title: Effect of multiple birth on infant mortality in Bangladesh.
abstract: OBJECTIVE
  Levels of infant and child mortality in many developing countries remain unacceptably high, and they are disproportionably higher among high-risk groups such as newborn and infant of multiple births, particularly in countries where advanced medical cares are available only at regional referral levels with limited access by the poor rural women and children. This study examined the relationship between high-risk infant of multiple birth and infant mortality in Bangladesh.
  
  
  METHODS
  The analysis uses information on 7001 childbirths in 5 years preceding the 2004 Bangladesh Demographic and Health Survey to examine the relationship between multiple birth and infant mortality using multivariate analysis, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors.
  
  
  RESULTS
  Results indicate that children born multiple birth were more than six-times as likely to die during infancy as those born singletons (hazard ratio = 6.51; 95% confidence interval: 4.10, 10.36). Controlling for all other risk factors does not change the strength and direction of the relationship (hazard ratio = 6.18; 95% confidence interval: 3.65, 10.46). Receiving prenatal care and access to safe drinking water are associated with lower risk.
  
  
  CONCLUSIONS
  Multiple births are strongly negatively associated with infant survival in Bangladesh independent of other risk factors. This evidence suggests that improving maternal and child health at the community level, screening for high-risk pregnancies and making referral services for these conditions more accessible to the rural women and children will be key to improving child survival in Bangladesh.
authors.affiliation: Department of Global Health, School of Public Health and Health Services, George Washington University, Washington, DC, USA. rathavuth.hong@orcmaco.com
authors.forename: Rathavuth
authors.initials: R
authors.lastname: Hong
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D005260:Female; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data*; D012307:Risk Factors