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Year : 2021  |  Volume : 10  |  Issue : 5  |  Page : 1998-2005

Social, health system and clinical determinants of fever mortality during an outbreak of dengue fever in Kerala, India

1 Departments of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
2 Department of Community Medicine, SUT Academy of Medical Sciences, Vattapara, Thiruvananthapuram, Kerala, India
3 Departments of Infectious Diseases, Government Medical College, Thiruvananthapuram, Kerala, India
4 Department of Health Services, Kerala, India
5 Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala; State Prevention of Epidemics and Infectious Diseases Cell Co-Ordinator, India

Correspondence Address:
Dr. Chintha Sujatha
Department of Community Medicine, Government Medical College, Thiruvananthapuram - 695 011, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jfmpc.jfmpc_2434_20

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Background and Objectives: The morbidity and mortality spectrum of the south Indian state of Kerala is dominated by chronic non-communicable diseases, yet febrile illnesses because of neglected tropical diseases and emerging viral infections are often reported. As fever deaths are mostly avoidable, understanding the determinants of mortality is essential for implementing preventive measures. Methods: A case-control study was done during an ongoing dengue outbreak in Thiruvananthapuram district, Kerala during 2017–18. Cases included all fever deaths from the line list of Integrated Disease Surveillance Program (IDSP). Data were obtained from hospital case records and by interviewing patients or care givers. The theoretical model for determinants of mortality was constructed at three levels namely sociodemographic factors, access to health care and health seeking behavior, and clinical determinants. Results: This study confirmed association of mortality with age above 40 years (P = 0.010, OR = 3.48), being heavy built (P = 0.029, OR = 13.25), clinical symptoms of breathlessness (P < 0.001, OR = 24.89), restlessness (P < 0.001, OR = 97.26), clinical signs of drowsiness (P = 0.024, OR = 7.97), hypotension (P < 0.001, OR = 42.22), complications such as ARDS (P = 0.047, OR = 171.56), and myocarditis (P = 0.012, OR = 16.59). A low occupation status of semiskilled work or less (P = 0.012, OR = 0.30), choosing a nearby hospital for treatment (P = 0.018, OR = 0.48) and shortening the time gap between onset of symptom and final diagnosis (P = 0.044, OR = 0.72) was found to be protective. Conclusion: Along with biological and clinical factors, distal determinants like social factors, health seeking behavior, and health system factors are associated with fever mortality.

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