Notified dengue deaths in Myanmar (2017-18): profile and diagnosis delays.

Nwe Ni Linn,Aye Mon Mon Kyaw,Aung Thi,San Kyawt Khine,Khine Wut Yee Kyaw,Myat Min Tun,Nay Yi Yi Linn,Zaw Lin,Hemant Deepak Shewade

doi:10.12688/f1000research.23699.1

Abstract

Background: Complications in dengue usually occur between day four and day six after fever onset. Hence, early diagnosis and haematological monitoring are vital. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Methods: This was a descriptive study involving secondary data. For all the notified deaths, death investigation forms were not available in prescribed format and therefore, data were extracted from hospital case records. Results: Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended.

Highlights

Dengue is a mosquito-borne viral disease that has rapidly spread in tropical and subtropical regions
Most of the patients did not have a diagnosis of dengue fever before admission and more than half of the patients were in shock at admission
This study reported a long diagnosis delay after fever onset among dengue deaths reported over two years in Myanmar

Summary

Introduction

Dengue is a mosquito-borne viral disease that has rapidly spread in tropical and subtropical regions. Severe dengue usually occurs between day four and six after fever onset (called the critical stage, during which fever subsides) and is one of the leading causes of hospitalization and death among children and adults in most Asian and Latin American countries[4]. Among all hospital reported dengue deaths in Myanmar in 2017-18, we assessed the i) patient profile, ii) proportion of patients who arrived with a dengue diagnosis at admission and iii) delays in diagnosis after fever onset. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and patient level factors for better understanding of the reasons of delay. Filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended

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