# Public health facility vulnerabilities, preparedness, and health outcomes for Plasmodium falciparum and dengue virus-infected children under 5 years with acute febrile illnesses in Western Kenya

## TL;DR

This study examines how public health facilities in Western Kenya handle malaria and dengue in children under 5, finding vulnerabilities and uneven preparedness.

## Contribution

The study highlights the lack of preparedness for dengue in public health facilities and links climate change to health system vulnerabilities.

## Key findings

- Only 18% of facilities could diagnose and treat dengue, compared to 81% for malaria.
- Bunyala Sub-County had a higher recovery rate (96.8%) than Kisumu (91.0%).
- Children with dengue had longer hospitalizations, indicating worse outcomes.

## Abstract

Climate change and infectious health risks are threatening healthcare systems, cascading into devastating consequences globally. This crisis is altering the footprints of many vector-borne disease control programs. Sub-Saharan countries face complex challenges as patterns of vector-borne diseases transform, causing more than 17% of the global mortality. Climate change-related disasters are increasing worldwide, with Sub-Saharan Africa being the most prone region. Although healthcare facilities should be on the front line in protecting lives, they are often under pressure and are vulnerable to extreme weather events. Public healthcare preparedness and the associated health outcomes are less frequently considered.

This was a three-month follow-up prospective cohort study that determined public health facility vulnerability, preparedness, and health outcomes through a questionnaire administered to facilities in charge, guardians of children seeking health services, and those with acute febrile illnesses. Key Informant Interviews were conducted with selected members of the County's Health Management Team.

A total of 378 participants were successfully followed. A total of 17 (81.0%) facilities were able to diagnose and treat malaria, while 4 (18.0%) were only able to diagnose and treat dengue virus cases. In Bunyala Sub-County, 6 of the 10 facilities were located on or near floodplains or wetlands, while 5 (45.0%) facilities in Kisumu had the same location. The longest hospitalizations (>5 days) were observed at the Kisumu site, while the highest recovery rate [184 (96.8%)] was noted in Bunyala Sub-County compared to 171 (91.0%) in Kisumu.

Public health facilities are not only vulnerable but also unprepared to contain the rising climate change-driven infectious disease burden. Even though healthcare facilities are fairly able to diagnose and treat malaria, the majority lack the ability to diagnose and treat dengue fever. Longer hospitalization was highest among children diagnosed with dengue fever. There is a need for enhanced arboviral disease surveillance and policies on integrated multisectoral approaches to reduce health system vulnerabilities and increase preparedness.