Facteurs associés à la surmortalité infanto-juvénile des jumeaux à Haïti.

Introduction : In Haiti, excess mortality among twins is an additional health burden, given that child mortality levels are already very high there. Haiti is the country in the Latin America and Caribbean region with the highest rate of twin births (about 17 ‰). However, there, the excess mortality among twins has been little studied. PURPOSE OF RESEARCH:To identify factors associated with excess mortality among twins. METHODS:With data from the Demographic and Health Surveys, calculation of under-five mortality rates (U5MR) and using a Cox regression to analyze factors associated with excess mortality among twins. RESULTS:Twins have U5MRs that are three times higher than those of singletons. However, these U5MRs fell sharply, but more sharply among twins than singletons. Indeed, between 1994 and 2016, the U5MR for twins decreased by about 53% (from 432 ‰ to 204‰), while for singletons, it was only 36% (from 121‰ to 77‰). The multivariate results show that all else being equal, twins have a 3.3 (2.86-3.87) times higher Hazard Ratio of death than singletons. They also show low birth weight, lack of prenatal visits, and lack of breastfeeding are independently associated with excess mortality among twins in Haiti.Conclusions : The health of twin children remains a major challenge for Haiti. To further reduce their excess mortality, the government has to develop accessible obstetric and pediatric services essential for the care of twin pregnancies.