The Excess Mortality among Twins in the Dominican Republic and Haiti

Adama Ouedraogo, Université de Versailles – Saint-Quentin-en-Yvelines (UVSQ)
David Jean Simon, Université Laval
Ann Kiragu, Université Paris 1 Panthéon-Sorbonne
Nicole Estefany Aponte CUETO, Universidade Federal de Minas Gerais
Vénunyé Claude KONDO TOKPOVI, Université Laval

BACKGROUND: Mortality rates among children in developing countries have fallen, but disparities persist between countries. METHODS: This study employed data from nine Demographic and Health Surveys in the Dominican Republic and Haiti to analyse mortality rates and factors among twins and singletons in categories of the under-five age group, including neonatal, post-neonatal, and child mortality. We then used Cox models to examine the factors associated with excess mortality among twins. FINDINGS: In the Dominican Republic, from 1996-2013, the under-five mortality rate (U5MR) for singletons fell from 56 per 1,000 live births (95% CI: 47–64) to 30 per 1,000 live births (95% CI: 22–39), and the U5MR for twins decreased from 108 per 1,000 (95% CI: 53–164) to 53 per 1,000 (95% CI: 16–89). In Haiti, between 1994 and 2016, the U5MR for singletons declined from 121 per 1,000 (95% CI: 109–133) to 77 per 1,000 (95% CI: 80 - 68), and from 432 per 1,000 (95% CI: 327–538) to 204 per 1,000 (95% CI: 149–260) among twins. Low birthweight, lack of breastfeeding, absence of or inadequate antenatal care, non-caesarean section birth, and high birth order were identified as factors associated with excess mortality among twins in both countries.

Keywords: Mortality and Longevity, Health and Morbidity, Children, Adolescents, and Youth, Comparative methods

See paper.