Miyahara Reiko, Jasseh Momodou, Mackenzie Grant Austin, Bottomley Christian, Hossain M Jahangir, Greenwood Brian M, D'Alessandro Umberto, Roca Anna
Medical Research Council, Banjul, The Gambia.
Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
BMC Pediatr. 2016 Mar 15;16:39. doi: 10.1186/s12887-016-0573-2.
A high twinning rate and an increased risk of mortality among twins contribute to the high burden of infant mortality in Africa. This study examined the contribution of twins to neonatal and post-neonatal mortality in The Gambia, and evaluated factors that contribute to the excess mortality among twins.
We analysed data from the Basse Health and Demographic Surveillance System (BHDSS) collected from January 2009 to December 2013. Demographic and epidemiological variables were assessed for their association with mortality in different age groups.
We included 32,436 singletons and 1083 twins in the analysis (twining rate 16.7/1000 deliveries). Twins represented 11.8 % of all neonatal deaths and 7.8 % of post-neonatal deaths. Mortality among twins was higher than in singletons [adjusted odds ratio (AOR) 4.33 (95 % CI: 3.09, 6.06) in the neonatal period and 2.61 (95 % CI: 1.85, 3.68) in the post-neonatal period]. Post-neonatal mortality among twins increased in girls (P for interaction = 0.064), being born during the dry season (P for interaction = 0.030) and lacking access to clean water (P for interaction = 0.042).
Mortality among twins makes a significant contribution to the high burden of neonatal and post-neonatal mortality in The Gambia and preventive interventions targeting twins should be prioritized.
双胞胎出生率高以及双胞胎死亡风险增加，导致非洲婴儿死亡率负担沉重。本研究调查了冈比亚双胞胎对新生儿和新生儿后期死亡率的影响，并评估了导致双胞胎死亡率过高的因素。
我们分析了2009年1月至2013年12月从巴塞健康与人口监测系统（BHDSS）收集的数据。评估人口统计学和流行病学变量与不同年龄组死亡率的关联。
分析纳入了32436名单胎婴儿和1083对双胞胎（双胞胎出生率为16.7/1000次分娩）。双胞胎占所有新生儿死亡的11.8%，占新生儿后期死亡的7.8%。双胞胎的死亡率高于单胎婴儿[新生儿期调整优势比（AOR）为4.33（95%CI：3.09，6.06），新生儿后期为2.61（95%CI：1.85，3.68）]。双胞胎的新生儿后期死亡率在女孩中有所增加（交互作用P值 = 0.064），在旱季出生（交互作用P值 = 0.030）以及无法获得清洁水源的情况下也有所增加（交互作用P值 = 0.042）。
双胞胎死亡率对冈比亚新生儿和新生儿后期的高死亡率负担有重大影响，应优先针对双胞胎采取预防干预措施。
