Assessing antenatal care utilization, socioeconomic inequalities and low birth weight outcomes: a population-based analysis using the 2022 Ghana demographic and health survey data.

BACKGROUND

Sub-Saharan Africa continues to face significant challenges with low birth weight (LBW). Factors such as antenatal care (ANC) utilization and socioeconomic status play critical roles in birth outcomes. It is therefore imperative to understand these relationships, which are crucial to developing tailored, workable interventions to improve maternal and child health outcomes in Ghana.

OBJECTIVE

This study aimed to examine the association between ANC utilization patterns, socioeconomic disparities, and low birth weight outcomes among women in Ghana.

METHODS

The study included 6,965 observations, with 4,056 complete cases. Due to substantial missingness in key variables (LBW, adequate ANC), a monotone missing data pattern consistent with Missing at Random (MAR) was observed. Multiple Imputation by Chained Equations (MICE) was employed using Fully Conditional Specification across 20 imputed datasets. Survey-weighted logistic regression was performed on each imputed dataset, with estimates pooled via Rubin's Rules. Model fit was assessed using the Hosmer-Lemeshow goodness-of-fit test. The slope index of inequality was calculated to examine socioeconomic disparities.

RESULTS

The prevalence of LBW was 10.0% in complete cases and 19.2% in imputed data. Socioeconomic inequality analyses revealed significant pro-rich gradients in ANC utilization. The disparities were more pronounced for optimal ANC (8 + visits; SII: 0.431; RII: 1.538) than adequate ANC (4 + visits; SII: 0.203; RII: 1.224). LBW was disproportionately concentrated among women of lower socioeconomic status (SII: -0.159; RII: 1.172). The adjusted multivariable model showed inadequate ANC (aOR: 1.97; 95% CI: 1.34-2.90), suboptimal ANC (aOR: 1.73; 95% CI: 1.27-2.36), and poor wealth status (aOR: 1.79; 95% CI: 1.18-2.72) were independently associated with higher odds of LBW.

CONCLUSION

ANC visit frequency and household wealth are independently associated with LBW among Ghanaian women. These findings underscore the need for targeted interventions to improve ANC attendance and address socioeconomic disparities to reduce the burden of LBW in Ghana.