title: Contextual risk factors for low birth weight: a multilevel analysis.
abstract: BACKGROUND
  Low birth weight (LBW) remains to be a leading cause of neonatal death and a major contributor to infant and under-five mortality. Its prevalence has not declined in the last decade in sub-Saharan Africa (SSA) and Asia. Some individual level factors have been identified as risk factors for LBW but knowledge is limited on contextual risk factors for LBW especially in SSA.
  
  
  METHODS
  Contextual risk factors for LBW in Ghana were identified by performing multivariable multilevel logistic regression analysis of 6,900 mothers dwelling in 412 communities that participated in the 2003 and 2008 Demographic and Health Surveys in Ghana.
  
  
  RESULTS
  Contextual-level factors were significantly associated with LBW: Being a rural dweller increased the likelihood of having a LBW infant by 43% (OR 1.43; 95% CI 1.01-2.01; P-value <0.05) while living in poverty-concentrated communities increased the risk of having a LBW infant twofold (OR 2.16; 95% CI 1.29-3.61; P-value <0.01). In neighbourhoods with a high coverage of safe water supply the odds of having a LBW infant reduced by 28% (OR 0.74; 95% CI 0.57-0.96; P-value <0.05).
  
  
  CONCLUSIONS
  This study showed contextual risk factors to have independent effects on the prevalence of LBW infants. Being a rural dweller, living in a community with a high concentration of poverty and a low coverage of safe water supply were found to increase the prevalence of LBW infants. Implementing appropriate community-based intervention programmes will likely reduce the occurrence of LBW infants.
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Gbenga A
authors.initials: GA
authors.lastname: Kayode
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Ghana Health Service, Greater Accra Region, Accra, Ghana.
authors.forename: Mary
authors.initials: M
authors.lastname: Amoakoh-Coleman
authors.affiliation: Ghana Health Service, Greater Accra Region, Accra, Ghana; School of Public Health, University of Ghana, Legon, Accra, Ghana.
authors.forename: Irene Akua
authors.initials: IA
authors.lastname: Agyepong
authors.affiliation: Ghana Health Service, Greater Accra Region, Accra, Ghana.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ansah
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.affiliation: Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Klipstein-Grobusch
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009035:Mothers / Q000706:statistics & numerical data; D055361:Multilevel Analysis; D011204:Poverty Areas; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D014881:Water Supply; D055815:Young Adult