Sunguya, 2021	Larger household size; Young maternal age (15–19 years)	Age 20–34 years; Education (primary or higher); ≥3 pregnancies; Health insurance; Delivery in a health facility; Received anti-malarial drugs during pregnancy; Adequate ANC attendance; Food-secure household	-
Stephen, 2018	Clinic of recruitment; Low educational level	-	No association
Gibore, 2021	Inadequate dietary diversity; Drinking tea/coffee with meals; <3 meals/day; Higher education; Short birth interval (<2 years); Multigravida	-	-
Margwe, 2018	High gravidity; Low knowledge about anaemia; Unfavourable attitude towards anaemia prevention	-	-
Nyagawa, 2025	Young age (15–24 years)	Being married; College education; ≥8 ANC visits; Pregnancy interval > 2 years; Adequate knowledge and positive attitude towards anaemia prevention	-
Marwa, 2025	Clinic of recruitment; Low household income; Living ≤ 5 km from a health facility; Reported iron supplement side effects	-	Preterm birth
Msuya, 2011	Maternal HIV; Malaria; Clinic of recruitment; Low income	-	Increased risk of LBW
Kara, 2020	Low education; Poor occupation status; Low family income; High gravidity; Breastfeeding; Advanced gestational age	-	-
Schmiegelow, 2024	-	-	Foetal weight z-score reduction; Reduced newborn anthropometric indices (birth weight z-score, abdominal circumference); Least reduction in haemoglobin associated with smaller newborns
Ali, 2019	Gravidity; Irregular intake of iron tablets; Having a child aged < 2 years	-	-
John, 2023	Age 20–24 years; Unemployment; No iron/folic acid supplementation; Not consuming edible vegetable cooking oil	Higher socio-economic status	-
Mlugu, 2020	Adolescent age (<20 years); Primigravida; Late initiation of ANC	-	-

Factors associated with anaemia in pregnancy

Educational status

Seven studies reported a significant association between educational status and anaemia among pregnant women. Three studies identified low education as a risk factor: Lema and Seif⁴ and Kara et al.¹⁸ both reported an AOR of 2.3, while Margwe and Lupindu¹⁹ associated informal education and anaemia in pregnancy. Three studies found higher education to be protective. Sunguya et al.²⁵ found that primary and secondary education reduced anaemia risk by 31% and 26%, respectively, compared to no education (p < 0.001). Nyagawa et al.²³ reported a higher education level as a protective effect against anaemia among pregnant women, and Stephen et al.³ found that primary and secondary education reduced the odds of anaemia by 72% and 79%, respectively. However, one study¹⁶ found an increased risk of anaemia among women with higher education (AOR = 3.4).

Knowledge and attitude

Two studies reported that knowledge and attitudes towards anaemia significantly influence anaemia risk in pregnancy. Margwe and Lupindu¹⁹ identified low knowledge and an unfavourable attitude towards anaemia prevention as risk factors. While Nyagawa et al.²³ reported that adequate knowledge and a positive attitude towards anaemia prevention were protective factors.

Household income

Five studies identified a significant association between low socioeconomic status or household income and anaemia in pregnancy. Abdallah et al.¹⁴ and Marwa²² found that women from low income households were more likely to be anaemic. Similarly, Kara et al.¹⁸ and Msuya et al.²¹ reported that limited financial resources increased the risk of anaemia. In contrast, John et al.¹⁷ noted that women with higher socioeconomic status had a lower risk of anaemia.

Maternal age

Six studies reported a significant association between maternal age and anaemia in pregnancy. Younger age groups (15–24 years) were identified as risk factors,^14,19,20,25 whereas older age groups (20–34 years) were found to be protective.^23,25

Occupation

Ali et al.¹⁵ found that unemployment increased the risk of anaemia, whereas Kara et al.¹⁸ reported that employment in the public or private sector was protective, with employed women being less likely to be anaemic. Furthermore, Married women had a lower risk of anaemia,²³ whereas a larger household size was associated with a higher risk.²⁵

Nutritional and dietary factors

Six studies identified poor dietary habits, particularly low intake of iron-rich foods, as major contributors to anaemia in pregnancy. Abdallah et al.¹⁴ reported that not consuming dark green leafy vegetables daily and using vegetable liquid cooking oil increased the risk, while John et al.¹⁷ found that not consuming edible vegetable oil was also a risk factor. Lema and Seif⁴ and Ngimbudzi et al.¹⁰ highlighted low dietary diversity and inadequate intake of vegetables, meat, eggs, and fish as key risks. Gibore et al.¹⁶ noted that consuming fewer than three meals per day and drinking tea or coffee with meals elevated the risk. Conversely, Sunguya et al.²⁵ observed that living in a food-secure household was protective against anaemia.

Multigravidity

Six studies identified an association between multigravidity and anaemia in pregnancy. Ali et al.,¹⁵ Mlugu et al.,²⁰ Gibore et al.,¹⁶ Margwe and Lupindu,¹⁹ and Kara et al.¹⁸ reported that women with multiple pregnancies had a higher risk of developing anaemia. In contrast, a study by Sunguya et al.²⁵ found that having three or more pregnancies was associated with a lower risk of anaemia.

Pregnancy interval

Four studies identified an association between the interval between pregnancies and anaemia in pregnancy. Lema and Seif,⁴ Ali et al.,¹⁵ and Gibore et al.¹⁶ reported that short inter-pregnancy intervals, less than 18 months and less than 2 years, respectively, were risk factors. Whereby, Nyagawa et al.²³ found that an interval greater than 2 years was associated with a lower risk.

Gestational age

Three studies^4,10,18 identified being in the third trimester or having advanced gestational age as a risk factor for anaemia in pregnancy.

Supplementation and prophylaxis

Four studies examined the association between iron supplementation and anaemia in pregnancy. Lema and Seif,⁴ Ali et al.,¹⁵ and John et al.¹⁷ identified a lack of iron and folic acid supplementation as a key risk factor, while Marwa²² found that experiencing side effects from iron supplements was paradoxically associated with a lower risk of anaemia.

Two studies indicated an association between the use of Intermittent Preventive Treatment (IPT) and anaemia in pregnancy. Lema and Seif⁴ reported that not taking IPT during pregnancy was associated with an increased risk of anaemia. Similarly, Sunguya et al.²⁵ found that receiving antimalarial drugs during pregnancy was a protective factor against anaemia.

Health conditions

Msuya et al.²¹ found that underlying health conditions, especially malaria and maternal HIV infection, significantly increase the risk of anaemia during pregnancy.

ANC visits

Three studies reported an association between ANC attendance and a reduced risk of anaemia in pregnancy. Nyagawa et al.²³ found that attending more than eight ANC visits was protective, while Sunguya et al.²⁵ reported that adequate attendance (four or more visits) lowered the risk. Conversely, Mlugu et al.²⁰ found that late initiation of ANC increased the likelihood of anaemia.

Clinic of recruitment

Three studies^3,21,22 identified the clinic of recruitment as a significant factor for anaemia in pregnancy, with some clinics showing higher odds of anaemia among pregnant women compared to others.

Distance to health facility

Distance to health facility appears to influence anaemia risk in pregnancy. Marwa²² reported that living within 5 km of a health facility was protective, whereas Msuya et al.²¹ found that a greater distance contributed to an increased risk of anaemia.

Perinatal outcomes

Four studies examined anaemia in pregnancy and perinatal outcomes. Msuya et al.²¹ reported increased risk of LBW, Marwa²² found a significant association with preterm birth, and Stephen et al.³ found no significant link. Schmiegelow et al.²⁴ showed that anaemia was associated with reduced foetal weight z-scores and smaller newborn anthropometric indices, including birth weight and abdominal circumference.

Discussion

This scoping review synthesised evidence from 16 studies on anaemia in pregnancy in Tanzania, revealing a high pooled prevalence of 52.6%. Key risk factors included young age, low education and income, poor diet, short birth intervals, inadequate ANC, and infections such as HIV and malaria. Protective factors were higher education, adequate ANC, facility delivery, malaria prevention, and food security. Anaemia was linked to preterm birth, LBW, and reduced newborn size, highlighting its continued public health importance.

This study estimated a pooled prevalence of anaemia of 52.6% among pregnant women in Tanzania, exceeding the WHO threshold of 40% that defines a severe public health concern.²⁷ This indicates that anaemia in pregnancy remains a major and persistent challenge. Subgroup analyses showed an increasing prevalence over time, from 47.4% in 2011–2015 to over 54% in studies published between 2016 and 2025, suggesting limited progress in control efforts. Marked geographical variation was also observed, with higher prevalence in the Coastal and Lake zones and lower levels in the Northern, Central, and Southern Highlands zones. These differences likely reflect variations in malaria burden, nutrition, and access to antenatal care.

Compared with the East African average of 41.8%²⁸ and nearly similar to Ghana’s prevalence of 50%,⁸ Tanzania’s pooled estimate reflects a notably higher burden. In contrast, much lower rates reported in Southwest China (18%)²⁹ highlight how disparities in dietary patterns, healthcare access, and socioeconomic development can affect maternal anaemia outcomes.^30,31 The pronounced heterogeneity and persistently high prevalence despite expanded ANC coverage underscore potential gaps in the reach, quality, and implementation of interventions aimed at preventing and managing anaemia during pregnancy.²⁵ These findings emphasise the need for region-specific strategies to strengthen ANC services, enhance nutrition education, ensure equitable access to iron and folic acid supplementation, and address socioeconomic inequalities to effectively reduce anaemia and improve maternal and neonatal health outcomes in Tanzania.

This study highlights the pivotal role of education in shaping anaemia risk among pregnant women, emphasising the need to understand its multifaceted effects. Education enhances women’s awareness of nutrition, ANC attendance, and adherence to iron supplementation, while also improving their ability to navigate the healthcare system and make informed health decisions.^18,25 Similarly, good knowledge and positive attitudes towards anaemia prevention are associated with healthier behaviours, such as consuming iron-rich foods and adhering to supplementation, which lower anaemia risk.³² Evidence from Ethiopia and Ghana supports that higher educational attainment leads to better dietary practices and reduced anaemia prevalence.^6,8 However, some studies report higher anaemia rates among educated urban women, possibly due to lifestyle factors such as dietary transitions, stress, or limited time for self-care.^16,33 These findings suggest that education interacts with socioeconomic and cultural contexts in complex ways. Therefore, beyond expanding formal education, integrating context-specific health literacy and nutritional counselling into ANC programmes is essential to ensure that knowledge effectively translates into improved maternal health outcomes.

Low household income and socioeconomic status increase the risk of anaemia in pregnancy by limiting access to nutritious food, dietary diversity, and essential healthcare services like iron supplementation and ANC.³⁰ Financial constraints restrict the ability to afford iron-rich foods and preventive measures, increasing susceptibility to anaemia caused by nutritional deficiencies and infections like malaria.³⁴ Studies from Nigeria and Nepal also show a strong link between low economic status and higher anaemia prevalence.^5,30 Large household size, often linked to poverty, limits access to health services and increases anaemia risk in pregnancy.^25,33 These combined factors contribute to adverse maternal and perinatal outcomes, such as LBW and preterm delivery. Addressing anaemia in pregnancy requires integrated strategies that tackle poverty and expand access to quality ANC for underserved populations.

Adequate ANC attendance, four or more visits, significantly reduces anaemia risk by facilitating timely iron supplementation, malaria prevention, and health education, consistent with evidence from SSA.^28,35 However, anaemia remains prevalent due to late ANC initiation, poor adherence, and variability in health facility resources and quality of care.^5,8,21 Geographic accessibility further influences outcomes: living within 5 km of a health facility lowers anaemia risk by improving ANC access, while greater distances are associated with higher anaemia prevalence, reduced adherence to interventions, and poorer maternal health outcomes.^{28,30,36–38} Similar patterns have been reported in Ethiopia, Nigeria, Uganda, and rural Indonesia, highlighting the importance of facility proximity and capacity in maternal health.^5,37–39 Strengthening early and frequent ANC attendance, expanding healthcare infrastructure, and improving transportation and mobile health services are critical strategies to reduce anaemia and improve maternal outcomes.

Maternal age is a key factor in anaemia risk during pregnancy, with adolescents (15–19 years) consistently shown to be more vulnerable due to biological immaturity, higher nutritional demands, and limited access to healthcare and nutrition.^19,25 Similarly, studies from Australia and China show that younger age is linked to higher anaemia prevalence and worse pregnancy outcomes.^33,40 In contrast, women aged 20–34 tend to have a lower risk due to better health awareness, nutritional status, and ANC use.^23,41 Targeted adolescent interventions, health education, nutrition, and delayed pregnancy are vital in high-burden, low-income settings.⁴² To reduce anaemia in pregnant adolescents in Tanzania, strengthen nutrition and ANC education, train providers for adolescent-friendly care, promote reproductive health to delay early pregnancies, and integrate nutrition support into maternal health programmes.

Poor dietary habits such as low intake of iron-rich foods, infrequent meals, and drinking tea or coffee with meals significantly contribute to anaemia in pregnancy, while food security lowers the risk. Poor diet limits iron intake, while tea and coffee reduce iron absorption. In contrast, food security ensures access to nutritious foods, lowering anaemia risk.⁴³ This aligns with studies from Ethiopia and a systematic review identifying low meat intake, poor dietary diversity, and meal timing as key risk factors.^36,43 Tea and coffee inhibit iron absorption, while meat and vegetables provide essential nutrients like haeme iron and folic acid. To prevent anaemia, it is crucial to promote dietary diversity, increase intake of iron- and vitamin C-rich foods, and limit iron absorption inhibitors during meals.^36,43 These nutrition-focussed strategies, along with food security initiatives, are vital for addressing anaemia among pregnant women.

Multigravidity, having multiple pregnancies, is a known risk factor for anaemia during pregnancy due to cumulative nutritional depletion, shorter birth intervals, and increased physiological demands. Each pregnancy reduces maternal iron stores, and without sufficient time and nutrition to replenish them, women become more vulnerable to anaemia.^8,31 Similarly, studies show multigravida women have significantly lower haemoglobin levels and higher rates of moderate to severe anaemia compared to first-time mothers.³¹ Increased blood volume and foetal iron demands worsen iron depletion, especially with closely spaced pregnancies and poor nutrition, causing risks like preterm birth and LBW. Limited ANC and iron supplements in low-resource settings further increase this risk.^8,44 Addressing anaemia in multigravida women requires strengthening ANC, promoting birth spacing, and ensuring iron supplementation with dietary counselling to improve maternal and neonatal health.

Short inter-pregnancy intervals (less than 24 months) significantly increase the risk of anaemia due to insufficient time for maternal iron and nutrient stores to replenish. A systematic review⁴³ confirms this link, especially in low-resource settings with inadequate nutrition and supplementation.³³ Advanced gestational age, particularly the third trimester, is also associated with higher anaemia risk. This is due to physiological haemodilution and increased foetal iron demands that deplete maternal stores.^33,45 Studies consistently show higher anaemia rates as pregnancy progresses.³⁰ Birth spacing, anaemia screening, and integrated care can reduce anaemia and improve maternal and newborn health.

Iron and folic acid (IFA) supplementation, combined with IPT for malaria, significantly reduces anaemia risk during pregnancy. Daily IFA use markedly lowers maternal anaemia, with one study reporting a 75% reduction among women taking over 180 tablets,³⁹ and WHO recommends daily iron (30–60 mg) with 400 µg folic acid.⁴⁶ Although side effects may occur, intermittent regimens are better tolerated, and nutrition education improves adherence, haemoglobin levels, and anaemia prevention.⁴⁷ In malaria-endemic areas, IPT with sulfadoxine-pyrimethamine is critical to prevent malaria-related haemolysis and inflammation, and lack of IPT increases anaemia risk.⁴⁶ When integrated into ANC, IFA supplementation, IPT, and adherence support can reduce anaemia by up to 73% and iron deficiency by 67%.⁴⁸ Addressing barriers such as side effects through education and community engagement further enhances effectiveness, particularly in low-resource settings.

Malaria and HIV are major contributors to anaemia in pregnancy, especially in low-resource settings. Malaria increases anaemia risk by causing red blood cell destruction, placental sequestration, and impaired blood production.⁴⁹ A systematic review found that even asymptomatic malaria increases the risk of anaemia by more than two times.³⁵ HIV worsens anaemia through inflammation, nutrient deficiencies, bone marrow suppression, and infections.⁵⁰ Routine screening and treatment of malaria and HIV, use of IPT and ART and health education during ANC are key to reducing anaemia-related complications in pregnancy.

Maternal anaemia adversely affects perinatal outcomes, including LBW, preterm birth, and reduced newborn anthropometric indices, with evidence supported by meta-analyses and cohort studies.^33,47 Severe or early-pregnancy anaemia increases the risk of preterm delivery, likely due to reduced oxygen supply to the foetus and placenta.⁴⁰ Studies from Ethiopia and other settings also link maternal anaemia, particularly iron deficiency, to stillbirth, congenital anomalies, and neonatal mortality, often exacerbated by poor nutrition, infections, and inadequate ANC.^1,38,40 Early screening, timely iron supplementation, and quality ANC, implemented through coordinated efforts by the Ministry of Health, regional and district medical authorities, and local and international non-governmental organisations (NGOs), are critical to mitigating these adverse maternal and neonatal outcomes.

Limitations and implications of the study

The study’s strengths include the use of diverse data sources and a focus on Tanzania, providing relevant insights and policy guidance. Although it relies on published data of varying quality and lacks primary data, the inclusion of grey literature and theses helped capture a broader range of evidence. High heterogeneity and potential publication bias were acknowledged, with pooled estimates interpreted cautiously. These strengths support policy-relevant conclusions, emphasising the need to strengthen early ANC, improve iron supplementation, and enhance health facility capacity to reduce maternal anaemia and improve pregnancy outcomes.

Conclusion

Anaemia in pregnancy remains a major public health concern in Tanzania, with prevalence exceeding the WHO threshold and highlighting the urgent need for coordinated action. Addressing this burden requires an integrated maternal health package that combines multiple interventions within routine ANC. Such a package could include nutrition counselling and iron-folic acid supplementation to improve dietary diversity, malaria prevention strategies such as intermittent IPTp and distribution of insecticide-treated nets, and promotion of family planning to support optimal birth spacing. Embedding these interventions within ANC services ensures accessibility and continuity of care. Effective implementation will require coordinated efforts among the Ministry of Health, regional and district medical authorities, and local and international NGOs to strengthen health systems, improve maternal nutrition, and ultimately reduce anaemia-related complications and adverse perinatal outcomes across Tanzania.

Supplemental Material

sj-docx-1-phj-10.1177_22799036261423640 – Supplemental material for Prevalence, risk factors, and birth outcomes of anaemia in pregnancy across Tanzania: A scoping review

Supplemental material, sj-docx-1-phj-10.1177_22799036261423640 for Prevalence, risk factors, and birth outcomes of anaemia in pregnancy across Tanzania: A scoping review by Magnus Michael Sichalwe, Dolness Erick Charles, Regnald Raymond Kimaro, Abdul Basit, Grace Tavengana and Manas Ranjan Behera in Journal of Public Health Research

Footnotes

Acknowledgements

We sincerely thank all the authors whose studies contributed to this review, providing valuable data and insights on anaemia in pregnancy. We are also grateful to our colleagues and mentors for their guidance and support throughout the study. Special appreciation goes to the institutions and organisations that facilitated access to research resources and literature.

ORCID iDs

Magnus Michael Sichalwe

Manas Ranjan Behera

Author contributions

M.M. Sichalwe: Conceptualisation, Methodology, Data collection and curation, Formal analysis, Funding acquisition, Investigation, Resources, Project administration, Writing–original draft, Writing–review & editing. D.E. Charles: Methodology, Project administration, Writing–original draft, Writing–review & editing. R.R. Kimaro: Methodology, Resources, Writing–original draft, Writing–review & editing. A. Basit: Methodology, Resources, Writing–original draft, Writing–review & editing. G. Tavengana: Methodology, Data curation, Formal analysis, Resources, Project administration, Writing–original draft, Writing–review & editing. M.R. Behera: Methodology, Resources, Writing–original draft, Writing–review & editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

All data supporting the findings of this study are included within the article.

Supplemental material

Supplemental material for this article is available online.

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Supplementary Material

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Prevalence,risk factors,and birth outcomes of anaemia in pregnancy across Tanzania: A scoping review