Abstract
BackgroundA high twinning rate and an increased risk of mortality among twins contribute to the high burden of infant mortality in Africa. This study examined the contribution of twins to neonatal and post-neonatal mortality in The Gambia, and evaluated factors that contribute to the excess mortality among twins.MethodsWe analysed data from the Basse Health and Demographic Surveillance System (BHDSS) collected from January 2009 to December 2013. Demographic and epidemiological variables were assessed for their association with mortality in different age groups.ResultsWe included 32,436 singletons and 1083 twins in the analysis (twining rate 16.7/1000 deliveries). Twins represented 11.8 % of all neonatal deaths and 7.8 % of post-neonatal deaths. Mortality among twins was higher than in singletons [adjusted odds ratio (AOR) 4.33 (95 % CI: 3.09, 6.06) in the neonatal period and 2.61 (95 % CI: 1.85, 3.68) in the post-neonatal period]. Post-neonatal mortality among twins increased in girls (P for interaction = 0.064), being born during the dry season (P for interaction = 0.030) and lacking access to clean water (P for interaction = 0.042).ConclusionMortality among twins makes a significant contribution to the high burden of neonatal and post-neonatal mortality in The Gambia and preventive interventions targeting twins should be prioritized.
Highlights
A high twinning rate and an increased risk of mortality among twins contribute to the high burden of infant mortality in Africa
The estimated probabilities of Statistical analyses All children born in the Basse Health and Demographic Surveillance System (BHDSS) from January 2009 to December 2013 were included in the analysis; triplets were excluded
Our study has shown that mortality among twins remains very high in The Gambia during the neonatal and post-neonatal periods
Summary
A high twinning rate and an increased risk of mortality among twins contribute to the high burden of infant mortality in Africa. This study examined the contribution of twins to neonatal and post-neonatal mortality in The Gambia, and evaluated factors that contribute to the excess mortality among twins. In sub-Saharan Africa, under-5 mortality has declined significantly since 2000, rates are still unacceptably high. The decline in neonatal mortality has been slower than in older children and the relative contribution of neonates to under-5 deaths has increased. In 2013, almost half of under-5 deaths worldwide were neonates [1]. Twins have an increased risk of death during the neonatal period, and this extends at least until the first anniversary. The high rate of mortality in twins is probably
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