Health directorate fails to decrease dengue deaths

Dengue deaths have been occurring from the very outset of the year, way back in January. In mid-August, the deaths have reached close to 450. The health directorate is still unaware of the main causes behind the dengue deaths. The directorate's death review committee has only just commenced work.

Public health experts believe had there been a review, the deaths could have been decreased to an extent. The physicians would have gained new insights and changed their medical treatment accordingly. But this time the health directorate has not given due importance to the deaths. It is failing to curtail these dengue deaths.

Yesterday, Thursday, the health directorate's Health Emergency Operation Centre and Control Room reported 9 more dengue deaths. This has brought the number of dengue deaths this year to 444. Never before has there been such a high number of deaths due to dengue in one year. This time 84 children under the age of 18 have died for dengue. A total of 94,312 dengue patients have been admitted to hospital in the country so far this year.

According to the health directorate's disease control unit, the health directorate even last year had formed a death review committee. Last year 281 persons died of dengue. Experts reviewed over 200 of these deaths. But the results of the review were not published.

In 2019, over 100,000 persons had been afflicted with dengue. But the number of deaths had been relatively low. That year 164 patients had died. But that year the government's Institute of Epidemiology, Disease Control and Research (IEDCR) reviewed the dengue deaths and published the findings.

This year the health directorate formed the death review committee on 23 July. Additional Director General (planning and development) of the Directorate General Health Services (DGHS), Prof. Ahmedul Kabir, is the head of the 13 member committee. Member secretary of the committee Abul Kalam Azad only said that till now the committee had held two meetings, the last one taking place on Monday.   

After a patient dies of dengue in hospital, the hospital authorities fill out a form mentioning the cause of death, along with other details. It is stated that the cause of death is dengue haemorrhagic fever or dengue shock syndrome or expanded dengue syndrome. Two causes can be mentioned at the same time too.

No one has any information on the causes of most of the 444 deaths that have taken place so far this year. Only about a month ago, on behalf of the DGHS' disease control unit, was it said that 80 per cent of the patients died within three days of being admitted to hospital. Also, almost one and a half months ago the DGHS director general Khurshed Alam had said that this year there was a higher propensity of shock syndrome among the patients. But he did not offer any figures.

Talking to several exports and three members of the present death review committee, it was learnt that such reviews reveal how long after being diagnosed with dengue was the patient brought to hospital, how long after coming to hospital did the patient die, whether it was dengue haemorragic fever or dengue shock syndrome or expanded dengue syndrome, whether the patient had any other illnesses, which of the four types of dengue was the patient afflicted with, which age group was dying the most and so on.

An expert, on condition of anonymity, said that even a few years ago, the physicians of this country knew nothing about expanded dengue syndrome. After death reviews and from experiences of other countries, the matter came to light.

Speaking to Prothom Alo, public health expert Be-Nazir Ahmed said, we can benefit in two ways from the death review information. If we see that delayed admission to hospital is a reason of death, then we must make the people cautious and conscious of this. The government can run an extensive public campaign so that they rapidly get admitted to hospital instead of taking any risk. If the review reveals any problems in treatment, then the physicians must be duly apprised of that and update their treatment accordingly. He said if both of these are carried out, then deaths would have decreased. But they didn't attach any importance to this.

DGHS sources say there is delay in the files with the details of the dead persons being sent from the hospitals to the health directorate. Till yesterday, 95 dead persons' details were submitted to the directorate. Another 100 or so files needs to be reviewed. Some of the files do not have complete information. Alongside reviewing the files, the reviewers will also speak to the families of the patients. This will take time. It is uncertain when this task will be completed.

Member of the review committee and IEDCR's former director Professor Meerzadi Sabrina told Prothom Alo, if a death review committee is formed in every hospital, the task may be easier and quick results may be obtained. If there are committees in the hospitals, they will be able to review the cause of death immediately. And if the concerned hospital has any problem, that too can be identified. The directorate's committee will coordinate the work of the various hospitals and provide guidelines.

Towards the start of the year, entomologists predicted that there was a risk of dengue increasing this year. Despite being aware of this, the local government ministry took no measures to control the carrier of dengue, Aedes mosquitoes. Now dengue patients are being admitted to hospitals in all 64 districts of the country. So far there are more patients outside of Dhaka and within Dhaka. Outside Dhaka there have been 108 dengue deaths. Despite knowing about the deaths, the health directorate did not take timely measures to address the situation.

Bangladesh Medical Association (BMA) secretary general Ihteshamul Huq Chowdhury, speaking to Prothom Alo, said, "I feel the officials of the directorate are not attaching due importance to the matter. Had they given importance to the issue, the situation would not have reached such a state."