Background Each year, about 20 million Low Birth Weight (LBW) babies are born with very high proportion (96.5%) occuring in developing countries. In the last decade, the incidence of LBW in Ghana has not declined. Brong Ahafo Region of Ghana recorded a LBW prevalence of 11% which was higher than the the national average of 10%. This study identifed determinants of LBW delivery in the Brong Ahafo Region. Methods We conducted a 1:2 unmatched case control study among mothers with singleton deliveries in 3 major health facilities in the Brong Ahafo Region. A case was defined as a mother who delivered a baby weighing less than 2500g in any of the three selected health facilities between 1st December, 2015 and 30th April, 2016. A control was defined as a mother who within 24 h of delivery by a case, delivered a baby weighing at least 2500g and not exceeding 3400g in the same health facility. Deliveries that met the inclusion criteria for cases were selected and two controls were randomly selected from the pool of deliveries that meet criteria for controls within 24 h of delivery of a case. A total of 120 cases and 240 control were recruited for the study. We computed odds ratios at 95% confidence level to determine the associations between low birth weight and the dependent factors. Results After controlling for confounders such as planned pregnancy, mode of delivery, parity and previous LBW in stepwise backward logistic regression, first trimester hemoglobin < 11 g/dl (aOR 3.14; 95%CI: 1.50–6.58), delivery at 32-36 weeks gestation (aOR 13.70; 95%CI: 4.64–40.45), delivery below 32 weeks gestation (aOR 58.5; 95%CI 6.7–513.9), secondary education of mothers (aOR 4.19; 95%CI 1.45–12.07), living with extended family (aOR 2.43; 95%CI 1.15–5.10, living alone during pregnancy (aOR 3.9; 95%CI: 1.3–11.7), and not taking iron supplements during pregnancy (aOR 3.2; 95%CI: 1.1–9.5) were found to be significantly associated with LBW. Conclusion Determinants of LBW were: preterm delivery, mothers with secondary education, living alone during pregnancy, not taking daily required iron supplementation and mothers with first trimester hemoglobin below 11 g/dl. Education during antenatal sessions should be tailored to address the identified risk factors in the mother and child health care services.

This is defined as the weight of a baby measured immediately after birth and is below 2500grams. Extremely low birth weight This is defined as the weight of a baby measured immediately after birth and is below 1000 grams, Very low birth weight This is defined as the weight of a baby measured immediately after birth and is 1500grams or less, but not lower than 1000grams. Normal birth weight: This is defined as the weight of a baby measured immediately after birth and its 2500grams or more but not exceeding 3400grams.