Anaemia in pregnancy (AIP) is a public health concern due to its devastating effects on women and their unborn babies, resulting in increased maternal and neonatal deaths in developing countries. Despite several Ghanaian health policies to combat AIP, AIP is still on the rise. It becomes imperative to identify geographic-specific factors for developing appropriate interventions for the management of AIP. However, Kassena Nankana West District (KNWD) in the Upper East Region of Ghana lacks a study on anaemia risk factors, therefore, this study estimated the prevalence and risk factors for anaemia among pregnant women in the district.   A household-based cross-sectional study was conducted on 376 pregnant women in their third trimester from February to March 2023. Anthropometric, obstetric, sociodemographic, and health facility resource characteristics were collected using structured questionnaires and antenatal records. Mixed-effect logistic regression was used to identify independent factors of anaemia at 95% confidence interval.   Prevalence of AIP was 53.9%. Mild, moderate, and severe anaemia prevalence was 16.9%, 35.3%, and 1.7% respectively. Malaria infection during pregnancy (aOR=1.563; 95%CI:1.087 – 2.475) and accessing health facilities without trained laboratory personnel (aOR=5.271; 95%CI:1.641 – 16.93) were associated with increased odds of AIP. Belonging to the major ethnic group (aOR=0.431; 95%CI:0.280 – 0.675), accessing health facilities without laboratory services (aOR=0.151; 95%CI:0.047 – 0.487), and accessing health facilities without sulphadoxine-pyrimethamine drugs …