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Background:  Anaemia in pregnancy is associated with adverse obstetric outcomes. When detected early in pregnancy, it can be treated; however, information on its prevalence and associated factors is limited in rural Ghana., Aim:  The aim of this study was to determine the prevalence and maternal factors associated with anaemia in pregnancy at first antenatal care (ANC) visits., Setting:  The study was conducted in the Navrongo War Memorial Hospital, a secondary referral facility in the Kassena-Nankana district in rural northern Ghana., Methods:  A retrospective analysis of antenatal clinic records of pregnant women collected from January to December 2014. All pregnant women initiating antenatal clinic, who had initial haemoglobin (Hb) levels measured, were included in the study. Logistic regression analyses were carried out to determine factors associated with anaemia at the initiation of ANC., Results:  We analysed data from 506 women with median Hb of 11.1 g/dL (IQR 7.31-13.8). The median gestational age at booking was 14 weeks (5-36 weeks). The prevalence of anaemia was 42.7%, with 95% confidence interval (CI) [38.4-47.1], and was high among teenage mothers (52% [34.9-67.8]), mothers who booked in the third trimester (55% [33.6-74.7]) and grand multiparous women (58% [30.7-81.6]). Factors associated with anaemia included grand multiparity (odds ratio [OR] = 1.94 with 95% CI [1.58-2.46]), booking during the third trimester (OR = 2.06 [1.78-2.21]) and mother who were underweight compared to those with normal weight (OR = 3.17 [1.19-8.32])., Conclusion:  Burden of anaemia in pregnancy is still high in rural northern Ghana. We advocate further strengthening of the primary health care system to improve early access to ANC delivery.