E-Dengue System Insights: Exploring The Factors Influencing Dengue-Related Deaths in Urbanized State in Low-Middle Income Country (LMIC)

Abstract

Background Dengue has emerged as a rapidly escalating health issue in low- and middle-income countries, with its burden and geographic spread increasing over the years. Malaysia, in particular, has witnessed a significant rise in dengue cases, accompanied by a spike in mortality rates. Several studies have identified various factors, primarily focusing on the clinical aspects of severe dengue infection and the development of dengue-related fatalities. This research aims to go beyond clinical factors and explore different perspectives, including individual, healthcare and environmental factors related to dengue mortality, to enhance service quality and improve public health interventions and prevention strategies. Methods This is a 1:2 case-control study utilizing the E-dengue system database from 2015 to 2022. A total of 219 registered dengue cases were included, with 73 cases in the case group (all dengue fatalities) and 146 cases in the control group (randomly selected survivors). Multivariate regression models were conducted to identify predictors of dengue mortality. Results Multivariate analysis revealed several significant predictors of death: a platelet level less than 50,000/µL (OR 15.7; 95% CI: 5.65–43.53), having one comorbid condition (OR 3.1; 95% CI: 1.2-8.0), having more than two comorbid conditions (OR 11; 95% CI: 33), bronchial asthma (OR 12; 95% CI: 1.08-132.13), and outbreak locality status (OR 2.3; 95% CI: 1.11–4.79). Conclusion In conclusion, this prediction model can be used to identify, prioritize and improve clinical care of individuals at higher risk of death during dengue episodes as well as to implement particular surveillance and preventive measures. Beyond clinical factors, a new finding in this study is the significance of outbreak locality as a critical predictor of dengue mortality. Therefore, in addition to health screening and public awareness and medical preparedness, it is essential to implement targeted and enhanced monitoring and preventive measures in areas with frequent dengue outbreaks.