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Caregiver Misconceptions and Delayed Hospital Presentation Associated With Severe Dengue Among Hospitalised Children in Bangladesh

Year: 2026

Type: article

Abstract: Background: Dengue remains a major cause of hospitalisation and severe illness among children in Bangladesh.Caregivers' recognition of warning signs, decisions to seek healthcare, and use of traditional remedies can significantly affect disease progression.This study assessed gaps in caregivers' knowledge, the use of traditional remedies, and factors associated with severe dengue and delayed hospital presentation among hospitalised children.Methodology: A hospital-based cross-sectional study was conducted among 390 children with laboratoryconfirmed dengue admitted to two tertiary care centres in Dhaka between June and December 2025.Structured questionnaires were used to collect data on sociodemographic characteristics, healthcare-seeking pathways, traditional practices, and caregiver knowledge.The primary outcomes were severe dengue and delayed hospital presentation, defined as presentation >4 days after illness onset.Multivariable binary logistic regression models were fitted using 384 complete cases to identify independent predictors of severe disease and delayed presentation.Results: Severe dengue was identified in 98 children (25.1%), while 142 children (36.4%) presented after the fourth day of illness.Substantial knowledge gaps were evident, including poor recognition of warning signs in 352 (90.3%), lack of recognition of shock signs in 289 (74.1%), and limited critical-phase awareness in 379 (97.2%).Traditional or non-medical remedies were used in 261 cases (66.9%).In the multivariable logistic regression analysis, delayed hospital presentation (>4 days) emerged as a strong independent risk factor for severe dengue (adjusted odds ratio (AOR) = 9.45, 95% confidence interval (CI): 5.12-17.44,P < 0.001), alongside travel-related delay (AOR = 4.68, 95% CI: 2.69-8.13,P < 0.001).Furthermore, the misconception that clinical recovery occurs after fever subsides (AOR = 3.71, 95% CI: 2.25-6.12,P < 0.001) and travel barriers (AOR = 4.52, 95% CI: 2.68-7.63,P < 0.001) were significant independent predictors of delayed hospital presentation.Conclusions: Widespread cognitive misconceptions and structural barriers were significantly associated with delayed hospital presentation and severe dengue among children in Dhaka.Paediatric dengue management and community health strategies must prioritise targeted parental education, focusing on recognising clinical warning signs, understanding critical disease progression around defervescence, and seeking prompt medical care.

Source: Cureus

DOI: 10.7759/cureus.119081