Table 4 Social and environmental dimension aspects related to dengue mortality according to content analysis

Poverty

Yes

• Contributes directly to income, education and living conditions.

[87, 92]

• Represents a barrier for access to health care and thereby contributes to rise in dengue mortality.

Social behavior

Yes

• Absence or delays in care-seeking were described as explaining dengue mortality.

[29–31, 76, 77, 80, 91, 93]

• Reflects social and cultural aspects and is related to risk perception and awareness of disease by patients and health staff.

Environmental/vector presence

NC

• Rural residence and geographical barriers were more related to access to health care than to dengue mortality itself.

[27, 87, 88, 92–97]

• Vector presence and occurrence of dengue outbreaks were described as a condition that increased the risk of severe forms of dengue.

Virus characteristics

Yes

• Heterogeneous infections and virulence of strains might increase disease severity

[11, 29, 32, 33, 37–41, 52, 55, 60, 62, 66, 70, 73, 76, 79, 80, 83, 88, 98–101]

• Together with type of infection/immunological status, was described as an important determinant.