Abstract
Objective: Hemorrhagic fever is a very serious complication of dengue, which remains a major public health concern in the Philippines. On average, there are 170, 503 symptomatic dengue infections and 750 deaths reported in 4 years, with an incidence of around 180 dengue episodes per 100, 000, and a case fatality rate of approximately 0.44%, owing mostly to bleeding secondary to thrombocytopenia, with reported mortalities occurring among individuals less than 20 years of age. In most rural areas in the country, a health care institution is often inaccessible and most patients cannot afford the high cost of hospitalization and transfusion. In a local study of the knowledge, attitude, and practices on dengue, herbal medicines including “tawa-tawa” and papaya are often used as an alternative supportive treatment due to easy availability and low cost. Animal studies also support a potential therapeutic effect. The objective of this review is to assess the effects of C. papaya leaf extract as an adjunct treatment among patients with dengue hemorrhagic fever using a systematically searched and synthesized meta-analysis.
 Materials and Methods: Six randomized clinical trials with a total of 988 subjects involving the efficacy of C. papaya leaf extract in increasing platelet count in dengue patients were searched through PubMed, Google Scholar, Scopus, and Science Direct and selected after assessing the eligibility and validity of the articles through a standard criterion. Mean difference of platelet counts from days 1 to 5 were pooled together and analyzed by Review Manager (RevMan) software 5.3.
 Results: Pooled estimates revealed significant increase in platelet count at Day 3 (MD=12.18; CI 10.28-14.08), Day 4 (MD=31.30; CI 27.77-34.83), and Day 5 (MD=13.23; CI 9.90-16.55). Random effects model at Day 5 also showed significant increase in platelet count. Likewise, a subgroup analyses of studies based on route of administration, frequency, and dosage were performed and showed significant increase in platelet count.
 Conclusion: Based on this meta-analysis, supplementation with C. papaya leaf extract in patients with dengue shows a beneficial effect in increasing platelet count.
Highlights
Dengue fever is an acute infectious viral disease transmitted via a bite of an infected female Aedes mosquito
Dengue hemorrhagic fever, if left untreated, has a mortality rate of 10-20% with an even higher mortality rate if it progresses to dengue shock syndrome (DSS) [1]
Given the potential of this alternative approach, this review aims to assess the effects of Carica papaya leaf extract as an adjunct in the treatment of dengue fever patients
Summary
Dengue fever is an acute infectious viral disease transmitted via a bite of an infected female Aedes mosquito. It is usually seen in infants and young children but it can affect anyone at any age. It manifests as high fever, severe headache, myalgia and arthralgia, rash, nose bleeding, and gastrointestinal bleeding, which could eventually lead to massive bleeding, shock, and even death if not managed properly. The Philippines ranked seventh with the highest number of dengue fever cases in the world between 2004 and 2010.
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