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Objective To determine prevalence of anaemia in pregnancy in southern Malawi, and to establish if an ‘at risk’ group can be identified for targeted intervention.

Design Prospective cross-sectional study.

Setting A semi-urban hospital and a rural health clinic in southern Malawi.

Population Pregnant women attending the antenatal clinic for their booking visit.

Methods Haemoglobin concentration (g/dL) measured from a capillary blood sample (fingerprick) by battery operated HemoCue machine.

Results In urban Blantyre 57% of women were anaemic by WHO standards (haemoglobin < 11.0 g/dL) and 3.6% were severely anaemic (haemoglobin < 7.0 g/dL). The prevalence was higher in the rural area; 72% and 4.0%, respectively. Primiparae were at slightly increased risk for overall anaemia and severe anaemia but the effect of targeting this group alone for interventions would mean at least 65% of anaemic women and over half of the women with severe anaemia would be excluded. When the effect of age was examined separate from gravidity, adolescents were not found to be at increased risk of anaemia. Anaemia was more prevalent in the wet season and in women who booked late for antenatal care.

Conclusion The prevalence of anaemia in pregnancy in our population is unacceptably high and deserves more attention. Prophylaxis of all women rather than an ‘at risk’ group based on age or gravidity is recommended.