Disinformation has become a structural feature of electoral competition worldwide, yet its drivers within political economy contexts and voter-level effects in emerging democracies remain underexplored. This paper analyses how party incentives, media market structures, and digital network dynamics shape disinformation electioneering in Ghana, and examines how exposure to such content affects citizens' institutional trust, turnout intentions, and vote choice. Drawing on the political-economics framework, disinformation is conceptualised as a low-cost campaign strategy yielding higher returns under conditions of political polarisation and weak fact-checking capacity. Using a cross-sectional design with a nationally representative voter survey (N = 1,200), exposure and belief were measured using validated scales. Statistical analysis employed OLS, logistic, and multinomial logit models, along with causal mediation analysis. Findings indicate that exposure to disinformation significantly reduces trust in democratic institutions (b = -0.20, p < 0.001) and reinforces partisan bias in vote choice (b = 0.08, p = 0.016). Although exposure slightly reduces turnout intentions, the effect is not statistically significant (p = 0.095). Media literacy emerges as a protective factor that strengthens institutional trust (b = 0.06, p = 0.021), though its influence on behavioural outcomes remains limited. Mediation results further show that affective polarisation explains part of the disinformation effect on voter behaviour. Based on the findings, this paper concludes that the winner-takes-all nature of Ghanaian politics, partisan media ecosystems, weak fact-checking infrastructure, and low digital literacy rates create conditions where disinformation flourishes as a rational campaign strategy. Ghana’s democracy in the digital age requires both structural reforms and citizen-centered interventions to address the phenomenon of disinformation proactively. This can reinforce the legitimacy of her electoral processes, maintain competitive party politics, and continue her trajectory as a stable and inclusive democracy in sub-Saharan Africa.