<b>A cross-sectional analysis of proximate household environmental predictors of birth outcomes in Ghana.</b>

Regions such as the Northern and Volta regions exhibit substantial ecological, climatic, and socio-environmental disparities. The Northern region is characterized by semi-arid conditions, high reliance on open well/surface water, widespread biomass fuel use, and severe infrastructural poverty.

In contrast, the Volta region encompasses coastal and transitional forest zones with distinct microclimates, hydrological profiles, and varying levels of urban-rural development. Standard epidemiological studies frequently treat environmental exposures as uniform across populations, ignoring how geographical and ecological context modulates exposure intensity and healthcare access. Assessing proximate household environmental predictors across distinct ecological zones is therefore essential for disentangling environmental toxicity from socioeconomic confounding.</p><p dir="ltr">Despite growing recognition of environmental health threats, comprehensive population-based analyses evaluating household environmental predictors of birth outcomes while adjusting for structural socio-demographic confounders across ecologically distinct regions in Ghana remain limited.