Background Anemia during pregnancy is a major public health problem, particularly in malaria-endemic regions such as the Democratic Republic of Congo (DRC). This study aimed to estimate the prevalence of maternal anemia and identify associated factors among pregnant women delivering in Mbujimayi, a city in central DRC. Methods A cross-sectional study carried out from August 15, 2023 to March 14, 2024 in four maternity units. Data combined individual interviews with medical record searches and biological laboratory analyses. Hemoglobin levels were determined on arrival at the maternity hospital, using a HemoCue？ automatic hematology analyzer. Capillary blood was tested for plasmodial infections using thick drop and thin smear microscopy, as well as a rapid diagnostic test targeting the Plasmodium falciparum HRP2 antigen. Uni- and multivariate statistical logistic regression models were used to assess factors associated with anemia. Results A total of 199 parturients were recruited, with an average age of 28.3 ± 6.4 years, mainly secondary education (72.4%) and a domestic occupation (51.3%). The prevalence of maternal anemia was 21.1% [CI 95% 15.8 - 27.6] and that of malaria was 18.1% [CI 95% 13.1; 24.3]; P. falciparum was the most prevalent species (85.7% [95% CI 42.0; 99.2]), followed by P. malariae (14.3% [95% CI 0.75; 57.9]). The median hemoglobin level was statistically different according to malaria status: 11.2 g/dL (8.5 - 14 g/dL) versus 11.9 g/dL (8.1 - 14.2 g/dL) with p = 0.0028. Illiteracy and history of malaria during pregnancy were found to be significant factors, multiplying the risk of anemia by 2.5 for the former (aOR = 2.5 [95% CI 1.1; 5.9]; p = 0.035) and by 4 for the latter (aOR = 4.3 [95% CI 1.9; 9.9]; p ？ 0.001). Preterm delivery was significantly associated with anemia (adjusted OR = 3.7 [95% CI 1.4; 9.1]; p = 0.006). Conclusion Anemia is common among pregnant women in Mbujimayi, so education of young girls must be encouraged, and preventive and curative treatment of malaria must be stepped up.
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