Regional and socioeconomic inequalities and factors associated with low birth weight in Ghana: a multilevel analysis of the 2022 Ghana Demographic and Health Survey

Introduction Low birth weight (LBW) remains a major public health challenge globally, particularly in low- and middle-income countries (LMICs). In Ghana, socioeconomic and regional inequalities in birth outcomes persist. This study examined LBW prevalence, socioeconomic and regional inequalities, and factors associated with LBW using nationally representative data. Methods A secondary analysis of the 2022 Ghana Demographic and Health Survey (GDHS) was conducted using a weighted sample of 5,768 live births to women aged 15–49 years. Multilevel binary logistic regression was used to assess factors associated with LBW, with a random intercept specified at the DHS cluster level. Socioeconomic inequality was assessed using a concentration curve ranked by household wealth. Regional differences were described using regional prevalence estimates, while between-cluster variation was assessed using the intraclass correlation coefficient (ICC) and median odds ratio (MOR). Results The overall prevalence of LBW was 11.0%. Prevalence was highest among births in the poorest and poorer wealth quintiles (13%) and lowest in the richest quintile (6%). Regionally, prevalence was highest in Ashanti (15%) and Northern (14%) and lowest in Greater Accra (6%). In the fully adjusted multilevel model ( n = 3,421), multiple pregnancy was associated with substantially higher odds of LBW (AOR = 10.09, 95% CI: 6.19–16.44), while adequate ANC attendance (≥8 visits) was associated with lower odds of LBW (AOR = 0.46, 95% CI: 0.32–0.66). The association between household wealth and LBW was not statistically significant after adjustment. Cluster-level ICC was 11.1% in the final model, indicating meaningful between-cluster variation. Conclusions LBW prevalence varied across socioeconomic and regional groups in Ghana. Multiple pregnancy and adequate ANC attendance were the principal factors associated with LBW in the fully adjusted model, while household wealth was not statistically significant after adjustment. The findings support strengthening quality ANC, particularly for pregnancies at higher risk, alongside equity-oriented maternal and newborn health services.