This study sought to identify the determinants of LBW and PTD among women in the Volta Region of Ghana. Overall, the study found the prevalence of LBW to be 12.9%. This proportion is higher than the 10% national prevalence which was reported in the 2014 by GDHS. The reported prevalence in this study is also higher than the 6% recorded for the Volta region in the same 2014 by DHS (20). The prevalence of LBW in this study is also higher than what was reported in the United Arab Emirates. That study reported a prevalence of 9.4% (27). This could be attributed to geographical differences in study sites.
This study found that women aged 20–34 years were less likely to have LBW babies compared to those aged less than 20 years. This is consistent with data published by Althabe and colleagues, Alemu, and Taha and friends These studies reported teenage mothers have an increased risk of delivering LBW babies compared to older women (16,17,27). However, this finding was inconsistent with those found by (19) and (18) who reported older women have an increased risk of LBW as compared to younger women. These results still point to the fact that inconsistent results still exist about maternal age and adverse birth outcomes, particularly LBW. Teenage mothers are most likely to be first timers with little or no experience with management of pregnancies. This could be a contributory factor to why women aged 20–34 years had less odds of LBW compared to teenage mothers in this study. Additionally, teenage mothers may not be physically and emotionally mature. Thus, their bodies may be unable to deal with the stress of pregnancy (24). Coupled with this, good maternal nutrition, socio-economic status and adequate ANC attendance could have made the 20-34-year-old women less likely to experience LBW.
Low birthweight babies were less likely to be born to multiparous women. This is consistent with a recent study conducted in India that reported that increased parity of a mother increased the mean birthweight of babies (28). Similarly, another study in Bangladesh also found that increasing parity increases birthweight leading to reduction in the occurrence of LBW (29). A plausible explanation for this observation might be that increased parity might lead to increased experience with pregnancy and childcare, ANC attendance, nutritional status and health seeking behaviour. However, this finding was incongruent with a similar study conducted in the Brong-Ahafo region of Ghana. That literature suggested that increasing parity significantly increased the odds of low birthweight (30). Another study in Ethiopia reported similar findings to those of Mohammed and colleagues (31).
In this study, the odds of delivering a LBW baby was significantly high among women who delivered their babies through CS compared to those with vaginal deliveries. This finding resonates with a studies conducted in the United Arab Emirates (27) and China (32). Some studies have reported an epidemic of CS which these studies have found to increase adverse birth outcomes such as LBW and preterm delivery (33,34). A plausible explanation for this finding in this study could be attributed to the abuse of planned CS. A phenomenon which has been documented in an earlier study in Brazil where it was reported that CS was wrongfully associated with LBW particularly among private hospitals (35). In that regard, there is the need to adhere to WHO’s recommendations that CS birth should not be planned before 39 completed weeks of gestation unless it is medically indicated for the benefit of either the foetus or mother or both (36). There are inconsistent results regarding the association between LBW and CS. This is because some studies have reported that CS is protective against low birth weight (37,38) while others have shown that it increases the likelihood of LBW (39) which is similar to the current findings.
The WHO recommends pregnant women take three or more doses of Sulphadoxine Pyrimethamine for intermittent prevention of malaria in pregnancy (SP/IPTp) in moderate to high malaria transmission areas (40). We found that more than 3 doses of SP/IPTp significantly reduced the odds of LBW. This is in conformity with several studies conducted in Tanzania (41,42), Cameroon (43), Nigeria (44) and Ghana (45). The protective nature of SP against LBW could be explained by its therapeutic effect against both malaria and non-malaria infections. This is supported by evidence from a Zambian study which reported that the bacterial and parasitic effects of SP significantly improved the birthweight of neonates born to women who took more doses of SP during pregnancy. The Sulphadoxine component of SP provides a broad spectrum of anti-parasitic and bacterial activities (46). Thus, constant exposure via monthly update of SP could reduce microbial density and immunological reactions leading to adverse birth outcomes such as LBW (46–48).
Our findings further indicate that the likelihood of LBW was significantly higher among hypertensive women compared to their normotensive counterparts. This is consistent with literature in China (49), Ethiopia (50), Brazil (51) and Haiti (52). Some studies have linked the association between pregnancy induced hypertension and LBW to intrauterine growth restriction as a result of the placenta not receiving enough nutrients. This occurs as a result of poor perfusion of blood containing nutrients via the placenta. The placenta provides blood and essential nutrients from the mother to the foetus for optimal growth and development (50). Thus, pregnancy induced hypertension increases the risk of poor foetal nutrition hence poor foetal growth leading to LBW (49,53).
The current study also identified determinants of PTD and found that women who took more than three doses of SP had reduced odds of having preterm birth. This resonates with data published in an earlier study in Northern Ghana where it was reported that high uptake was significantly associated with delivery at term (54). The uptake of more doses of SP is known to reduce prevalence and intensity of placenta malaria as well as placenta parasitemia which are significant risk factors for preterm delivery (44,55,56). This finding provides useful information on the effectiveness of SP particularly in malaria endemic settings. Additionally, some researchers have reported that SP may have some secondary effects on bacterial and fungal infections which promotes maternal and foetal health thereby reducing the occurrence of preterm delivery (57–59).
The importance of Antenatal care in the prevention, detection and treatment of pregnancy-related conditions cannot be underestimated. With this, WHO recommends all pregnant women go for their first ANC visits in the first trimester of their pregnancy. This recommendation will allow for early diagnosis and management of health conditions as well as identifying risk factors which can negatively affect the progress and outcomes of pregnancy (60). Our study found that women with more than four ANC visits had reduced odds of delivering preterm. In Ghana, ANC services assessed by pregnant women are in consonance with WHO’s recommendations including counselling on healthy diet and good nutrition, tobacco and substance use and physical activity, HIV and malaria prevention, tetanus vaccination, foetal measurements and advice for dealing with physiological pregnancy symptoms such as nausea, back pain and constipation (60). This comprehensive ANC package could have helped identify high risk pregnancies among the women with more ANC visits. Subsequently, measures would have been put in place to reduce these high-risk pregnancies and thus the lower risk of preterm delivery. This assertion is corroborated by different studies by Turienzo and Cunningham who emphasized on how the content and type of ANC packages help reduce adverse birth outcomes (61,62).
We found that babies born through caesarean section were twice as likely to be born preterm compared to those born through vaginal delivery. One plausible explanation for this could be that preterm babies were delivered through CS due to foetal compromises such as foetal distress (63). It could also mean that the CS was planned due to history of previous CS or as a result of pregnancy induced hypertension. There are inconsistent results on the impact of CS on preterm delivery. This is because, some earlier studies reported CS improves the outcomes of preterm babies (64,65), while others suggest vaginal birth is protective against preterm delivery (66).
A major limitation to this study is that, data collected for routine healthcare services and not primarily for research was used for analysis. With this, there is possibility of errors occurring during documentation. However, routine healthcare services data can be used for planning, monitoring and evaluation of public health interventions.