Late referrals driving dengue deaths at DMCH

Fourteen-year-old Akash Khan has been lying in critical condition in the dengue ward of Dhaka Medical College Hospital (DMCH) since November 18.

A resident of Shariatpur, Akash was first admitted to Shariatpur Sadar Hospital that morning. Doctors later referred him to DMCH due to his worsening condition.

His parents brought him to Dhaka by bus because they could not afford an ambulance.

"It cost around Tk 1,000 for the three of us by bus. An ambulance would have cost eight to ten thousand," said his father, Farhad Khan. The journey took three hours.

Farhad said Akash had abdominal pain and nosebleeds, and his platelet count had dropped to 15,000, rising to 20,000 by Thursday morning.

Similarly, Mohammad Arafat, 13, from Barishal's Muladia, was admitted to the DMCH dengue ward on Wednesday after a seven-hour journey from his local hospital.

"I was treated at my upazila hospital for three days, and the doctor advised my parents to take me either to Barishal Medical College or a larger hospital in Dhaka," said Arafat.

Their stories reflect the situation at DMCH, which handles the country's most critical dengue cases.

According to DGHS, 353 dengue patients have died and 88,893 have been hospitalised nationwide this year as of yesterday morning.

Meanwhile, among hospitals, DMCH recorded the highest number of deaths -- 84 -- treating 3,275 patients. The DNCC Dedicated Covid-19 Hospital in Mohakhali treated the most patients -- 5,183 -- but recorded 30 deaths.

Experts say delayed hospitalisation is a major contributor to the high death toll, as many critically ill patients are referred from outside districts.

Naznin Naher, in-charge of a DMCH dengue ward, said most critical cases come from outside Dhaka. "Patients often wait at home after the initial fever and arrive three or four days later, when their condition has already become severe."

HM Nazmul Ahsan, associate professor at Shaheed Suhrawardy Medical College Hospital, said many dengue patients arrive in extremely critical condition.

"Some die within hours of arrival. They often come in profound shock -- almost no blood pressure, no pulse, cold limbs, and fluid in the chest. By then, treatment makes little difference," he said.

He said patients from districts like Barishal, Pirojpur, and Barguna often begin travelling in pre-shock and reach Dhaka in full shock due to the long journey.

That is why deaths are highest at the DMCH, where many such patients are referred, he added.

Nazmul also pointed to a lack of proper dengue management training for doctors outside Dhaka, leading to fluid mismanagement and preventable deaths. Limited resources in smaller hospitals add to the challenge.

Public health expert Mushtuq Hussain stressed the need for early detection and decentralised healthcare.

"If people could test for dengue near their homes at low cost, cases would be identified earlier," he said. "Patients now have to come to large hospitals and wait long hours. By the time they arrive, the fever often subsides -- but the critical phase begins after the fever ends."

He suggested offering dengue tests at community clinics, similar to COVID-19 testing, to reduce pressure on large hospitals.

"Dhaka has almost no primary or secondary care -- only tertiary hospitals. Rural facilities exist but are poorly equipped. Strengthening care across the country is essential," he said.