{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:45:58Z","timestamp":1785415558622,"version":"3.56.0"},"reference-count":66,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["107741\/A\/15\/Z"],"award-info":[{"award-number":["107741\/A\/15\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]},{"award":["107741\/A\/15\/Z"],"award-info":[{"award-number":["107741\/A\/15\/Z"]}],"id":[{"id":"https:\/\/ror.org\/029chgv08","id-type":"ROR","asserted-by":"publisher"}]},{"name":"UK Foreign, Commonwealth & Development Office"},{"id":[{"id":"https:\/\/ror.org\/037wke960","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Developing Excellence in Leadership, Training and Science in Africa"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Despite declining malaria transmission, maternal anaemia and low birthweight (LBW) remain high in Ghana, suggesting that non-malarial determinants now dominate these outcomes. A cohort of 5197 pregnant women was enrolled at eight health facilities across Ghana\u2019s Ashanti and Volta regions. Independent predictors of anaemia at term and LBW were identified by multivariable logistic regression using multiple imputation by chained equations. Anaemia at term prevalence was 60.57% and LBW was 11.54%. No intestinal helminths were detected. Anaemia at antenatal care (ANC) booking was the strongest predictor of anaemia at term (aOR 3.98; absolute risk increase of 31.4 percentage points). Three or more iron and folic acid doses and eight or more ANC contacts each reduced risk by only four to six percentage points. For LBW, household poverty (absolute risk increase 8.8%), short maternal stature, and male foetal sex dominated. Intermittent preventive treatment of malaria in pregnancy with sulfadoxine\u2013pyrimethamine (aOR 0.65) remained protective despite booking parasitaemia being non-significant. The Volta region had higher anaemia (71.1%vs. 47.7%) but lower LBW (9.6%vs. 14.4%) than Ashanti, with markedly higher parasite densities among infected women, consistent with waning naturally acquired immunity. Persistent anaemia and LBW reflect nutritional depletion, structural poverty, and increased malaria vulnerability under declining transmission. Pre-conception nutrition, social protection, and sub-microscopic malaria surveillance must complement clinic care.<\/jats:p>","DOI":"10.3390\/pathogens15060618","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T02:59:31Z","timestamp":1781146771000},"page":"618","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Persistence of High Maternal Anaemia and Low Birthweight Despite Declining Malaria Transmission and Prevalence in Ghana"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9300-665X","authenticated-orcid":false,"given":"Harry","family":"Tagbor","sequence":"first","affiliation":[{"name":"Department of Community Health and School of Medicine, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana"},{"name":"Department of Community, College of Medicine and Allied Sciences, North Legon, Accra, Greater Accra Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5366-3997","authenticated-orcid":false,"given":"Joseph","family":"Osarfo","sequence":"additional","affiliation":[{"name":"Department of Community Health and School of Medicine, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doris","family":"Okyere","sequence":"additional","affiliation":[{"name":"Department of Community Health and School of Medicine, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8637-0704","authenticated-orcid":false,"given":"Ekoue","family":"Kouevidjin","sequence":"additional","affiliation":[{"name":"MARCAD Consortium Secretariat, Faculty of Medicine, University Cheikh Anta Diop of Dakar, Dakar-Fann BP 5005, Senegal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matilda","family":"Aberese-Ako","sequence":"additional","affiliation":[{"name":"Malaria Centre of the Health Research Institute, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gifty Dufie","family":"Ampofo","sequence":"additional","affiliation":[{"name":"Department of Community Health and School of Medicine, University of Health and Allied Sciences, PMB 31, Ho, Volta Region, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1016\/S0140-6736(23)01198-4","article-title":"National, regional, and global estimates of low birthweight in 2020, with trends from 2000: A systematic analysis","volume":"403","author":"Okwaraji","year":"2024","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/s12884-023-05489-6","article-title":"Maternal low and high hemoglobin concentrations and associations with adverse maternal and infant health outcomes: An updated global systematic review and meta-analysis","volume":"23","author":"Young","year":"2023","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100660","DOI":"10.1016\/j.eclinm.2020.100660","article-title":"International values for haemoglobin distributions in healthy pregnant women","volume":"29\u201330","author":"Ohuma","year":"2020","journal-title":"EClinicalMedicine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1846280","DOI":"10.1155\/2018\/1846280","article-title":"Anaemia in pregnancy: Prevalence, risk factors, and adverse perinatal outcomes in Northern Tanzania","volume":"2018","author":"Stephen","year":"2018","journal-title":"Anemia"},{"key":"ref_5","unstructured":"World Health Organization (2025). 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