Association between twin birth and risk of anthropometric failure and morbidity outcomes among children in India, 2019-2021.

BACKGROUND

Twinning rates are increasing globally and in India, yet a comprehensive analysis of nutritional outcomes and growth patterns among twins in low-and middle income countries remains limited.

METHODS

This was a cross-sectional study utilizing data from India's National Family Health Survey, 2019-2021. The final analytic sample comprised 224 177 children (0-59 months). We employed logistic regression models and Coarsened Exact Matching. The primary outcomes included anthropometric failure (stunting, wasting, underweight), anemia, diarrhea, and acute respiratory infection (ARI).

RESULTS

Twins had a consistently higher prevalence for most adverse health outcomes. For instance, severe anemia prevalence was 4.29% (95% CI: 3.42, 5.16) in twins versus 2.09% (95% CI: 2.03, 2.15) in singletons, with 70% higher adjusted odds (aOR: 1.70; 95% CI: 1.28, 2.25). Nutritional disadvantages were most pronounced in the 0-5 months age group and attenuated with age. Disparities were greatest among the poorest groups, though the increased risk of severe anemia persisted across all wealth quintiles. Twins had lower prevalence and adjusted odds for ARI and diarrhea than singletons.

CONCLUSION

Significant health disparities persist between twins and singletons in India, particularly in early childhood and among disadvantaged groups. These findings underscore the need for targeted, equity-focused public health interventions to improve nutritional and health outcomes for twins across India.