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INTRODUCTION There is extensive evidence that twins and higher-order multiple births worldwide are associated with a substantially-higher risk of maternal and perinatal mortality and morbidity compared to singletons (1-4). Globally, the highest burden of multiple births has been found in sub-Saharan Africa, with an average twining rate of 20 per 1,000 deliveries compared to 10 per 1,000 deliveries in Europe or around 5-6 per 1,000 deliveries in Asia (5-7). Nigeria has the highest prevalence of multiple births worldwide (5,7,8). Twining is a multifactorial phenomenon principally attributable to genetic and environmental factors, such as advanced maternal age and increased parity (3,5,7).