Maternal anemia in helminth-infected pregnant women: Dose–response with hookworm intensity and other risk factors in a Ugandan cross-sectional study

BACKGROUND: Anemia remains a significant global public health challenge, affecting approximately 25% of the world's population and disproportionately impacting pregnant women, with an estimated 40% prevalence worldwide. Intestinal helminth infections exacerbate this burden, with anemia prevalence reported as high as 55.6% among infected pregnant women compared to 16.4% in those uninfected. This study aimed to determine the burden of anemia and its determinants among pregnant women with helminthiasis attending antenatal care at tertiary Hospitals in western Uganda. Methods: A hospital-based cross-sectional study was conducted from 1st November 2022-1st March 2023, enrolling 420 pregnant women diagnosed with helminthiasis attending antenatal clinics. Data were collected via interviewer-administered questionnaires and laboratory records. Descriptive statistics and multivariable logistic regression analyses were performed using IBM SPSS version 23 to identify factors independently associated with anemia. Results: The prevalence of anemia was 26.2% (95% CI: 22.2-30.6), with 39.1% (95% CI: 30.5-48.4) mild, 35.5% (95% CI: 27.1-44.7) moderate, and 25.5% (95% CI: 18.2-34.3) severe cases. Multivariate analysis showed that moderate and heavy hookworm intensities increased anemia risk nearly two-fold (aOR = 1.90, 95% CI: 1.16-3.54; p = 0.028) and 2.4-fold (aOR = 2.40, 95% CI: 1.06-5.41; p = 0.041), respectively. Protective factors included being a student (aOR = 0.17, 95% CI: 0.05-0.63; p = 0.008), deworming ≥3 months prior (aOR = 0.11, 95% CI: 0.01-0.88; p = 0.038), using borehole water (aOR = 0.60, 95% CI: 0.36-1.00; p = 0.048), and gestational age 14-27 weeks (aOR = 0.57, 95% CI: 0.35-0.92; p = 0.020). Conclusions: Maternal anemia showed a clear dose-response with hookworm intensity, with risk increasing from moderate to heavy infection. Delayed deworming and unsafe water increased odds, whereas being a student and second-trimester gestation were protective. Timely anthelminthic treatment, improved water access, and strengthened antenatal care are critical in endemic settings.