Anemia among Women of Reproductive Age (WRA) continues to be among the major public health problems in many developing countries, including Rwanda, where it increased in prevalence between the 2015 and 2010 Rwanda Demographic and Health Survey (RDHS) reports. A thorough understanding of its risk factors is necessary to design better interventions. However, to the best of our knowledge, no study has been conducted in Rwanda on a nationally representative sample to assess factors associated with

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... nemia among WRA. Accordingly, this study was conducted to address such gap. Methods A quantitative, cross-sectional study was conducted using data from the RDHS 2014-2015 report. The study population consisted of 6680 WRA who were tested for anemia during the survey. Anemia was defined as having a hemoglobin level equal to or below 10.9 g/dl for a pregnant woman, and hemoglobin level equal to or below 11.9 g/dl for a non-pregnant woman. Pearson's chi-squared test and multiple logistic regression were conducted for bivariate and multivariable analysis, respectively. Results The prevalence of anemia among WRA was 19.2% (95% CI: 18.0 -20.5). Four factors were found to be associated with lower odds of anemia, including being obese (OR: 0.61, 95% CI: 0.40 -0.91), being in the rich category (OR: 0.74, 95% CI: 0.63 -0.87), sleeping under a mosquito net (OR: 0.85, 95% CI: 0.74 -0.98), and using hormonal contraceptives (OR: 0.61, 95% CI: 0.50 -0.73). Five factors were associated with higher odds of anemia, including being underweight (OR: 1.39, 95% CI: 1.09 -1.78), using an intrauterine device (OR: 1.98, 95% CI: 1.05 -3.75), being separated or widowed (OR: 1.35, 95% CI: 1.09 -1.67), and living in the Southern province (OR: 1.45, 95% CI: 1.11 -1.89) or in the Eastern province (OR: 1.41, 95% CI: 1.06 -1.88). Conclusion Anemia continues to pose public health challenges; novel public health interventions should consider geographic variations in anemia risk, seek to improve women's economic statuses, and strengthen iron supplementation especially for Intrauterine device users. Additionally, given the association between anemia and malaria, interventions to prevent malaria should be enhanced. Background Anemia is a significant public health problem affecting around 1.93 billion people worldwide (1). It Study setting Rwanda is a land-locked African country with an estimated population of 10,515,973 in 2012, of which 51.8% were female. Around 48.55% of all female are women of reproductive age, between 15 and 49 years of age (19). The country is characterized by rapid population growth (2.6% annually) and a GDP per capita of 702.84 USD (19,20). Rwanda has demonstrated marked improvement in maternal health over the past 20 years (21). In 2015, the Total Fertility Rate was 4.2 (down from 6.1 in 2005), and the maternal mortality rate was 210 per 100,000 live births, reduced from 1071 in 2000. Ninety-nine percent (99%) of pregnant women attend at least one antenatal care session, and 91% delivered at health facilities. The contraceptive prevalence rate was estimated to be 53% (10). Study design: This study used a quantitative, cross-sectional design by analysing data from the 2014-2015 Rwanda Demographic and Health Survey (RDHS). Sampling and Data Collection Method The 2014-15 RDHS data were collected using standard Demographic and Health Survey (DHS) questionnaires, which were adapted by stakeholders from the Rwandan government and its partners to reflect specific social and cultural issues in Rwanda. All questionnaires were translated from English to Kinyarwanda and were pre-tested prior to actual data collection. The data collection was conducted by qualified and trained professionals with rigorous supervision. Sampling was based on the 2012 Rwanda Population and Housing Census (RPHC) which consists of a list of villages, considered enumeration areas (EAs). They were stratified by type of residence (rural or urban) in each district, and 60 sampling strata were created from all districts. A two-stage cluster sampling design was used to ensure that estimates were representative at national level. At the first stage, 492 EAs were selected from all sampling strata (113 from urban areas and 379 from rural areas), and then, a systematic sampling strategy was carried out by first listing all households in selected EAs. At the second stage, 26 households were randomly selected from each EA, resulting in 12,792 households Furthermore, the authors also thank the MEASURE DHS Project for availing open access to the data. Authors' contributions DH designed the project, acquired the data, conducted the literature review, wrote the manuscript, and was responsible to submit it. DH and MN conducted the statistical analysis. RW and JL provided overall advisory on the project and manuscript revision. All authors reviewed and approved the final manuscript.