Abstract

Anemia in pregnancy is one of the most prevalent, multifactorial, and preventable contributors to maternal mortality 
in Africa. This comparative review synthesizes epidemiologic evidence, biological mechanisms, health-system 
determinants, and intervention strategies to examine how anemia exacerbates maternal mortality risks across 
diverse African contexts. Iron deficiency remains the leading cause globally, yet in Africa its impact is magnified by 
malaria, helminth infections, HIV, tuberculosis, nutritional deficiencies, and hemoglobinopathies such as sickle cell 
disease. The synergistic interaction between pre-existing anemia and obstetric hemorrhage is identified as a key 
pathway to maternal death. Comparative analysis highlights regional differences: malaria and SCD dominate in 
West Africa, hookworm and dietary insufficiencies in East Africa, HIV-related anemia in Southern Africa, and diet
driven anemia in North Africa. Health-system factors including limited antenatal care coverage, fragile blood 
transfusion services, and supply-chain gaps further amplify risks. While proven interventions exist, including iron
folic acid supplementation, intermittent preventive treatment in pregnancy, deworming, intravenous iron therapy, 
and strengthened blood systems, their impact is often undermined by low coverage, poor adherence, and systemic 
weaknesses. Addressing these challenges requires integrated, context-sensitive strategies, robust data systems, and 
sustained policy commitment. This review underscores anemia as a central determinant of maternal survival and 
proposes a pragmatic agenda for reducing preventable maternal deaths in Africa.