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Clinical Presentations, Outcome and Cost of Illness of Dengue in a Tertiary Care Hospital of Bangladesh: An Observational Study

Received: 30 June 2021    Accepted: 12 July 2021    Published: 9 August 2021
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Abstract

Background: Dengue is a fast-emerging viral disease in many parts of the world, having a potential to present with a varied spectrum of clinical manifestations with atypical presentations being more frequent. This study was conducted to evaluate the clinical features, outcome and Cost of Illness (COI) of dengue cases admitted in a tertiary-care government hospital in Chattogram, Bangladesh. Methods & materials: It was a hospital based prospective observational study and was carried out in the Department of Medicine, Chittagong Medical College Hospital. All the consecutive serologically positive (NS1 antigen, IgM, IgG antibodies) dengue cases (age >12 years) admitted in the Department of Medicine of Chittagong Medical College Hospital from 1st August 2019 to 31st July 2020, were enrolled in the study. Severity of each dengue case was determined as per the recent WHO classification (2009) Clinical presentations of the cases were carefully assessed. In-hospital outcomes of the patients in terms of mortality, duration of hospital stay, need for ICU or other support were recorded. The COI questionnaire included three major cost components: direct medical costs (DMC), direct non-xiv medical costs (DNMC), and indirect costs (IC). Data analysis was done on the SPSS 23 version. Results: Out of 425 patients, the maximum number of dengue cases reported were males (76.9%) and belonging to the 21-30 years age group (38.8%). Fever was the main complaint in all the cases followed by headache (78%), myalgia (56%), persistent vomiting (44%). Of the 91.5% Dengue fever cases, 88.2% were classified as Dengue fever without warning signs and 3.3% with warning signs and 8.5% as severe dengue. Thrombocytopenia was present in 53.9% and leukopenia in 42.1% of cases. 3.3% of patients needed ICU admission and the mortality rate was 1.2%. The median total COI was BDT 8703 (IQR: 6240-11795) with median DMC of 3580 (IQR: 2525-4885), DNMC of 2000 (IQR: 1250-3225) and INMC of 2400 (IQR: 1045-4000). Conclusions: Overwhelming number of cases and their varied clinical presentations lead to an increase in hospitalization in this outbreak. Though the outcomes have been mostly favorable, the cost incurred as a result has been immense and has impacted households greatly, since most medical costs in Bangladesh are out-of-pocket expenses.

Published in Clinical Medicine Research (Volume 10, Issue 4)
DOI 10.11648/j.cmr.20211004.16
Page(s) 142-150
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Dengue Fever, Clinical Presentations, Outcome of Dengue, Cost of Illness (COI)

References
[1] Bhatt, S., Gething, P., Brady, O., Messina, J., Farlow, A., Moyes, C., Drake, J., Brownstein, J., Hoen, A., Sankoh, O., Myers, M., George, D., Jaenisch, T., Wint, G., Simmons, C., Scott, T., Farrar, J. and Hay, S., 2013. The global distribution and burden of dengue. Nature, 496 (7446), pp. 504-507.
[2] World Health Organization. (2019). What is dengue? [online] Available at: https://www.who.int/denguecontrol/disease/en/ [Accessed 21 Aug. 2019].
[3] DGHS (Directorate General of Health Services). Health Bulletin on current Dengue situation published by CDC, DGHS. [Internet]Available from: https://reliefweb.int/report/bangladesh/bangladesh-dengue-situation-2019-healthbulletin-volume-2-03-august-2019.
[4] Dghs.gov.bd. 2020. Daily Dengue Status Report. [online] Available at: https://dghs.gov.bd [Accessed 5 September 2020].
[5] World Health Organization. Dengue: guidelines for diagnosis, treatment, prevention and control. Geneva: World Health Organization Press; 2009.
[6] Pervin, M., Sweety, A., Hossain, M., Sharmin, R., Fatema, N., Rahman, M., Nehar, N., Yasmin, M., Khoda, M., Rahman, K. and Azad, K. (2018). Seraepidemiology of Dengue Virus Infection in Clinically Suspected Patients Attended in Dhaka Medical College Hospital During January to December 2016. Journal of Dhaka Medical College, 26 (2), pp. 111-116.
[7] kumar, M., Verma, R. and Kumar, D. (2019). Recent Trends in Clinical Presentation in Cases of Dengue Presenting At Tertiary Care Hospital. International Journal of Science and Healthcare Research, 4 (1), pp 507-509.
[8] Mahmood B, Mahmood S (2011) Emergence of dengue in Bangladesh a major international public health concern in recent years. J. Environ. Res. Manage. 2 (3): pp. 35–41.
[9] Shepard, D. S., Halasa, Y. A., Tyagi, B. K., Adhish, S. V., Nandan, D., Karthiga, K. S., et al. (2014) Economic and disease burden of dengue illness in India. Am J Trop Med Hyg, 91 (6): pp. 1235–42, doi: http://dx.doi.org/10.4269/ajtmh.14-0002.
[10] Panmei, K., Joseph, A., Rose, W., Abraham, O., Mathuram, A., Kumar, S. and Abraham, A. (2019). Direct cost of illness for dengue in hospitalized children and adults at a referral hospital in India. International Journal of Infectious Diseases, 84, S64-S67.
[11] Suaya, J., Lum, L., Huy, R., Tyo, K., Sughayyar, R., Armien, B., et al. (2009). Cost of Dengue Cases in Eight Countries in the Americas and Asia: A Prospective Study. The American Journal of Tropical Medicine and Hygiene, 80 (5), pp. 846-855.
[12] Lee J-S, Mogasale V, Lim JK, Ly S, Lee KS, Sorn S, et al. (2019) A multi-country study of the economic burden of dengue fever based on patient-specific field surveys in Burkina Faso, Kenya, and Cambodia. PLoSNegl Trop Dis 13 (2): e0007164. https://doi.org/10.1371/journal. pntd.0007164.
[13] Selvaraj, S., Farooqui, H., & Karan, A. (2018). Quantifying the financial burden of households’ out-of-pocket payments on medicines in India: a repeated cross sectional analysis of National Sample Survey data, 1994–2014. BMJ Open, 8 (5), e018020.
[14] Lee, J., Lourenço, J., Gupta, S. and Farlow, A. (2018). A multi-country study of dengue vaccination strategies with Dengvaxia and a future vaccine candidate in three dengue-endemic countries: Vietnam, Thailand, and Colombia. Vaccine, 36 (17), pp. 2346-2355.
[15] World Health Organization. 2011, Comprehensive guidelines for prevention and control of dengue and dengue haemorrhagic fever. Revised and expanded edition.[Internet] http://apps.searo.who.int/pds_docs/B4751.pdf.
[16] Uis.unesco.org. 2016. Bangladesh | UNESCO UIS. [online].
[17] Yunus, Emran Bin, Bangali, A Mannan, Mahmood, M Ataul Haq, Rahman, M Mushfiqur, Chowdhury, A R. et al. (2001). Dengue Outbreak 2000 in Bangladesh: From Speculation to Reality and Exercises. WHO Regional Office for South-East Asia. https://apps.who.int/iris/handle/10665/163630.
[18] Pervin M, Tabassum S, Ali MM, Mamun KZ and Islam MN. Clinical and Laboratory Observations associated with the 2000 Dengue Outbreak in Dhaka, Bangladesh. Dengue Bulletin. 2004; 28: pp. 96-106.
[19] Raza, F. A., Rehman, S. ur, Khalid, R., Ahmad, J., Ashraf, S., Iqbal, M., & Hasnain, S. (2014). Demographic and Clinico-Epidemiological Features of Dengue Fever in Faisalabad, Pakistan. PLoS ONE, 9 (3), e89868. doi: 10.1371/journal.pone.0089868.
[20] Thaher, M. A., Ahmad, S. R, & Chandrasekhar, A. (2016) Clinical presentation and outcome of dengue cases in a tertiary-care hospital, Hyderabad. Int J Med Sci Public Health, 5 (10), pp. 2009-2012.
[21] Chew, M., Rahman, M. and Salleh, S., 2012. Dengue in Malaysia: An epidemiological perspective study. Pak J Med Sci, 28 (4), pp. 643-647.
[22] Libraty, D. H., Young, P. R., Pickering, D., Endy, T. P., Kalayanarooj, S., Green, S., et al. (2002). High circulating levels of the dengue virus nonstructural protein NS1 early in dengue illness correlate with the development of dengue haemorrhagic fever. J Infect Dis, 186 (6), pp. 1165-8.
[23] Singh, P., Bano, M., Rawat, V., Joshi, A. (2017). Clinico-epidemiological study of Dengue outbreaks- an overview from Kumaon region of Uttarakhand, JMSCR, 5 (4), pp. 20962-20971.
[24] Ukey, P., Bondade, S., Paunipagar, P., Powar, R., & Akulwar, S. (2010). Study of seroprevalence of dengue Fever in central India. Indian journal of community medicine: official publication of Indian Association of Preventive & Social Medicine, 35 (4), pp. 517–519.
[25] Bbs.portal.gov.bd. 2020. 2020. Bangladesh Statistics 2019. [online] Available at: https://bbs.portal.gov.bd [Accessed 3 September 2020].
[26] Rahman, M., ahman, K., Siddque, A. K., Shoma, S., Kamal, A. H., Ali, K. S., Nisaluk, A., & Breiman, R. F. (2002). First outbreak of dengue hemorrhagic fever, Bangladesh. Emerging infectious diseases, 8 (7), 738–740. https://doi.org/10.3201/eid0807.010398.
[27] El-Gilany, A., Eldeib, A. and Hammad, S. (2010). Clinico–epidemiological features of dengue fever in Saudi Arabia. Asian Pacific Journal of Tropical Medicine, 3 (3), pp. 220-223.
[28] Zafar, H., Dhodhy, M., Hayyat, A., Akhtar, N., Rizwan, F., Chaudhary, B. and Zareef, S., 2010. Seroprevalence of Dengue Viral Infection in Healthy Population residing in Rural Areas of District Rawalpindi. International Journal of Pathology, 8 (1), pp. 13-15.
[29] Uis.unesco.org. 2020. Bangladesh | UNESCO UIS. [online] Available at: http://uis.unesco.org/en/country/bd?theme=education-and-literacy [Accessed 3 September 2020].
[30] Md Khaja M, Devadas S. (2017). Clinical profile and outcome of dengue fever in a paediatric tertiary care centre. Int J Contemp Pediatr, 4, pp 875-7. DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20171689.
[31] Hasan S, Jamdar SF, Alalowi M, Al Ageel Al, Beaiji SM. (2016). Dengue virus: A global human threat: Review of literature. J Int Soc Prevent Communit Dent 2016; 6: 1-6. DOI: 10.4103/2231-0762.175416.
[32] Ahmed, F., Mahmood, C., Sharma, J., Hoque, S., Zaman, R. and Hasan, M., 2001. Dengue and Dengue Haemorrhagic Fever in Children During the 2000 Outbreak in Chittagong, Bangladesh. Dengue Bulletin, Vol 25, pp. 33-39.
[33] Seet, R., Ooi, E., Wong, H. and Paton, N., 2005. An outbreak of primary dengue infection among migrant Chinese workers in Singapore characterized by prominent gastrointestinal symptoms and a high proportion of symptomatic cases. Journal of Clinical Virology, [online] 33 (4), pp. 336-340.
[34] Kuan, G., Hin, Y. and Isa, R., 2015. Comparison of vomiting and diarrhoea frequency among dengue-infected patients. Journal of Coastal Life Medicine, 3 (8), pp. 616-620.
[35] Endy TP, Chunsuttiwat S, Nisalak A, Libraty DH, Green S, Rothman AL, et al. (2002). Epidemiology of inappropriate and symptomatic acute dengue virus infection: a prospective study of primary school children in Kamphaeng Phet, Thailand. Am J Epidemiol; 156 (1): pp. 40-51.
[36] National Guideline for Clinical Management of Dengue Syndrome. 2018, National Malaria Elimination & Aedes Transmitted Disease Control Program Disease Control Unit Directorate General of Health Services Mohakhali, Dhaka-1212.
[37] Tozan, Y., Ratanawong, P., Sewe, M. O., Wilder-Smith, A., Kittayapong, P. (2017) Household costs of hospitalized dengue illness in semi-rural Thailand. PLoS Negl Trop Dis 11 (9): e0005961. https://doi.org/10.1371/journal.pntd.0005961.
[38] Bb.org.bd. 2020. Exchange Rate of Taka. [online] Available at: https://www.bb.org.bd/econdata/exchangerate.php [Accessed 8 September 2020].
[39] Statistics and informatice division (SID), Ministry of Planning, Government of Peoples Republic of Bangladesh, 2019, Final reports on household income and expenditure survey 2016. Dhaka: Bangladesh Bureau of Statistics (BBS), pp. 29-35.
Cite This Article
  • APA Style

    Nur Jahan Aktar, Milton Barua, Amanat Ullah, Abdus Sattar, Shoman Sarkar, et al. (2021). Clinical Presentations, Outcome and Cost of Illness of Dengue in a Tertiary Care Hospital of Bangladesh: An Observational Study. Clinical Medicine Research, 10(4), 142-150. https://doi.org/10.11648/j.cmr.20211004.16

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    Nur Jahan Aktar; Milton Barua; Amanat Ullah; Abdus Sattar; Shoman Sarkar, et al. Clinical Presentations, Outcome and Cost of Illness of Dengue in a Tertiary Care Hospital of Bangladesh: An Observational Study. Clin. Med. Res. 2021, 10(4), 142-150. doi: 10.11648/j.cmr.20211004.16

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    AMA Style

    Nur Jahan Aktar, Milton Barua, Amanat Ullah, Abdus Sattar, Shoman Sarkar, et al. Clinical Presentations, Outcome and Cost of Illness of Dengue in a Tertiary Care Hospital of Bangladesh: An Observational Study. Clin Med Res. 2021;10(4):142-150. doi: 10.11648/j.cmr.20211004.16

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  • @article{10.11648/j.cmr.20211004.16,
      author = {Nur Jahan Aktar and Milton Barua and Amanat Ullah and Abdus Sattar and Shoman Sarkar and Sujat Paul and Shofiur Rahman and Mitan Chakma and Mahmudul Islam Talukder and Mahatabur Rahman and Mohammad Faisal Kabir},
      title = {Clinical Presentations, Outcome and Cost of Illness of Dengue in a Tertiary Care Hospital of Bangladesh: An Observational Study},
      journal = {Clinical Medicine Research},
      volume = {10},
      number = {4},
      pages = {142-150},
      doi = {10.11648/j.cmr.20211004.16},
      url = {https://doi.org/10.11648/j.cmr.20211004.16},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20211004.16},
      abstract = {Background: Dengue is a fast-emerging viral disease in many parts of the world, having a potential to present with a varied spectrum of clinical manifestations with atypical presentations being more frequent. This study was conducted to evaluate the clinical features, outcome and Cost of Illness (COI) of dengue cases admitted in a tertiary-care government hospital in Chattogram, Bangladesh. Methods & materials: It was a hospital based prospective observational study and was carried out in the Department of Medicine, Chittagong Medical College Hospital. All the consecutive serologically positive (NS1 antigen, IgM, IgG antibodies) dengue cases (age >12 years) admitted in the Department of Medicine of Chittagong Medical College Hospital from 1st August 2019 to 31st July 2020, were enrolled in the study. Severity of each dengue case was determined as per the recent WHO classification (2009) Clinical presentations of the cases were carefully assessed. In-hospital outcomes of the patients in terms of mortality, duration of hospital stay, need for ICU or other support were recorded. The COI questionnaire included three major cost components: direct medical costs (DMC), direct non-xiv medical costs (DNMC), and indirect costs (IC). Data analysis was done on the SPSS 23 version. Results: Out of 425 patients, the maximum number of dengue cases reported were males (76.9%) and belonging to the 21-30 years age group (38.8%). Fever was the main complaint in all the cases followed by headache (78%), myalgia (56%), persistent vomiting (44%). Of the 91.5% Dengue fever cases, 88.2% were classified as Dengue fever without warning signs and 3.3% with warning signs and 8.5% as severe dengue. Thrombocytopenia was present in 53.9% and leukopenia in 42.1% of cases. 3.3% of patients needed ICU admission and the mortality rate was 1.2%. The median total COI was BDT 8703 (IQR: 6240-11795) with median DMC of 3580 (IQR: 2525-4885), DNMC of 2000 (IQR: 1250-3225) and INMC of 2400 (IQR: 1045-4000). Conclusions: Overwhelming number of cases and their varied clinical presentations lead to an increase in hospitalization in this outbreak. Though the outcomes have been mostly favorable, the cost incurred as a result has been immense and has impacted households greatly, since most medical costs in Bangladesh are out-of-pocket expenses.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Clinical Presentations, Outcome and Cost of Illness of Dengue in a Tertiary Care Hospital of Bangladesh: An Observational Study
    AU  - Nur Jahan Aktar
    AU  - Milton Barua
    AU  - Amanat Ullah
    AU  - Abdus Sattar
    AU  - Shoman Sarkar
    AU  - Sujat Paul
    AU  - Shofiur Rahman
    AU  - Mitan Chakma
    AU  - Mahmudul Islam Talukder
    AU  - Mahatabur Rahman
    AU  - Mohammad Faisal Kabir
    Y1  - 2021/08/09
    PY  - 2021
    N1  - https://doi.org/10.11648/j.cmr.20211004.16
    DO  - 10.11648/j.cmr.20211004.16
    T2  - Clinical Medicine Research
    JF  - Clinical Medicine Research
    JO  - Clinical Medicine Research
    SP  - 142
    EP  - 150
    PB  - Science Publishing Group
    SN  - 2326-9057
    UR  - https://doi.org/10.11648/j.cmr.20211004.16
    AB  - Background: Dengue is a fast-emerging viral disease in many parts of the world, having a potential to present with a varied spectrum of clinical manifestations with atypical presentations being more frequent. This study was conducted to evaluate the clinical features, outcome and Cost of Illness (COI) of dengue cases admitted in a tertiary-care government hospital in Chattogram, Bangladesh. Methods & materials: It was a hospital based prospective observational study and was carried out in the Department of Medicine, Chittagong Medical College Hospital. All the consecutive serologically positive (NS1 antigen, IgM, IgG antibodies) dengue cases (age >12 years) admitted in the Department of Medicine of Chittagong Medical College Hospital from 1st August 2019 to 31st July 2020, were enrolled in the study. Severity of each dengue case was determined as per the recent WHO classification (2009) Clinical presentations of the cases were carefully assessed. In-hospital outcomes of the patients in terms of mortality, duration of hospital stay, need for ICU or other support were recorded. The COI questionnaire included three major cost components: direct medical costs (DMC), direct non-xiv medical costs (DNMC), and indirect costs (IC). Data analysis was done on the SPSS 23 version. Results: Out of 425 patients, the maximum number of dengue cases reported were males (76.9%) and belonging to the 21-30 years age group (38.8%). Fever was the main complaint in all the cases followed by headache (78%), myalgia (56%), persistent vomiting (44%). Of the 91.5% Dengue fever cases, 88.2% were classified as Dengue fever without warning signs and 3.3% with warning signs and 8.5% as severe dengue. Thrombocytopenia was present in 53.9% and leukopenia in 42.1% of cases. 3.3% of patients needed ICU admission and the mortality rate was 1.2%. The median total COI was BDT 8703 (IQR: 6240-11795) with median DMC of 3580 (IQR: 2525-4885), DNMC of 2000 (IQR: 1250-3225) and INMC of 2400 (IQR: 1045-4000). Conclusions: Overwhelming number of cases and their varied clinical presentations lead to an increase in hospitalization in this outbreak. Though the outcomes have been mostly favorable, the cost incurred as a result has been immense and has impacted households greatly, since most medical costs in Bangladesh are out-of-pocket expenses.
    VL  - 10
    IS  - 4
    ER  - 

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Author Information
  • General Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, North Somerset, UK

  • Department of Medicine, Chittagong General Hospital, Chittagong, Bangladesh

  • Acute Medicine, Medway NHS Foundation Trust, Kent, UK

  • Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh

  • Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh

  • Department of Medicine, Chittagong Medical College Hospital, Chittagong, Bangladesh

  • Department of Cardiology, Chittagong General Hospital, Chittagong, Bangladesh

  • Department of Otolaryngology, Chittagong Medical College Hospital, Chittagong, Bangladesh

  • Department of Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh

  • Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

  • Department of Medicine, MH Samorita Hospital & Medical College, Dhaka, Bangladesh

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