The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature.
While the main causes of maternal mortality in low and middle income countries are well understood, less is known about whether patterns for causes of maternal deaths among adolescents are the same as for older women. This study systematically reviews the literature on cause of maternal death in adolescence. Where possible we compare the main causes for adolescents with those for older women to ascertain differences and similarity in mortality patterns.



An initial search for papers and grey literature in English, Spanish and Portuguese was carried out using a number of electronic databases based on a pre-determined search strategy. The outcome of interest was the proportion of maternal deaths amongst adolescents by cause of death. A total of 15 papers met the inclusion criteria established in the study protocol.



The main causes of maternal mortality in adolescents are similar to those of older women: hypertensive disorders, haemorrhage, abortion and sepsis. However some studies indicated country or regional differences in the relative magnitudes of specific causes of adolescent maternal mortality. When compared with causes of death for older women, hypertensive disorders were found to be a more important cause of mortality for adolescents in a number of studies in a range of settings. In terms of indirect causes of death, there are indications that malaria is a particularly important cause of adolescent maternal mortality in some countries.



The main causes of maternal mortality in adolescents are broadly similar to those for older women, although the findings suggest some heterogeneity between countries and regions. However there is evidence that the relative importance of specific causes may differ for this younger age group compared to women over the age of 20 years. In particular hypertensive conditions make up a larger share of maternal deaths in adolescents than older women. Further, large scale studies are needed to investigate this question further.
Department of Social Statistics and Demography, University of Southampton, Southampton, UK. S.Neal@soton.ac.uk.
Sarah
S
Neal
Options Consultancy Services, London, UK.
Shanti
S
Mahendra
Sustainable Development and Health, Ferney Voltaire, France.
Krishna
K
Bose
SRH Team, Latin America and the Caribbean Regional Office, United Nations Population Fund, Panama City, Panama.
Alma Virginia
AV
Camacho
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine , Liverpool, UK.
Matthews
M
Mathai
Novametrics, Derby, United Kingdom.
Andrea
A
Nove
Instituto Nacional de Endocrinología, Havana, Cuba.
Felipe
F
Santana
Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
Zoë
Z
Matthews
D000028:Abortion, Induced / Q000401:mortality; D000293:Adolescent; D002423:Cause of Death; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000401:mortality; D063130:Maternal Death / Q000209:etiology*; D008428:Maternal Mortality; D006473:Postpartum Hemorrhage / Q000401:mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality*; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D018805:Sepsis / Q000401:mortality