title: A population-based study of effect of multiple birth on infant mortality in Nigeria.
abstract: BACKGROUND
  Multi-foetal pregnancies and multiple births including twins and higher order multiples births such as triplets and quadruplets are high-risk pregnancy and birth. These high-risk groups contribute to the higher rate of childhood mortality especially during early period of life.
  
  
  METHODS
  We examined the relationship between multiple births and infant mortality using univariable and multivariable survival regression procedure with Weibull hazard function, 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
  Children born multiple births were more than twice as likely to die during infancy as infants born singleton (hazard ratio = 2.19; 95% confidence interval: 1.50, 3.19) holding other factors constant. Maternal education and household asset index were associated with lower risk of infant mortality.
  
  
  CONCLUSIONS
  Multiple births are strongly negatively associated with infant survival in Nigeria independent of other risk factors. Mother's education played a protective role against infant death. This evidence suggests that improving maternal education may be key to improving child survival in Nigeria. A well-educated mother has a better chance of satisfying important factors that can improve infant survival: the quality of infant feeding, general care, household sanitation, and adequate use of preventive and curative health services.
authors.affiliation: Center for Evidence-Based Global Health, Ilorin, Kwara State, Nigeria. uthlekan@yahoo.com
authors.forename: Olalekan A
authors.initials: OA
authors.lastname: Uthman
authors.forename: Mubashir B
authors.initials: MB
authors.lastname: Uthman
authors.forename: Ismail
authors.initials: I
authors.lastname: Yahaya
mesh_terms: D000293:Adolescent; D000328:Adult; D001722:Birth Order; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008423:Maternal Age; D008875:Middle Aged; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data*; D009549:Nigeria / Q000453:epidemiology; D009752:Nutritional Status; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D011295:Prenatal Care / Q000706:statistics & numerical data; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D016019:Survival Analysis
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