title: Slow improvement of clinically-diagnosed dengue haemorrhagic fever case fatality rates.
abstract: Dengue haemorrhagic fever (DHF) is recognized as a leading cause of hospitalization and death among children in many Southeast Asian countries. This study reviews the case fatality rates of DHF cases admitted to a referral hospital in Cebu (Philippines) over the past 5 years. Information on patients 14 years old or younger admitted from 1 January 1997 to 31 December 2001 with the final clinical diagnosis of DHF was collated and analysed. Case fatality rates were compared before and after a standardized management protocol was implemented by the healthcare staff and after introduction of revisions to that protocol. The case fatality rate during the 2-year periods prior and after introduction of the management protocol decreased significantly from 197/2644 (7.45%) to 39/1182 (3.30%) (P < 0.01). Following the introduction of revisions to the protocol, the case fatality was reduced even further to 52/1697 (3.06%) (P = 0.7). In this government hospital the introduction of a standardized management protocol for DHF was associated with a significant improvement in the case fatality rate of hospitalized children with clinically diagnosed DHF. However, compared with reports from hospitals in other dengue-endemic countries, the improvement has been slow. Possible ways to decrease fatality rates further have been identified.
authors.affiliation: Department of Pediatrics, Southern Islands Medical Center, Cebu City, Philippines.
authors.forename: Nelma S
authors.initials: NS
authors.lastname: Magpusao
authors.forename: Alan
authors.initials: A
authors.lastname: Monteclar
authors.forename: Jacqueline L
authors.initials: JL
authors.lastname: Deen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D010679:Philippines / Q000453:epidemiology; D012621:Seasons; D019595:Severe Dengue / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy