Women have accounted for 59% of dengue deaths in Bangladesh this year, despite representing only 38% of total infections, prompting the Institute of Epidemiology, Disease Control and Research (IEDCR) and the Directorate General of Health Services (DGHS) to begin reviewing the causes of female deaths.
DGHS data for this year show that dengue infections and deaths have been rising since July. While more men have been infected, more women have died. Women of reproductive and working age, particularly those aged 20 to 50, have recorded the highest number of deaths. A large share of total dengue deaths among women has occurred in the 21 to 50 age group.
Analysis of updated DGHS dengue data from the start of the year to yesterday, Sunday, shows that 28,929 people were hospitalised with dengue across the country. Of them, 17,908 were men, or 62%, and 11,015 were women, or 38%.
The mortality pattern was the reverse. A total of 82 people have died of dengue this year. Of them, 48 were women, accounting for more than 59% of all deaths, while men accounted for 41%.
Statistics show that in city corporation areas, 26 of the 37 patients who died while under treatment were women, while 10 were men. Outside city corporation areas, 44 people died in hospitals, including 22 men and 22 women.
The higher female death toll in urban areas is being attributed to possible delays or neglect in hospital admission and access to emergency treatment for women with dengue, compared with rural or small-town areas.
Health sector experts say delayed hospital admission, failure to detect physical complications in time and neglect after infection from mosquito bites in domestic settings may be increasing women’s risk of death. In many cases, women do not go to hospital until symptoms become severe. Treatment becomes more complicated if patients are brought in only after platelet counts have fallen dangerously low or dengue shock syndrome has developed.
Senior public health expert Professor Dr Abu Jamil Faisal told Ajker Patrika that no scientific conclusion has yet been reached on why women are dying in greater numbers. “An autopsy must be conducted. There is no alternative. Where autopsy is not possible, verbal autopsy should be done. That means speaking to the patient’s relatives to understand the final condition and reviewing treatment documents,” he said.
Professor Faisal said women lag behind in access to healthcare and face neglect at every stage from the onset of illness. He said women often do not receive the treatment they should, due both to family neglect and their own lack of awareness and inattention. Referring to a similar pattern in 2023, he said the government still does not have data on why women died in higher numbers, calling it a failure and negligence by state institutions. He also said government agencies had failed to take effective steps to build awareness.
IEDCR has intensified field investigations and laboratory-based research to determine whether the higher female mortality rate is linked to viral type, treatment delays or other causes, even though more men have been infected this year.
Professor Dr Ahmed Nowsher Alam, Chief Scientific Officer (Virology) at IEDCR, said: “From the laboratory, we mainly work on dengue serotypes and positivity rates. This year, sample tests in Dhaka found the ‘DEN-3’ serotype more frequently. On the other hand, samples collected from Bandarban outside Dhaka showed more ‘DEN-2’.” He said sample collection, once largely centred on Dhaka, has now expanded to different parts of the country.
On reviewing the causes of death, or conducting a “death review”, IEDCR Director Dr Kazi Ahmed Jaki said: “To clarify the actual causes of women’s deaths, we need to conduct a detailed death review. Last week, we received instructions to carry out a death review of those who died of dengue this year, and we have started planning with a team to analyse the causes and patterns of those deaths.”
Dr Jaki said teams would visit hospitals to collect treatment records, speak to relatives and review medical information. The review will examine where gaps or delays occurred in treatment, when patients arrived at hospital and whether there was any deviation from prescribed treatment protocols, in order to identify the root causes.
Professor Faisal, however, said autopsies would also be needed alongside the IEDCR review to determine the actual causes of women’s deaths.
Dr Ashrafun Nahar, Deputy Director (Disease Control) and the designated DGHS official to speak to the media on dengue, said it would not be possible to say why more women were dying without a death review. She said every government hospital in the country has a death review committee, which examines when, how and in what condition a patient arrived at hospital and in what condition the patient died. She added that IEDCR is also working on the issue and that no conclusions can be drawn without reviewing what complications led to the deaths of women.
Separate IEDCR findings show that the DENV-3 serotype has again become dominant in Bangladesh after several years. For the previous four years, DENV-2 had been the main dengue serotype. Analysis of 71 samples from hospitalised patients this year found DENV-3 in 91.5% of cases and DENV-2 in 8.5%.
According to the World Health Organization, dengue virus has four serotypes: DENV-1, DENV-2, DENV-3 and DENV-4. Infection with one serotype creates lasting immunity only against that specific type. As a result, people who had previously developed antibodies to DENV-2 may be infected again with DENV-3.
Public health experts have warned that a second infection with a different serotype may increase the risk of complications and dengue shock syndrome. They urged people not to ignore fever or symptoms and to seek testing and treatment quickly.