Utilization of medical services and quality of life among dengue patients in eight countries

Presentation at:American Society of Tropical Medicine and Health

56th Annual Meeting, Philadelphia, PA, Nov. 5, 2007

Abstract in:Am J Trop Med Hyg 77(5, Suppl): 220.

Utilization of medical services and quality of life among dengue patients in eight countriesDonald S. Shepard1, Jose A. Suaya1, Blas Armien2, Mariana Caram1, Leticia Castillo3, Ngan Chantha4, Fàtima Garrido5, Sukhontha Kongsin6, Lucy Lum7,

Romeo H. Montoya8, João B. Siqueira9, Rana Sughayyar1, Karen Tyo1

1Brandeis University, Waltham, MA, United States, 2Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City, Panama, 3National Health Laboratory, Ministry of Health and Social Assistance, Guatemala City, Guatemala, 4National Dengue Control Program at the National Center for Malaria, Ministry of Health, Phnom Penh, Cambodia, 5Ministry of Health and Social Development, Caracas, Venezuela, 6Mahidol University, Bangkok, Thailand, 7University of Malaya Medical Center, Kuala Lumpur, Malaysia, 8Ministry of Health and Social

Assistance, San Salvador, El Salvador, 9Federal University of Goiás, Goiana, Brazil

Introduction:Symptomatic dengue is responsible for extensive use of medical services in endemic countries.Using a standardized methodology, this study measured utilization of health services by symptomatic dengue patients in eight dengue endemic countries.

Methods:This study was conducted in 8 countries of which 5 were in the Americas (Brazil, El Salvador, Guatemala, Panama, and Venezuela) and 3 in Asia (Cambodia, Malaysia, and Thailand).The 1695 eligible participants, recruited mostly in 2005, were consecutively or randomly selected clinical or confirmed dengue patients treated at representative, mostly public, hospitals and ambulatory facilities.Data came from 1-2 interviews with each patient (or parent) and abstracts of medical records.Medical utilization included numbers of both private and public ambulatory visits and inpatient days. Supported by the Pediatric Dengue Vaccine Initiative (PDVI). Shepard@Brandeis.edu; Suaya@Brandeis.edu

Results:About half (48%) of the sample patients were aged 0-14, 55% were ambulatory participants, and 71% had dengue confirmed by laboratory tests.Ambulatory patients averaged 4.2 visits (SD 2.7) while hospitalized patients averaged 4.6 visits (SD 2.2) before and after their hospitalization. Most of the ambulatory care was received in the public sector.Utilization patterns varied by country. The mean number of visits ranged from 2.8 (Guatemala) to 6.3 (El Salvador) among ambulatory patients and from 2.0 (El Salvador) to 7.1 (Malaysia) among hospitalized patients.The average length of stay for hospitalized patients was 3.8 days (SD 2.5) with country means ranging from 2.8 days (Malaysia) to 6.4 (Guatemala).The duration of fever averaged 4.9 (SD 2.9) days among ambulatory patients and 5.9 (SD 2.8) days among hospitalized patients.The mean total duration of illness was 11.9 (SD 6.9) days among ambulatory patients and 10.9 (SD 4.6) days among hospitalized patients.Using the Euroqual quality of life “thermometer” (where 0 is lowest and 100 best), ambulatory patients averaged only 30 (SD 18) and hospitalized patients 33 (SD 25).

Conclusion:Treatment patterns varied by country. On average, however, use of ambulatory visits, length of fever, duration of illness, and quality of life were almost as severe among ambulatory patients as among hospitalized patients.Utilization of medical services is substantial and quality of life is low for both ambulatory and hospitalized dengue cases across 8 countries on two continents.

Length of stay for hospitalized patients by country (mean and standard error)

3.0 3.4

6.4

5.2 5.3

3.32.8

4.93.8

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

BRA ESAL GUA PAN VEN CAM MAL THA ALL

Americas Asia

Region and Country

Da

ys

Number of visits by cohort and country(mean and standard error)

4.0

6.3

2.8

6.0

4.13.7

5.6

4.24.6

3.6

2.02.5

4.1

6.57.1

4.2

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

BRA ESAL GUA PAN VEN CAM MAL THA ALL

Americas Asia

Region and Country

Da

ys

Hospitalized Ambulatory

Participating countries

Duration of illness for ambulatory cohort

4.8 4.9 6.1 6.13.6

5.5 5.0

7.5

3.8

4.9

13.5

5.03.1

6.9

12

9

11

20

9 9

12

0

5

10

15

20

25

30

BRA ESAL GUA PAN VEN CAM MAL THA ALL

Country

Day

s

Days of illness without fever

Days of illness with fever