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  • Title: Causes of mortality in twins in a rural region of The Gambia, West Africa.
    Author: Jaffar S, Jepson A, Leach A, Greenwood A, Whittle H, Greenwood B.
    Journal: Ann Trop Paediatr; 1998 Sep; 18(3):231-8. PubMed ID: 9924561.
    Abstract:
    Little is known about birth or mortality rates of twins in The Gambia. There are no reports of the causes of death among twins in sub-Saharan Africa. We identified twin births and deaths from a community-based study which had been carried out in a large rural region of The Gambia over a 5-year period from 1989 to 1993. The overall twinning rate excluding stillbirths was 14.3 (95% CI 12.9, 15.8) per 1000 live deliveries. This was significantly lower among the Mandinka ethnic group (8.8 per 1000) than among the Serahulis (15.1 per 1000) or Fulas (18.3 per 1000). The early-neonatal, late-neonatal and post-neonatal twin mortality rates were 114.0, 45.9 and 64.2 per 1000 live twin births, respectively. In comparison, the early-neonatal, late-neonatal and post-neonatal mortality rates of singletons were 18.6, 16.0 and 41.1 per 1000, respectively. In the post-neonatal period, malnutrition was more frequently a cause of death among twins than among singletons (7.8 per 1000 twin births vs 2.0 per 1000 singleton births; p = 0.0008). Appropriate strategies for preventing malnutrition are required for this high-risk group. A community-based study was conducted over a 5-year period (1989-93) in the rural Upper River Division of The Gambia to investigate causes of mortality among children under 5 years old focusing on the differences between singleton and twin mortality. During 1989-93, 26,496 deliveries were recorded. These include 396 twin pairs, 1 triplet, and 1 quadruplet delivery. Of the 396 twin deliveries, 7 pairs were stillborn and 11 pairs consisted of 1 stillbirth and 1 live birth, giving an overall twinning rate of 14.3/1000 live deliveries excluding stillbirths. The Mandinka ethnic group twinning rate excluding stillbirths was significantly lower than that among Fulas and Serahulis, which were recorded from June 1992 until the end of the study. On the other hand, there were 193 deaths of twins and 3583 singleton deaths recorded. The early neonatal, late-neonatal, and post-neonatal mortality rates of twins were 114.0, 45.9, and 64.2 per 1000 twins born alive, respectively. In comparison, the early-neonatal, late-neonatal, and post-neonatal mortality rates of singletons were 18.6, 16.0, and 41.1 per 1000 live births, respectively. Mortality rates were higher among males than in females. This held true among twins and singletons. The survey showed that malaria was frequently diagnosed in both twins and singletons while malnutrition was the etiologic factor of death among twins more often than singletons. In summary, it showed that mortality among twins, particularly among boys, was extremely high, which was likely due to the consequence of very low birth weight. However, malnutrition was a major cause of death among twins in the post-neonatal period.
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