Abstract
OBJECTIVE: This study aimed to assess the pooled prevalence and factors of low birth weight among newborns in the top 20 countries with the highest infant mortality rates. DESIGN: We conducted a community-based cross-sectional analysis using data from Demography and Health Surveys across these countries. The final analysis included a weighted sample of 82 430 live births. We employed binary logistic regression to identify predictors of low birth weight, allowing for the interpretation of results as probabilities. This approach enhances the understanding of event likelihood, which is particularly valuable for policymakers. Statistical significance was determined at a 95% CI with p values <0.05. SETTING: The focus was on the top 20 countries that report the highest infant mortality. OUTCOME VARIABLE: Low birth weight (binary: Yes/No). RESULT: The pooled prevalence of low birth weight among newborns was found to be 13% (95% CI: 11% to 14%), showing notable variation across countries, ranging from 5% in Sierra Leone to 25% in Mauritania. Statistically significant factors included maternal age of 15-19 years (adjusted OR (AOR): 1.38; 95% CI: 1.19 to 1.61), lack of formal education among mothers (AOR: 1.36; 95% CI: 1.26 to 1.46), unemployed mothers (AOR: 1.54; 95% CI: 1.46 to 1.63), divorced mothers (AOR: 1.20; 95% CI: 1.10 to 1.36), absence of antenatal care (ANC) visits (AOR: 1.24; 95% CI: 1.10 to 1.39) and one to three ANC visits (AOR: 1.30; 95% CI: 1.22 to 1.38). Other significant factors included a parity of one to two children (AOR: 1.29; 95% CI: 1.21 to 1.39), twin births (AOR: 6.40; 95% CI: 5.68 to 7.26), and female newborns (AOR: 1.21; 95% CI: 1.15 to 1.28). CONCLUSION AND RECOMMENDATION: The findings indicate that more than 1 out of 10 newborns in these highest infant mortality countries are classified as low birth weight. To mitigate this issue, it is imperative to enhance access to quality healthcare with particular emphasis on ANC and to promote maternal education, especially for younger and less-educated mothers. Increasing the presence of skilled birth attendants and addressing socioeconomic factors, such as women's unemployment, is crucial. Targeted interventions should support divorced women and address risks associated with maternal age, terminated pregnancies and twin births. Additionally, country-specific strategies that focus on female infants can play a significant role in reducing the prevalence of low birth weight and improving neonatal health outcomes.