title: Comparison and critical appraisal of dengue clinical guidelines and their use in Asia and Latin America.
abstract: The World Health Organization (WHO) dengue classification scheme for dengue fever (DF) and dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) has been adopted as the standard for diagnosis, clinical management and reporting. In recent years, difficulties in applying the WHO case classification have been reported in several countries. A multicenter study was carried out in Asia and Latin America to analyze the variation and utility of dengue clinical guidelines (DCGs) taking as reference the WHO/PAHO guidelines (1994) and the WHO/SEARO guidelines (1998). A document analysis of 13 dengue guidelines was followed by a questionnaire and Focus Group discussions (FGDs) with 858 health care providers in seven countries. Differences in DCGs of the 13 countries were identified including the concept of warning signs, case classification, use of treatment algorithms and grading into levels of severity. The questionnaires and FGDs revealed (1) inaccessibility of DCGs, (2) lack of training, (3) insufficient number of staff to correctly apply the DCGs at the frontline and (4) the unavailability of diagnostic tests. The differences of the DCGs and the inconsistency in their application suggest a need to re-evaluate and standardise DCGs. This applies especially to case classification and case management.
authors.affiliation: Department of Tropical Hygiene and Public Health, University Hospital Heidelberg, Germany, INF 324, 69120 Heidelberg, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Santamaria
authors.forename: E
authors.initials: E
authors.lastname: Martinez
authors.forename: S
authors.initials: S
authors.lastname: Kratochwill
authors.forename: C
authors.initials: C
authors.lastname: Soria
authors.forename: L H
authors.initials: LH
authors.lastname: Tan
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authors.initials: A
authors.lastname: Nuñez
authors.forename: E
authors.initials: E
authors.lastname: Dimaano
authors.forename: E
authors.initials: E
authors.lastname: Villegas
authors.forename: H
authors.initials: H
authors.lastname: Bendezú
authors.forename: A
authors.initials: A
authors.lastname: Kroeger
authors.forename: I
authors.initials: I
authors.lastname: Castelobranco
authors.forename: J B
authors.initials: JB
authors.lastname: Siqueira
authors.forename: T
authors.initials: T
authors.lastname: Jaenisch
authors.forename: O
authors.initials: O
authors.lastname: Horstick
authors.forename: L C S
authors.initials: LC
authors.lastname: Lum