Incidence of low birth weight among newborns delivered in health facilities in the Volta Region, 2019–2023

Abstract

Introduction

Low birth weight (LBW) is a significant determinant of newborn survival, child health and development. There is limited information on the burden and geographical distribution of neonates with LBW in the Volta Region of Ghana. We determined the incidence and distribution of LBW in the region from 2019 to 2023.

Method

A review of institutional birth weights in the Volta Region from 2019 to 2023 was performed using data extracted from the District Health Information Management System. The variables extracted were live births, birth weight, parity of mother, district and year. We performed descriptive statistics and presented the results in a table, graph and map.

Results

A total of 190,385 live births were recorded, with 15,960 LBW neonates, 8.4% [95% CI: 8.3–8.5]. The trend of LBWs ranged from 8.5% in 2019 to 8.2% in 2023, with the highest value of 8.8% in 2022. The majority of LBWs were recorded among multiparous mothers (59.8%, 95% CI: 59.1–60.6%). LBW cases were recorded across all districts in the region with the highest rate, 12.0% in Ho, and South Dayi Districts and the lowest rate, 2.0% in Afadzato South District.

Conclusion

The incidence of LBW in the Volta region from 2019 to 2023 was 8.4%, with notable variations across districts. The highest rates were observed in Ho and South Dayi, whereas Afadzato South recorded the lowest rates. These findings provide a basis for further studies to reduce the incidence of LBW in the Volta Region of Ghana.

Background

The World Health Organization (WHO) defines low birth weight (LBW) as a birth weight less than 2.5 kilograms (5.5 pounds). Globally, it is estimated that 15–20% of all babies born have LBW. This translates to more than 20 million new-borns each year [1]. LBW is one of the significant contributors to perinatal and underfive mortalities [2]. Demographic and socioeconomic factors, lifestyle behaviors, biological factors and care during pregnancy have been found to be directly linked with LBW [3]. Nonetheless, the predominant direct factor contributing to LBW is preterm birth, which is a biological factor [4, 5]. This means that the quality of care provided to pregnant women is essential. A reduction in the number of women who give birth before term is expected to translate to a reduction in the number of babies with LBW [5].

LBW continues to be a significant global public health concern because it affects all regions worldwide [2]. Significant disparities exist in the prevalence of LBW across different regions and within individual countries. Notably, a substantial proportion of LBW births occur in low- and middle-income countries. Regional estimates of LBW have been reported to be 27% in South Asia, 14% in sub-Saharan Africa and 9% in Latin America [6]. These estimates provide the basis for quantifying the burden of health conditions [7]. Although these estimates are high, there are still more cases that are unreported [1].

Ghana has an estimated LBW incidence rate of 14% [6] and an average annual reduction rate (AARR) of 0.39%. By the year 2025, WHO aims to achieve a 30% decline in the incidence of infants born weighing less than 2.5 kg, which corresponds to an average annual reduction of 3% [1]. Achieving this goal requires a coordinated effort by all countries. On the basis of current trends, it appears unlikely Ghana will meet this target, given its current average annual reduction rate. Neonatal morbidity and mortality, as well as long-term health implications, including stunted growth, developmental delays, and chronic diseases in adulthood, are associated with LBW [8]. Access to quality healthcare has been identified as a key factor in reducing the negative impacts of these long-term health implications. However, socioeconomic barriers limit access to essential health services such as antenatal care [9, 10]. In the Volta Region, approximately 58% of the population live in rural areas [11] and most of these people engage in subsistence farming, which is heavily reliant on rain. The absence of rain significantly limits their ability to find other sources of income to access healthcare. Analysing LBW data across districts will provide a critical opportunity to estimate the burden of the phenomenon and identify high-risk areas that require focused attention. This district-level analysis will enable the development and implementation of context-specific interventions tailored to the needs of the most vulnerable populations. Given this context, this study aimed to provide an in-depth analysis of the incidence of LBW and its distribution across districts in the Volta Region of Ghana from 2019 to 2023. By shedding light on geographical and temporal trends, the findings contribute to evidence-based planning and resource allocation to accelerate progress toward achieving the global target.

Methods

Study design and setting

We conducted a retrospective review of the monthly midwives’ reports in the District Health Information Management System II (DHIMS-II). The focus of this review was on aggregated data on LBW from 2019 to 2023 in the Volta Region of Ghana captured as primipara and multipara LBW. The Volta Region has 18 administrative districts with an estimated population of 1.7 million people [9]. The region currently has a total of 557 health facilities, with the majority being community-based health planning service (CHPS) compounds and a teaching hospital located in the Ho Municipality, which is the capital city of the region. A map showing the region and its district boundaries was created in a previous publication [12].

Data collection and processing

Data were extracted from the DHIMS-II as seen from the flowchart (Fig. 1). All the registered health facilities in the Volta Region have access to this electronic data capture system. This system facilitates the compilation of monthly data generated at each facility. Data on all births in the health facilities are collated and entered into the DHIMS-II via the monthly midwife report form. These data are reported on an aggregated level. At the end of each month, officers responsible for collating data on births count the number of live births seen. Out of the number seen, it is then disaggregated into primipara and multipara LBW. This information is then captured on the monthly midwife report form, which is then entered into the DHIMS-II. In this study, we included infants of all gestational age because the aggregated data extracted does not have information on gestational age of the newborns.

Fig. 1

Flowchart of the data extraction process

Data analysis

The data were analysed descriptively and presented in tables, charts and maps via Excel and the Quantum Geographical Information System (QGIS). The incidence was calculated by dividing the number of LBW cases by the total number of live births multiplied by 100%.

Results

Background characteristics of low-birth-weight births

Over the five-year study period, there was a total of 15,960 cases of LBW in the Volta Region, with 59.8% (9,549/15,960) reported among multiparas (Table 1).

Table 1 Characteristics of reported LBW cases to health facilities, Volta Region, 2019–2023

Incidence of LBW, 2019–2023

The overall incidence of LBW over the five years was 8.4% (95% CI: 8.3–8.5). Over the five years, there was a slight decline in the overall LBW rate from 8.5 to 8.2% in 2023. The primary LBW rate declined from 3.5% in 2019 to 3.1% in 2023. However, there was a slight increase in the multipara LBW rate from 5.0 to 5.1% between 2019 and 2023 (Fig. 2).

Fig. 2

Trend of the LBW rate in the Volta Region of Ghana, 2019–2023

Geospatial distribution of LBW in the Volta Region

LBW cases were recorded across all districts in the Volta Region, with district cumulative rates ranging from 2.0 − 12.0%. The highest cumulative rate of 12.0% was recorded in Ho District and South Dayi District, with the lowest rate of 2.0% in Afadjato South District (Fig. 3).

Fig. 3

Incidence of LBW distribution by district in the Volta Region of Ghana, 2019–2023

Discussion

This study sought to determine the incidence and distribution of LBW in the Volta region. Overall, the incidence of LBW in the Volta Region was 8.4%. The findings of this study show that the incidence of LBW in the Volta Region is low compared with the national estimate of 14% [6]. This finding indicates that the Volta Region has met the WHO target of less than 10% LBW [9]. Although this estimate is lower than the global estimates, it is important for the health authorities within the region to continue with efforts to sustain the gains.

Over the five years studied, there was a marginal decrease in the incidence of LBW. Our study found the highest incidence of 8.8% in 2022. In that same year, Axame et al. reported a higher estimate of 12.9% [13]. The difference in estimates could be because our study used data collated over a five-year period, whereas the latter used data collated over a three-month period at a teaching hospital. The findings from this study are lower than the national prevalence of 14% reported in 2021 by UNICEF [6] and 11% reported in 2022 by the Ghana Demographic and Health Survey (GDHS) [14]. However, this study’s estimate was higher than the prevalence of 7% reported in the same 2022 in the Volta Region [14]. The variation in estimates for the Volta region may be attributed to differences in data collection methods. Factors such as sampling techniques, data sources, or the timing of data collection can influence the outcomes, leading to discrepancies between our findings and those from other surveys. The GDHS collects data by interviewing eligible women aged 15–49 years within households and obtaining birth weights of children at birth by reviewing the mother’s maternal and child health records booklet [14]. This study, however, utilized data obtained from all health facilities in the region. These facilities report all births through the monthly Midwife’s Returns form, which is fed into the DHIMS-II database, the national repository for routine health data. However, home deliveries that do not result in hospital visits are not recorded in this system. While the GDHS sampling method is robust, we believe that the findings from our study accurately reflect the true situation in the region, despite the possibility of underreporting. Documented reports indicate that data completeness and accuracy for maternal health services in the country exceed 90% [15, 16], suggesting that data quality issues related to maternal health services are not a concern in the region.

The findings from our study also revealed a greater incidence of multipara LBW than primiparous LBW. This finding is consistent with a study in the Brong Ahafo Region of Ghana, which reported that an increase in parity increased the odds of LBW [17]. Additionally, a study in Ethiopia revealed that the risk of LBW was greater in multiparous women [18]. However, a study by Axame et al. (2022) revealed that LBW babies were less likely to be born to multiparous women [13]. Similarly, a study in India reported that an increase in parity increased the mean birth weight of a baby [19]. The reason for the higher incidence of LBW among multiparas has yet to be established. It is expected that increased parity could lead to increased experience with pregnancy and childcare, ANC attendance, nutritional status, and health-seeking behaviour.

The incidence of LBW was consistently high across the years studied in the Ho Municipality. The Ho Municipality is the capital city of the Volta Region and has a Teaching Hospital commissioned in 2019. The teaching hospital, which serves as a referral center in the region, is located within the municipality, which may have resulted in the referral of complicated obstetric cases to the facility for specialized care. We believe this could have influenced the consistent increase in the incidence of LBW in the municipality. Additionally, the cumulative incidence of LBW across the five years was > 10% in North Tongu. This could be attributed to the fact that specialist obstetric services are provided at North Tongu District Hospital, which makes the hospital a preferred destination for mothers within and outside the region.

Strengths and limitations

This study is the first to determine the rate, trend, and distribution of LBW using routine health data in the Volta Region of Ghana. However, this study has important limitations. First, the DHIMS-II data captured inadequate characteristics of babies with LBW. For example, data on gestational ages of babies is not routinely collated and so it is difficult to segregate data by term of birth. Therefore, this limited the kind of analysis that could be performed to describe LBW in the region. Additionally, only cases of LBW reported at health facilities were included, potentially underrepresenting the actual situation in the region.

Conclusion

The main goal of the current study was to document the incidence and distribution of LBW in the Volta Region from 2019 to 2023. Overall, the incidence of LBW in the region over the five-year period was 8.4%. The study revealed a higher incidence of LBW in 2022 in the Ho Municipality, which consistently recorded a higher incidence across the years studied. Interestingly, a greater incidence of LBW was observed among multiparous women than among primiparous women. These findings provide a basis for further studies to reduce the incidence of LBW in the Volta Region.