Twin–singleton early-life survival in sub-Saharan Africa

Christensen, Kaare; Bjerregaard-Andersen, Morten

doi:10.1016/s2214-109x(17)30223-1

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…In most high-resource settings, twin pregnancies are managed by routine prenatal monitoring and neonatal intensive care services, including early identification of twin pregnancies, serial antenatal ultrasound, referral to specialised centres and prenatal counselling. 8 In lower-resource settings, data are limited, but twin pregnancies may be at particularly high risk for adverse birth outcomes because of the lack of routine intensive prenatal monitoring and neonatal intensive care services. 1 9 Additionally, maternal outcomes with multigravid pregnancies may also be worse because of limitations in management of maternal conditions more common in twin pregnancies, such as postpartum haemorrhage and pre-eclampsia.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study

et al. 2021

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ObjectivesThis study aims to evaluate the prevalence and outcome of twin pregnancies in Botswana.SettingThe Tsepamo Study conducted birth outcomes surveillance at 8 government-run hospitals (~45% of all births in Botswana) from August 2014 to June 2018 and expanded to 18 hospitals (~70% of all births in Botswana) from July 2018 to March 2019.ParticipantsData were collected for all live-born and stillborn in-hospital deliveries with a gestational age (GA) greater than 24 weeks. This analysis included 117 593 singleton and 3718 twin infants (1859 sets (1.6%)) born to 119 477 women between August 2014 and March 2019 and excluded 73 higher order multiples (23 sets of triplets and 1 set of quadruplets).Outcomes measuredOur primary outcomes were preterm delivery (<37 weeks GA), very preterm delivery (<32 weeks GA) and stillbirth (APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score of 0, 0, 0).ResultsWomen with twin pregnancies had a similar median number of antenatal care visits (9 vs 10), but were more likely to deliver in a tertiary centre (54.8% vs 45.1%, p<0.001) and more likely to have a cesarean-section (54.6% vs 22.0%, p<0.001) than women with singletons. Compared with singletons, twin pregnancies had a higher risk of preterm delivery (<37 weeks GA) (47.6% vs 16.7%, adjusted risk ratio (aRR) 2.8, 95% CI 2.7 to 2.9) and very preterm delivery (<32 weeks) (11.8% vs 4.0%, aRR 3.0 95% CI 2.6 to 3.4). Among all twin pregnancies, 128 (6.9%) had at least one stillborn infant compared with 2845 (2.4%) stillbirths among singletons (aRR 2.8, 95% CI 2.3 to 3.3).ConclusionAdverse birth outcomes are common among twins in Botswana, and are often severe. Interventions that allow for earlier identification of twin gestation and improved antenatal management of twin pregnancies may improve infant and child survival.

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Section: Introductionmentioning

confidence: 99%

Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study

et al. 2021

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“…Despite this finding, previous research supports the need for improvements in coverage in these priority maternal and child health areas [ 29 ]. Progress towards health system access and utilisation is especially relevant for high-risk pregnancies with other studies demonstrating the need for improved detection of and guidance on care for pregnancies with multiples [ 30 – 32 ].…”

Section: Discussionmentioning

confidence: 99%

Identifying determinants of under-five child mortality in northern Togo

Levano,

Kraemer,

Dabla

et al. 2024

J Glob Health

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Background Although global rates of under-five mortality have declined, many low- and middle-income countries (LMICs), including Togo, have not achieved sufficient progress. We aimed to identify the structural and intermediary determinants associated with under-five mortality in northern Togo. Methods We collected population-representative cross-sectional household surveys adapted from the Demographic Household Survey (DHS) and Multiple Indicator Cluster Survey from women of reproductive age in northern Togo in 2018. The primary outcome was under-five mortality for children born to respondents in the 10-year period prior to the survey. We selected structural and intermediary determinants of health from the World Health Organization Conceptual Framework for Action on the Social Determinants of Health. We estimated associations between determinants and under-five mortality for births in the last 10 years (model 1 and 2) and two years (model 3) using Cox proportional hazards models. Results Of the 20 121 live births in the last 10 years, 982 (4.80%) children died prior to five years of age. Prior death of a sibling (adjusted hazard ratio (aHR) = 5.02; 95% confidence interval (CI) = 4.23–5.97), maternal ethnicity (i.e. Konkomba, Temberma, Lamba, Losso, or Peul), multiple birth status (aHR = 2.27; 95% CI = 1.78–2.90), maternal age under 25 years (women <19 years: aHR = 2.05; 95% CI = 1.75–2.39; women 20–24 years: aHR = 1.48; 95% CI = 1.29–1.68), lower birth interval (aHR = 1.51; 95% CI = 1.31–1.74), and higher birth order (second or third born: aHR = 1.45; 95% CI = 1.32–1.60; third or later born: aHR = 2.14; 95% CI = 1.74–2.63) were associated with higher hazard of under-five mortality. Female children had lower hazards of under-five mortality (aHR = 0.80; 95% CI = 0.73–0.89). Under-five mortality was also lower for children born in the last two years (n = 4852) whose mothers received any (aHR = 0.48; 95% CI = 0.30–0.78) or high quality (aHR = 0.51; 95% CI = 0.29–0.88) prenatal care. Conclusion Compared to previous DHS estimates, under-five mortality has decreased in Togo, but remains higher than other LMICs. Prior death of a sibling and several intermediary determinants were associated with a higher risk of mortality, while receipt of prenatal care reduced that risk. These findings have significant implications on reducing disparities related to mortality through strengthening maternal and child health care delivery.

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“…Thus, addressing twin mortality during early life should be a priority. Previously, we have outlined how such interventions would include improved antenatal care (particularly with a focus on recognizing twin pregnancies), that twin deliveries take place in hospitals adequately equipped and staffed to perform emergency cesarean sections and neonatal resuscitation, and that twins are carefully evaluated before hospital discharge (Christensen & Bjerregaard-Andersen, 2017). Strategies recommended for a reduction of stillbirths in the general population (e.g., proper fetal monitoring during labor, use of partograms and perinatal audits; Bjerregaard-Andersen et al, 2018) would likely also benefit twins considerably.…”

Section: Consistency With Other Findingsmentioning

confidence: 99%

“…Thus, one pooled analysis of 90 demographic and health surveys across the continent found that one-fifth of the twins die before the age of 5 years (Monden & Smits, 2017). This has a huge impact on the overall childhood mortality in the region (Christensen & Bjerregaard-Andersen, 2017;Monden & Smits, 2017).…”

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confidence: 99%

The Guinea-Bissau Twin Registry Update: A Platform for Studying Twin Mortality and Metabolic Disease

et al. 2019

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Sub-Saharan Africa has the highest natural twinning rate in the world. Unfortunately, due to lack of adequate care during pregnancy, labor and postnatally, twin mortality in Sub-Saharan Africa also remains very high. Thus, it has been estimated that one in five twins dies during the childhood years. In spite of this, surprisingly few twin studies have been conducted in the region, making additional epidemiological data much needed. In 2009, we established one of the first twin registries in Sub-Saharan Africa at the Bandim Health Project in Guinea-Bissau. The registry had two main objectives. First, we wanted to describe the twinning rate and mortality patterns among newborn twins, including mortality risk factors and hospitalization patterns. Such studies can help the local clinicians improve twin health by identifying the most vulnerable children. Second, and in light of the rapidly increasing diabetes rates in Africa, we wanted to use the registry to particularly focus on metabolic disorders. Twins are often born with low birth weight, which according to the ‘thrifty phenotype hypothesis’ could predispose them to metabolic disorders later in life. Yet, no such ‘fetal programming’ data have previously been available from African twins despite the fact that nutritional patterns and influences from other factors (e.g., infections) could be markedly different here compared to high-income settings. In this article, we summarize the findings and current status of the Guinea-Bissau twin registry.

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Twin–singleton early-life survival in sub-Saharan Africa

Cited by 5 publications

References 10 publications

Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study

Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study

Identifying determinants of under-five child mortality in northern Togo

The Guinea-Bissau Twin Registry Update: A Platform for Studying Twin Mortality and Metabolic Disease

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