Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 
https://doi.org/10.1186/s12884-019-2315-6
RESEARCH ARTICLE Open Access
Determinants of low birth weight in
neonates born in three hospitals in Brong
Ahafo region, Ghana, 2016- an unmatched
case-control study
Zakariah Adam1,2, Donne Kofi Ameme1, Priscillia Nortey1, Edwin Andrew Afari1 and Ernest Kenu1*
Abstract
Background: Each year, about 20 million Low Birth Weight (LBW) babies are born with very high proportion (96.5%)
occuring in developing countries. In the last decade, the incidence of LBW in Ghana has not declined. Brong Ahafo
Region of Ghana recorded a LBW prevalence of 11% which was higher than the the national average of 10%. This
study identifed determinants of LBW delivery in the Brong Ahafo Region.
Methods: We conducted a 1:2 unmatched case control study among mothers with singleton deliveries in 3 major
health facilities in the Brong Ahafo Region. A case was defined as a mother who delivered a baby weighing less than
2500g in any of the three selected health facilities between 1st December, 2015 and 30th April, 2016. A control was
defined as a mother who within 24 h of delivery by a case, delivered a baby weighing at least 2500g and not
exceeding 3400g in the same health facility. Deliveries that met the inclusion criteria for cases were selected and two
controls were randomly selected from the pool of deliveries that meet criteria for controls within 24 h of delivery of a
case. A total of 120 cases and 240 control were recruited for the study. We computed odds ratios at 95% confidence
level to determine the associations between low birth weight and the dependent factors.
Results: After controlling for confounders such as planned pregnancy, mode of delivery, parity and previous
LBW in stepwise backward logistic regression, first trimester hemoglobin < 11 g/dl (aOR 3.14; 95%CI: 1.50–6.58),
delivery at 32-36 weeks gestation (aOR 13.70; 95%CI: 4.64–40.45), delivery below 32 weeks gestation (aOR 58.5;
95%CI 6.7–513.9), secondary education of mothers (aOR 4.19; 95%CI 1.45–12.07), living with extended family
(aOR 2.43; 95%CI 1.15–5.10, living alone during pregnancy (aOR 3.9; 95%CI: 1.3–11.7), and not taking iron
supplements during pregnancy (aOR 3.2; 95%CI: 1.1–9.5) were found to be significantly associated with LBW.
Conclusion: Determinants of LBW were: preterm delivery, mothers with secondary education, living alone
during pregnancy, not taking daily required iron supplementation and mothers with first trimester hemoglobin below
11 g/dl. Education during antenatal sessions should be tailored to address the identified risk factors in the mother and
child health care services.
Keywords: Low birth weight, Brong Ahafo region, Case control study
* Correspondence: ernest_kenu@yahoo.com
1Ghana Field Epidemiology and Laboratory Trainning Programme,
Department of Epidemiology and Disease Control, University of Ghana
School of Public Health, Legon, Ghana
Full list of author information is available at the end of the article
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 Page 2 of 9
Background function, and psychological disorders [20–23]. In the
Low birth weight (LBW) remains a major issue of public Brong Ahafo Region of Ghana, little is known about the
health concern globally with a disproportionate burden factors that predispose the pregnant woman to delivery
on low and middle income countries. LBW contributes of a LBW baby. Therefore, identifying these factors will
significantly to morbidity, mortality and disability in significantly contribute to ongoing efforts to address
neonatal, infancy, and childhood periods. It also has long LBW. A reduction in the incidence of LBW will reduce
term effects on health outcomes in adult life. the cost of care of the LBW to the healthcare system
Low birth weight contributes 60 to 80% of all neonatal and eventually reduce neonatal and child mortality.
deaths [1]. Therefore, reducing the incident rates of
LBW, is essential to reducing child mortality [2]. Pro-
gress made in reducing neonatal mortality has been Methods
slower in Sub-Saharan Africa compared to any other re- Study design
gion in the world [3]. The incidence of LBWs in Ghana We carried out a 1:2 an unmatched case control study
for 2014 was 160 per 1000 births. Ghana has not re- in three major hospitals in Brong Ahafo Region, Ghana
corded any reduction in LBW in the last decade [4]. In from 1st December 2015 to 30th April 2016. These hos-
one of the three major tertiary hospitals in Ghana, 16.5% pitals recorded the largest number of deliveries per year
of the 11,647 babies born were low birth weight in the in the region and serve as the major referral centres in
year 2013 [5]. Also about 46% of all LBW babies in the region.
Ghana die in the first 28 days of life [6]. In the Brong
Ahafo region the incidence of LBW was 11.0% in 2014, Study site
this is higher than the national incidence of 10%. In The study was conducted in the Brong Ahafo Regional
addition to the LBW of the region being consistently Hospital, Sunyani Municipal Hospital and the Holy Fam-
higher than the national average since 2010, it recorded ily Hopsital.
397 neonatal deaths in 2014 [7]. Together, the hospitals Brong Ahafo Regional Hospital is the main referral
selected for the study recorded 1149 (11.4%) LBW ba- centre in the region for patients requiring secondary
bies out of the 10,075 live births in the region for 2015 healthcare services. In 2015, data from DHIMS revealed
[7]. Care for low birth weight babies comes with sub- that the hospital recorded a total of 3261 live births with
stantial costs to the health system and imposes a signifi- 12.6% (410/3261) being low birth weight. The hospital
cant burden on the society as a whole [8]. The weight of has one gynecological theatre, one labour ward, three
a newborn is an important predictor of the infant’s post-delivery wards and one neonatal unit.
growth and survival [9, 10]. LBW babies from birth are Holy family hospital serves as another referral
disadvantaged and their survival is very poor. LBW centre for medical conditions including obstetric and
babies have been known to have a higher risk of death gynecological conditions. It is located in Techiman,
compared to infants of normal weight, [11]. A Cana- which is considered the busiest trading centre of the
daian study also confirmed that LBW was a significant region. Data from the DHIMS for 2015 showed that
factor associated with neonatal death [12]. There are risk the hospital recorded a total of 5152 live births with
factors that increase a pregnant woman’s chance of 12.4% (641/5152) low birth weight babies. The hos-
having a low birth weight baby. These include: smoking, pital one labour ward, a post-delivery ward and one
alcohol consumption, underweight, being younger than neonatal unit.
15 years, or older than 35 years. Also the social and eco- The Sunyani Municipal Hospital is the third referral
nomic factors, such as low income, low educational hospital and it serves the Sunyani Municipality. It re-
level, stress, domestic violence or other abuse, and being corded a total of 1662 live births with 5.9% (98/1662)
an unmarried woman may increase the risk of a low low birth weights for 2015 (DHIMS 2015). It has one
birth weight delivery. [13–16]. LBW is usually an indica- theatre, one labour ward and one post-delivery ward. All
tor of chronic maternal malnutrition, maternal illness the data collected from this hospital were in the records
and poor prenatal care, hence, a good indicator of the of the post-delivery ward.
socioeconomic status of inhabitants [17, 18].
Low birth weight infants are predisposed to both short
and long term health problems. Some short term condi- Case selection
tions include, respiratory distress syndrome, infections, Case
enterocolitis, hydrocephalus, and mental retardation A case was defined as a mother who delivered a
[19]. Some of the long term conditions are: coronary baby weighing less than 2500g in any of the three
heart disease, non-insulin dependent diabetes, childhood selected health facilities between 1st December, 2015
hypertension, behavioral disorders, impaired cognitive and 30th April, 2016.
Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 Page 3 of 9
Control Two controls were selected on the same day of deliv-
A control was defined as a mother who within 24 h of de- ery of a case by a simple random method. Where more
livery by a case, delivered a baby weighing at least 2500g than two controls were delivered within 24 h after deliv-
and not exceeding 3400g in the same health facility. ery of the case, the controls are assigned numbers which
were entered into a random digit selection software to
Inclusion criteria select the controls randomly. This was done concur-
Mothers with singleton deliveries of babies whose weight rently in all the three health until the required sample
is 3400 g or less. Mothers who consent to participate in size was reached.
the study. Consenting mothers were taken to an office within the
ward for the questionnaire to be administered to ensure
Exclusion criteria confidentiality.
Babies with congenital abnormalities or still births. The data collected included:
Mothers who are critically ill. Socio demographic information: age, occupation of
mother, educational status, income status, baby’s sex,
Sample size calculation marital status, social support status, height, weight, resi-
A sample size calculation formula for unmatched case dence, and planning of pregnancy.
control study was used with the following parameters: Obstetric data included: gestation at booking, gestation
power of the study was 80%, Zβ = 0.84 and at 0.05 at delivery, mode of delivery, family planning methods
significance level, Zα = 1.96. The proportion exposed in used, previous abortions, previous delivery of a LBW
the control group used was 33%, thus the exposure was baby, parity, number of Antenatal Care (ANC) visits.
nulliparity in a study carried out in The Gambia Medical status information: any chronic medical
(Jammeh et al., 2011). condition, illness during pregnancy, hospital admissions
Minimal detectable odds ratio that was used was 2. during pregnancy, intake of required daily dose of iron
Based on this a total of 360 case control respondent supplementation, appetite during pregnancy, use of
pairs, that is a 1:2 unmatched case control pairs was herbal medications during pregnancy and alcohol intake
arrived at. An additional 15% was added to adjust for during pregnancy.
missing data. Data collection was carried out with the help of two
data collection officers. The officers were health profes-
Data collection technique and tools sionals trained in the area of maternal and child health.
A data collection questionnaire was designed to collect They were selected from the facilities used for the study.
data from mothers who delivered and met the criteria to They were trained a week prior to commencement of
be included in the study. The questionnaire obtained the data collection. They were then introduced to the
both primary and secondary data. We obtained the heads of departments where recruitment was done.
secondary data by reviewing the antenatal and postnatal Data was cross-checked for errors and entered using
health records of the mother. The questionnaire was EpiInfo 7 software. Data was saved in password pro-
pretested in a health facility with similar characteristics tected files and no one had access to it except for
as the study sites. The questionnaire was revised to im- cross-referencing. Filled questionnaires were kept in
prove clarity of some of the questions. locked cabinets. Participants were identified by codes.
The required data from mothers with low birth weight
babies were collected within 24 h upon delivery. Data Data processing and analysis
was collected each time a low birth weight baby was de- Data were analyzed using STATA software Version 13.
livered until the required sample size was obtained. The Continuous variables were summarized into means and
data collection officer visited the post-delivery, labour, proportions, whiles categorical variables were summa-
and neonatal wards three times each day (morning, rized into frequencies.
afternoon and evening) to identify study participants. Bivariate analysis was done between birthweight and
Also, the staff on duty at the post delivery, labour, and each of the independent variables to determine the asso-
neonatal units alerted the data collection officer each ciations using the chi-square test of proportions. The
time a delivery meeting the case definition and inclusion odds ratios and confidence intervals were reported using
criteria occurred. Data was collected by administering 95% level of significance. All variables in the bivariate
the structured questionnaire to the mother and also analysis with a p-value of less than 0.05 was considered
recording information from the mothers’ antenatal re- for multiple logistic regression analysis. The backward
cords book and the maternity ward records. Data were stepwise logistic regression model was used to test for
collected concurrently in all the three health facilities the determinant predictors for LBW. The level of signifi-
until the total required sample size was obtained. cance for regression analysis was set at 95%.
Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 Page 4 of 9
Ethical consideration measurements and low birth weight (LBW) are summa-
We obtained ethical approval from the Ghana Health rized in Table 2.
Service Ethics Review Committee (GHS/ERS 071015).
Also, permission was obtained from the Brong Ahafo Obstetric characteristics of study participants
Regional Health Directorate and the Heads of the Majority of the mothers had a first trimester ANC
Sunyani Regional Hospital, Sunyani Municipal Hospital attendance [64.8% (68/120) among cases and 69.1%
and Holy Family Hospital to access the participants and (161/240) among controls]. Most of them had attended
their records. The study was explained to participants ANC at least four times during the pregnancy period
and their concerns addressed. A written informed con- (82.2% of cases and 95.8% of controls). Booking in the
sent was obtained from all participants. Each consenting 3rd trimester (OR;5.2, 95%CI:1.70–15.98):, fewer than
participant signed or thumb printed on the consent form three ANC visits (OR; 4.94, 95%CI: 2.12–11.12),
before the questionnaire was administered. For partici- unplanned pregnancy (OR:1.6, 95%CI: 1.00–2.53), deliv-
pant who were under 18, consent was sought form their ery by caesarian section (OR:1.64, 95%CI:1.00–2.68),
guardians, and the participant provided a written assent primiparity (OR: 2.66, 95%CI: 1.09–6.48), and previous
to take part in the study. Both the mother or guardian delivery of a LBW/premature baby (OR: 2.6, 95%CI:
and participant signed a consent form before the inter- 0.95–7.31) were significantly associated with delivery of
views were conducted. a LBW baby (Table 3).
Results Maternal health characteristics of study participants
Socio demographic characteristics of study participants The hemoglobin level of 66.6% (240/360) of the mothers
A total of 120 cases and 240 controls were studied in with low birth weight babies was below 11g/dl, whiles
the three health facilities. The mean age of the mothers 47.9% (172/360) of the mothers with normal weight ba-
was 28.2 ± 5.9 yeras for cases and 29.0 ± 5.9 years for bies had theirs below 11g/dl. First trimester hemoglobin
controls). About 10.1% (12/120) of the cases and 11.8% (OR: 2.18, 95%CI:1.34–3.55), hospital admissions during
(28/240) of the controls had no formal education. Ma- pregnancy (OR:2.65, 95%CI: 1.59–4.92), no iron supple-
jority of the mothers; 61.1% (73/120) cases and 73.5% mentation intake (OR:2.83, 95%CI:137–5.85) and intake
(176/240) of controls lived in urban areas (Table 1). of herbal preparations (OR: 3.02, 95%CI:1.57–5.84) were
significantly associated with delivery of a LBW in the
Anthropometric characteristics of study participants bivariate analysis (Table 4).
Most of the cases, 97.2%(103/120), and controls,
97.8%(221/240) were at least 1.46m tall. Majority of the Determinants of LBW among study participants
cases, 56.9%(58/120), and controls, 63.3%(138/240) had On multiple logistic regression, first trimester hemoglobin
normal BMI. The associations between the anthropometric below 11g/dl, delivery at 32-36 weeks gestational age,
Table 1 Socio-demographic characteristics of study participants, Brong Ahafo Region, 2016
Variable No. of Cases (%) (n = 120) No. of Control (%) (n = 240)
Age group of mother (years)
19 and below 10 (8.3) 18 (7.5)
20–29 51 (42.5) 103 (42.9)
30+ 59 (49.2) 119 (49.6)
Marital status of mother
Married 83 (69.2) 186 (78.5)
Not married 37 (30.8) 51 (21.5)
Mothers occupation
Farming 17 (14.3) 28 (11.8)
Trader/artisan 63 (52.9) 136 (57.1)
Government/formal job 16 (13.4) 33 (13.9)
Unemployed 23 (19.3) 41 (17.2)
Residence of mother
Urban 69 (61.1) 172 (73.5)
Rural 44 (38.9) 62 (26.5)
Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 Page 5 of 9
Table 2 Bivariate analysis of anthropometric characteristics of study participants, Brong Ahafo Region, 2016
Variables Cases(N = 120) Controls (N = 240) OR 95% CI p-value
N (%) N (%)
Mothers height(m)
1.46 m or above (normal) 103 (97.2) 221 (97.8) 1 ref
Below 1.46 m(short) 3 (2.8) 5 (2.2) 1.29 0.20–6.75 0.50 ˄
Mothers weight
45 kg and above 107 (97.3) 219 (96.5) 1 ref
Below 45 kg 3 (2.7) 8 (3.5) 0.77 0.13–3.27 0.50 ˄
BMI of mother (kg/m2)
18.5–24.9 (normal) 58 (56.9) 138 (63.3) 1 ref
Below 18.5 (underweight) 3 (2.9) 13 (6.0) 0.55 0.15–2.01 0.36
Above 24.9(obese) 41 (40.2) 67 (30.7) 1.46 0.89–2.40 0.14
˄-fischer exact p-value
Table 3 Obstetric characteristics of study participants, Brong Ahafo Region, 2016
Variables Cases (N = 120) Controls (N = 240) OR 95% CI P-value
N (%) N (%)
Gestation at booking
1st trimester 68 (64.8) 161 (69.1) 1 ref
2nd trimester 26 (24.8) 67 (28.8) 0.92 0.54–1.57 0.76
3rd trimester 11 (10.5) 5 (2.1) 5.21 1.70–15.98 < 0.001
ANC visits
4 and above 97 (82.2) 228 (95.8) 1 Ref
0–3 21 (17.8) 10 (4.2) 4.94 2.12–11.12 < 0.001
Planned pregnancy
Yes 64 (53.8) 155 (65.1) 1 ref
No 55 (46.2) 83 (34.9) 1.6 1.00–2.53 0.038
Mode of delivery
Spontaneous 73 (61.3) 172 (72.3) 1 Ref
Caesarian section 46 (38.7) 66 (27.7) 1.64 1.00–2.68 0.036
Parity
Nulliparity 44 (37.3) 62 (26.1) 2.66 1.09–6.48 0.024
Primiparity 21 (17.80 55 (23.1) 1.43 0.56–3.65 0.45
Multiparty(2–3) 45 (38.1) 91 (38.2) 1.85 0.78–4.41 0.16
Grand multiparity(4+) 8 (6.8) 30 (12.6) 1 ref
Family planning method
No 84 (70.0) 185 (77.1) 1 Ref
Yes 36 (30.0) 55 (22.9) 1.45 0.86–2.44 0.14
Previous abortion
No 96 (80.0) 192 (80.0) 1 ref
Yes 24 (20.0) 48 (20.0) 1.01 0.55–1.79 0.99
Previous LBW/premature Delivery
No 109 (90.8) 232 (96.3) 1 ref
Yes 11 (9.2) 9 (3.7) 2.6 0.95–7.31 0.034
Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 Page 6 of 9
Table 4 Bivariate analysis of the maternal health characteristics of study participants, Brong Ahafo Region, 2016
Variables Cases(N = 120) Controls(N = 240) OR 95% CI p-value
N (%) N (%)
First trimester hemoglobin
11 g/dl and above 39 (33.3) 124 (52.1) 1 ref
Below 11 g/dl 78 (66.6) 114 (47.9) 2.18 1.34–3.55 < 0.001
Hospital admissions in pregnancy
No 72 (60.0) 191 (79.9) 1 ref
Yes 48 (40) 48 (20.1) 2.65 1.59–4.42 < 0.001
Iron supplementation intake
Always 69 (57.5) 175 (73.2) 1 ref
Not regularly 32 (26.7) 47 (19.7) 1.73 1.01–2.94 0.042
Never 19 (15.8) 17 (7.1) 2.83 1.37–5.85 < 0.001
Poor appetite
No 49 (41.2) 122 (52.6) 1 ref
Yes 70 (58.8) 110 (47.4) 1.58 0.99–2.54 0.043
Poor appetite
No 49 (41.2) 122 (52.6) 1 ref
Yes 70 (58.8) 110 (47.4) 1.58 0.99–2.54 0.043
Intake of Herbal medications
No 92 (76.7) 218 (90.8) 1 ref
Yes 28 (23.3) 22 (9.2) 3.02 1.57–5.84 < 0.001
delivery before 32 weeks gestational age, and secondary increased risk of LBW [27]. In our study the social sup-
education of mother were significantly associated with port system referred to who the mother lived with dur-
LBW (Table 5). ing the pregnancy. The study shows a four fold
increased odds of having a LBW delivery for a mother
who lived alone, compared with one who lived with a
Discussion partner or the unborn baby’s father during the preg-
The study was conducted to identify determinants of nancy. A study by Feldman showed that social support
LBW delivery in the three selected health facilities in the was linked with infant birth weight through processes of
Brong Ahafo region of Ghana. fetal growth [26]. This suggests that, poor social support
Women younger than 19 years had an increased odds during pregnancy could affect fetal growth and result in
of delivering a low birth weight baby. This is because, a low birth weight.
adolescent mothers may not have a fully developed re- Majority of the participants had their anthropometric
productive system. A study by Guimares and colleagues measurements within the normal ranges. A short, over-
has shown that adolescent (< 20 years of age) mothers weight, or obese woman had an increased odds of having
have poorer socioeconomic and reproductive conditions a LBW baby. However, these asssocaitions were not sta-
as compared with older age groups and this increases tistically significant, and this is not surprising because
the risk of having a LBW baby [24]. With respect to one meta-analysis concluded that anthropometric mea-
educational level, mothers with secondary education had surements are not good predictors of LBW [28].
a four-fold increased odds of delivering a LBW baby Iron deficiency has been reported as the commonest
compared to mothers with tertiary education. In keeping cause of anemia in pregnancy [29]. Anaemia in preg-
with findings from our study, a meta-analysis by Silver- nancy is associated with an increased odds of having
strin and his team showed that having a higher educa- LBW babies [30], and our study findings supports asso-
tion had a protective effect, whereas having a medium ciation. A meta-analysis by Imdad has shown that iron
education had no protective effects [25] . supplementation significantly reduces the incidence of
Social support which is a measure of support from anemia in pregnancy by about 20%. Our study also
family, the baby’s father, and general functional support revealed that mothers who never took daily required
is a necessary factor for good pregnancy outcomes [26]. iron supplementation during pregnancy had a threefold
Lack of social support has been associated with increased odds of delivering a LBW baby [29].
Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 Page 7 of 9
Table 5 Determinants of Low Birth Weight among study participants, Brong Ahafo Region, 2016
Characteristics Cases Controls cOR aOR
N = 120 (%) N = 240 (%) (95%CI) (95%C)
Gestation at delivery
Term delivery(37–40 weeks) 76 (63.3) 228 (95.8) 1 1
Preterm delivery(32-36 weeks) 32 (26.4) 9 (3.8) 10.5* (4.46–24.68) 13.70* (4.64–40.45)
Severe preterm delivery (< 32 weeks) 12 (10.3) 1 (0.4) 61.89* (6.84–560.33) 58.50* (6.66–513.87)
Educational level of mother
Post-secondary/tertiary 16 (13.4) 43 (18.1) 1 1
Primary/JHS 35 (29.4) 101 (42.0) 0.94 (0.47–1.88) 1.15 (0.39–3.40)
Secondary 57 (47.1) 68 (28.2) 2.25* (1.13–4.47) 4.19* (1.45–12.07)
No formal education 12 (10.1) 28 (11.8) 1.16 (0.47–2.81) 1.88 (0.46–7.63)
Supplementary iron intake
Regular intake 69 (57.5) 175 (73.2) 1 1
Irregular intake 32 (26.7) 47 (19.7) 1.73* (1.01–2.94) 2.19 (0.99–4.84)
No intake 19 (15.8) 17 (7.1) 2.83* (1.37–5.85) 3.19* (0.99–4.84)
Who mother lived with during pregnancy
Partner 55 (46.2) 157 (65.4) 1 1
Extended family 41 (34.5) 63 (26.2) 1.86* (1.12–3.09) 2.43* (1.15–5.10)
Lived alone 23 (19.3) 20 (8.4) 3.24* (1.62–6.48) 3.95* (1.33–11.74)
1st trimester hemoglobin
11 g/dl and above 39 (33.3) 125 (52.1) 1 1
Below 11 g/dl 78 (66.6) 115 (47.9) 2.18* (1.34–3.55) 3.14* (1.50–6.58)
Hospital admissions during pregnancy
No 72 (60.0) 192 (79.9) 1 1
Yes 48 (40) 48 (20.1) 2.65* (1.59–4.42) 2.08 (1.00–4.30)
* p-value for the odds ratio is less than 0.05
OR Odds Ratio, aOR Adjusted Odds Ratio, CI Confidence Interval
Our study had a few limitations. We obtained mothers’ Maternal anthropometric measurements do not influ-
hemoglobin levels from their antenatal records and used ence birth weight. We recommend that the regional and
it to assess anemia as a risk factor to LBW. Since the municipal health directorates in the Brong Ahafo re-
mothers attend ANC clinic at different gestational ages. gion intensify education of all pregnant women on the
It would have been more accurate to follow the trends need to take iron supplementation during pregnancy to
of their hemoglobin levels from the beginning of their prevent anemia and consequent LBW. Establishment of
antenatal period to delivery in assessing the association preconception clinics by the Ministry of Health to iden-
of anemia to LBW. Data on weight gain and height ob- tify high risk pregnancies in all health facilities will add
tained from mothers’ antenatal record cards were the to the efforts at preventing negative birth outcomes.
weights and heights of mothers at initiation of ANC,
and therefore, associations between weight gain during Abbreviations
ANC: Antenatal Care; BMI: Body Mass Index; CS: Caesarian section;
pregnancy and actual BMI of the mother during preg- DHIMS: District Health Information Management System; ELBW: Extremely
nancy. These limitations notwithstanding, the study has Low Birth Weight; GDHS: Ghana Demographic and Health Survey;
revealed some important risk factors that may contribute GSS: Ghana Statistical Service; ICD: International Classification of Disease;
IUGR: Intrauterine Growth Restriction; LBW: Low birth weight; LMIC: Low and
to the occurrence of low birth weight in the Brong Middle Income Countries; MDG: Millennium Development Goals;
Ahafo Region. PTB: Preterm birth; SGA: Small for Gestational Age; SVD: Spontaneous Vaginal
Delivery; VLBW: Very Low Birth Weight; WHO: World Health Organization
Conclusion Acknowledgments
Preterm delivery, mothers with secondary education, liv- I acknowledge the roles played by the entire staff of the Department of
ing alone during pregnancy, not taking daily required Epidemiology and Disease Control, School of Public Health.
I would like to also thank the Ghana Field Epidemiology and Laboratory
iron supplementation and mothers with first trimester Training Programme secretariat for the assistance in making this work a
hemoglobin below 11 g/dl are determinants of LBW. reality.
Adam et al. BMC Pregnancy and Childbirth          (2019) 19:174 Page 8 of 9
Special thanks go to the Regional Health Directorate, Brong Ahafo Region, 3. AbouZahr C, Wardlaw T. Maternal mortality at the end of a decade: signs of
The Regional Hospital, Sunyani, The Sunyani Municipal Hospital and The Holy progress? Bull World Health Organ. 2001;79(6):561–73. https://doi.org/10.
Family Hospital, Techiman for the diverse contributions and assistance they 1590/S0042-96862001000600013.
gave to ensure the success of this work. 4. Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF
My thanks also goes to the study participants who gave their time and International. Ghana Demographic and Health Survey 2014. Rockville: GSS,
information to make this study possible. GHS, and ICF International; 2015. Accessed 12 Dec 2015
Finally I would like to acknowledge Mr. Faisal Keliou for his immense support 5. Korle Bu Teaching Hospital. 2013 Annual Report. Accra: Korle Bu Teaching;
during this work. 2013. Retrieved from: http://kbth.gov.gh/assets/downloads/pdf/Korlebu-
Annual-Report-2013.pdf. Accessed 20 May 2018
Funding 6. Ghana Statistical Service (GSS). Ghana multiple Indicator cluster survey with
This work was funded by West Africa Health Organization through Ghana an enhanced malaria module and biomarker, final report. Accra: GSS; 2011.
field epidermioogy and laboratory training programme. http://dhsprogram.com/pubs/pdf/FR262/FR262.pdf
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explained to participants and their concerns addressed. A written consent s12884-015-0677-y.
was sought from all participants. An informed consent document was 14. Kayode GA, Amoakoh-Coleman M, Agyepong IA, Ansah E, Grobbee DE,
administered to all the participants before they took part in the study. Each Klipstein-Grobusch K. Contextual risk factors for low birth weight: a
participant who agreed to be part of the study signed or thumb printed on multilevel analysis. PLoS One. 2014;9(10):e109333.
the consent form before the questionnaire was administered. For 15. Bhaskar RK, Deo KK, Neupane U, Chaudhary Bhaskar S, Yadav BK, Pokharel
participants who were under 18, a written consent was sought form their HP, Pokharel PK. A case control study on risk factors associated with low
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factors of low birth weight and effect of them on growth pattern of
Consent for publication children up to sixth months of life: a cross-sectional study. J Educ Health
Not applicable. Promot. 2015;4:40. https://doi.org/10.4103/2277-9531.157226.
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