Data Availability StatementUnderlying data Figshare: Nwe Ni Linn et al 2020 dataset v2. Of 304 deaths, 184 (60.5%) were female and 233 (76.6%) were less than 10 years old. Township level hospitals or below reported 36 deaths (11.8%) and the remaining deaths were from higher level facilities. Dengue was diagnosed before admission in 26 Lypressin Acetate (8.5%) people and 169 (55.6%) were in shock at admission. Of 208 with date of fever onset recorded, the median diagnosis delay was four (interquartile range-IQR: 3, 5) days. Patient level delay (median three days) was a major contributor to the diagnosis delay. Conclusions: Most of the patients who died did not have a diagnosis of dengue before admission. This calls for an urgent review of health system preparedness in peripheral health facilities to suspect, diagnose, monitor, refer and treat dengue in children and individual level factors for better understanding of the reasons of delay. Timely filling of death investigation forms in a prescribed format and quarterly death reviews based on these is recommended. strong class=”kwd-title” Keywords: Dengue fever, Mortality, Delay in diagnosis, Severe dengue, Operational Research, SORT IT Introduction Dengue is usually a mosquito-borne viral disease that has rapidly spread in tropical and subtropical regions. Around 3.9 billion people are at Lypressin Acetate risk of dengue in 128 countries where there is good evidence of dengue occurrence 1. In recent years, transmission has increased predominantly in urban and semi-urban areas and the incidence of dengue in adults is usually increasing 2, 3. In 2016, there were a total of 3.3 million reported dengue patients 4. Severe dengue usually occurs between day four and six after fever onset (called the crucial stage, during which fever subsides) and is one of the leading causes of hospitalization and death among children and adults in most Asian and Latin American countries 4. You will find four unique serotypes of dengue computer virus (DEN-1, DEN-2, DEN-3 and DEN-4). People who recover from dengue infection may get lifelong AKT1 immunity against one particular serotype and cross-immunity for any few months. Subsequent infections by other serotypes increase the risk of developing severe dengue 4. Half a million people with severe dengue require hospitalization every year, and around 2.5% of them pass away 4. Mortality is usually highest in more youthful age groups and reduces with increasing age 5. Dengue mortality can be reduced by early detection and good referral systems especially at the primary health care level, predicting and managing severe dengue with appropriate treatment at the hospital level, reorienting health services to cope with dengue outbreaks, and training health staff at all levels of the health system 6. Once the diagnosis is usually confirmed or suspected, severe dengue can be detected early by clinical (significant abdominal pain, persistent vomiting, lethargy, restlessness, mucosal bleeding, fluid accumulation) and haematological monitoring 7, 8. Delay in diagnosis could be at the level of the patient or health system 9, 10. Late presentation Lypressin Acetate is associated with severe disease in adult dengue patients 10. Dengue death is commonly associated with co-morbidities and clinicians should be aware if dengue patients fulfil the severe case definition on admission 11, 12. Myanmar is usually a high dengue burden country in the Asia Pacific Region. Between 2011 and 2015, of the 89,832 dengue related admissions, 97% were children 13. There is limited published literature on diagnosis delays after fever onset among children or adults who died due to dengue. Therefore,.