Trends and determinants of preterm birth and neonatal mortality in Ghana (2008–2022): a WHO antenatal care guidelines analysis

Preterm birth and neonatal mortality continue to pose significant public health challenges in Ghana. This study explores their temporal trends and associated determinants from 2008 to 2022. Birth record data from the Ghana Demographic and Health Surveys (2008, 2014, and 2022) were used to analyse trends and determinants in neonatal mortality and preterm birth aligned with World Health Organization antenatal care (ANC) guidelines using Pearson’s Chi-square test and multivariate logistic regression with statistical significance at P < 0.05 and 95 % confidence intervals ( CI ). Preterm birth rate and neonatal mortality rate decreased from 13.0 % to 9.1 % and 27.6 to 23.7 per 1000 live births from 2008 to 2022 respectively. Lack of iron supplementation (odds ratio OR 1.127, 95 % CI : 1.047 to 1.967) a nutritional intervention maternal assessments (moderate/severe anaemia ( OR 1.423, 95 % CI : 1.178 to 2.051), preventive measures (Untreated malaria ( OR 1.449, 95 % CI : 1.104 to 2.411) or deworming ( OR 1.267, 95 % CI : 0.970 to 1.645) were associated with increased preterm birth risk. Attending < 8 ANC visits raised the odds of preterm birth ( OR 1.24, 95 % CI : 1.03 to 1.257) and neonatal mortality ( OR 1.583, 95 % CI : 1.120 to 2.480). Despite reductions in preterm birth and neonatal mortality rates, substantial gaps in antenatal care remain. Strengthening the implementation of World Health Organization ANC guidelines is critical to reducing preterm birth and neonatal mortality in Ghana.