Socio-demographic characteristics
A total of 6680 women were included in the analysis. The mean age was 28.6 years (SD: 9.4). Among the samples, 1386 (20.7%) were within the age group 15–19 years old while 1,225 (18.3%) were 20—24 and 1,153 (17.3%) were 25–29 years old. Around 24.6% (1646) of the participants were from the Eastern province, 21.6% (1442) were from the Western province, 24% (1605) were from the Southern province, 16.3% (1088) were from the Northern province and 13.5% (899) were from Kigali city. The highest education level achieved varied, with 2863 (42.9%) having completed primary school and only 184 (2.8%) having education above secondary education. More than half (n = 3434, 51.4%) of the women were married or living together with their husbands; 2622 (39.3%) were in poor economic status, 1249 (18.7%) were in middle class and 2809 (42.1%) were in rich class (Table 1).
Anemia status
The mean Haemoglobin (Hb) level across the sample, adjusted for altitude and smoking status, was 13.02 g/dl (SD: 1.52), translating to a 19.2% anemia prevalence among WRA (95% CI: 18.0 - 20.5). Most cases were of mild anemia, with a prevalence of 15.7% (95% CI: 14.6 - 16.8); 3.4% (95% CI: 2.9 - 3.9) were moderate anemia, and 0.2% (95% CI: 0.1 - 0.3) were severe anemia.
The anemia prevalence was found to be higher among women aged 45—49 years (24.2%, 95% CI: 20.3 - 28.1), among those aged 40–44 years (19.7%, 95% CI; 16.7 - 23.2), in the Southern province (22.9%, 95% CI: 20.4 - 25.6), in the Eastern province (21.8%, 95% CI: 18.9 - 25.0), among women in the poor category (22.5%, 95% CI; 20.6 - 24.5), among women with no education (22.5%, 95%CI: 19.5 - 25.8), who were separated from their husbands or widowed (24.8%, 95% CI: 21.4 - 28.5), who were underweight (26.3%, 95% CI: 22.0 - 31.1), those who did not sleep under a mosquito net (21.5%, 95% CI: 19.5 - 23.6), and among women who were using Intra-Uterus Devices (IUDs) as a contraceptive method (29.1%, 95% CI: 19.2 - 41.5) (Table 1).
Anemia prevalence was relatively low among those who completed secondary school (15.9%, 95% CI: 12.1 - 20.7) and primary school (16.8%, 95% CI: 14.8 - 19.1), as well as among women in the rich category (16.4%, 95% CI: 14.9 - 18.0).
The bivariate analysis found 11 variables were significantly associated with anemia: 1) province of residence (p = <0.001), 2) educational attainment (p = 0.010), 3) economic status (p = <0.001), 4) marital status (p = 0.001), 5) pregnancy status (p = 0.019), 6) type of FP method used (p = <0.001), 7) nutrition status (p = <0.001), 8) have a mosquito bed net for sleeping (p = 0.020), 9) sleeping under a mosquito bed net the night before the survey (p = 0.003), 10) type of toilet facility used in the household (p = 0.003), and 11) type of residence (p = 0.010) (Table 1)..
Factors associated with anemia
Six risk factors for anemia among WRA adjusted for age and marital status were found in the multivariate analysis, they were: 1) the nutrition status, 2) economic status, 3) type of contraceptive method used, 4) use of a mosquito net, 5) marriage status, and 6) province of residence (Table 2).
Compared to WRA with normal BMI, underweight women were more likely to have anemia (OR: 1.39, 95% CI: 1.09 - 1.77, p value = 0.009) while obese women were less likely to have anemia (OR: 0.61, 95% CI: 0.41 - 0.92, p value = 0.019).
Compared to women in poor category, women in the rich category were less likely to have anemia (OR: 0.74, 95% CI: 0.63 - 0.87, p value <0.001). There was a marginally significant difference in the likelihood of having anemia between women in the poor category and women in the middle category (OR: 0.83, 95% CI: 0.69—1.00, p value = 0.044).
Women who were using hormonal contraceptives were less likely to have anemia (OR: 0.60, 95% CI: 0.50 - 0.72, p value: <0.001) while those who were using Intrauterine Devices were more likely to have anemia (OR: 1.97, 95% CI: 1.04 - 3.73, p value = 0.037) compared to those who were not using any contraceptive method or who were using natural barriers or permanent contraceptive methods.
Compared to women who were not married, women who were separated or widowed were more likely to have anemia (OR: 1.35, 95% CI: 1.09 - 1.67, p = 0.006). There was no difference between married and non-married women (p = 0.25).
Women who reported sleeping under a mosquito net the night before the survey were less likely to have anemia (OR: 0.85, 95% CI: 0.73 - 0.98, p value = 0.025) than those who did not sleep under a mosquito net the night before the survey. Additionally, women who were living in Southern province (OR: 1.45, 95% CI: 1.15 - 1.82, p value = 0.002) and in Eastern province (OR: 1.41, 95% CI: 1.11 - 1.79, p value = 0.005) were more likely to be have anemia than were WRA living in Kigali city.