Size and morbidity in Malawian twins

Area of Science:

• Pediatric Growth and Development
• Global Health
• Twin Studies

Background:

• Twinning in developing countries presents unique challenges, including potential disadvantages from reduced birth size, nutrition, and increased infection risk.
• Longitudinal data on growth and morbidity in African twins, a high-risk group, are scarce.
• Malawi has a high twinning rate, necessitating focused research on twin outcomes.

Purpose of the Study:

• To describe and compare the growth trajectories of Malawian twins and singletons from birth to 52 weeks of age.
• To assess and compare the incidence of morbidity in Malawian twins and singletons during infancy.
• To identify potential growth catch-up or persistent disadvantages in Malawian twins.

Main Methods:

• A longitudinal study design was employed, tracking infants from birth to 52 weeks.
• Morbidity episodes were systematically recorded at 4-weekly intervals and during unscheduled health center visits.
• Anthropometric measurements, including weight, length, head circumference, and mid-upper arm circumference (MUAC), were taken at birth and at 4-weekly intervals.

Main Results:

• Twins exhibited reduced fetal growth compared to singletons, with a noticeable decline in percentile ranking from 33 weeks gestation.
• Infant growth percentiles for twins remained below those of singletons throughout the first year but did not show a further decline relative to singletons.
• No significant differences in the incidence of morbidity were observed between twins and singletons during the infancy period.

Conclusions:

• Malawian twins do not demonstrate catch-up growth during infancy, maintaining smaller size percentiles compared to singletons.
• The smaller size of Malawian twins was not associated with an increased risk of morbidity during infancy.
• Findings highlight the need for continued monitoring and support for twin growth in similar settings.