Excess Infant Mortality of Twins Over Singletons in Arab Countries: The Evidence of Relative Survival Methods

Abstract

There are no studies and only limited data that compare the difference in mortality between twins and singletons in the Arab world. We studied the survival of 306,966 children, including 9,280 twins, over the period 1970–2013 in six Arab countries (Algeria, Egypt, Iraq, Mauritania, Sudan and Tunisia) based on the Multiple Indicator Cluster Survey (MICS) database. With the use of relative survival models, we estimated the mortality of twins relative to singletons by including socioeconomic and demographic variables. This study confirms the results of previous studies on the excess risk of death of twins compared to singletons. There is evidence that excess mortality decreases with follow-up; in addition, male twins have a higher risk of death compared to females for all countries except Tunisia. Wealth index and education levels of women are factors that influence the risk of mortality. It is recommended that these findings are considered when performing future health and population strategies in these Arab countries.

Determinants of Under-Five Child Mortality in Arab Countries. Are the Effects Homogeneous Across Birth Order and Among Countries?

“…The most common causes of such an excess of deaths are biological, such as complications at birth (Uthman et al, 2008), and low birth weight (Parker et al, 2001). Furthermore, this partial finding (ratio level) was consistent with those reported by Kleinman et al (1991), andChellai &Boudrissa (2019). Consequently, we confirmed that twins are at an increased risk of under-five-child death compared to singletons across all birth orders (women's parities) in the selected Arab countries.…”

“…As a comparison between twins and singletons, all previous studies stated that twins (and triples) have a higher risk of death than singletons during childhood (first year, underfive). Chellai & Boudrissa (2019) used relative survival approaches to confirm the excess deaths of twins over singletons in these six Arab countries. The most common causes of such an excess of deaths are biological, such as complications at birth (Uthman et al, 2008), and low birth weight (Parker et al, 2001).…”

“…Despite the existence of studies in this field, we cite the study of Shawky (2001), where he tried to give concise responses of the effects of socio-demographic, prenatal and economic factors on infant mortality in Arab countries. In a specific context, a recent analysis was conducted on excess infant mortality between twins and singletons in these six Arab countries (Chellai and Boudrissa, 2019). As a primary feature of the current study, the summary statistics of the mortality rates in the MICS datasets of the six countries showed that there is an excess of mortality rates among different birth orders, which motivated us to analyze the main factors affecting such differences in mortality rates.…”