OBJECTIVES: Anaemia in pregnancy remains disease of Public Health Concerns in Ghana, however limited intervention exits for its prevention during preconception period. This study aimed at determining prevalence and factors associated with it at ANC registration at District Health facility to inform policy. METHODS: We conducted analytic cross-sectional study. A total of 232 ANC registrants aged 15-45 years were randomly selected between February –July 2016. We interviewed participants on socio-demographic, past medical, obstetrics, diet, medications using interviewer administered structured questionnaires, and routinely requested Hemoglobin and malaria parasitamia data were analyzed. Data abstracted was managed in EPI info 7 and Stata 13.0. Univariate and Multiple logistic regression analysis were done at 95% confidence level. RESULTS: Prevalence of anaemia among participants was 31.0%. While 44% of participants aged 25-29, 25% aged 30-34 years. Fifty two percent had primary education, 30.2 and 11.6 percent had secondary and tertiary respectively. Whiles 72.8 percent registered in 2nd and 3rd trimesters, only 27.2% registered in the 1^st trimester. Logistic regression analysis (95% confidence level) showed low monthly income < 25.00 USD [APOR= 2.33; Pvalue 0.05], Sickle Cell Disease [APOR= 3.41; Pvalue 0.01], eating fish [APOR= 0.29; Pvalue 0.01], and eating of fruits [APOR= 0.24; Pvalue 0.00] were significantly associated with developing anaemia in pregnancy at registration. However, only bivariate analysis showed preconception haematenic intake [POR= 1.20; CI 0.51-2.79], having some formal education [POR=0.56; CI 0.20-1.52], eating cereal/grain [POR=2.34; CI 1.07-5.12] and tubers [POR=0.62; CI 0.35-1.10] to be associated with the disease. CONCLUSIONS: Undoubtedly, there is high prevalence of anaemia in pregnancy particularly among low income earning women with majority of registrants presenting late. Preconception sickle cell disease screen coupled with comprehensive dietary counseling and support among prospective pregnant women has the potential to prevent anaemia in pregnancy.