Postpartum Anemia After Cesarean Delivery and Its Associated factors in Southern Ethiopia: A Cross-Sectional Study

Abstract Background: Postpartum anemia (PPA) is a common maternal health problem, particularly among mothers undergoing cesarean delivery due to increased perioperative blood loss. Despite the rising rate of cesarean section in Ethiopia, evidence on the burden of post-cesarean delivery anemia is lacking in the Southern Ethiopia region. This study aimed to assess the prevalence of postpartum anemia and its associated factors. Methods: An institution-based cross-sectional study was conducted from May 1 to September 30, 2025, among 349 mothers who underwent cesarean section at Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH). Participants were selected using systematic sampling, and data were collected via an interviewer-administered questionnaire and a medical record review. Postpartum anemia was diagnosed as a hemoglobin level < 11 g/dL after 24 hours of cesarean section. Multivariable regression models were used to identify factors independently associated with postpartum anemia. Results: The mean age of participants was 26.6 ± 6.4 years. The prevalence of post-cesarean delivery anemia was 81/349 (23.2%) (95% CI: 18.6–28.3) After controlling for potential confounding variables, lack of antenatal care follow-up (AOR = 4.90; 95% CI: 2.60–9.23), postpartum hemorrhage (PPH) (AOR = 6.50; 95% CI: 2.77–15.26), poor adherence to iron and folic acid supplementation (AOR = 2.30; 95% CI: 1.22–4.34), and prolonged surgery duration (≥ 60 minutes) (AOR = 2.10; 95% CI: 1.19–3.71) were significantly associated with postpartum anemia. Conclusion Nearly one-quarter of mothers who underwent cesarean delivery developed postpartum anemia. Comprehensive antenatal and postpartum care to prevent postpartum anemia after cesarean section should focus on improving antenatal care utilization, preventing postpartum hemorrhage, enhancing adherence to folic acid and iron supplementation, and minimizing unnecessary prolongation of cesarean section procedures.