Twins in West Africa: A Hidden Crisis of Survival

In the rural health facilities of Burkina Faso and the bustling urban clinics of The Gambia, a quiet crisis unfolds with every twin delivery. While twins represent only a small fraction of births, they account for a disproportionate share of stillbirths and newborn deaths. A new study published on medRxiv, led by J. C. Jones and colleagues, sheds light on the clinical epidemiology of twins in these West African settings. Drawing from the PregnAnZI2 randomised clinical trial, the research analysed data from 12,192 newborns born to 11,983 women across eight peripheral health facilities in rural Burkina Faso and two urban health facilities in The Gambia. The findings reveal an average twinning rate of 35 per 1000 total births (95% CI: 32 to 39), with rates varying significantly by country: 27 per 1000 in The Gambia and 45 per 1000 in Burkina Faso. These numbers underscore the need for context-specific interventions to improve twin survival.

The study identified maternal ethnicity and parity as key risk factors for twinning. In Burkina Faso, certain ethnic groups showed higher twinning rates, while in The Gambia, the rates were lower overall. Parity also played a role, with higher parity associated with increased likelihood of twins. These findings align with global patterns but highlight unique local determinants. The disparity between the two countries—45 per 1000 in Burkina Faso versus 27 per 1000 in The Gambia—suggests that environmental, genetic, or healthcare access factors may influence twinning rates. The authors emphasise that understanding these determinants is crucial for tailoring antenatal care. For instance, early identification of twin pregnancies through improved ultrasound access could allow for better preparation and management, potentially reducing adverse outcomes. The study's conceptual framework, which guided the analyses, integrates these risk factors with outcomes, providing a comprehensive view of twin epidemiology in West Africa.