Anemia among pregnant and lactating women in Baghdad, Iraq: Prevalence, severity, and independent predictors in a comparative cross-sectional study

Background: Anemia in women of reproductive age remains a major public health problem, with the highest risk during pregnancy and lactation. Baghdad’s two health directorates, Al-Rusafa and Al-Karkh, are rarely compared with each other.
Objectives: To compare the prevalence and severity of anemia among pregnant and lactating women attending primary health care centers (PHCs) in the two directorates, and to identify its independent determinants.
Methods: A comparative cross-sectional study included 600 pregnant and lactating women attending PHCs in Baghdad, 300 per directorate. A structured interview covered sociodemographic, obstetric and dietary variables; dietary diversity was assessed with the Minimum Dietary Diversity for Women (MDD-W) indicator. Hemoglobin was measured in all participants and anemia defined by WHO cut-offs. Directorates were compared using chi-square and t-tests, and variables significant at the bivariate level entered a multivariable logistic regression model.
Results: Overall anemia prevalence was 41.3% (248/600), significantly higher in Al-Rusafa than Al-Karkh (47.3% versus 35.3%, P = 0.003), with correspondingly lower mean hemoglobin (10.8 ± 1.6 versus 11.4 ± 1.3 g/dL, P < 0.001). Anemia was mostly mild (21.3%) or moderate (16.3%); 3.7% was severe. Seven variables were independently associated with anemia: no iron supplementation (adjusted OR [AOR] 2.86, 95% CI 1.81–4.52), fewer than four antenatal care visits (AOR 2.41, 1.54–3.76), low dietary diversity (AOR 2.11, 1.34–3.31), tea immediately after meals (AOR 1.89, 1.22–2.93), birth spacing under 24 months (AOR 1.76, 1.11–2.78), Al-Rusafa residence (AOR 1.68, 1.07–2.64) and age under 25 years (AOR 1.54, 1.01–2.36).
Conclusions: Anemia affected about four in ten pregnant and lactating women attending PHCs in Baghdad, with an uneven burden between directorates. Because the strongest predictors were service-related and dietary, they are largely modifiable. Securing supplement supply and adherence, improving antenatal attendance, and counselling on dietary diversity and tea timing are practical priorities, beginning in Al-Rusafa.