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Sex-Differential Effect on Infant Mortality of Oral Polio Vaccine Administered with BCG at Birth in Guinea-Bissau. A Natural Experiment 1 2 2 1 3 Christine Stabell Benn *, Ane Bærent Fisker , Amabelia Rodrigues , Henrik Ravn , Erliyani Sartono , 4 3 2 Hilton Whittle , Maria Yazdanbakhsh , Peter Aaby 1 Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark, 2 Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau, 3 Department of Immunoparasitology, Leiden University Medical Centre, Leiden, The Netherlands, 4 The MRC Laboratories, Fajara, The Gambia Abstract Background: The policy to provide oral polio vaccine (OPV) at birth was introduced in low-income countries to increase coverage. The effect of OPV at birth on overall child mortality was never studied. During a trial of vitamin A supplementation (VAS) at birth in Guinea-Bissau, OPV was not available during several periods. We took advantage of this ‘‘natural experiment’’ to test the effect on mortality of receiving OPV at birth. Methodology: Between 2002 and 2004, the VAS trial randomised normal-birth-weight infants to 50,000 IU VAS or placebo administered with BCG. Provision of OPV at birth was not part of the trial, but we noted whether the infants received OPV or not. OPV was missing during several periods in 2004. We used Cox proportional hazards models to compute mortality rate ratios (MRR) of children who had received or not received OPV at birth. Principal Findings: A total of 962 (22.1%) of the 4345 enrolled children did not receive OPV at birth; 179 children died within the first year of life. Missing OPV at birth was associated wit