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Postneonatal and child mortality among twins in Southern and Eastern Africa
1Department of Public Health, Erasmus University, Rotterdam, The Netherlands.
Insights
Twin children in sub-Saharan Africa face significantly higher mortality rates than singletons, especially in the first year of life. Factors like male sex and low socioeconomic status increase this risk, highlighting the need for targeted interventions.
Area of Science:
- Global Health
- Demography
- Pediatrics
Background:
- Limited research exists on twin vs. singleton mortality in sub-Saharan Africa's postneonatal and childhood periods.
- Investigating excess twin mortality and contributing factors is crucial for public health.
- Healthcare utilization differences were hypothesized as a key factor in increased twin mortality.
Purpose of the Study:
- To quantify the excess mortality of twins compared to singletons in postneonatal and childhood periods.
- To identify specific factors contributing to higher twin mortality rates.
- To assess the role of healthcare utilization in observed mortality differences.
Main Methods:
- Pooled Demographic and Health Survey data from Malawi, Tanzania, and Zambia.
- Employed logistic regression to estimate twin/singleton mortality differences.
- Analyzed intermediate factors and effect modifiers on mortality risk.
Main Results:
- The study included 18,214 singletons and 706 twins.
- Twin/singleton odds ratio for mortality was 2.33 (95% CI: 1.85-2.93), highest in the first year.
- Preventive care and breastfeeding did not significantly alter the mortality gap; male sex, unwanted birth, short birth interval, and low SES were risk modifiers.
Conclusions:
- Sub-Saharan African twins experience considerable excess mortality compared to singletons.
- Healthcare access or breastfeeding practices do not fully explain this disparity.
- High-risk groups include male twins, unwanted children, those with short birth intervals, and the socioeconomically disadvantaged, requiring focused attention at under-5 clinics.
Background:
Few studies have evaluated the difference in mortality between twins and singleton children during the postneonatal and childhood period in sub-Saharan Africa. The aim of this study was to quantify the excess mortality of twins during the postneonatal and childhood period and to identify factors that contribute to the excess mortality among twins. The different use made of health care services was hypothesized to contribute to the increased mortality.
Methods:
The Demographic and Health Survey data on Malawi, Tanzania and Zambia were pooled. Logistic regression was used to estimate twin/singleton differences for the combined postneonatal and child mortality and to study the role of intermediate factors and effect modifiers.
Results:
The study was based on 18 214 singleton children and 706 twins. The twin/ singleton odds ratio (OR) of the combined postneonatal and child mortality was 2.33 (95% CI : 1.85-2.93). This excess mortality was largest during the first year of life. Control for intermediate factors (preventive health care and breastfeeding) did not sizeably diminish the mortality difference. Effect modifiers that were associated with increased twin/singleton OR were male sex, unwanted child, short birth interval and low socioeconomic status.
Conclusions:
The excess mortality of twins compared to singletons is considerable. A difference in use of preventive health care or in breastfeeding cannot explain the increased mortality. Males, unwanted children, those born after a short birth interval and the socioeconomically disadvantaged are at special risk. The generally good attendance at under-5 clinics gives health care providers the opportunity for increased surveillance of these high-risk groups.