Background: Anaemia continues to be a major cause of morbidity amongst pregnant women with attendant consequences. Rural women are likely to be more predisposed to anaemia in pregnancy than their urban counterparts as a result of lower socio-economic environment prevalent in the rural areas. This study was carried out to determine the prevalence of anaemia in pregnant women within a rural environment prior to antenatal care. Objective: To determine the prevalence of anaemia and factors that influence aneamia in pregnancy in rural women prior to commencing antenatal care. Materials and Methods: This is a descriptive study of pregnant women at the antenatal registration visit at Irrua Specialist Hospital in 2012. Three hundred and eighty pregnant women were randomly selected and their packed cell volume (PCV) determined at presentation for antenatal care. Biomedical data was collected at presentation using a structured questionnaire. Data was collated and analyzed with Statistical Package for Social Sciences (SPSS) software Version 17 and presented as percentages, proportions and cross tabulations. Findings: The mean age of the studied population was 30.2 ± 5.2 years. The mean gestational age at booking was 16.5 ± 7.6 weeks. The mean packed cell volume for the women at booking was 33.9 ± 3.1%. However, one hundred and thirty two (34.7%) of three hundred and eighty women were anaemic (packed cell volume < 33%) though majority (29.2%) had mild anaemia. There was none with severe anaemia. Lack of education, increasing parity and reduced interval from last pregnancy are factors associated with anaemia in these rural women. Conclusion/Recommendations: Anaemia is prevalent in the rural Irrua women at booking. High parity, low level of education and use of heamatinics prior to booking all associated with the occurrence of anaemia in pregnancy in these women. The study suggested that anaemia may predate the pregnancy in the majority of cases. Preconception care should be encouraged which will include, educating mothers on anaemia and family planning. This, accompanied by iron and folic acid supplementation as well as antimalarial prophylaxis will strongly reduce this prevalence of anaemia in pregnancy.