Postneonatal and child mortality among twins in Southern and Eastern Africa
Postneonatal and child mortality among twins in Southern and Eastern Africa
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DOI：
10.1093/ije/29.4.678
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发表时间：
2000-08-01
影响因子：
7.7
通讯作者：
Kunst, A
中科院分区：
文献类型：
--
作者：
Justesen, A;Kunst, A
背景 很少有研究评估撒哈拉以南非洲地区双胞胎和单胎儿童在新生儿后期和儿童时期的死亡率差异。本研究的目的是量化新生儿后和儿童时期双胞胎的超额死亡率，并确定导致双胞胎超额死亡率的因素。假设对医疗保健服务的不同利用导致了死亡率的增加。方法汇总了马拉维、坦桑尼亚和赞比亚的人口和健康调查数据。 Logistic 回归用于估计双胞胎/单胎新生儿和儿童死亡率的差异，并研究中间因素和效应修正的作用。结果 该研究基于 18 214 名单胎儿童和 706 名双胞胎。新生儿和儿童合并死亡率的双胞胎/单胞比值比 (OR) 为 2.33 (95% CI: 1.85-2.93)。这种超额死亡率在生命的第一年是最大的。对中间因素（预防性医疗保健和母乳喂养）的控制并没有显着缩小死亡率差异。与双胞胎/单胎增加相关的影响因素是男性、不想要的孩子、生育间隔短和社会经济地位低。 结论 与单胎相比，双胞胎死亡率过高。预防性保健的使用或母乳喂养的差异不能解释死亡率的增加。男性、不想要的孩子、短生育间隔后出生的人和社会经济弱势群体面临特别的风险。 5 岁以下儿童诊所的就诊率普遍较高，这使得医疗保健提供者有机会加强对这些高危人群的监测。
Background Few studies have evaluated the difference in mortality between twins and singleton children during the postneonatal and childhood period in sub-Saharan Africa. The aim of this study was to quantify the excess mortality of twins during the postneonatal and childhood period and to identify factors that contribute to the excess mortality among twins. The different use made of health care services was hypothesized to contribute to the increased mortality.Methods The Demographic and Health Survey data on Malawi, Tanzania and Zambia were pooled. Logistic regression was used to estimate twin/singleton differences for the combined postneonatal and child mortality and to study the role of intermediate factors and effect modifiers.Results The study was based on 18 214 singleton children and 706 twins. The twin/singleton odds ratio (OR) of the combined postneonatal and child mortality was 2.33 (95% CI: 1.85-2.93). This excess mortality was largest during the first year of life. Control for intermediate factors (preventive health care and breastfeeding) did not sizeably diminish the mortality difference. Effect modifiers that were associated with increased twin/singleton OR were male sex, unwanted child, short birth interval and low socioeconomic status.Conclusions The excess mortality of twins compared to singletons is considerable. A difference in use of preventive health carl or in breastfeeding cannot explain the increased mortality. Males, unwanted children, those born after a short birth interval and the socioeconomically disadvantaged are at special risk. The generally good attendance at under-5 clinics gives health care providers the opportunity for increased surveillance of these high-risk groups.