Factors associated with anemia severity among anemic pregnant women attending antenatal care at Mohamed Mooge and Xawaadle health centers, Hargeisa, Somaliland: a cross-sectional study

Abstract Background Anemia in pregnancy is defined by the World Health Organization (WHO) as a hemoglobin concentration below 11 g/dL. It remains a significant public health challenge in many developing countries and is associated with increased risks of maternal and perinatal mortality, premature delivery, and low birth weight. Objectives To identify factors associated with anemia severity among pregnant women attending antenatal care at Mohamed Mooge and Xawaadle Health Centers in Hargeisa, Somaliland. Methods A facility-based cross-sectional study was conducted at Mohamed Mooge and Xawaadle Health Centers. A total of 210 pregnant women were recruited using a structured questionnaire, and data were collected from 1 June to 30 June 2026. Descriptive statistics and ordinal logistic regression were performed using Stata. The ordinal logistic regression analyses were restricted to the 190 women diagnosed with anemia to identify factors associated with anemia severity, categorized as mild, moderate, or severe. Results The overall prevalence of anemia among the 210 pregnant women was 90.48% (190/210). Among the 190 women with anemia, 43.16% had mild anemia, 44.21% had moderate anemia, and 12.63% had severe anemia. In the final multivariable ordinal logistic regression model, gestational age was significantly associated with anemia severity. Compared with women in the first trimester, those in the second trimester had lower odds of greater anemia severity (AOR = 0.39, 95% CI: 0.17–0.91, p = 0.029), as did those in the third trimester (AOR = 0.34, 95% CI: 0.14–0.84, p = 0.019). Good nutritional practices were associated with lower odds of greater anemia severity, although the association did not reach statistical significance (AOR = 0.47, 95% CI: 0.22–1.02, p = 0.059). Conclusion Anemia was highly prevalent among pregnant women attending antenatal care at the selected health facilities in Hargeisa. Gestational age was significantly associated with anemia severity, while good nutritional practices showed a non-statistically significant association with lower odds of greater anemia severity. Strengthening anemia prevention and control strategies, including nutrition counseling and routine nutritional assessment within antenatal care, may help address the high burden of anemia. Further prospective studies are recommended to clarify the temporal relationships between gestational characteristics, nutritional practices, clinical factors, and anemia severity among pregnant women in Somaliland.