Levels, Spatial and Temporal Variations, and Associated Factors of Twin Excess Mortality From Ages 0–5 in Sub-Saharan Africa: Analyses of National Surveys From 42 Countries

Adama Ouédraogo (1) , Gilles Pison (1, 2) , Sophie Le Coeur (1) , Abdramane Soura

1 INED - Institut national d'études démographiques
2 EA - Éco-Anthropologie

BACKGROUND Twin children are more likely to die than singletons. In sub-Saharan African countries, this is an additional burden, as child mortality levels are already higher than anywhere else. OBJECTIVE This article presents under-5 mortality rates (U5MR) for twins and singletons in sub-Saharan Africa from 1986 to 2016. It describes the geographical variations and changes over time. It also describes the variation of twins’ excess mortality according to age, between 0 and 5 years old. Moreover, it analyses the factors associated with twins’ excess mortality. METHODS We have used data from 156 national surveys (Demographic and Health Surveys (DHS) & Multiple Indicator Cluster Survey) from 42 countries. RESULTS The findings show that U5MR are, on average, 3 times higher among twins compared to singletons. The multivariate results show that, all else being equal, the adjusted Hazard Ratio (HRa) of twins is 3.2 times higher (2.9 -3.3; p<0.001) than that of singletons. The main factors associated with excess mortality risks among twins are a set of biomedical and nutritional features, composed of birthweight, caesarean section, antenatal visits and breastfeeding. Among these factors, non-breastfeeding is associated with 4 times higher mortality risks for twins than for singletons; and caesarean delivery is associated with lower mortality risks for twins than for singletons. CONCLUSION In sub-Saharan Africa, the health of twin children is a major health challenge. CONTRIBUTION The geographical variations and changes over time in twins' excess mortality in sub-Saharan Africa analysed here is a new contribution to the literature.

Mots clés: Twins; Under-five mortality; Excess mortality; Associated factors; Sub-Saharan Africa

Domaines: Sciences de l'Homme et Société

Adama Ouédraogo, Gilles Pison, Sophie Le Coeur, Abdramane Soura. Levels, Spatial and Temporal Variations, and Associated Factors of Twin Excess Mortality From Ages 0–5 in Sub-Saharan Africa: Analyses of National Surveys From 42 Countries. Population Association of America (PAA) Annual Meeting, May 2021, St. Louis, Missouri (Virtual), United States. , 2021. ⟨hal-03243707⟩