Clinical presentations associated with adverse outcomes among patients admitted with dengue at a tertiary hospital in Dar es salaam.
Date of Award
Master of Medicine (MMed)
Dr. Riaz Ratansi
Dr. Kamran Hameed
Dr. Muzdalfat Abeid
Medical College (East Africa)
Introduction Dengue is one of the most important mosquito viral borne infections caused by four viral serotypes (DENV 1-4). In 2019 WHO named dengue as among the top ten global threats due to an increase in the number of cases worldwide. Tanzania is among the countries in Africa with multiple outbreaks; 2010, 2013-2014, and 2019. Dengue has variable clinical presentations ranging from nonspecific such as fever, joint pain, and fatigue to more serious such as hemorrhage and shock. Dengue can result in adverse outcomes such as ICU admissions and prolonged hospital stays. Clinical presentations associated with adverse outcomes have been shown to differ with epidemiological settings, and this study aimed to determine these clinical presentations in our setting.
Methods A retrospective cross-sectional study was conducted using secondary data from 2014 to 2020 at the Aga Khan Hospital, Dar es Salaam. All laboratory confirmed dengue NS1, IgM and/or IgG positive from patients aged ≥18 years were included. Data were analyzed using SPSS version 25. Chi-square was performed for comparison between those with and without adverse outcomes. Univariate logistic regression was performed and all variables with p-value < 0.25 were entered into multiple logistic regression.
Results A total of 429 laboratory confirmed dengue cases with a median age of 37(IQR 30-45) were analyzed. The most common symptoms were fever (96.3%), fatigue (92.8%), headache (89.0%), myalgia and arthralgia (73.2%), and nausea and vomiting (58.5%). Having both hypertension and diabetes mellitus OR (5.97), and thrombocytopenia < 150,000 platelets /mm 3 (OR 1.88), were independently vi associated with adverse outcomes. About half of the participants (49.8%) had adverse outcomes. The prevalence of expanded dengue syndrome was 0.033 (95% CI 0.018-0.054).
Conclusion The results point out a high proportion of patients with adverse outcomes. With early identification of these factors, time and resources can be allocated to high-risk patients especially during dengue outbreaks.
Mkasa, Nakiganda John (2021). Clinical presentations associated with adverse outcomes among patients admitted with dengue at a tertiary hospital in Dar es salaam (Unpublished Masters Thesis). Dar es salaam: Aga Khan University