Regional and sub-regional estimates of low birth weight and its determinants in 44 low- and middle-income countries: evidence from demographic and health survey data

Abstract

Background

Low birth weight continues to be a significant cause of perinatal morbidity and mortality, contributing to 80% of neonatal deaths in low and middle-income countries. To the authors’ knowledge, no prior study has estimated the regional and sub-regional prevalence of low birth weight and its determinants in these settings. Therefore, this study aimed to examine the pooled and regional estimates of low birth weight in low and middle-income countries.

Methods

We used a weighted sample of 343,898 birth records, taken from the pooled demographic and health surveys conducted from 2015 to 2022 in 44 low and middle-income countries. Overall and sub-regional trends in low birth weight estimates were presented using a line graph. A multilevel mixed-effect analysis was done to identify determinants of low birth weight. Model comparison was performed using deviance and log-likelihood values, and statistical significance was determined at a P-value of less than 0.05.

Results

The overall prevalence of low birth weight births was 13.7% [95% CI: 13.5%—13.8%], showing significant variations among countries and regions. Asia region had the highest prevalence at 16%, followed by Latin America, the Caribbean, and Europe at 11.5%, and Africa at 9.5%. Our study also indicated a decline in low birth weight from 11.4% to 9.5% over eight-year periods, with no consistent trend observed. Furthermore, factors such as health insurance, household wealth, maternal age, access to healthcare facilities, maternal education, neonate’s sex, prenatal care, and antenatal iron supplementation were found to be statistically associated with low birth weight.

Conclusion

Our findings highlight the significant burden of low birth weight births, with notable variations in rates among countries and regions. The study also reveals a slight decline in low birth weight over time, although no consistent trend was observed. Importantly, maternal and household factors play significant roles in influencing low birth weight. Thus, addressing these factors through targeted interventions and policies could help reduce the incidence of low birth weight births in LMICs.