Factors Associated with the Time of Admission among Notified Dengue Fever Cases in Region VIII Philippines from 2008 to 2014

Abstract

In cases of Dengue fever, late hospital admission can lead to treatment delay and even death. In order to improve early disease notification and management, it is essential to investigate the factors affecting the time of admission of Dengue cases. This study determined the factors associated with the time of admission among notified Dengue cases. The study covered the period between 2008 and 2014 in Region VIII, Philippines. The factors assessed were age, sex, hospital sector, hospital level, disease severity based on the 1997 WHO Dengue classification, and period of admission (distinguishing between the 2010 Dengue epidemic and non-epidemic time). We analysed secondary data from the surveillance of notified Dengue cases. We calculated the association through chi-square test, ordinal logistic regression and linear regression at p value < 0.05. The study included 16,357 admitted Dengue cases. The reported cases included a majority of children (70.09%), mild cases of the disease (64.00%), patients from the public sector (69.82%), and non-tertiary hospitals (62.76%). Only 1.40% of cases had a laboratory confirmation. The epidemic period in 2010 comprised 48.68% of all the admitted cases during this period. Late admission was more likely among adults than children (p<0.05). The severe type of the disease was more likely to be admitted late than the mild type (p<0.05). Late admission was also more likely in public hospitals than in private hospitals (p<0.05); and within tertiary level hospitals than non-tertiary hospitals (p<0.05). Late admission was more likely during the non-epidemic period than the 2010 epidemic period (p<0.05). A case fatality rate of 1 or greater was significantly associated with children, severe diseases, tertiary hospitals and public hospitals when admitted late (p<0.05). Data suggests that early admission among child cases was common in Region VIII. This behavior is encouraging, and should be continued. However, further study is needed on the late admission among tertiary, public hospitals and non-epidemic period with reference to the quality of care, patient volume, out of pocket expense, and accessibility We recommend the consistent use of the 2009 WHO Dengue guidelines in order to standardize the admission criteria and time across hospitals.

Impact of Reactive Dengue NS1 Antigen with Time for Hospital Admission in Dengue Viral Infection Patient

“…This can emphasizes practice of early admission among children patient. [11] There are earlier study that showed Free NS1 levels in plasma correlated with viremia levels and were higher in patients with DHF than in those with DF. An elevated free NS1 level (≥600 ng/mL) within 72 hours of illness onset identified patients at risk for developing DHF, Immune complex formation with secreted (sNS1) and sNS1 binding to endothelial cells have been proposed as potential factors in DHF pathogenesis.…”

“…This phenomenon especially occurs in regions with a high incidence of DHF cases. [11] Other study in Southeast Asia found that cases of dengue adults showed mild signs and symptoms. [12] In contrast, a majority of the severe cases occur in children aged 2-15 years.…”

“…The dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS) were grouped together, and defined as a severe case. [11] Laboratory diagnosis divided into confirmed cases using NS 1 antigen dengue rapid test and probable cases using IgM antibody dengue rapid test. The variable of number of days between the onset of illness and the time of admission was categorized into early (0-2 days), regular (3-5 days), and late (6 or more days) admission.…”

“…The variable of number of days between the onset of illness and the time of admission was categorized into early (0-2 days), regular (3-5 days), and late (6 or more days) admission. [11] These categories were arbitrarily derived from clinical phase and period of dengue: febrile, critical and recovery.…”

Primary Dengue Infection in Patients Requiring Hospitalization During an Outbreak in a Low Incidence Mexican Region

“…Because many clinically severe cases did not qualify as DHF, new guidelines were issued in 2009, now grouping cases into dengue without warning signs, dengue with warning signs (DWWS), and severe dengue (SD) that includes DSS (WHO 2009a). The advantages of the new classification have been discussed (Abello et al 2016, da Silva et al 2018; however, the 1997 classification remains in use among some clinicians and in literature.…”