The causes of maternal mortality in adolescents in low and middle income countries: a systematic review of the literature.

Sarah Neal,Zoë Matthews,Felipe Santana,Matthews Mathai,Shanti Mahendra,Alma Virginia Camacho,Andrea Nove,Krishna Bose

doi:10.1186/s12884-016-1120-8

Abstract

BackgroundWhile 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.MethodsAn 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.ResultsThe 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.ConclusionThe 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.

Highlights

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
The systematic review found that haemorrhage contributed to a fair proportion of maternal deaths amongst adolescents, it was not the leading cause of death amongst them
The three Nigerian studies found that deaths due to haemorrhage contributed 8 % [25] 12 % [26] and 4 % [27] respectively to the total adolescent maternal deaths

Summary

Introduction

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. While recent studies suggest the increased risk of maternal mortality faced by adolescents is not as great as previously believed [4, 5], pregnancy-related conditions are still a major cause of death among adolescent girls and young women, with an estimated 15 % of all deaths globally in women aged 10–25 years being a result of maternal causes [6]. While the main causes of maternal death for women of all ages were similar across all regions, the study found significant regional variation for the proportion each cause contributes to total maternal mortality. Around 27 % of maternal deaths for all ages are from indirect causes, but less is known about the specific conditions that contribute to this figure [11]

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Results

Discussion

Conclusion