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Research shows that dietary zinc oxide (ZnO) at pharmacological level improves growth and/or reduces diarrhoea in weaned pigs (Mavromichaelis et al., 2000). However, the theories to explain ZnO action conflict with experimental data, and it is not clear if other zinc sources supplied over requirements can improve growth or health of piglet. Thus, dietary strategies to supplement zinc within the EU rules are difficulty identified. Recent findings show also that dietary glutamate reduces villus atrophy after weaning (Ewtushik et al., 2000) and is an important fuel for the enterocyte (Reeds et al., 2000)...

The objective of this study was to analyse over time the evolution of E. coli O157:H7 faecal shedding in a dairy herd producing raw milk for direct human consumption. The study was performed between October 2012 and September 2013 in an average size Italian dairy farm where animals are housed inside the barn all over the year. The farm housed about 140 animals during the study – 70 cows and 70 calves and heifers. Twenty-six animals were randomly selected from both the cows and young animals group, and faecal sampling was performed rectally six times two months apart in each animal. Eleven animals were culled during the study and a total of 285 faecal samples were collected. At each faecal sampling, three trough water samples and two trough feed samples were also collected for a total of 36 water samples and 24 feed samples. Samples were analysed by real time polymerase chain reaction (RT-PCR) and culture. Overall, 16 (5.6%) faecal samples were positive for E. coli O157 by RT-PCR. Cultural examination found 9 (3.1%) samples positive for E. coli O157; all the isolates were positive for stx1, stx 2 and eae genes. One (4.1%) feed sample was positive for E. coli O157 by RT-PCR; none of the water samples was positive for E. coli O157. The model highlighted a general significant reduction of the number of positive samples observed during the study from the first to the sixth sampling (P=0.000) and a positive relation between the presence of positive samples and average environmental temperature (P=0.003). The results of the study showed that in an Italian dairy farm housing animals all year, faecal shedding of E. coli O157 followed the same temporal trend reported for other types of farming. The enhanced faecal shedding during warmer months may have a significant impact on environmental contamination and the safety of raw milk and its byproducts.

64 weaned pigs (24d-old), were fed a control diet or a control plus 1% thymol diet, with or without Salmonella typhimurium challenge. Thymol reduced feed intake but did not affect significantly the final body weight after 29d of trial. Salmonella did not affect the performances. Body temperature was lower in the thymol group before, but also 1d after challenge, when Salmonella increased the values more in unsupplemented pigs. Fecal excretion of S. typhimurium in challenged pigs was not changed by the diet. The thymol group had a higher concentration of immunoglobulin (Ig) in serum before the challenge, but after there was an interaction between diet and challenge. The diet and the challenge did not affect saliva parameters, and ATPase gene expression in the fundic gastric mucosa. Thymol increased the number of parietal cells for 100 μm depth of oxintic gland. In conclusion the important supplementation with thymol reduced the intake, but not performance in the medium period. Some factors of the gut barrier were positively influenced. Salmonella challenge did not reduce significantly the performance of the weaned piglet.

The practice of adding organic acid to diets for weaning pigs is quite established. An improvement of growth after weaning has been averagely demonstrated with a meta-analysis of feeding trials (Partanen and Mroz, 1999). However data showing that organic acids can positively counteract the presence of post-weaning diarrhoea and of enterotoxigenic E. coli k88 (ETEC) (Tsiloyiannis et al., 2001) contrast with the absence of positive results in ETEC challenged pigs (Risley et al., 1993).

Objective and methods: We conducted a prospective observational cohort study in 458 pregnant and puerperal women, with confirmed COVID-19 at Hospital San Jose, Santiago, Chile, to determine the impact of COVID-19 on pregnancy and confirm safety and feasibility of a management protocol based on clinical presentation of the disease. Results: 25.5% (117/458) of women were severe and 74.4% (341/458) mild presentation. Three percent (9/341) of mild presentations required a subsequent hospitalization. Overall, 26/458 women (5.6%) were admitted to ICU, and 13/458 (2.8%) required mechanical ventilation. One maternal death occurred at 49-days postpartum. Severe presentation, infection above 24 weeks, and comorbidities were associated with an adverse maternal outcome. Of total deliveries, 16.5% (36/217) were <37 weeks. Perinatal mortality was 6/226 (2.7%), mostly due to the fetal component. Conclusions: A quarter of the women had severe COVID-19 that, combined with occurrence of disease in the second half of pregnancy, resulted in substantial maternal compromise. Perinatal morbidity and mortality in women with severe disease were high and warrant consideration. Outpatient management was safe for mild cases. [ABSTRACT FROM AUTHOR]

Objective To evaluate the risk of recurrence of adverse perinatal outcomes in second pregnancies in developing countries. Methods Data from the 2004-2008 Global Survey on Maternal and Perinatal Health were used to determine the outcomes of singleton second pregnancies for 61 780 women in 23 developing countries. The mother-infant pairs had been followed up until discharge or for 7 days postpartum. Findings At the end of their second pregnancies, women whose first pregnancy had ended in stillbirth (n = 1261) or been followed by neonatal death (n = 1052) were more likely than women who had not experienced either outcome to have given birth to a child with a birth weight of < 1500 g (odds ratio, OR: 2.52 and 2.78, respectively) or 1500-2499 g (OR: 1.22 and 1.60, respectively), or to an infant requiring admission to an intensive care unit (OR: 1.64 and 1.68, respectively). At the end of their second pregnancies, those whose first pregnancy had ended in a stillbirth were at increased risk of another stillbirth (OR: 2.35) and those whose first infant had died as a neonate were at increased risk of having the second infant die within the first 7 days of life (OR: 2.82). These trends were found to be largely unaffected by the continent in which the women lived. Conclusion In the developing world, a woman whose first pregnancy ends in stillbirth or is followed by the death of the neonate is at increased risk of experiencing the same outcomes in her second pregnancy. Objectif Evaluer le risque de recidive des issues perinatales indesirables lors des deuxiemes grossesses dans les pays en developpement. Methodes Les donnees de l'Enquete mondiale sur la sante maternelle et perinatale menee sur la periode 2004-2008 ont ete utilisees pour determiner les resultats des deuxiemes grossesses uniques aupres de 61 780 femmes dans 23 pays en developpement. Les couples mereenfant ont ete suivis jusqu'a la fin de leur hospitalisation ou encore pendant 7 jours apres I'accouchement. Resultats A la fin de leurdeuxieme grossesse, les femmes dont la premiere grossesse s'etait terminee par la naissance d'un enfant mort-ne (n = 1 261) ou par la mort du nourrisson (n = 1 052) etaient plus susceptibles que les femmes ne se trouvant dans aucun de ces cas de figure de donner naissance a un enfant dont le poids de naissance serait inferieur a 1 500 g (rapport des cotes, RC: 2,52 et 2,78, respectivement) ou compris entre 1 500 et 2 499 g (RC: 1,22 et 1,60, respectivement), ou de donner naissance a un enfant necessitant une admission dans une unite de soins intensifs (RC: 1,64 et 1,68, respectivement). A la fin de leur deuxieme grossesse, les femmes dont la premiere grossesse s'etait terminee par une mortinaissance couraient un risque accru de redonner naissance a un enfant mort-ne (RC: 2,35), et celles dont la premiere grossesse s'etait terminee par la mort du nourrisson couraient un risque accru de voir leur deuxieme enfant mourir dans les 7 jours suivant l'accouchement (RC: 2,82). Ces tendances ne semblent vraisemblablement pas affectees par le continent sur lequel ces femmes vivent. Conclusion Dans les pays en developpement, une femme dont la premiere grossesse se termine par la naissance d'un enfant mort-ne ou par la mort du nourrisson presente un risque accru de subir la meme issue perinatale lors de sa deuxieme grossesse. Objetivo Evaluar el riesgo de recurrencia de los resultados perinatales adversos de los segundos embarazos en paises en desarrollo. Metodos Se emplearon datos de la Encuesta Global en Salud Materna y Perinatal realizada entre 2004 y 2008 para determinar los resultados del segundo embarazo de feto unico de 61 780 mujeres en 23 paises en desarrollo. Se hizo un seguimiento de cada par madre-nino hasta el alta de la madre o durante los 7 dias posteriores al parto. Resultados Al termino de sus segundos embarazos, aquellas mujeres cuyo primer embarazo habia terminado en muerte prenatal (n = 1261) o al cual le habia sucedido una muerte neonatal (n = 1052) tenian mas probabilidad de dar a luz a un nino con un peso inferior a 1500 g (cociente de probabilidades, CP: 2,52 y 2,78, respectivamente), entre 1500 y 2499 g (CP: 1,22 y 1,60, respectivamente), o a un niflo que necesitara ser ingresado en la unidad de cuidados intensivos (CP: 1,64y 1,68, respectivamente). Al final de sus segundos embarazos, las m ujeres cuyo primer embarazo habia terminado en muerte prenatal presentaron un riesgo mayor de suffir otra muerte prenatal (CP: 2,35), y aquellas cuyo primer bebe habia fallecido como neonato presentaron un riesgo mayor de que el segundo nino falleciera en los primeros siete dias de vida (CP: 2,82). Se descubrio que el continente en el que vivian las mujeres no afecto en gran medida a estas tendencias. Conclusion En el mundo en desarrollo, una mujer cuyo primer embarazo finaliza en muerte neonatal o al cual le sucede la muerte del neonato presenta un riesgo superior de volver a experimentar los mismos resultados en el segundo embarazo., Introduction Although stillbirths and neonatal deaths are tragic events to the affected mothers and their families, they remain common pregnancy outcomes in developing countries. (1-3) Almost all (97-99%) of the [...]

Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite adverse maternal outcome within 48 hours of admission. Model internal validation was accomplished by bootstrapping and external validation was completed using data from 1,300 women in the Pre-eclampsia Integrated Estimate of RiSk (fullPIERS) dataset. Predictive performance was assessed for calibration, discrimination, and stratification capacity. The final miniPIERS model included: parity (nulliparous versus multiparous); gestational age on admission; headache/visual disturbances; chest pain/dyspnoea; vaginal bleeding with abdominal pain; systolic blood pressure; and dipstick proteinuria. The miniPIERS model was well-calibrated and had an area under the receiver operating characteristic curve (AUC ROC) of 0.768 (95% CI 0.735-0.801) with an average optimism of 0.037. External validation AUC ROC was 0.713 (95% CI 0.658-0.768). A predicted probability ≥25% to define a positive test classified women with 85.5% accuracy. Limitations of this study include the composite outcome and the broad inclusion criteria of any hypertensive disorder of pregnancy. This broad approach was used to optimize model generalizability.The miniPIERS model shows reasonable ability to identify women at increased risk of adverse maternal outcomes associated with the hypertensive disorders of pregnancy. It could be used in LMICs to identify women who would benefit most from interventions such as magnesium sulphate, antihypertensives, or transportation to a higher level of care.

We analyzed Brazil's efforts in reducing child mortality, improving maternal and child health, and reducing socioeconomic and regional inequalities from 1990 through 2007. We compiled and reanalyzed data from several sources, including vital statistics and population-based surveys. We also explored the roles of broad socioeconomic and demographic changes and the introduction of health sector and other reform measures in explaining the improvements observed. Our findings provide compelling evidence that proactive measures to reduce health disparities accompanied by socioeconomic progress can result in measurable improvements in the health of children and mothers in a relatively short interval. Our analysis of Brazil's successes and remaining challenges to reach and surpass Millennium Development Goals 4 and 5 can provide important lessons for other low- and middle-income countries. (Am J Public Health. 2010;100:1877-1889. doi: 10.2105/AJPH.2010.196816)

Objective To describe the declining trend in maternal mortality observed in Mongolia from 1992 to 2007 and its acceleration after 2001 following implementation of the Maternal Mortality Reduction Strategy by the Ministry of Health and other partners. Methods We performed a descriptive analysis of maternal mortality data collected through Mongolia's vital registration system and provided by the Mongolian Ministry of Health. The observed declining mortality trend was analysed for statistical significance using simple linear regression. We present the maternal mortality ratios from 1992 to 2007 by year and review the basic components of Mongolia's Maternal Mortality Reduction Strategy for 2001-2004 and 2005-2010. Findings Mongolia achieved a statistically significant annual decrease in its maternal mortality ratio of almost 10 deaths per 100 000 live births over the period 1992-2007. From 2001 to 2007, the maternal mortality ratio in Mongolia decreased approximately 47%, from 169 to 89.6 deaths per 100 000 live births. Conclusion Disparities in maternal mortality represent one of the major persisting health inequities between low- and high-resource countries. Nonetheless, important reductions in low-resource settings are possible through collaborative strategies based on a horizontal approach and the coordinated involvement of key partners, including health ministries, national and international agencies and donors, health-care professionals, the media, nongovernmental organizations and the general public. Objectif Decrire la tendance a la baisse de la mortalite maternelle observee en Mongolie entre 1992 et 2007 et son acceleration apres 2001, suite a la mise en oeuvre de la Strategie de reduction de la mortalite maternelle par le Ministere de la sante et d'autres partenaires. Methodes Nous avons realise une analyse descriptive des donnees de mortalite maternelle collectees par I'intermediaire du systeme mongol d'enregistrement de l'etat-civil et fournis par le Ministere de la sante mongol. Nous avons analyse la tendance a la baisse de la mortalite pour evaluer sa significativite statistique par regression lineaire simple. Nous presentons les ratio de mortalite maternelle annuels de 1992 a 2007 et passons en revue les composantes de base de la Strategie de reduction de la mortalite maternelle mongole pour les periodes 2001-2004 et 2005-2010. Resultats La Mongolie a obtenu une baisse annuelle statistiquement significative de son ratio de mortalite maternelle de pres de 10 deces pour 100 000 naissances vivantes sur la periode 1992-2007. De 2001 a 2007, le ratio de mortalite maternelle mongol a diminue d'environ 47 %, passant de 169 a 89,6 deces pour 100 000 naissances vivantes. Conclusion Les disparites en termes de mortalite maternelle representent I'une des principales sources d'inegalites persistantes entre les pays a faible revenu et les pays riches. Neanmoins, des diminutions importantes de cette mortalite sont possibles dans les regions demunies si l'on fait appel a des strategies collaboratives reposant sur une approche horizontale et sur la participation coordonnee de partenaires des, dont les ministeres de la sante, les agences et les donateurs nationaux et internationaux, les professionnels de sante, les medias, les organisations non gouvernementales et la population generale. Objetivo Describir la tendencia decreciente de la mortalidad materna observada en Mongolia entre 1992 y 2007 y su aceleracion a partir de 2001, despues de que el Ministerio de Salud y otros asociados aplicaran la estrategia de reduccion de la mortalidad materna. Metodos Realizamos un analisis descriptivo de los datos de mortalidad materna reunidos a traves del sistema de registro civil de Mongolia y proporcionados por el Ministerio de Salud. La tendencia observada de reduccion de la mortalidad fue analizada mediante regresion lineal simple para determinar la significacion estadistica. Presentamos las razones de mortalidad materna entre 1992 y 2007 para cada ano y examinamos los componentes basicos de la estrategia de reduccion de la mortalidad materna de Mongolia en 2001-2004 y 2005-2010. Resultados Mongolia logro una disminucion anual estadisticamente significativa de su razon de mortalidad materna de casi 10 muertes por 100 000 nacidos vivos durante el periodo 1992-2007. Entre 2001 y 2007, la razon de mortalidad materna disminuyo aproximadamente un 47%, de 169 a 89,6 defunciones por 100 000 nacidos vivos. Conclusion Las disparidades de la mortalidad materna son una de las principales inequidades en salud que aun persisten si se comparan los pa[ses de bajos recursos y los que cuentan con altos recursos. Sin embargo, es posible lograr reducciones importantes en los entornos con recursos escasos aplicando estrategias de colaboracion basadas en un enfoque horizontal y coordinando la participacion de asociados clave, como los ministerios de salud, los organismos y donantes nacionales e internacionales, los profesionales de la salud, los medios de comunicacion, las organizaciones no gubernamentales y el publico en general., Introduction Global disparities in women's reproductive health represent one of the starkest health inequities of our times and a major social injustice. Each year approximately 530 000 women die from [...]

Objective To analyse preterm birth rates worldwide to assess the incidence of this public health problem, map the regional distribution of preterm births and gain insight into existing assessment strategies, Methods Data on preterm birth rates worldwide were extracted during a previous systematic review of published and unpublished data on maternal mortality and morbidity reported between 1997 and 2002. Those data were supplemented through a complementary search covering the period 2003-2007. Region-specific multiple regression models were used to estimate the preterm birth rates for countries with no data. Findings We estimated that in 2005, 12.9 million births, or 9.6% of all births worldwide, were preterm. Approximately 11 million (85%) of these preterm births were concentrated in Africa and Asia, while about 0.5 million occurred in each of Europe and North America (excluding Mexico) and 0.9 million in Latin America and the Caribbean. The highest rates of preterm birth were in Africa and North America (11.9% and 10.6% of all births, respectively), and the lowest were in Europe (6.2%). Conclusion Preterm birth is an important perinatal health problem across the globe. Developing countries, especially those in Africa and southern Asia, incur the highest burden in terms of absolute numbers, although a high rate is also observed in North America. A better understanding of the causes of preterm birth and improved estimates of the incidence of preterm birth at the country level are needed to improve access to effective obstetric and neonatal care. Objectif Analyser les taux de prematurite dans le monde pour evaluer l'incidence de ce probleme de sante publique, cartographier la distribution par regions des naissances avant terme et mieux connaftre les strategies d'evaluation existantes. Methodes Les donnees relatives aux naissances avant terme dans le monde ont ete extraites dans le cadre d'une revue systematique anterieure des donnees publiees et non publiees sur la mortalite et la morbidite maternelles, produites entre 1997 et 2002. Ces donnees ont ete completees par une recherche supplementaire couvrant la periode 2003-2007. Des modeles de regression multiple specifiques aux differentes regions ont ete utilises pour estimer les taux de prematurite dans les pays ne disposant pas de donnees. Resultats Nous avons estime qu'en 2005, 12,9 millions de naissances, soit 9,6 % de la natalite mondiale totale, etaient intervenues avant terme. Environ 11 millions (85 %) de ces naissances prematurees etaient concentrees en Afrique et en Asie, tandis que l'Europe et l'Amerique du Nord (Mexique inclus) accueillaient chacune 0,5 million de naissances de ce type et l'Amerique latine et les Carafbes 0,9 million. Les taux de prematurite les plus eleves etaient releves en Afrique et en Amerique du Nord (11,9 % et 10,6 % de l'ensemble des naissances, respectivement) et les plus bas en Europe (6,2 %). Conclusion La naissance avant terme constitue un important probleme de sante perinatale partout dans le monde. Les pays en developpement, en particulier ceux d'Afrique et du Sud de l'Asie, subissent la pius forte charge en termes absolus, bien qu'un taux de prematurite eleve soit aussi observe en Amerique du Nord. Une meilleure comprehension des causes de naissance prematuree et de meilleures estimations de l'incidence des naissances avant terme a l'echelle des pays sont necessaires pour ameliorer l'acces a des soins obstetricaux et neonatals efficaces. Objetivo Analizar las tasas de prematuridad a nivel mundial para evaluar la incidencia de este problema de salud publica, determinar la distribucion regional de los partos prematuros y profundizar en el conocimiento de las actuales estrategias de evaluacion. Metodos Los datos utilizados sobre las tasas de prematuridad a nivel mundial se extrajeron a lo largo de una revision sistematica anterior de datos publicados e ineditos sobre la mortalidad y morbilidad maternas notificados entre 1997 y 2002. Esos datos se complementaron mediante una busqueda que abarco el periodo 2003-2007. Las tasas de prematuridad de los paises sin datos se estimaron mediante modelos de regresion multiple especificos para cada region. Resultados Estimamos que en 2005 se registraron 12,9 millones de partos prematuros, lo que representa el 9,6% de todos los nacimientos a nivel mundial. Aproximadamente 11 millones (85%) de ellos se concentraron en Africa y Asia, mientras que en Europa y America dei Norte (excluido Mexico) se registraron 0,5 millones en cada caso, y en America Latina y el Caribe, 0,9 millones. Las tasas mas elevadas de prematuridad se dieron en Africa y America del Norte (11,9% y 10,6% de todos los nacimientos, respectivamente), y las mas bajas en Europa (6,2%). Conclusion El parto prematuro es un problema de salud perinatal importante en todo el mundo. Los paises en desarrollo, especialmente de Africa y Asia meridional, son los que sufren la carga mas alta en terminos absolutos, pero en America del Norte tambien se observa una tasa elevada. Es necesario comprender mejor las causas de la prematuridad y obtener estimaciones mas precisas de la incidencia de ese problema en cada pais si se desea mejorar el acceso a una atencion obstetrica y neonatal eficaz., Introduction Preterm birth, defined as childbirth occurring at less than 37 completed weeks or 259 days of gestation, is a major determinant of neonatal mortality and morbidity and has long-term [...]

Background: National estimates for the numbers of babies born small for gestational age and the comorbidity with preterm birth are unavailable. We aimed to estimate the prevalence of term and preterm babies born small for gestational age (term-SGA and preterm-SGA), and the relation to low birthweight (

Objectives. We analyzed trends in maternal, newborn, and child mortality in Chile between 1990 and 2004, after the introduction of national interventions and reforms, and examined associations between trends and interventions. Methods. Data were provided by the Chilean Ministry of Health on all pregnancies between 1990 and 2004 (approximately 4000 000). We calculated yearly maternal mortality ratios, stillbirth rates, and mortality rates for neonates, infants (aged >28 days and Results. During the study period, the maternal mortality ratio decreased from 42.1 to 18.5 per 100000 live births. The mortality rate for neonates decreased from 9.0 to 5.7 per 1000 births, for infants from 7.8 to 3.1 per 1000 births, and for young children from 3.1 to 1.7 per 1000 live births. The stillbirth rate declined from 6.0 to 5.0 per 1000 births. Disparities in these mortality statistics between the poorest and richest district quintiles also decreased, with the largest mortality reductions in the poorest quintile. Conclusions. During a period of socioeconomic development and health sector reforms, Chile experienced significant mortality and inequity reductions. (doi:10.2105/AJPH.2008.143578)

Obstetric hemorrhage is the leading cause of maternal mortality. Using a cluster randomized design, we investigated whether application of the Non-pneumatic Anti-Shock Garment (NASG) before transport to referral hospitals (RHs) from primary health care centers (PHCs) decreased adverse outcomes among women with hypovolemic shock. We hypothesized the NASG group would have a 50% reduction in adverse outcomes.We randomly assigned 38 PHCs in Zambia and Zimbabwe to standard obstetric hemorrhage/shock protocols or the same protocols plus NASG prior to transport. All women received the NASG at the RH. The primary outcomes were maternal mortality; severe, end-organ failure maternal morbidity; and a composite mortality/morbidity outcome, which we labeled extreme adverse outcome (EAO). We also examined whether the NASG contributed to negative side effects and secondary outcomes. The sample size for statistical power was not reached; of a planned 2400 women, 880 were enrolled, 405 in the intervention group. The intervention was associated with a non-significant 46% reduced odds of mortality (OR 0.54, 95% CI 0.14-2.05, p = 0.37) and 54% reduction in composite EAO (OR 0.46, 95% CI 0.13-1.62, p = 0.22). Women with NASGs recovered from shock significantly faster (HR 1.25, 95% CI 1.02-1.52, p = 0.03). No differences were observed in secondary outcomes or negative effects. The main limitation was small sample size.Despite a lack of statistical significance, the 54% reduced odds of EAO and the significantly faster shock recovery suggest there might be treatment benefits from earlier application of the NASG for women experiencing delays obtaining definitive treatment for hypovolemic shock. As there are no other tools for shock management outside of referral facilities, and no safety issues found, consideration of NASGs as a temporizing measure during delays may be warranted. A pragmatic study with rigorous evaluation is suggested for further research.ClinicalTrials.gov NCT00488462.

BackgroundTwin pregnancies in low- and middle-income countries (LMICs) pose a high risk to mothers and newborns due to inherent biological risks and scarcity of health resources. We conducted a secondary analysis of the WHO Global Survey dataset to analyze maternal and perinatal outcomes in twin pregnancies and factors associated with perinatal morbidity and mortality in twins.MethodsWe examined maternal and neonatal characteristics in twin deliveries in 23 LMICs and conducted multi-level logistic regression to determine the association between twins and adverse maternal and perinatal outcomes.Results279,425 mothers gave birth to 276,187 (98.8%) singletons and 6,476 (1.2%) twins. Odds of severe adverse maternal outcomes (death, blood transfusion, ICU admission or hysterectomy) (AOR 1.85, 95% CI 1.60-2.14) and perinatal mortality (AOR 2.46, 95% CI 1.40-4.35) in twin pregnancies were higher, however early neonatal death (AOR 2.50, 95% CI 0.95-6.62) and stillbirth (AOR 1.22, 95% CI 0.58-2.57) did not reach significance. Amongst twins alone, maternal age 15%, born second, preterm birth and low birthweight were associated with perinatal mortality. Marriage and caesarean section were protective.ConclusionsTwin pregnancy is a significant risk factor for maternal and perinatal morbidity and mortality in low-resource settings; maternal risk and access to safe caesarean section may determine safest mode of delivery in LMICs. Improving obstetric care in twin pregnancies, particularly timely access to safe caesarean section, is required to reduce risk to mother and baby.