Physical fighting is an important behavioral concern of public health importance among adolescents worldwide. The present study examines the patterns and correlates of physical fighting among a school-based population in a low-income country setting. Data on 6235 adolescents aged 11–16 years were derived from the Republic of Ghana contributions to the Global School-based Health Survey. Three thresholds of participation in a physical fight during a 12-month recall period were compared against several independent sociodemographic variables. Bivariate analyses were used to screen for statistically significant associations and multinomial logistic regression was used to examine significant relationships while adjusting for covariates. Within the recall period, 32% of adolescents had reported being involved in two or more physical fights. Those involved in a physical fight during three or more days during the recall period were more likely to have been bullied (relative risk ratios (RRR) = 1.86; 99% confidence intervals (CI): 1.38–2.52), have had a troubled experience with alcohol (RRR = 2.202; CI = 1.55–2.64), and miss days of school (RRR = 2.02; CI = 1.39–2.92). When adjusted only for age and sex, having understanding parents was protective (RRR = 0.64; CI = 0.53–0.78) as was having a positive school environment (RRR = 0.73; CI = 0.55–0.97). Our findings suggest that school-based programming which simultaneously targets multiple risk behaviors and conflict resolution may be helpful in interventions to reduce rates of physical fighting.