Red tape hides actual dengue death figures

In the face of a phenomenal rise in dengue infections in Bangladesh this year, the government agency tasked to monitor the diseases has resorted to a ‘bureaucratic process’ to confirm the dengue deaths, keeping in the dark the general people as well as the academicians intending to study the disease.

The dengue death reports officially provided by the government hospitals and those independently collected by the journalists contradicted the reports issued by the Institute of Epidemiology, Disease Control and Research, the disease monitoring arm of the government.

The health emergency operation centre and control room of the Directorate General of Health Services on Monday said that it received 173 reports of suspected dengue deaths so far this year.

Besides, 64,765 suspected dengue patients were hospitalised across the country so far this year with 1,251 in the 24 hours ending at 8:00am Monday, it said.

Public health experts said that any bureaucratic process or playing hide-and-seek about the dengue deaths was unnecessary and counter-productive as it did not provide the actual picture of the mosquito-borne viral fever.

They also suspected that there might have been instructions from some quarters to show a ‘conservative’ death figure.

IEDCR director Meerjady Sabrina Flora told New Age that of the 173 reports of suspected dengue deaths they received this year, they confirmed 52 of them after reviewing 88 cases so far.

She has said that they collect the reports and send them to a death review committee that confirms the deaths if those are due to dengue.

‘It’s a lengthy and time-consuming process that includes collection of samples from the patients, medical reports and verbal autopsy of relatives,’ said Flora, who heads the death review committee.

IEDCR gets reports from 53 hospitals only, she said, although there are over 15,000 hospitals and clinics across the country.

And even all these 53 hospitals always do not provide the death reports to the IEDCR, she said.

‘The actual death figure cannot be known as we review only the death reports that we receive,’ Flora said.

‘And our purpose of reviewing the deaths is not to know only if the deaths have been caused by dengue, but for the purpose of study by the IEDCR,’ she said.

Public health expert and IEDCR’s former director Mahmudur Rahman believes that the review of deaths is totally unnecessary.

‘Keeping the death figure conservative or playing hide-and-seek would  deprive researchers and people of learning the actual picture of the dengue menace,’ he said.

He viewed that when a hospital had issued a death certificate mentioning the cause of death, it was enough to prove how a patient had died.

‘Does the IEDCR change the death certificates after their reviews?’ he questioned.

‘When hospitals do not always keep samples from the patients in Bangladesh, how can the death review committee get the scope of a thorough analysis?’ he further asked.

Mahmudur Rahman pointed out that review of deaths was necessary in the instances of compensation or insurance, but even for those purposes the hospital certificates were enough.

‘There might have been instructions from some quarters to show a conservative death figure to keep the people in dark,’ he suspected.

The officials of the government hospitals, who send the dengue death reports to the IEDCR, are also baffled over the differing findings of the IEDCR about the dengue deaths.

Among the 173 death reports as of Monday, 15 came from Mugda Medical College Hospital. It has the second highest dengue death figure for a hospital after Dhaka Medical College Hospital.

The IEDCR has disclosed that it has confirmed one dengue death out of the three cases it has analysed so far among the Mugda hospital’s 15 fatalities.

When asked, Mugda hospital director Amin Uddin Khan told New Age that he was confused over the IEDCR findings.

‘There is no scope of wrong reporting,’ he said.

‘Sometimes we lack information about a particular patient, but we only send reports of the confirmed deaths and confirmed cases,’ Amin added.

He has also said that patients sometimes arrive when they are already at a critical stage, like dengue shock syndrome, and at that moment they prioritise management of the patients, not the testing of the patients.

And if such patients die, Amin said, they issue death certificates based on their own findings plus the medical reports from the previous hospitals that tested the patients dengue positive.

Dhaka Medical College Hospital has sent 23 reports of dengue deaths to the IEDCR and only three cases have been confirmed after analysis of eight cases so far.

Shaheed Suhrawardy Medical College Hospital has sent reports of six deaths but no case has been confirmed after analysis of three cases so far.

Among the private hospitals, Square Hospital in the capital has sent the highest number of dengue death reports – 10 – to the IEDCR and all of them have been confirmed after analysis.

The IEDCR director has said that in the cases where information is lacking about a patient, they collect the missing information from the hospitals concerned on their own and from the verbal autopsy of the patients’ relatives.

She has further said that all the hospitals do not keep records of all the patients while the verbal autopsy cannot always ascertain the required information or reasons due to indifference of patients’ relatives.

The World Health Organisation recommends taking a verbal autopsy one month after the patient’s death as the relatives still remain in shock.

Flora has said that they follow the recommendation and sometimes it takes over three months to take the verbal autopsy.

News Courtesy: www.newagebd.net