Mortality among twins and singletons in sub-Saharan Africa between 1995 and 2014: a pooled analysis of data from 90 Demographic and Health Surveys in 30 countries
Mortality among twins and singletons in sub-Saharan Africa between 1995 and 2014: a pooled analysis of data from 90 Demographic and Health Surveys in 30 countries
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DOI：
10.1016/s2214-109x(17)30197-3
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发表时间：
2017-07-01
影响因子：
34.3
通讯作者：
Smits, Jeroen
中科院分区：
文献类型：
--
作者：
Monden, Christiaan W. S.;Smits, Jeroen
背景 撒哈拉以南非洲地区的 5 岁以下儿童和新生儿死亡率以及自然双胞胎率最高。双胎妊娠给儿童和母亲带来很高的风险。过去几十年来，撒哈拉以南非洲地区 5 岁以下儿童死亡率有所下降。目前尚不清楚双胞胎是否也参与了这一下降。 方法 我们汇集了 1995 年至 2014 年间对 30 个撒哈拉以南非洲国家进行的 90 项人口统计和健康调查的出生数据。我们使用了 1 685 110 例单胎活产和 56 597 例双胞胎活产的信息来计算单胎和双胞胎死亡率的趋势。我们研究了双胞胎单胎率是否可归因于生物学、社会经济、护理相关因素或出生体型，并估计了撒哈拉以南非洲双胞胎的死亡率负担。研究结果 双胞胎中 5 岁以下死亡率从 1995-2001 年每 1000 名活产 327.7 (95% CI 312.0-343.5) 下降到 213.0 2009-14 年 (196.7-229.2)。 35.0% 的下降幅度远小于单身人士 50.6% 的下降幅度（从 1995-2001 年每 1000 名活产儿 128.6 [95% CI 126.4-130.8] 下降到 2009-14 年每 1000 名活产儿 63.5 [61.6-65.3]）。在撒哈拉以南非洲地区，双胞胎在 5 岁以下儿童死亡中所占的比例越来越大：目前，双胞胎占 5 岁以下儿童死亡率的 10.7%，占新生儿死亡率的 15.1%。我们估计，撒哈拉以南非洲地区每年约有 315 000 对双胞胎（不确定性区间 289 000-343 000）死亡。双胎死亡率过高不能用 5 岁以下儿童死亡的常见危险因素（包括出生体重）来解释。新生儿死亡率与单胎的差异尤其明显（比率 5.0，95% CI 4.5-5.6）。 51.7% 的双胞胎孕妇表示在出生时接受了医疗救助。 解读 撒哈拉以南非洲地区双胞胎的命运落后于单胞胎。该地区有五分之一的双胞胎在 5 岁之前死亡，这一数字令人震惊，是单胞胎死亡率的三倍。双胞胎在 5 岁以下儿童和新生儿死亡率中所占的比例越来越高，但在文献中却被忽视了。需要采取协调行动来改善这一极其弱势群体的状况。资金 无。版权所有 (C) 作者。由 Elsevier Ltd 出版。这是一篇采用 CC BY 4.0 许可的开放获取文章。
Background Sub-Saharan Africa has the world's highest under-5 and neonatal mortality rates as well as the highest naturally occurring twin rates. Twin pregnancies carry high risk for children and mothers. Under-5 mortality has declined in sub-Saharan Africa over the last decades. It is unknown whether twins have shared in this reduction.Methods We pooled data from 90 Demographic and Health Surveys for 30 sub-Saharan Africa countries on births reported between 1995 and 2014. We used information on 1 685 110 singleton and 56 597 twin livebirths to compute trends in mortality rates for singletons and twins. We examined whether the twin-singleton rate ratio can be attributed to biological, socioeconomic, care-related factors, or birth size, and estimated the mortality burden among sub-Saharan African twins.Findings Under-5 mortality among twins has declined from 327.7 (95% CI 312.0-343.5) per 1000 livebirths in 1995-2001 to 213.0 (196.7-229.2) in 2009-14. This decline of 35.0% was much less steep than the 50.6% reduction among singletons (from 128.6 [ 95% CI 126.4-130.8] per 1000 livebirths in 1995-2001 to 63.5 [61.6-65.3] in 2009-14). Twins account for an increasing share of under-5 deaths in sub-Saharan Africa: currently 10.7% of under-5 mortality and 15.1% of neonatal mortality. We estimated that about 315 000 twins (uncertainty interval 289 000-343 000) die in sub-Saharan African each year. Excess twin mortality cannot be explained by common risk factors for under-5 mortality, including birthweight. The difference with singletons was especially stark for neonatal mortality (rate ratio 5.0, 95% CI 4.5-5.6). 51.7% of women pregnant with twins reported receiving medical assistance at birth.Interpretation The fate of twins in sub-Saharan Africa is lagging behind that of singletons. An alarming one-fifth of twins in the region dies before age 5 years, three times the mortality rate among singletons. Twins account for a substantial and growing share of under-5 and neonatal mortality, but they are largely neglected in the literature. Coordinated action is required to improve the situation of this extremely vulnerable group.Funding None. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.