This study aims to evaluate the prevalence of nutritional anaemia and identify its associated factors among pregnant women in the Sibu Sire District, Western Ethiopia.

A facility-based cross-sectional study.

Public health centres in the Sibu Sire District, Western Ethiopia.

A total of 422 pregnant women attending antenatal care services between February and July 2023.

The primary outcome was the prevalence of nutritional anaemia, determined by haemoglobin concentration. Secondary outcomes included the relationship between nutritional anaemia and factors such as household size, maternal nutritional status (mid-upper arm circumference (MUAC)) and dietary diversity.

Nutritional anaemia was prevalent in 45.7% of the study participants. Multivariable logistic regression analysis revealed significant associations between anaemia and household size (adjusted OR (AOR) = 1.43; 95% CI 1.05 to 1.94), poor maternal nutritional status (MUAC

Nutritional anaemia remains a significant public health issue among pregnant women in the Sibu Sire District, affecting nearly half of the study population. The findings underscore the critical influence of household size, maternal nutritional status and dietary diversity on anaemia risk during pregnancy. Addressing these modifiable factors through comprehensive antenatal nutrition programmes, community-based education and targeted interventions may improve maternal and fetal health outcomes in resource-limited settings.