Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 19, 2021
Date Accepted: Sep 23, 2021
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Risk factors of Dengue fever in urban areas of district Rawalpindi, Pakistan- 2017
ABSTRACT
Background:
During August 2017, an increased number of suspected dengue fever cases were reported in the hospitals of district Rawalpindi. A case control study was conducted to measure the extent of the outbreak, to determine the risk factors, and recommend preventive measures.
Objective:
To determine the risk factors and recommend control measures.
Methods:
A case was defined as an acute febrile illness with one or more of the following; retro-orbital pain, headache, rash, myalgia, arthralgia, and hemorrhage, confirmed with ELISA among residents of Rawalpindi district from 30th Aug- 30th Oct. 2017. All ELISA confirmed cases were recruited from the hospital. Age and sex matched controls were selected from the same community. Frequencies, univariate and multivariate analysis was performed using epi Info 7.
Results:
Total 373 cases were recruited. The mean age was 36±2.9 years (range:10-69yeras) and 75% were male. The most affected age group was 21-30 years (AR 40%) followed by 31-40 years (AR 23%). Two deaths were reported (CFR 0.53%). The most frequent signs/symptoms were; fever (100%), myalgia (86%) headache (86%), and retro-orbital pain (73%). Serotype identification carried out in 322 cases and DEN-2 was dominant (34%, n=126). Contact with a confirmed dengue case (OR 4.27, CI: 3.14-5.81, P<0.0001) and stored water in open containers at home (OR 2.04, CI: 1.53-2.73, P <0.0001) and travel to a dengue outbreak area (OR 2.88, CI: 2.12-3.92, P<0.0001) had higher odds while the use of mosquito repellents (OR 0.12, CI 0.09-0.18, P < 0.0001) and regular water supply at home (OR 0.03, CI: 0.02-0.04, P <0.0001) showed a protective effect. Geographical distribution was limited to densely populated areas and all the water samples were tested positive for dengue larvae.
Conclusions:
Stored water in containers inside houses and subsequent mosquito breeding was the most probable cause of this outbreak. The study led to a recommendation to undertake activities to improve the use of repellents and remove sources of breeding (indoor uncovered stored water).
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