Ampicillin and Gentamicin Are a Useful First-line Combination for the Management of Sepsis in Under-five Children at an Urban Hospital in Bangladesh

The study evaluated the commonly-used drugs for the management of sepsis and their outcome among under-five children. We evaluated the hospital-records of all paediatric sepsis patients (n= 183) in the intensive care unit (ICU) and longer-stay unit (LSU) of the Dhaka Hospital of icddr,b. These records were collected from the hospital management system (SHEBA) during November 2009 to October 2010. A total of 183 under-five children with clinical sepsis were found during the study period, and 14 (8%) of them were neonates. One hundred and eighty-one patients had received a combination of injection ampicilin and injection gentamicin, and two patients had received the combination of injection ceftriaxone and injection gentamicin. Only 46 (25%) patients required a change of antibiotics to the combination of intravenous ceftriaxone plus gentamicin after non-response of injection ampicilin and injection gentamicin combination; 7/181 (4%) patients died who received injection ampicilin and injection gentamicin whereas none died among the other two patients who received injection ceftriaxone and injection gentamicin (p=1.00). The combination of injection ampicilin and injection gentamicin as the first-line antibiotics for the management of sepsis in children even beyond the neonatal age is very effective, resulting in lower mortality.Key words: Antibiotics, Children, Diarrhoea, Infant, Sepsis, Bangladesh     

Association between Predictors of Vitamin D Serum Levels and Risk of Retinoblastoma in Children: A Case-Control Study

Background: vitamin D (VD) may be a protective factor for retinoblastoma, though no temporal association has been reported during pregnancy or the child’s first year of life. Serum VD concentrations are determined by both distal (DF) and proximal factors (PF). Objective: To identify if DF and PF can predict VD insufficiency (VDI) and VD deficiency (VDD) in women of childbearing age; and to test whether maternal exposure to DF and PF during pregnancy and a child’s exposure during the first 11.9 months postpartum are associated with sporadic retinoblastoma (SRb) in children. Methods: This is a secondary analysis of data from the Epidemiology of SRb in Mexico (EpiRbMx) study and the National Health and Nutrition Survey 2018–2019 (ENSANUT 2018–2019, for its acronym in Spanish). The association of DF and PF with VDD or VDI was estimated using ENSANUT 2018–2019, and the association of DF and PF with SRb using EpiRbMx. All were estimated using logistic regression, with comparable samples selected from ENSANUT 2018–2019 and EpiRbMx. Results: Altitude, latitude and obesity predicted VDI and VDD in ENSANUT women. In EpiRbMx, residence in a rural location during pregnancy increased the risk of SRb. For children, rural residence and latitude increased the risk of SRb, while the number of days exposed to the spring–summer season during months 6 to 11.9 of life was protective. Conclusions: risk of VDI and VDD in women (ENSANUT 2018–2019) increased with altitude, urban dwelling, overweight and obesity. The child and mother’s place of residence, including altitude, latitude and rural classification were important predictors of SRb in EpiRbMx.     

Risk Factors of Rheumatic Heart Disease in Bangladesh: A Case-Control Study

Not all cases of rheumatic fever (RF) end up as rheumatic heart disease (RHD). The fact raises the possibility of existence of a subgroup with characteristics that prevent RF patients from developing the RHD. The present study aimed at exploring the risk factors among patients with RHD. The study assessed the risk of RHD among people both with and without RF. In total, 103 consecutive RHD patients were recruited as cases who reported to the National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh. Of 309 controls, 103 were RF patients selected from the same centre, and the remaining 206 controls were selected from Shaheed Suhrawardy Medical College Hospital, who got admitted for other non-cardiac ailments. RHD was confirmed by auscultation and colour Doppler echocardiography. RF was diagnosed based on the modified Jones criteria. An unadjusted odds ratio was generated for each variable, with 95% confidence interval (CI), and only significant factors were considered candidate for multivariate analysis. Three separate binary logistic regression models were generated to assess the risk factors of RF, risk factors of RHD compared to non-rheumatic control patients, and risk factors of RHD compared to control with RF. RF and RHD shared almost a similar set of risk factors in the population. In general, age over 19 years was found to be protective of RF; however, age of the majority (62.1%) of the RHD cases was over 19 years. Women [odds ratio (OR)=2.2, 95% CI 1.1-4.3], urban resident (OR=3.1, 95% CI 1.2–8.4), dwellers in brick-built house (OR=3.6, 95% CI 1.6-8.1), having >2 siblings (OR=3.1, 95% CI 1.5- 6.3), offspring of working mothers (OR=7.6, 95% CI 2.0-24.2), illiterate mother (OR=2.6, 95% CI 1.2-5.8), and those who did not brush after taking meals (OR=2.5, 95% CI 1.0-6.3) were more likely to develop RF. However, more than 5 members in a family showed a reduced risk of RF. RHD shared almost a similar set of factors in general. More than three people sharing a room also showed an increased risk of RHD (OR=1.9, 95% CI 1.0-3.4), in addition to the risk factors of RF. Multivariate model also assessed the factors that may perpetuate RHD among RF patients. Overcrowding (OR=2.4, 95% CI 1.2-4.7) and illiteracy (OR=2.4, 95% CI 1.1-5.2) posed the risk of RHD in the RF patients. The study did not find new factors that might pose an increased risk, rather looked for the documented risk factors and how these operate in the population of Bangladesh.Key words: Case-control study, Rheumatic fever, Rheumatic heart disease, Risk factors, Bangladesh     

Intravenous Lipid Emulsions Affect Respiratory Outcome in Preterm Newborn: A Case-Control Study

(1) Background: Hypertriglyceridemia (HiTG) is a metabolic complication of intravenous lipid emulsions (ILEs) infusion. We aimed to evaluate the influence of HiTG on the respiratory outcome of preterm babies; (2) Methods: We enrolled, in a case–control study, newborns with gestational age <32 weeks or birth weight <1500 g, over a 3-year period. They were divided into cases and controls; cases were defined by the detection of HiTG defined as serum triglycerides (TG) value >150 mg/dL; (3) Results: We enrolled 40 cases and 105 controls. Cases had an increased incidence of bronchopulmonary dysplasia (30.0% vs. 14.3%, p < 0.05) and longer duration of invasive mechanical ventilation (7 days, 95% CI 4–10 days vs. 4 days, 95% CI 1–7 days, p < 0.01) compared to controls. Multivariate analysis confirmed that HiTG independently influenced the duration of invasive mechanical ventilation, also in the subgroups with gestational age ≤28 + 6/7 weeks or birth weight ≤1000 g; (4) Conclusion: Newborns with HiTG related to ILEs had a longer duration of invasive mechanical ventilation. Temporary suspension or reduction in ILEs in the case of HiTG is associated with an improvement of respiratory outcome.     

Predictors of Rehospitalization Among Elderly Patients Admitted to a Rehabilitation Hospital: The Role of Polypharmacy,Functional Status,and Length of Stay

Objectives

Rehospitalizations for elderly patients are an increasing health care burden. Nonetheless, we have limited information on unplanned rehospitalizations and the related risk factors in elderly patients admitted to in-hospital rehabilitation facilities after an acute hospitalization.

Setting

In-hospital rehabilitation and aged care unit.

Design

Retrospective cohort study.

Participants

Elderly patients 65 years or older admitted to an in-hospital rehabilitation hospital after an acute hospitalization between January 2004 and June 2011.

Measurements

The rate of 30-day unplanned rehospitalization to hospitals was recorded. Risk factors for unplanned rehospitalization were evaluated at rehabilitation admission: age, comorbidity, serum albumin, number of drugs, decline in functional status, delirium, Mini Mental State Examination score, and length of stay in the acute hospital. A multivariable Cox proportional regression model was used to identify the effect of these risk factors for time to event within the 30-day follow-up.

Results

Among 2735 patients, with a median age of 80 years (interquartile range 74–85), 98 (4%) were rehospitalized within 30 days. Independent predictors of 30-day unplanned rehospitalization were the use of 7 or more drugs (hazard ratio [HR], 3.94; 95% confidence interval, 1.62–9.54; P = .002) and a significant decline in functional status (56 points or more at the Barthel Index) compared with the month before hospital admission (HR 2.67, 95% CI: 1.35–5.27; P = .005). Additionally, a length of stay in the acute hospital of 13 days or more carried a twofold higher risk of rehospitalization (HR 2.67, 95% CI: 1.39–5.10); P = .003).

Conclusions

The rate of unplanned rehospitalization was low in this study. Polypharmacy, a significant worsening of functional status compared with the month before acute hospital admission, and hospital length of stay are important risk factors.     

Congenital Anomalies in Neonates Admitted to a Tertiary Hospital in Southwest Ethiopia: A Cross Sectional Study

BackgroundCongenital anomalies affect 2–3% of all live births. Anomalies of the central nervous system account for the highest incidence followed by that of the cardiovascular and renal systems. There is scarcity of data in developing countries like Ethiopia. The aim of the study was determining the magnitude and type of congenital anomalies and associated factors in neonates admitted to the neonatology ward of Jimma Medical Center, Southwest Ethiopia.MethodsInstitution based cross sectional study was done from March 1 to July 30, 2020. A total of 422 mother-infant pairs were enrolled into the study. Structured questionnaires were used to capture the socio-demographic, obstetric and medical characteristics of the mothers, demographic characteristics of the infants and type of congenital anomalies. Univariate and multivariate logistic regression analyses were done and results are presented as narratives and using figures and tables.ResultsCloser to one in five neonates admitted to the neonatology ward (78, 18.5%, 95%CI 14.7–22.3) had congenital anomalies; the majority (59, 13.98%) having only one type of anomaly. Anomalies of the nervous system (29, 6.87%) and gastrointestinal system (24, 5.68%) accounted for the majority of the cases. Inadequate antenatal care follow-up (p=0.018, AOR=1.9, 95%CI1.115, 3.257) and lack of folate supplementation during pregnancy (p=0.027, AOR=2.35, 95%CI 1.101, 5.015) were associated with congenital anomalies in the neonates.ConclusionCongenital anomalies account for significant number of admissions. Significant association was seen between neonatal congenital anomalies and poor antenatal attendance and lack of folic acid supplementation during pregnancy.     

Potential Barriers to Healthcare in Malawi for Under-five Children with Cough and Fever: A National Household Survey

Failure to access healthcare is an important contributor to child mortality in many developing countries. In a national household survey in Malawi, we explored demographic and socioeconomic barriers to healthcare for childhood illnesses and assessed the direct and indirect costs of seeking care. Using a cluster-sample design, we selected 2,697 households and interviewed 1,669 caretakers. The main reason for households not being surveyed was the absence of a primary caretaker in the household. Among 2,077 children aged less than five years, 504 episodes of cough and fever during the previous two weeks were reported. A trained healthcare provider was visited for 48.0% of illness episodes. A multivariate regression model showed that children from the poorest households (p=0.02) and children aged >12 months (p=0.02) were less likely to seek care when ill compared to those living in wealthier households and children of higher age-group respectively. Families from rural households spent more time travelling compared to urban households (68.9 vs 14.1 minutes; p<0.001). In addition, visiting a trained healthcare provider was associated with longer travel time (p<0.001) and higher direct costs (p<0.001) compared to visiting an untrained provider. Thus, several barriers to accessing healthcare in Malawi for childhood illnesses exist. Continued efforts to reduce these barriers are needed to narrow the gap in the health and healthcare equity in Malawi.Key words: Healthcare surveys, Health expenditure, Health services accessibility, Malaria, Pneumonia, Malawi     

Factors Associated with Extended Length of Stay for Patients Presenting to an Urban Psychiatric Emergency Service: A Case-Control Study

This study assessed factors associated with extended length of stay (ELOS) for patients presenting to a psychiatric emergency service (PES). Two hundred six subjects with a length of stay of 24 h or longer were compared with time-matched controls (patients that presented directly after the ELOS patient). Binary logistic regression was used to identify risk factors for ELOS. ELOS was associated with suicidal ideation, disposition to an inpatient unit, homicidal ideation, lack of insurance, homelessness, male gender, past history of psychiatric hospitalization, diagnosis of substance abuse, significant psychiatric co-morbidity (represented by three or more Axis I diagnoses), and diagnosis of a psychotic disorder. Lack of insurance, suicidal ideation, disposition to inpatient unit, and homicidal ideation all made nonredundant contributions to predicting stays of 24 h or longer.     

Prevalence and Predictors of Vitamin D Deficiency and Insufficiency among Pregnant Rural Women in Bangladesh

Although adequate vitamin D status during pregnancy is essential for maternal health and to prevent adverse pregnancy outcomes, limited data exist on vitamin D status and associated risk factors in pregnant rural Bangladeshi women. This study determined the prevalence of vitamin D deficiency and insufficiency, and identified associated risk factors, among these women. A total of 515 pregnant women from rural Bangladesh, gestational age ≤ 20 weeks, participated in this cross-sectional study. A separate logistic regression analysis was applied to determine the risk factors of vitamin D deficiency and insufficiency. Overall, 17.3% of the pregnant women had vitamin D deficiency [serum 25(OH)D concentration <30.0 nmol/L], and 47.2% had vitamin D insufficiency [serum 25(OH)D concentration between 30–<50 nmol/L]. The risk of vitamin D insufficiency was significantly higher among nulliparous pregnant women (OR: 2.72; 95% CI: 1.75–4.23), those in their first trimester (OR: 2.68; 95% CI: 1.39–5.19), anaemic women (OR: 1.53; 95% CI: 0.99–2.35; p = 0.056) and women whose husbands are farmers (OR: 2.06; 95% CI: 1.22–3.50). The risk of vitamin deficiency was significantly higher among younger pregnant women (<25 years; OR: 2.12; 95% CI: 1.06–4.21), nulliparous women (OR: 2.65; 95% CI: 1.34–5.25), women in their first trimester (OR: 2.55; 95% CI: 1.12–5.79) and those with sub-optimal vitamin A status (OR: 2.30; 95% CI: 1.28–4.11). In conclusion, hypovitaminosis D is highly prevalent among pregnant rural Bangladeshi women. Parity and gestational age are the common risk factors of vitamin D deficiency and insufficiency. A husband’s occupation and anaemia status might be important predictors of vitamin D insufficiency, while younger age and sub-optimal vitamin A status are risk factors for vitamin D deficiency in this population.     

Prevalence of and Risk Factors for Lead Poisoning in Young Children in Bangladesh

Lead poisoning is a major public-health problem in Bangladesh. A cross-sectional study was conducted to determine the extent of and risk factors for elevated blood lead levels (BLLs) in children in Bangladesh during September 2007–July 2009. The study included 919 children aged less than 16 years. The children were recruited from six urban locations in Dhaka and one rural area in Chirirbandar, Dinajpur. In total, 495 (54%) children had high BLLs (>10 µg/dL), with higher BLLs observed among children aged 5-9 years compared to children of other ages (p<0.001). The BLLs among children in urban Dhaka were significantly higher than those in rural areas (13.45±8.21 µg/dL vs 7.29±6.25 µg/dL, p<0.001). The high BLLs correlated with low body mass index (r=-0.23, p<0.001) and low haemoglobin status (r=-0.10, p=0.02). On bivariate analysis, proximity to industry (p<0.001), drinking-water from municipal supply or tubewell (p<0.001), brass or lead water-taps (p<0.001), use of melamine plate (p=0.001), and indigenous medicinal (kabiraji) treatments (p=0.004) significantly correlated with higher BLLs. Proximity to industry and the use of indigenous medicines remained significant predictors of high BLLs after controlling for the confounders. Several risk factors appropriate for future educational interventions to prevent exposure to lead poisoning were identified.Key words: Child, Cross-sectional studies, Lead poisoning, Risk factors, Bangladesh     

Food Protein-Induced Enterocolitis Syndrome in Children with Down Syndrome: A Pilot Case-Control Study

Food protein-induced enterocolitis syndrome (FPIES) is a non-immunoglobin E-mediated food hypersensitivity disorder. However, little is known about the clinical features of FPIES in patients with Down syndrome (DS). Medical records of children with DS diagnosed at our hospital between 2000 and 2019 were retrospectively reviewed. Among the 43 children with DS, five (11.6%) were diagnosed with FPIES; all cases were severe. In the FPIES group, the median age at onset and tolerance was 84 days and 37.5 months, respectively. Causative foods were cow’s milk formula and wheat. The surgical history of colostomy was significantly higher in the FPIES group than in the non-FPIES group. A colostomy was performed in two children in the FPIES group, both of whom had the most severe symptoms of FPIES, including severe dehydration and metabolic acidosis. The surgical history of colostomy and postoperative nutrition of formula milk feeding may have led to the onset of FPIES. Therefore, an amino acid-based formula should be considered for children who undergo gastrointestinal surgeries, especially colostomy in neonates or early infants. When an acute gastrointestinal disease is suspected in children with DS, FPIES should be considered. This may prevent unnecessary tests and invasive treatments.     

Dietary Patterns and Attention Deficit Hyperactivity Disorder Among Iranian Children: A Case-Control Study

Objective: Associations between nutritional/dietary factors and mental disorders have been suggested. This study was conducted to assess the relation of major dietary patterns determined by factor analysis with attention-deficit/hyperactivity disorder (ADHD) in a group of Iranian preschool- and school-aged children.

Methods: This case-control study was conducted with 500 preschool- and school-aged children (4–12?years old) matched by age and sex, in Isfahan, Iran. Dietary intake was identified by a 168-item questionnaire, and major dietary patterns were identified by factor analysis. The multivariable logistic regression is used for the association of dietary patterns with the diagnosis of ADHD. ADHD diagnosis was carried out with the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Results: Two major dietary patterns were identified: healthy and Western. The healthy dietary pattern was rich in fruits, vegetables, vegetable oils, whole grains, legumes, and dairy products. The Western pattern was rich in processed meat, red meat, pizza, eggs, snacks, animal fat, hydrogenated fat, and salt. After controlling for potential confounders, children in the top quintile of the Western dietary pattern score had greater odds having ADHD, compared with those in the lowest quintile (odds ratio [OR]?=?3.45; 95% confidence interval [CI], 1.17–18.3; p_trend?=?0.03). The healthy pattern was inversely associated with ADHD (OR = 0.46; 95% CI, 0.38–0.91; p_trend?=?0.01).

Conclusions: A significant independent association was found between the Western dietary pattern and the odds of ADHD. The healthy dietary pattern was associated with lower odds of having ADHD. Prospective studies are needed to confirm these findings.     

Clinical Profile of Neonates Admitted with Sepsis to Neonatal Intensive Care Unit of Jimma Medical Center,A Tertiary Hospital in Ethiopia

BackgroundGlobally, over 3 million newborn die each year, one million of these attributed to infections. The objective of this study was to determine the etiologies and clinical characteristics of sepsis in neonates admitted to intensive care unit of a tertiary hospital in Ethiopia.MethodsA longitudinal hospital based cohort study was conducted from April 1 to October 31, 2018 at the neonatal intensive care unit of Jimma Medical Center, southwest Ethiopia. Diagnosis of sepsis was established using the World Health Organization''s case definition. Structured questionnaires and case specific recording formats were used to capture the relevant data. Venous blood and cerebrospinal fluid from neonates suspected to have sepsis were collected.ResultsOut of 304 neonates enrolled in the study, 195 (64.1%) had clinical evidence for sepsis, majority (84.1%; 164/195) of them having early onset neonatal sepsis. The three most frequent presenting signs and symptoms were fast breathing (64.6%; 122/195), fever (48.1%; 91/195) and altered feeding (39.0%; 76/195). Etiologic agents were detected from the blood culture of 61.2% (115/195) neonates. Bacterial pathogens contributed for 94.8% (109/115); the rest being fungal etiologies. Coagulase negative staphylococci (25.7%; 28/109), Staphylococcus aureus (22.1%; 24/109) and Klebsiella species (16.5%; 18/109) were the most commonly isolated bacteria.ConclusionMajority of the neonates had early onset neonatal sepsis. The major etiologies isolated in our study markedly deviate from the usual organisms causing neonatal sepsis. Multicentre study and continuous surveillance are essential to tackle the current challenge to reduce neonatal mortality due to sepsis in Ethiopia.     

Immunization Status of Children Admitted to a Tertiary-care Hospital of North India: Reasons for Partial Immunization or Non-immunization

Reasons for the low coverage of immunization vary from logistic ones to those dependent on human behaviour. The study was planned to find out: (a) the immunization status of children admitted to a paediatric ward of tertiary-care hospital in Delhi, India and (b) reasons for partial immunization and non-immunization. Parents of 325 consecutively-admitted children aged 12–60 months were interviewed using a semi-structured questionnaire. A child who had missed any of the vaccines given under the national immunization programme till one year of age was classified as partially-immunized while those who had not received any vaccine up to 12 months of age or received only pulse polio vaccine were classified as non-immunized. Reasons for partial/non-immunization were recorded using open-ended questions. Of the 325 children (148 males, 177 females), 58 (17.84%) were completely immunized, 156 (48%) were partially immunized, and 111 (34.15%) were non-immunized. Mothers were the primary respondents in 84% of the cases. The immunization card was available with 31.3% of the patients. All 214 partially- or completely-immunized children received BCG, 207 received OPV/DPT1, 182 received OPV/DPT2, 180 received OPV/DPT3, and 115 received measles vaccines. Most (96%) received pulse polio immunization, including 98 of the 111 non-immunized children. The immunization status varied significantly (p<0.05) with sex, education of parents, urban/rural background, route and place of delivery. On logistic regression, place of delivery [odds ratio (OR): 2.3, 95% confidence interval (CI) 1.3–4.1], maternal education (OR=6.94, 95% CI 3.1–15.1), and religion (OR=1.75, 95% CI 1.2–3.1) were significant (p<0.05). The most common reasons for partial or non-immunization were: inadequate knowledge about immunization or subsequent dose (n=140, 52.4%); belief that vaccine has side-effects (n=77, 28.8%); lack of faith in immunization (n=58, 21.7%); or oral polio vaccine is the only vaccine required (n=56, 20.9%. Most (82.5%) children admitted to a tertiary-care hospital were partially immunized or non-immunized. The immunization status needs to be improved by education, increasing awareness, and counselling of parents and caregivers regarding immunizations and associated misconceptions as observed in the study.Key words: Child, Immunization, Vaccination, India     

Incidence and Predictors of Mortality among Preterm Neonates Admitted to the Neonatal Intensive Care Unit at Debre Markos Referral Hospital,Northwest Ethiopia

BackgroundPrematurity is the most frequent cause of neonatal death and the second leading cause of under-five mortality. Preterm related complications accounts for 35 % of neonatal deaths within the first week after birth. So far, most studies done in Ethiopia have focused on estimating the prevalence and determinant factors of premature neonatal death. The current study aimed to assess the incidence and predictors of mortality among preterm neonates admitted to neonatal intensive care unit at Debre Markos Referral Hospital.MethodsAn institution-based retrospective follow up study was conducted among premature neonates admitted to Neonatal Intensive Care Unit at Debre Markos Referral Hospital from July 2019 to October 2019. Around 498 patients were selected randomly. A multivariable cox proportional hazards model was fitted to identify predictors of mortality.ResultsA total of 498 preterm babies were followed, and the mean age for follow up at the time of admission to NICU was 15 hours ± 38 SD. Death rate in preterm was estimated to be 27.11% (95% CI: 23.3%, 31.1%). Preterm neonates with gestational age of less than 32 weeks (AHR=1.51; 95% CI: 1.02, 2.24), respiratory distress syndrome (AHR=1.49; 95% CI: 1.03, 2.17), perinatal asphyxia (AHR=1.74, 95% CI: 1.01, 2.76) and congenital malformation (AHR=3.38, 95% CI: 1.21, 8.77) were statistically significant predictors of mortality among preterms.ConclusionThe incidence of death in preterm neonates is relatively low. Gestational age less than 32 weeks, perinatal asphyxia, respiratory distress syndrome and congenital malformation were found as predictors.     

Clinical Manifestations and Trend of Dengue Cases Admitted in a Tertiary Care Hospital, Udupi District, Karnataka

Background:

India is one of the seven identified countries in the South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks and may soon transform into a major niche for dengue infection in the future with more and more new areas being struck by dengue epidemics

Objective:

To study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital.

Study Design:

Record-based study conducted in a coastal district of Karnataka. Required data from all the laboratory confirmed cases from 2002 to 2008 were collected from Medical Records Department (MRD) and analyzed using SPSS 13.5 version.

Results:

Study included 466 patients. Majority were males, 301(64.6%) and in the and in the age group of 15-44 years, 267 (57.5%). Maximum number of cases were seen in 2007, 219 (47%) and in the month of September, 89 (19.1%). The most common presentation was fever 462 (99.1%), followed by myalgia 301 (64.6%), vomiting 222 (47.6%), headache 222 (47.6%) and abdominal pain 175 (37.6%). The most common hemorrhagic manifestation was petechiae 84 (67.2%). 391 (83.9%) cases presented with dengue fever, 41 (8.8%) dengue hemorrhagic fever, and 34 (7.3%) with dengue shock syndrome. Out of 66 (14.1%) patients who developed clinical complications, 22 (33.3%) had ARDS and 20 (30.3%) had pleural effusion. Deaths reported were 11(2.4%).

Conclusion:

Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases.