The impact of the Tigray War on the incidence of low birth weight in Tigray, Ethiopia: A retrospective cohort study.

War and armed conflict negatively impact neonatal health. This study investigates the effect of the Tigray War on the incidence of low birth weight (LBW) among live births in Tigray, Ethiopia. A retrospective cohort study was conducted among 1,763 mothers from December 2018 to November 2022 at two public hospitals in Mekelle. Data were extracted from maternal records using systematic sampling, and multivariable logistic regression was used to identify factors associated with LBW, with significance defined as p < 0.05 and 95% confidence intervals (CI). The overall incidence of LBW was 12.9% (95% CI: 11.3-14.5). The incidence nearly doubled from 8.6% pre-war to 17.2% during the war (p < 0.001). Residence outside Mekelle, war exposure, mode of delivery, and preeclampsia were significantly associated with LBW. Mothers delivering during the war were over twice as likely to have LBW infants (Adjusted Odds Ratio [AOR] = 2.22; 95% CI: 1.64-3.00) compared to the pre-war cohort. LBW incidence increased significantly during the Tigray War. These findings demonstrate a strong association between war exposure and adverse birth outcomes, highlighting the urgent need for targeted maternal and child health interventions in war/conflict-affected regions.