Nursing perspectives on factors contributing to Dengue mortality in two public hospitals in Malaysia

The rising frequency and geographic spread of dengue have greatly affected global healthcare services and resources. This study aimed to identify the factors linked to dengue-related mortality in two public hospitals in Malaysia from a nursing perspective. A retrospective study was conducted for all dengue mortality cases in two public hospitals in Malaysia between 1st January 2013 and December 2015. Associations between sociodemographic and dengue characteristics and outcomes were analysed using the Statistical Package for Social Science version 20.0 (SPSS). Descriptive statistics were performed for the quantitative data to characterise the study population and the frequency of dengue fever in both hospitals. A total of 37 dengue mortalities were reviewed. There are 4358 dengue cases in these two public hospitals from 2013 to 2015. In most of the mortality cases aged more than 41 years, 54.05% were female, and the mean duration of illness before hospitalisation was 7.4 days. Eighteen (48.7%) cases of dengue mortality occurred in 2015, 12 (32.4%) in 2014, and 7(18.9%) in 2013. About 50% were admitted to the intensive care unit (ICU). This study discovered the factors contributing to dengue mortality are residing in an endemic area (78.4%), having co-morbidities (48.6%), travelling to endemic areas (8.1%), and working or living in construction zones (2.7%) and staying proximity to urban areas, which have substantial construction activities. Clinical manifestations were myalgia (83.8%), arthralgia (81.1%), headache (75.7%), persistent vomiting and fever (73.0%), dehydration (73.0%) and restlessness/lethargy (54.1%). Other clinical manifestations of patients with dengue mortality are abdominal pain/tenderness (29.7%), mucosal bleeding (18.9%), liver tenderness/enlargement (18.9%), body rashes (13.5%), pleural effusion/ascites (8.1%) and other lethargic symptoms. Patients who had co-morbid, including diabetes and hypertension, may have contributed to the rapid clinical deterioration of severe dengue. Approximately 59.5% documented the cause of death as severe dengue, and 37.8% stated multi-organ failure. Most patients had low platelet counts (91.9%) and low lymphocytes (83.8%). Additionally, a high percentage (94.6%) had low neutrophils. Most patients documented abnormal vital signs before admission. Nursing interventions implemented include reducing hyperthermia (64.3%), monitoring fluid volume deficit (42.9%) and managing hypovolemic shock related to excessive bleeding (46.4%). Nurses were found to lack knowledge in selecting the appropriate nursing interventions based on the severity of the patient's condition. Identifying risk factors associated with increased hospitalisation and mortality due to dengue infection can help categorise patients who require close monitoring. Early identification of warning signs and patients at increased risk is the key to decreasing dengue mortality.

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