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Table 1 Evidence grid based on included papers

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

Study

Site

Study design/data collection methods

Years

Adolescent age group

Number of adolescent deaths included

Causes of maternal deaths identified

Sub-Saharan Africa

Ā Ā Ā Ā 

Adolescent group

Comparison group (where available)

Asamoah B, Moussa K, Stafstrom M, Musinguzi G (2011) [18]

Ghana

Retrospective community survey with verbal autopsy questionnaire (Demographic and Household Survey)

2000ā€“2005

12ā€“19 years (as part of sample 12ā€“49 years: 12ā€“14 and 15ā€“19 were presented separately but were amalgamated when figures recalculated due to only three deaths in 12ā€“14 age group)

65 (as a sub- sample of 605 maternal deaths aged 12ā€“49)

Ā 

12ā€“19 years

12ā€“49 years

TotalĀ Direct

62Ā %

61Ā %

Abortion

29Ā %

14Ā %

Haemorrhage

11Ā %

23Ā %

(Pre) eclampsia

8Ā %

N/A

Sepsis

6Ā %

7Ā %

Obstructed labour

5Ā %

5Ā %

Miscarriage

3Ā %

3Ā %

Hypertensive disorders

N/A

9Ā %

Total Indirect

38Ā %

40Ā %

Other infectious diseases

14Ā %

14Ā %

Other non-infectious diseases

12Ā %

12Ā %

Miscellaneous

12Ā %

14Ā %

Figures were recalculated because theĀ dataĀ were presented as cause specific mortality by ageĀ group rather than adolescent mortality by cause

Ghana Statistical Service (GSS), Ghana Health Service (GHS), and Macro International (2009) [22]

Ghana

Retrospective community survey with verbal autopsy questionnaire (Demographic and Household Survey)

2000ā€“2005

12ā€“14 and 15ā€“19

(as part of sample 12ā€“49 years: 12ā€“14 and 15ā€“19 were presented separately but were amalgamated when figures recalculated due to only three deaths in 12ā€“14 age group)

56 aged 12ā€“19 (as a sub-sample of 486 maternal deaths aged 12ā€“49)

Ā 

12ā€“19 years

12ā€“49 years

Abortion

29Ā %

11Ā %

Haemorrhage

12Ā %

24Ā %

Hypertensive disorders

9Ā %

9Ā %

Sepsis

7Ā %

7Ā %

Miscarriage

4Ā %

4Ā %

Obstructed labour

3Ā %

4Ā %

Other miscellaneous

9Ā %

13Ā %

Other not classified elsewhere: infectious

15Ā %

15Ā %

Other not classified elsewhere: non-infectious

12Ā %

13Ā %

MallƩ D, Ross DA, Campbell O, Huttly S (1994) [23]

Mali (Bamako, Sissako and Mopti)

Retrospective study using data from 25 health facilities

1988 to 1992

14ā€“19 years

54 aged 14ā€“19 as a sub-sample of 288 maternal deaths aged 14ā€“49

Ā 

14ā€“19 years

14ā€“49 years

Haemorrhage

46Ā %

59Ā %

Toxaemia

30Ā %

14Ā %

Infection

17Ā %

13Ā %

Other

7Ā %

14Ā %

Granja A CL, Machungo F, et al. (2001) [24]

Mozambique

Retrospective hospital based Study

1989ā€“1993

Under 20 (with a comparison non-adolescent group aged 20ā€“45)

52 (with a further 80 non-adolescent deaths)

Ā 

<20Ā years

20ā€“45 years

Total Direct

54Ā %

61Ā %

Pregnancy-induced hypertension/eclampsia

21Ā %

9Ā %*

Puerperal infection

15Ā %

10Ā %

Abortion

10Ā %

7Ā %

Haemorrhage

4Ā %

33Ā %**

Amniotic fluid embolism

4Ā %

2Ā %

Total Indirect

47Ā %

38Ā %

Malaria

27Ā %

12Ā %**

Anaemia

6Ā %

6Ā %

Meningitis

6Ā %

4Ā %

Other indirect

6Ā %

16Ā %

Lema VM, Changole J, Kanyighe C, Malunga EV (2005) [29]

Malawi

Retrospective study using tertiary health facility data

1999ā€“2000

10Ā§Ā§ā€“19Ā years (as part of a sample aged 16ā€“40)

42 (as a subset of the total sample of 204 maternal deaths aged 10ā€“40)

Ā 

10ā€“19 years

16ā€“40 years

Postabortal sepsis

36Ā %

N/A

Puerperal sepsis

21Ā %

29Ā %

Postabortal haemorrhage

10Ā %

N/A

Ectopic pregnancy

10Ā %

3Ā %

Meningitis

10Ā %

10 %

Pneumonia

10Ā %

N/A

Eclampsia

2Ā %

N/A

Other

2Ā %

6Ā %

Postabortal complications

N/A

N/A

Other infections

N/A

24Ā %

Obstetric haemorrhage

N/A

20Ā %

Ruptured uterus/obstructed labour

N/A

11Ā %

Heart failure (due to anaemia)

N/A

3Ā %

Not established

N/A

2Ā %

Ā Ā 

3Ā %

Nkata M (1997) [28]

Zambia (Luapula province)

Retrospective study using secondary level hospital data

1993ā€“5

13ā€“19 years

33

Ā 

13ā€“19 years

No comparison data available

Total Direct

69Ā %

Ā 

Sepsis due to:

Ā Ā 

- Obstructed labour with uterine rupture

36Ā %

Ā 

- Obstructed labour without uterine rupture

9Ā %

Ā 

- Abortion

9Ā %

Ā 

- Puerperal sepsis

3Ā %

Ā 

Haemorrhage due to:

Ā Ā 

- Caesarean section

6Ā %

Ā 

- Ectopic pregnancy

3Ā %

Ā 

Eclampsia

3Ā %

Ā 

Total Indirect

30Ā %

Ā 

Malaria

18Ā %

Ā 

HIV infection

6Ā %

Ā 

Meningitis

3Ā %

Ā 

Airede LR and Ekele BA (2003) [27]

Nigeria

Retrospective hospital based Study

1990ā€“1999

<19Ā years

46

Ā 

<19Ā years

No comparison data available

Eclampsia

46Ā %

Ā 

Prolonged obstructed labour

30Ā %

Ā 

Anaemia

11Ā %

Ā 

Ruptured uterus

7Ā %

Ā 

Postpartum haemorrhage

4Ā %

Ā 

Abortion

4Ā %

Ā 

Puerperal sepsis

4Ā %

Ā 

Meningitis

2Ā %

Ā 

Congestive cardiac failure

2Ā %

Ā 

Sickle cell disease

2Ā %

Ā 

Total is over 100Ā % as in some cases two independent causes were included)

Ujah I, Aisien O, Muthihir J, et al. (2005) [25]

Nigeria (Plateau State)

Prospective study using tertiary health facility data

1991ā€“2001

10ā€“19 years

25

Ā 

10ā€“19 years

No comparison data available

Total Direct

76Ā %

Ā 

Abortion

28Ā %

Ā 

Sepsis

20Ā %

Ā 

Eclampsia

20Ā %

Ā 

Haemorrhage

8Ā %

Ā 

Total Indirect

24Ā %

Ā 

Sickle cell anaemia

8Ā %

Ā 

Other indirect causes

16Ā %

Ā 

Okusanya B, Algere E, Abe A, Ibrahim H and Salawu R (2013) [26]

Nigeria (Katsina State)

Prospective study using maternal mortality database in tertiary health facility

2008ā€“2012

15ā€“19 years

16

Ā 

15ā€“19 years

15ā€“45 years

Pre-eclampsia/eclampsia

37.5Ā %

18.9Ā %

Obstructed labour/uterine rupture

13Ā %

6.8Ā %

Puerperal sepsis

13Ā %

12.2Ā %

Tetanus in puerperium

13Ā %

5.4Ā %

Haemorrhage

12Ā %

21.6

Sickle cell anaemia

6Ā %

N/A

Anaemia

6 %

8.1

South East Asia

Fauveau V, Koenig MA, Chakraborty J, et al. (1988) [30]

Bangladesh (Matlab)

Data gathered from community based demographic surveillance system, with additional information gathered from health staff, health records and interviews with families

1976ā€“1985

15-19 years

78 adolescent deaths (originally 94 but 16 deaths from incidental causes removed and results recalculated) as a subsample of 387 deaths age 15ā€“45 years

Ā 

15ā€“19 years

20ā€“34 years

Total Direct

88Ā %

85Ā %

Toxaemia/eclampsia

22Ā %

14Ā %

Abortion

20Ā %

16Ā %

Postpartum haemorrhage

18Ā %

21Ā %

Other obstetric

14Ā %

18Ā %

Obstructed labour

7Ā %

7Ā %

Postpartum sepsis

6Ā %

8Ā %

Concomitant

12 %

14 %

Medical causes

7Ā %

7Ā %

Unspecified

5Ā %

7Ā %

Yusuf HR, Akhter HH, Chowdhury ME, Rochat RW (2007) [17]

Bangladesh

Data and health care provider interviews from 4751 health facilities in Bangladesh.

1995/6

10ā€“19 years

10ā€“19

1038 as a sub-sample of 8821 maternal deaths aged 10ā€“50

Ā 

10ā€“19 years

10ā€“50 years

Total Direct

89Ā %

88Ā %

Eclampsia

47Ā %

29Ā %

Abortion-related causes

12Ā %

18Ā %

PPH / APH

10Ā %

10Ā %

Obstructed labour

9Ā %

14Ā %

Retained placenta

5Ā %

8Ā %

Other obstructed causes

4Ā %

7Ā %

Tetanus

2Ā %

2Ā %

Total Indirect

11Ā %

12Ā %

Latin America and Caribbean/PAHO

Souza ML, Burgardt D, Ferreira LAP, Bub MBC, Monticelli M, Lentz HE (2010) [31]

Santa Catarina, Brazil

Retrospective population based study

1994ā€“2005

10ā€“19 years

58

(originally 64, but 6 deaths classified as ā€œunrelatedā€ were removed and proportions recalculated)

Ā 

10ā€“19 years

No comparison data available

Total Direct

74Ā %

Ā 

Toxaemia

29Ā %

Ā 

Infection

17Ā %

Ā 

Haemorrhage

16Ā %

Ā 

Other direct

12Ā %

Ā 

Total Indirect

26Ā %

Ā 

de SiqueiraĀ AAF, Tanaka ACd'A (1986) [32]

Brazil

Retrospective review of health records and official statistics

1980

10ā€“19 years (10ā€“14 and 15ā€“19 years were presented separately but were amalgamated for this study due to small number of deaths in 12ā€“14 age group)

306 (18 aged 10ā€“14

288 aged 15ā€“19 years)

Ā 

10ā€“19 years

No comparison data available

Hypertensive disorders

47Ā %

Ā 

Sepsis

16Ā %

Ā 

Haemorrhage

8Ā %

Ā 

Abortion

6Ā %

Ā 

Embolism

2Ā %

Ā 

Other pregnancy-related causes

12Ā %

Ā 

Other

7Ā %

Ā 

Donoso ES and Carvajal C (2012) [19]

Chile

Retrospective study of statistics from the yearbooks of Chileā€™s National Institute of Statistics

2000ā€“2009

15ā€“19 years

36 as a sub-sample of 431 maternal deaths aged 15ā€“49

Ā 

15ā€“19 years

20ā€“49 years

Hypertensive disorders

44Ā %

30Ā %

Abortion

18Ā %

11Ā %

Obstetric embolism

6Ā %

6Ā %

Postpartum haemorrhage

3Ā %

6Ā %

Puerperal sepsis

3Ā %

5Ā %

Ectopic pregnancy

N/A

7Ā %

Concurrent illness

28Ā %

35Ā %

Percentages were calculated based on births within each age groups and numbers of deaths by cause within each age group.

Acosta Chavez (2003) [33]

Peru

Retrospective from tertiary hospital

1986ā€“2002

Under 20Ā years

30

Ā 

<20Ā years

No comparison data available

Total Direct

70Ā %

Ā 

Septic abortion

33Ā %

Ā 

Infections

17Ā %

Ā 

Haemorrhage

13Ā %

Ā 

Toxaemia

7Ā %

Ā 

Total Indirect

30 %

Ā 

Pulmonary tuberculosis

10 %

Ā 

Liver failure

7Ā %

Ā 

Others

13Ā %

Ā 
  1. Ā§These figures were not presented in the paper, but were provided by the author in a personal communication
  2. Ā§Ā§There is a discrepancy in the paper on youngest age
  3. */**difference between adolescents and non-adolescents significant at 5Ā %/1Ā % level