High Under-Five Mortality among Twins in Sub-Saharan Africa: Patterns and Explanations

Sub-Saharan Africa has the highest levels of both twining and under-five mortality in the world. It also had high excess mortality among twins. Surprisingly little is known about the infant and child mortality pattern among African twins. We examine which factors are associated with excess twin mortality and to what extent these factors are ‘universal’ or vary in weight by regions in Sub-Saharan Africa. We pool over 60 Demographic and Health Surveys from 32 Sub-Saharan African countries to obtain data on more than 45,000 twins. We include factors associated with under-five mortality on the child, mother and household level (e.g. maternal age & education, birth-interval) and the regional and national level (e.g. health-care facilities and development). We examine differences in these factors between twins and singletons and test interaction-effects between each determinant of mortality and twin/singleton status. Finally, we examine variations in the determinants across regions of Sub-Saharan Africa.