There are no studies and only limited data that compare the difference in mortality between twins and singletons in the Arab world. We studied the survival of 306,966 children, including 9,280 twins, over the period 1970–2013 in six Arab countries (Algeria, Egypt, Iraq, Mauritania, Sudan and Tunisia) based on the Multiple Indicator Cluster Survey (MICS) database. With the use of relative survival models, we estimated the mortality of twins relative to singletons by including socioeconomic and demographic variables. This study confirms the results of previous studies on the excess risk of death of twins compared to singletons. There is evidence that excess mortality decreases with follow-up; in addition, male twins have a higher risk of death compared to females for all countries except Tunisia. Wealth index and education levels of women are factors that influence the risk of mortality. It is recommended that these findings are considered when performing future health and population strategies in these Arab countries.
