Abstract
BackgroundDengue is a viral disease whose clinical spectrum ranges from unapparent to severe forms and fatal outcomes. Although dengue death is 99 % avoidable, every year around 20,000 deaths are estimated to occur in more than 100 countries. We consider that, along with biological factors, social determinants of health (SDHs) are related to dengue deaths as well.MethodsA scoping review was conducted to explore what has been written about the role of SDHs in dengue mortality. The inclusion criteria were that documents (grey or peer-reviewed) had to include information about dengue fatal cases in humans and be published between 1997 and 2013 and written in English, Spanish, Portuguese or French. The search was conducted using a set of key words related to dengue mortality in several electronic databases: PubMed, LILACS, COCHRANE, Scielo, Science Direct, WHOLIS, OpenGrey, OpenSingle and Google Scholar. Information on SDHs was categorized under individual, social and environmental, and health systems dimensions. A summative content analysis using QDA Miner was conducted to assess the frequency of information on SDHs and its contextual meaning in the reviewed literature. The role of each SDH in dengue mortality was assessed using content analysis results.ResultsFrom a total of 971 documents retrieved, 78 met the criteria. Those documents were published in the Americas region (50.0 %), Asia (38.4 %), Europe (9.0 %) and Africa (2.6 %). The described SDHs related to dengue deaths included, in the individual dimension: age, ethnicity, education, type of infection and immunological status; and in the social dimension: poverty and care-seeking behavior. The health systems dimension included access, opportunity, and quality of care, as well as health staff knowledge. Ethnicity was considered a determinant that depends on cultural and socioeconomic conditions.ConclusionsAlong with biological factors, there are several SDHs related to dengue mortality. However, only a few of these have been systematically analyzed, suggesting the need for more studies on this subject to inform the design and implementation of sustainable interventions to decrease dengue mortality. These findings nevertheless provide a better understanding of the non-biological factors involved in dengue mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1058-x) contains supplementary material, which is available to authorized users.
Highlights
Dengue is a viral disease whose clinical spectrum ranges from unapparent to severe forms and fatal outcomes
Severe forms are characterized by the presence of hemorrhages, hypotension, thrombocytopenia and plasma leakage, accompanied by neurological alterations [10], conditions that could eventually lead to shock and multi-systemic failure and that could worsen in presence of comorbidities [1, 8, 9]
There was a notable lack of qualitative or social sciences oriented studies. This might be due to the fact that available information about dengue cases is usually focused on biological factors and the available evidence is published in biomedical databases [88, 93]
Summary
Dengue is a viral disease whose clinical spectrum ranges from unapparent to severe forms and fatal outcomes. Over the past 50 years, dengue incidence has increased dramatically. The clinical spectrum of this disease ranges from unapparent or asymptomatic to severe forms and fatal. In contexts where it is not possible to provide appropriate case management (because of limited resources, misdiagnosis or lack of knowledge), this could translate to fatal outcomes [1, 3, 8, 9]. Though dengue mortality is said to be 99 % preventable, case fatality rates (CFR) far higher than 1 % have been observed worldwide [1, 6, 11, 12]
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