Clinical profile and predictors of adverse outcomes in pediatric dengue fever presenting with febrile illness: a prospective observational study in Burao, Somaliland
Résumé
Background Dengue fever is a growing public health concern globally, and there is limited pediatric-focused data available in Somaliland. This study aimed to prospectively characterize the clinical profile and identify predictors of adverse outcomes among children presenting with febrile illness, suspected of dengue, in Burao, Somaliland. Methods This prospective observational study was conducted between September 2025 and April 2026 in pediatric outpatient and inpatient departments of hospitals in Burao. Children aged 0–18 years with acute febrile illness were consecutively enrolled. Clinical assessments and dengue confirmation using rapid diagnostic tests were performed. Disease severity followed WHO 2009 guidelines. Descriptive statistics summarized demographic and clinical characteristics. Multinomial logistic regression, using a prespecified causal framework rather than univariable screening, identified factors associated with recovery, complications, and death. Adjusted relative risk ratios (RRRs) with 95% confidence intervals (CIs) were reported. Results Of the 186 participants (mean age, 7.86 years; 61.8% male; 83.3% urban residents), common symptoms included rash (60.8%), nausea/vomiting (89.3%), abdominal pain (69.3%), bleeding manifestations (51.1%), and hepatomegaly (47.3%). Most children (83.9%) recovered, 12.4% developed complications, and 3.7% died. Bleeding manifestations were independently associated with a higher relative likelihood of complications than recovery (adjusted relative risk ratio [RRR] = 5.07, 95% CI: 1.42–18.05; p = 0.012). Longer fever duration was independently associated with a higher relative likelihood of death than recovery (RRR = 1.34, 95% CI: 1.07–1.68; p = 0.011). A higher maximum recorded temperature was associated with an increased relative likelihood of complications (RRR = 1.65, 95% CI: 1.01–2.68; p = 0.044). Abdominal pain was associated with a lower relative likelihood of complications (RRR = 0.28, 95% CI: 0.08–1.00; p = 0.049). Age, sex, and residence were not independently associated with the outcomes. Conclusion Pediatric dengue in Burao has favorable outcomes, but some children develop complications or die. Bleeding manifestations and prolonged fever independently predict adverse outcomes, while higher temperature and abdominal pain have borderline associations. Age, sex, and residence do not predict prognosis. Early recognition of bleeding signs and prolonged fever can improve triage, management, and outcomes. Prospective studies should validate these predictors for dengue care in Somaliland.
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