Background/Objectives Low birth weight (LBW) is an important public health indicator for infant morbidity, mortality, and risk for cardiovascular diseases in the later stages of one’s life. A LBW prevalence (12%) in Malawi is on a high side with higher disparities in the central region (15%). With this high prevalence rate in Malawi, little is currently known about determinants of LBW in Malawi. We aimed to examine the determinants of LBW in Malawi using the 2010 Malawi Demographic and Health Survey (MDHS) data.

Methods The MDHS data are collected every 5 years from nationally representative samples. A total of 9,039 women (15–49 y) who had children aged up to 59 mo were included in the study. Samples with biologically implausible birth weights (<500g or >6,000g) and with no data on antenatal care and supplement use were excluded from the analysis. Data on socio-demographics, antenatal care visit (ANC), and iron and folic acid (IFA) supplement usage of women were collected using a set of questionnaires. Hemoglobin level of women at the time of survey was measured using the HemoCue. Children’s birth weights were obtained from their health records or mothers’ recall. Multivariate logistic regression was used to identify determinants of LBW.

Results Most women (82%) lived in rural areas and had primary or less education level (79%). Teenagers and older women were more likely to have LBW babies. Maternal height, education and income level, number of children, IFA supplement usage, number of ANC visits, timing of the first ANC attendance were significantly associated with LBW (p < 0.05). Frequency and timing of the first ANC visits were positively associated with the number of IFA supplements taken during the pregnancy (p<0.001). Women who had <2 ANC visits had higher odds ratio for LBW (OR=1.42, 95% CI=1.09–1.86) compared to those who visited >5 ANC visits after adjusting for maternal age at birth, region, education, wealth index, and birth order of the child.

Conclusion The frequency of ANC visits is a key modifiable determinant of LBW in Malawi and is associated with use of the IFA during one’s pregnancy. We recommend further investigations on barriers of ANC attendance and IFA supplement usage to improve the risk of LWB in this population.