Anaemia during pregnancy is the leading cause of morbidity and mortality and poor birth outcomes worldwide. Despite control programmes, anaemia is far beyond the target of the fifth Millennium Development Goal. This study aimed at assessing the trend in anaemia and knowledge and attitude of pregnant women towards control measures in low income rural settings. A crosssectional study involving 354 pregnant women was conducted in Mbulu District, Tanzania. Socio-demographic and anaemia related information was gathered, and anaemia status determined. Descriptive statistics for socio-demographic and anaemia related data were computed. Knowledge and attitudes of pregnant women to anaemia were assessed using summated index and Likert scales respectively. Fisher‘s exact test was used to determine associations between variables. Multivariable logistic regression was run to quantify the risk factors for occurrence of anaemia. Prevalence of anaemia unadjusted and adjusted for altitude were 38.7% (95% CI: 0.34-0.44) and 46.3% (95% CI: 0.41-0.51) respectively. The overall score on the 11-point summated scale was 5.2, indicating low knowledge, while the overall score on Likert scale was 21.7 out of 40 points, indicating unfavorable attitude. High gravidity was a risk factor for anaemia during pregnancy (OR=13.09, 95% CI: 5.68 – 47.04 for 3-4 gravidity and OR=25.16, 95% CI: 12.46 – 37.23 for gravidity ≥ 5). There was upsurge of anaemia prevalence and low knowledge and unfavourable attitude were associated with anaemia (p-value<0.001). There is a need to set appropriate anaemia knowledge transfer and attitude change strategies in the community to have successful anaemia control program.