Levels and Determinants of Low Birth Weight in Infants Delivered Under the National Health Insurance Scheme in Northern Ghana Abdallah Ibrahim • Anne Marie O’Keefe • Anita Hawkins • Mian Bazle Hossain Ó Springer Science+Business Media New York 2014 Abstract This research determined the levels and odds ratios for low birth weight (LBW) infants delivered under the National Health Insurance Scheme (NHIS) compared to LBW infants delivered under the previous ‘‘Cash and Carry’’ system in Northern Ghana. Birth records of infants delivered before and after implementation of the NHIS in Northern Ghana were examined. Records of each day’s births during the identified periods were abstracted. Days with fewer or no births were accommodated by oversam- pling from days before or after. Chi squared tests of independence were used to examine the bivariate associa- tion between categorical independent variables and LBW. Multiple logistic regression models were used to examine the relationships among selected variables for mothers and infants and the odds ratios for LBW. Infants delivered under NHIS had lower rates of LBW (16.8 %) compared to infants born under Cash and Carry (23.3 %). Mothers who delivered under NHIS were significantly less likely to have infants at LBW (unadjusted OR 0.65; 95 % CI 0.49, 0.86). The rate of LBW among infants delivered under NHIS is significantly lower than among infants delivered under Cash and Carry. The rate of LBW under Cash and Carry in 2000 fell by 27 % in relation to the NHIS in 2010. These findings confirm that the NHIS, which gives pregnant women in Northern Ghana four antenatal visits and access to skilled health professionals for delivery at no cost to the mother, significantly improved birth weight outcomes. Keywords Low birth weight Á Northern Ghana Á NHIS Á Tamale Teaching Hospital Á Cash and Carry Introduction Low birth weight (LBW) is one of the most powerful and proximate predictors of infant mortality, and is also asso- ciated with a number of adverse physical and develop- mental consequences that may continue throughout the child’s lifespan [1]. The World Health Organization (WHO) has established the internationally accepted stan- dard defining LBW as 2,500 g (5.5 pounds) and less [2]. Infants who weigh \ 2,500 g at birth are 20 times more likely to die in infancy than are infants born at higher weights [3]. Low birth weight can be the result of preterm birth ( \ 37 weeks of gestation) or restricted intrauterine growth [4]. Birth weight is also inversely related to household income and parents’ educational levels [5, 6]. Low birth weight is not only a prime indicator of the newborn’s chances of survival, but also reflects a range of public health problems including long-term maternal mal- nutrition, poor health during pregnancy, and the quality of antenatal care the mother received during pregnancy [3, 7]. Although birth weight is affected by a confluence of fac- tors, it is so strongly related to the infant’s well-being that it has become one of the prime measures for population health. In the 2002 document ‘‘A World Fit for Children,’’ United Nations member countries pledged to reduce the proportion of LBW births by one-third by the end of 2010 [8]. Such dramatic reductions would require nations like Ghana to seriously address the factors known to be asso- ciated with low birth weight. The links between infant birth weight and maternal socioeconomic, environmental, and cultural factors have A. Ibrahim (&) School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana e-mail: aibrahim@ug.edu.gh A. M. O’Keefe Á A. Hawkins Á M. B. Hossain School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA 123 Matern Child Health J DOI 10.1007/s10995-014-1628-3