Contributory causes of death (n = 88).

Dengue is a mosquito-borne acute febrile illness, also known as break bone fever, and is a major public health problem in the tropics and subtropics worldwide. Understanding the factors that contribute to dengue-related mortalities is crucial for decision-making and implementing effective strategies for prompt patient care. This retrospective analysis aimed to understand the clinical characteristics as well as associated infections and co-morbidities related to dengue fatalities in Nepal. Additionally, this insight aids in developing targeted public health interventions to save lives, enhancing disease surveillance systems, and fostering community awareness about dengue prevention. We conducted a retrospective study of the dengue-related deaths in Nepal reported to the Epidemiology and Disease Control Division between 01 January and 30 November 2022 through early warning and reporting system. Medical records of 88 patients who died from dengue were collected and reviewed from 23 hospitals of Nepal. Among 88 deaths that were reviewed, 47 (53.4%) were males and 41 (46.6%) were females. Of all the death cases reviewed, 26% experienced septic shock, 23% had multiple organ dysfunction syndromes, 20% had a cardiopulmonary arrest, 15% had acute respiratory distress syndrome, and 5% had severe gastro-intestinal bleeding, before the death. Fatality from severe dengue were in 46 cases (52%), from dengue associated with other diseases were in 23 cases (26%), and from dengue associated with co-morbidity complications were in 19 cases 22%. Dengue-related mortality in Nepal disproportionately affected older adults with underlying health conditions and co-infections. Late presentation and rapid clinical deterioration were common. Strengthening early diagnosis, timely referral, and clinical management, particularly for high-risk groups is essential. Public awareness of dengue warning signs and prompt healthcare-seeking behavior should be a key component of dengue control strategies.