Objectives: To investigate the main causes of anemia in pregnancy in Dar-es-Salaam and identify appropriate investigations at all levels of care. Materials: All pregnant women booking for antenatal care at 2 clinics (n = 2,235) were screened for anemia. Investigations for etiology of anemia were done in all anemic women (Hb <10.5 g/dl) (n = 361). Methods: Blood cell counts, microscopy of blood films, S-ferritin, C-reactive protein, HIV, stool parasite and bone marrow analysis were performed. Results: Iron deficiency dominated in 86% and malaria in 1/3 of anemia cases. Since 42% had indication of ongoing inflammation, S-ferritin was less useful as indicator of iron deficiency but blood film microscopy identified most cases.