{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T22:27:54Z","timestamp":1792448874301,"version":"4.5.0"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T00:00:00Z","timestamp":1760313600000},"content-version":"unspecified","delay-in-days":73,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Twin Res Hum Genet"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Twin children are more likely to die than singletons. This is an additional burden in sub-Saharan African (SSA) countries, as child mortality levels are already higher than anywhere else. This article provides estimates of under-5 mortality rates (U5MRs) for twins and singletons in SSA from 1986 to 2016. It describes the geographical variations and changes over time. It also describes the variation of twins\u2019 excess mortality according to age from 0 to 5 years. Additionally, it analyzes the factors associated with twins\u2019 excess mortality. We used data from 156 national surveys from 42 countries. We estimated U5MRs for twins and single children and built a Cox model to analyze factors associated with excess mortality among twins. Although child mortality has declined on the continent, twins\u2019 excess mortality remains very high. U5MRs are, on average, 3 times higher among twins than singletons. The Cox model shows that all other things being equal, the adjusted hazard ratio of under-5 mortality (U5M) is 3.2 (2.9\u22123.3;\n                    <jats:italic>p<\/jats:italic>\n                    &lt; .001) times higher among twins than singletons. The main factors associated with excess mortality risks among twins are biomedical and nutritional features, such as low birth weight, non-use of cesarean section delivery, and lack of breastfeeding. Health policy makers in SSA should be aware of the vulnerability of twins, and interventions to prevent their early deaths should be considered.\n                  <\/jats:p>","DOI":"10.1017\/thg.2025.10007","type":"journal-article","created":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T02:33:24Z","timestamp":1760322804000},"page":"355-375","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["Trends and Factors Associated with Under-5 Excess Mortality among Twins in sub-Saharan Africa: A Study of 156 National Surveys from 42 Countries"],"prefix":"10.1017","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4725-1574","authenticated-orcid":false,"given":"Adama","family":"Ouedraogo","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00t5e2y66","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Versailles - Saint-Quentin-en-Yvelines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6952-9234","authenticated-orcid":false,"given":"Sophie","family":"Le Coeur","sequence":"additional","affiliation":[{"name":"The French Institute for Demographic Studies (INED)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5916-2360","authenticated-orcid":false,"given":"Gilles","family":"Pison","sequence":"additional","affiliation":[{"name":"The French Institute for Demographic Studies (INED)"},{"name":"The French National Museum of Natural History"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1539-6357","authenticated-orcid":false,"given":"Abdramane B.","family":"Soura","sequence":"additional","affiliation":[{"name":"University Joseph Ki-Zerbo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,10,13]]},"reference":[{"key":"S1832427425100078_ref1","doi-asserted-by":"publisher","DOI":"10.7910\/DVN\/OLI0ID"},{"key":"S1832427425100078_ref19","unstructured":"van der Pol, H. (1989). L\u2019influence du type d\u2019allaitement : Le cas de Yaound\u00e9. In\u00a0G. Pison, M. Sala-Diakanda, International Union for the Scientific Study\u00a0of Population, & E. V. de Walle (Eds.), Mortalit\u00e9 et soci\u00e9t\u00e9 en\u00a0Afrique\u00a0au sud du Sahara (pp. 325-338). Institut national d\u2019\u00e9tudes d\u00e9mographiques."},{"key":"S1832427425100078_ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s13524-012-0161-5"},{"key":"S1832427425100078_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0368-2315(09)73555-0"},{"key":"S1832427425100078_ref12","unstructured":"Pison, G. (1987). Les jumeaux en Afrique au sud du Sahara: Fr\u00e9quence, statut social et mortalit\u00e9. Institut National d\u2019Etudes D\u00e9mographiques \u00be Dossiers et recherches N\u00b011."},{"key":"S1832427425100078_ref13","first-page":"253","volume-title":"Mortality and society in sub-Saharan Africa","author":"Pison","year":"1992"},{"key":"S1832427425100078_ref16","unstructured":"Rutstein, S. O. (1984). Infant and child mortality: Levels, trends and demographic differentials [WFS Comparative Studies no. 43]. International Statistical Institute."},{"key":"S1832427425100078_ref8","unstructured":"Ouedraogo, A. (2020a). D\u00e9mographie et sant\u00e9 des jumeaux en Afrique subsaharienne [Thesis, Universit\u00e9 Paris 1 Panth\u00e9on Sorbonne]. https:\/\/hal.archives-ouvertes.fr\/tel-02954209"},{"key":"S1832427425100078_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30197-3"},{"key":"S1832427425100078_ref7","doi-asserted-by":"crossref","unstructured":"Oger, A.-S. , Robillard, P.-Y. , Barau, G. , Randrianaivo, H. , Bonsante, F. , Iacobelli, S. , & Boukerrou, M. (2013). Morbidit\u00e9 et mortalit\u00e9 p\u00e9rinatale des jumeaux et influence de la chorionicit\u00e9: Exp\u00e9rience de 10 ans dans le Sud-R\u00e9union. \u00c9tude de 775 grossesses. \/data\/revues\/03682315\/v42i7\/S0368231513000495\/. https:\/\/www.em-consulte.com\/en\/article\/846047","DOI":"10.1016\/j.jgyn.2013.02.010"},{"key":"S1832427425100078_ref2","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.08.010404"},{"key":"S1832427425100078_ref9","doi-asserted-by":"publisher","DOI":"10.3917\/dia.229.0185"},{"key":"S1832427425100078_ref10","unstructured":"Ou\u00e9draogo, A. , Pison, G. , Abdramane, S. , Le Coeur, S. , Delaunay, V. , & Kassoum, K. (2021a). La surmortalit\u00e9 infanto-juv\u00e9nile g\u00e9mellaire dans les observatoires de population d\u2019Afrique subsaharienne [INED, DEMOSTAF Working Paper No. 7]. https:\/\/www.ined.fr\/fichier\/rte\/158\/WP7.pdf"},{"key":"S1832427425100078_ref17","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-018-2082-9"},{"key":"S1832427425100078_ref18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0025239"},{"key":"S1832427425100078_ref20","volume-title":"A child under 15 dies every 5 seconds around the world","year":"2018"},{"key":"S1832427425100078_ref4","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-12-140"},{"key":"S1832427425100078_ref3","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.12388"},{"key":"S1832427425100078_ref15","doi-asserted-by":"publisher","DOI":"10.4054\/DemRes.2019.41.36"},{"key":"S1832427425100078_ref11","unstructured":"Ou\u00e9draogo, A. , Pison, G. , Le Coeur, S. , & Soura, A. (2021b, December). Levels, trends, and factors associated with under-5 excess mortality among twins in sub-Saharan Africa: Studies of national surveys from 42 countries [Paper presentation]. International Population Conference 2021, Hyderabad, India. https:\/\/ipc2021.popconf.org\/abstracts\/210183"}],"container-title":["Twin Research and Human Genetics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1832427425100078","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T07:42:29Z","timestamp":1761723749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1832427425100078\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["S1832427425100078"],"URL":"https:\/\/doi.org\/10.1017\/thg.2025.10007","relation":{},"ISSN":["1832-4274","1839-2628"],"issn-type":[{"value":"1832-4274","type":"print"},{"value":"1839-2628","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press on behalf of International Society for Twin Studies","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0\/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is used to distribute the re-used or adapted article and the original article is properly cited. The written permission of Cambridge University Press must be obtained prior to any commercial use.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}