Background/Objectives: Anemia remains a major global public health problem, disproportionately affecting women of reproductive age in low- and middle-income countries. In Mozambique, its high burden reflects persistent socioeconomic, nutritional, and regional inequalities. This study analysed trends in prevalence, regional distribution, and factors associated with anemia among women aged 15-49 years in Mozambique using data from the 2003, 2011, and 2022-2023 Demographic and Health Surveys (DHS).

Methods: Data from three population-based, cross-sectional DHS surveys conducted over a 20-year period were analyzed, including hemoglobin measurements from approximately 5,000 non-pregnant women per survey. Anemia was defined according to World Health Organization criteria. Weighted prevalence estimates were calculated, and associated factors were examined using Poisson regression with robust variance, accounting for the complex survey design. Analyses were performed using Stata 18.0.

Results: The national prevalence of anemia increased from 38% in 2003 to 44% in 2011 and 48% in 2022-2023, indicating a persistent severe public health problem. Marked regional inequalities were observed, with higher prevalences in the northern region in 2003 and 2011, and extremely high prevalences in Zambézia (61%) and Nampula (60%) in 2022-2023. After multivariable adjustment, residence in central and northern provinces, female headship of household, and lower socioeconomic status were associated with higher anemia risk, while higher education, contraceptive use, and better nutritional status were protective.

Conclusions/Recommendations: Anemia among women of reproductive age in Mozambique remains highly prevalent and unevenly distributed, driven by socioeconomic, reproductive, and nutritional determinants. Targeted, regionally tailored interventions are urgently needed to reduce anemia and related health inequalities nationwide.

Financiamento: Auxílio Pesquisador Visitante (PRINT 88887.878288/2023-00), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brasil.