RICSA, 3(2), 85-94. (2026)

Adherence to the 2016 PAHO Clinical Practice Guideline on Dengue in a Hospital in Northern Peru, 2022-2023.

Adherencia a la Guía de Práctica Clínica de la OPS 2016 sobre Dengue en un hospital del norte de Perú, 2022-2023.

Franco E. León Jiménez1,a,b; Nathaly BF. Mendoza-Farro2,c; Adriana Montoya Reategui1,d; Joel Emmanuel Inga-Chero3,4,e; Karim M.V. Dioses1,5,f; Moisés Barranzuela-Herrera1,g;Sofia Cavalcanti Ramírez1,h; Luz M. Moyano6,i from INERTROP working Group.

Filiation:

1. Department of Medicine, Hospital de la Amistad, Peru Korea Santa Rosa II-2, Piura, Perú.

2. Epidemiology and environmental health Unit, Hospital de la Amistad, Perú Korea Santa Rosa II-2, Piura, Perú.

3. School of Medicine, Universidad Nacional de Piura, Piura, Perú.

4. Scientific society of medical students, Universidad Nacional de Piura, Piura, Perú.

5. School of medicine, Universidad Cesar Vallejo, Piura, Perú.

6. Unidad Médico Legal I Contralmirante Villar, Instituto de medicina legal y ciencias forenses, Tumbes, Perú.

a. Medicina interna, b. Magister en epidemiologia clínica; c. Licenciada en enfermería; d. Médico Infectólogo; e. Estudiante de Medicina Humana; f. Médico Infectólogo; g. Médico Ocupacional; h. Médico Infectólogo; i. Doctorado en medio ambiente y sociedad, con mención en salud pública y medio ambiente.

Correspondence: Luz María Moyano Vidal, luzmariamoyano@gmail.com

ID ORCID the autor:

Franco E. León Jiménez https://orcid.org/0000-0002-9418-3236 Nataly BF. Mendoza-Farro https://orcid.org/0000-0002-0924-9297 Adriana Montoya Reategui https://orcid.org/0000-0003-0774-9201 Joel Emmanuel Inga-Chero https://orcid.org/0009-0003-6907-2176 Karim Dioses Diaz https://orcid.org/0000-0003-4597-5437 Moisés Barranzuela-Herrera https://orcid.org/0000-0002-9800-8558 Sophia Cavalcanti Ramírez https://orcid.org/0000-0003-4294-7019 Luz M. Moyano https://orcid.org/0000-0002-5878-5782

Authorship statement: Authorship statement: Writing–original draft: FELJ, SC, LMMV. Writing–review & editing: FELJ, SC, LMMV. Supervision: LMMV, LMBH, MPDG. Final approval of the manuscript: all authors. Funding: This study was funded with the author’s own resources and did not receive external funding from public or private institutions.

Conflict of interest disclosure: Sofía Cavalcanti Ramírez and Franco León Jiménez are members of the Hospital Research Committee. The authors have declared that no competing interests exist: Nataly BF. Mendoza-Farro, Adriana Montoya Reategui, Joel Emmanuel Inga-Chero, Moisés Barranzuela-Herrera, Karim Dioses Diaz and Luz

M. Moyano.

financing: This study was self-funded by the authors and received no external funding from public or private institutions

Acknowledgments: to the Hospital authorities for the permissions provided for data access.

Artificial Intelligence Use Declaration: During the preparation of this manuscript, Luz M. Moyano (LMMV) used Claude AI Pro (Anthropic), Perplexity AI Pro, Open Evidence, Medsearch, and Scopus AI for the following purposes: integrating clinical history data, reducing word redundancy, improving spelling and grammar, enhancing paragraph clarity, conducting real and updated scientific evidence searches, structuring the discussion section, and confirming references. After using these tools/technologies, the authors reviewed and edited the content as needed and assumed full responsibility for the last version of the publication.

Received: 20-06-2026.

Accepted: 28-06-2026.

Published: 30-06-2026.

Esta obra está publicada bajo la licencia CC BY 4.0

ABSTRACT

Objective: Effective dengue management enhances the chances of survival. The level of adherence to the suggestions in northern Peru is uncertain. The primary aim of the study was to assess adherence to the 2016 PAHO guideline on dengue in a hospital located in northern Peru during the period from 2022 to 2023. Material and methods: The study performed a cross-sectional design and exploratory analysis, reviewing 140 medical records. Fifty-four percent were from 2023; 66.43% were from women; 38,57% came from a first level healthcare center; 77.14 % had diagnosis of dengue with warning signs and 20.71% had severe dengue; 18.44% died. Results: We found at least one error in the classification of severity and/or treatment in non-hospital healthcare facilities (95 %), triage (90.23%), and uviclin/observation (58.93%). Errors in classification and inadequate hydration in the first level healthcare centers, triage, and uviclin/observation were: 40.68%/60.0%, 31.0.6%/76.6%, and 15.32%/44.14 %, respectively. Persistent errors were inadequate hydration in triage (76.69%) and urinary flow in the center (81.67 %). In a bivariate analysis, mortality was associated with age 18 years or older (p = 0.047), having a case from 2023 (p = 0.008), and having severe dengue (p<0.001). In the multivariate analysis, only severe dengue (PR: 28.13, 95% CI :9.32-84.86 p<0.001), and age 18 years or older (PR:2.97, 95%CI:1.19-7.43 p: 0.020), were associated with mortality. Conclusions: We found a high frequency of misclassification and management errors in these three scenarios, but they were not associated with higher mortality.

Palabras clave: Dengue, Adherence, Clinical Practice Guidelines, Mortality. (Source: MeSH-NLM)

RESUMEN

Objetivo. El manejo adecuado del dengue mejora las probabilidades de supervivencia. Sin embargo, se desconoce el nivel de adherencia a las recomendaciones vigentes en el norte del Perú. El objetivo principal de este estudio fue evaluar la adherencia a la guía de dengue de la Organización Panamericana de la Salud (OPS) de 2016 en un hospital del norte del Perú durante el período 2022–2023. Material y métodos: Se realizo´ un estudio de diseño transversal y análisis exploratorio mediante la revisión de 140 historias clínicas. El 54 % correspondió al año 2023; el 66,43 % fueron mujeres; el 38,57 % provenía de establecimientos de salud del primer nivel de atención; el 77,14 % tenía diagnóstico de dengue con signos de alarma y el 20,71 % de dengue grave; el 18,44 % falleció. Resultados: Se encontró al menos un error en la clasificación de la gravedad y/o en el tratamiento en los establecimientos de salud no hospitalarios (95 %), en triaje (90,23 %) y en la unidad clínica/observación (58,93 %). Los errores en la clasificación y la hidratación inadecuada en los establecimientos del primer nivel de atención, triaje y unidad clínica/observación fueron de 40,68 %/60,0 %, 31,06 %/76,69 % y 15,32 %/44,14 %, respectivamente. Los errores persistentes más frecuentes fueron la hidratación inadecuada en triaje (76,69 %) y el monitoreo inadecuado del flujo urinario en hospitalización (81,67 %).En el análisis bivariado, la mortalidad se asoció´ con tener 18 años o más (p = 0,047), corresponder al año 2023 (p = 0,008) y presentar dengue grave (p < 0,001). En el análisis multivariado, únicamente el dengue grave (RP: 28,13; IC 95 %: 9,32–84,86; p < 0,001) y la edad igual o mayor de 18 años (RP: 2,97; IC 95 %: 1,19–7,43; p = 0,020) se asociaron con la mortalidad. Conclusiones: Se encontró´ una alta frecuencia de errores en la clasificación y el manejo de los pacientes en los tres escenarios evaluados; sin embargo, estos errores no se asociaron con una mayor mortalidad.

Keywords: Dengue, Adherencia, guia de practica clinica, mortalidad (Fuente: DeCS-BIREME)

INTRODUCTION

centers/posts until passing through the hospital were evaluated. Dengue (DENV) was defined as WHO: “Dengue (break-bone fever) is a viral infection that spreads from mosquitoes to people.

It is more common in tropical and subtropical climates. Most people who get dengue will not have symptoms. But for those who do, the most common symptoms are high fever, headache, body aches, nausea, and rash. Most will get better in 1–2 weeks. Some people develop severe dengue and need care in a hospital “(3).

The algorithms followed were:

A. Dengue case algorithm with warning signs:

1. Start hydration with crystalloid solution (Hartman or 0.9% saline solution): 10cc/kg to pass in one hour, up to 3 loads; If there is no clinical improvement change to the severe dengue algorithm.

2. Gradual reduction of hydration to 5-7 ml/kg/h for 2-4 hours and hourly monitoring.

3. Reevaluation of the patient. If clinical improvement is evident and urine output is ≥ 1 ml/kg/h, reduction of hydration to 3-5 ml/kg/h for 2-4 hours and hourly monitoring.

4. Reevaluation. If clinical improvement is evident and urine output is ≥ 1 ml/kg/h, reduce hydration to 2-4 ml/kg/h and continue for 24-48 hours and hourly monitoring.

B. Severe Dengue Case Algorithm:

1. Immediate bolus administration of crystalloid solution (Hartman or 0.9% normal saline) 20 ml/kg in 15 to 30 minutes.

2. Reevaluation. If signs of shock disappear, decrease hydration to 10 ml/kg/h for 1-2 hours and hourly monitoring.

3. Reevaluation. If the evolution is satisfactory, decrease hydration to 5-7 ml/kg/h for 4-6 hours and hourly monitoring.

4. Reevaluation. If the evolution is satisfactory, reduction of hydration to 3-5 ml/kg/h for 2-4 hours and hourly monitoring.

5. If evolution is satisfactory, reduce fluids to 2-4 ml/kg/h for 24-48 hours.

In addition, the following were measured: Presence of the referral form from the healthcare center (presence and adequate completion), time elapsed from the reference from the health center to arrival at the hospital, and times spent in each service.

Two aspects were determined: 1. Appropriate initial diagnosis and 2. Appropriate management. Each researcher was assigned a defined number of records. They were previously trained by SCR and AMR.

Adequate initial diagnosis was defined if the diagnosis that appeared on the reference, triage and observation/Uviclin sheet coincided with the investigator's opinion: DWWS, DWS, SD.

Adequate management was defined if the indications in the evolution or monitoring sheets coincided with the researcher's evaluation in relation to parenteral fluid therapy, the frequency of monitoring vital functions (mean arterial pressure, diuresis) and the indication for blood products (all should be met).

For the evaluation of diagnosis and management of Dengue, confirmed and probable cases of dengue were included, as well as those ruled out since the outbreak scenario and the concept of case management were considered. If the written information was not found in clinical history, it would be considered indeterminate.

Statistical Analysis. Descriptive analysis with absolute and relative frequencies for categorical variables and measures of median and interquartile range (IQR) for numerical variables were estimated. The association between severity and mortality and adequate initial diagnosis and appropriate management was explored. Chi 2 and Fisher's test were used for categorical tests and Wilcoxon/Student's t test for numerical tests according to normality. A multivariable analysis was performed between mortality and diagnostic classification, sociodemographic and appropriate management classification with p <0.1 in the bivariate. Prevalence ratios were calculated through generalized linear models using the link log function and the binomial family with robust variance. For the statistical analysis we used StataCorp. 2023. Stata Statistical Software: Release

18. College Station, TX: StataCorp LLC.

Ethical aspects. The Hospital Research Committee approved the study protocol. The confidentiality of the information was maintained, and the databases were worked without identifiers. We delivered a final report to the hospital's general management and shared the results with the authorities and the hospital's dengue team.

Table 1. General characteristics of the total number of services (n=141)

Characteristics N %
Year
	2022	65	46.43
	2023	75	53.57
Sex
Women		93	66.43
Man		47	33.57
Age (m/iqr)		27.5	17 – 49.5
HSPI level
First level		54	38.57
Second level		86	61.43
Hours of delay in reference
< 1 hour	1		1.85
1-2 hours	23		42.59
2-4 hours		21	38.89
> 4 hours		9	16.67
Severity
No warning signs		3	2.14
With warning signs		108	77.14
Serious		29	20.71
Sick days (m/iqr) Days of Hospitalization (m/iqr)		5 4	4-Jun 2-Jun
Final condition
Alive		114	81.43
Deceased		26	18.57

HSPI: Health Service Provider Institution; m= median, iqr= interquartile range; ICU: Intensive care unit

When considering the classification of severity or treatment, at healthcare facilities outside of the study site, triage and Uviclin/observation, there were a frequency of at least one error in 91.5%, 88.5% and 52.6%, respectively (see table 2). To explore the association between sociodemographic features, hospital care variables and severity/mortality, voluntary withdrawals were considered alive until discharge and the observation of “missing data” was eliminated for the final outcome (n =140).

When comparing the presence of at least one error in the healthcare center, triage and observation/Uviclin, no difference was found in mortality: p= 0,486, p= 0.281, p= 0.85 (see table 3). In the exploratory multivariate analysis, only severe dengue (PR: 28.13, 95% [CI , 9.32-84.86] p<0.001), and age 18 years or older (PR:2.97, 95%[CI, 1.19-7.43] p: 0.020), were associated with mortality. Neither the presence of at least one error in the center (p= 0.486), triage (p=0.281), and observation/uviclin (p=0.853), was associated with mortality) (see table 4).

Table 2. Frequency of errors in diagnosis and treatment of Dengue by service (n=141), 2022-2023 period

	Healthcare center/Hospital (n=60)				Triage* (n=134)		Observation (n=114)**
	N %				N %		N %
Clasiffication error †
Correct diagnosis		35	59.32%	91		68.94%		94	84.68%
Incorrect diagnosis		24	40.68%	41		31.06%		17	15.32%
Hydration Adequate		24	40.00%	31		23.31%		62	55.86%
Not suitable		36	60.00%	102		76.69%		49	44.14%
Urinary flow measurement Adequate		11	18.33%	61		46.21%		94	84.68%
Not suitable		49	81.67%	71		53.79%		17	15.32%
MAP control It was recorded		41	68.33%	88		66.17%		98	88.29%
It was not recorded		19	31.67%	45		33.83%		13	11.71%
At least one mistake No		3	5.00%	13		9.77%		46	41.07%
Yes		57	95.00%	120		90.23%		66	58.93%

MAP: mean arterial pressure; *: Triage: medicine, pediatrics and gynecology; **: medicine, pediatrics and gynecology; only Uviclin has patients exclusively from this area.

Table 03. Factors associated with dengue mortality in Piura (N=140)

		Ali	ve	Decea	sed
Variables Freq.	%	Freq.	%	Freq.	%	p
Sex Women 93	66.43	78	83.87	15	16.13	0.296
Man 47	33.57	36	76.6	11	23.4
Age group
Under 18 38	27.14	35	92.11	3	7.89	0.047
18 or older 102	72.86	79	77.45	23	22.55
Year of illness
2022 65	46.43	59	90.77	6	9.23	0.008
2023 75	53.57	55	73.33	20	26.67
HSPI level
First level 54	38.57	46	85.19	8	14.81	0.365
Second level 86	61.43	68	79.07	18	20.93
At least 01 error in
Healthcare center
No mistake 3	2.14	3	100	0	0	0.486 *
at least one mistake 57	40.71	49	85.96	8	14.04
At least 01 error in
triage
No mistake 13	9.29	12	92.31	1	7.69	0.281
at least one mistake 120	85.71	96	80	24	20
At least 01 error in
observation
No mistake 46	32.86	37	80.43	9	19.57	0.854
at least one mistake 66	47.14	54	81.82	12	18.18
Dengue severity
Non Severe Dengue 111	79.29	108	97.3	3	2.7	<0,001
Severe Dengue 29	20.71	6	20.69	23	79.31

p of chi2; * p Fisher´s test; HSPI: Health Service Provider Institution

Table 04. Factors associated with dengue mortality in Piura (N=140)

Variables

Bivariate

p Multivariate

IC95%

PRa IC95%

Sex

Women

Ref.

Man

Age group

Under 18

1.45

0,72 - 2,91

Ref.

0.293

Ref.

18 or older

Year of illness

2022

2.86

0,91 - 8,97

Ref.

0.072

2.97

1,19 - 7,43

0.02

2023

HSPI level

First level

2.89

1,24 - 6,76

Ref.

0.014

Ref.

Second level

At least 01 error in

No mistake

1.41

triage

0,66 - 3,02

Ref.

0.373

0.65

0,38 - 1,10

Ref.

0.109

at least one mistake

2.6

0,38 - 17,68

0.329

1.75

0,85 - 3,60

0.13

At least 01 error in

No mistake

observation

Ref.

at least one mistake Dengue severity Non severe Dengue

0.93

0,43 - 2,02

Ref.

0.853

Ref.

Severe Dengue

29.34

9,46 - 90,98

<0,001

28.13 9,32 - <0,001

84,86

PR GLM link log and family binomial; PRa GLM link log and family poisson, adjusted by age group, HSPI level, at least one mistake in triage and dengue severity

The study's results indicate a high frequency of diagnostic and initial management errors in the pre-hospital and hospital phases. In both triage and the healthcare center, 9/10 treated patients experienced at least one error or omission during the process; in observation/Uviclin, this error occurred in 5/10 patients. Similarly, in the healthcare center (4/10) and in triage (3/10), patients were incorrectly classified based on their severity, which improved under observation. Only 2/10 patients in triage and 4/10 patients in the healthcare center, respectively, received adequate hydration.

The results may show bias in healthcare staff documentation because they may not have enough time to record every detail. Another possibility is a lack of standardized formats set up by the new National Technical Standard (5). This reality is often evident in scenarios of patient overload, epidemics, and care provided by front-line personnel with limited experience. A recent example was the COVID-19 pandemic, which made this type of inconvenience clear (14). On the other hand, a lack of adherence to the CPG recommendations is common not only in our country but in other realities and infectious pathologies such as COVID-19 (15).

Evidence suggests that the region has conducted training. Experts conducted four training sessions between 2023 and 2024: the first for 150 primary care health professionals (16), and the second for personnel with similar characteristics in the Morropon-Huancabamba Health Sub-Region (17). The Regional Directorate of Health Piura trained more than 1,200 nurses from the Ministry of Health (MINSA), Social Security (Essalud), Police Forces Health Facilities (Sanidad), and other healthcare establishments in a 12-hour workshop course in October 2023 (18, 19). However, it is crucial for any strategy to not only provide training for the personnel in charge but also to measure the baseline (knowledge, attitudes, and practices) (8)

(10) and determine the impact afterwards. In this scenario, quasi-experimental studies are an attractive model and an especially useful tool (20).

In an 18-month study in India by Balkrishnan et al., in patients with DWS, pre- and post-intervention measurements were carried out, determining that the educational program had an impact on improving the admission and classification criteria, monitoring of vital signs, correct use of bolus fluids, fluid therapy in titration, hematocrit monitoring, platelet transfusion when indicated, and discharge criteria. Also, mortality decreased from 7.1% to zero. The median hospital stays decreased by one day (21). An attractive possibility is to describe the before and after evaluations conducted on doctors in Piura in 2023 (19). Qualitative research is another unexplored scenario that is potentially helpful in exploring the perceptions, attitudes, and

limitations of human resources. Quantitative measurement of adherence to a guideline is insufficient to explore these scenarios (22).

The Peruvian Health Ministry Directorate for the Prevention and Control of Metaxenic and Zoonotic Diseases developed a strategy to measure adherence to the National Technical Standard's recommendations (5). According to their findings, in Peru, adherence was 70.5% (249 evaluations), with 51.27% in treatment and 73.76% in diagnosis. After reviewing 33 records, global adherence was 68.22% in Piura, 73.74% in diagnosis, and 49.19% in treatment, ranking ninth out of 13 regions (23).

These figures are more encouraging; however, the evaluation of compliance should focus on the correct completion of forms and sociodemographic data rather than clinical aspects. We believe that our results can provide input for metaxenic strategies and other managers looking to improve training, infrastructure, and political commitment to addressing dengue. In the case of the Peruvian Social Security Health System (ESSALUD), 42 clinical records as of March 2024 from cities Piura, Lambayeque, La Libertad, Ancash, and Ica, were audited. It was found that the frequencies of notification to epidemiology surveillance, recording of the date of onset of symptoms, observation/hospitalization, parenteral hydration, recording of vital functions, and request for at least one blood count were 62%, 83%, 83%, 76%, 71%, and 91%, respectively (24). The National Health Ministry Health System made similar observations.

Even in patients with DWS, the high mortality rate of 18% is striking. Other probable causes include related comorbidities (which were not measured in this study) and limitations in diagnosis and case management. In a recent systematic review of our country, out of 17 publications between 1993 and 2023, including 10 regions of Peru and 2310 patients, mortality was 1.73% (25). The significant variation in mortality could potentially be attributed to our study's bias, as we exclusively included patients from Piura, our non-random sampling method, and the severity of our patients (20.7% of those who had severe dengue). However, in the exploratory multivariable analysis, the presence of at least one error in the hospital and in the health center, was not ultimately associated with mortality. This could be attributed to biases in the sample size (140/158) and sample design (consecutive), as well as the challenges of applying a retrospective checklist, which, despite training, may have measurement biases. Only dengue severity and age over 18 years, were associated with higher mortality.

There has been serious criticism of the efficiency of the reference and counter-reference systems in Peru. The referral process took more than 2 hours for more than 60% of patients (26). According to

the regional government, the hospital where the study took place has approved the formation of a counter-referral team, but its implementation is still under development (27). Meanwhile, over 30% stayed in triage for over four hours. Understaffing and insufficient areas of attention are possible explanations. The current National Technical Standard mandates that in DWS, medical care should begin in less than 30 minutes, with immediate intravenous hydration; in SD, immediate attention is needed (5). This study has found many challenges in implementing these measures.

Regarding the observation/Uviclin area's findings (55% of "at least one error"), we could attribute these findings to time constraints, patient overload, burnout, unnecessary form filling (National Insurance/discharge procedures), and possibly a lack of organization. This area requires monitoring with practical protocols. It is also imperative to verify the proper operation of equipment and supplies.

Theoretically, hospitalized first-level health care facilities (I-3 and I-4) can handle dengue diagnosis and alarm signs by providing an immediate response based on hydration and vital sign monitoring (blood pressure, heart rate, respiratory rate, temperature, oxygen saturation, water and electrolyte balance, etc.), which forms the foundation of effective dengue management. These facilities typically have a basic laboratory that works between 12 and 24 hours for monitoring with a complete blood count, although dengue management is still clinical in the Americas, according to the WHO (28). Again, human resource training (3, 4), as well as a lack of clear and socialized processes, could explain this reality.

One of the study's limitations was that it did not meet the required sample size (n = 159 medical

records). Some of the reasons for this were the inability to find the clinical history, incomplete data in the follow-up, and a lack of digitization of data and processes. However, the limitations prevented a random sampling process. Likewise, the 2023 cases were limited to weeks 18–25 (the peak of the outbreak). However, we believe that these results can serve to support any effort in the implementation of the electronic health record to improve information management (29)(30). The Ministry of Health and the regional governments still have unresolved issues.

We firmly believe that there are various actions that the Government in alliance with universities, should apply to improve the processes of care for Dengue cases:

1. Improvement of information systems, which implies improving the infrastructure and interoperability of the systems that results in adequate registration of data and an improvement in health management.

2. Clarification and socialization of care processes in institutions and in reference and counter-reference processes between institutions.

3. Training through action-participation methodologies to achieve the involvement of administrative and clinical actors, evaluating the system's response before and after the interventions.

4. Commitment of the universities of the Piura region from undergraduate, postgraduate and specialization to generate joint work with the strategies of the Ministry of Health in the care of patients with dengue

In conclusion, we found a high frequency of errors in the diagnosis of severity and in the treatment of patients with DWS and SD in the pre-hospital and hospital phases, but the sample size was insufficient to determine whether this finding had an impact on mortality.

1. Pan American Health Organization. PLISA: Health Information Platform for the Americas [Internet]. Washington (DC): PAHO; [cited 2024 Feb 12]. Available from: https://opendata.paho.org/en

2. Peru. Ministerio de Salud. Centro Nacional de Epidemiologí´a, Prevencio´n y Control de Enfermedades. Sala situacional de dengue [Internet]. Lima: MINSA; [cited 2024 Feb 12]. Available from: https://www.dge.gob.pe/sala-situacional-dengue/diaria/

3. World Health Organization. Dengue and severe dengue [Internet]. Geneva: WHO; [cited 2022 Aug 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue

4. Pan American Health Organization. Dengue: guidelines for patient care in the Region of the Americas. 2nd ed. Washington (DC): PAHO; 2016. Available from: https://iris.paho.org/items/499a0290-7f8d-4bc8-865e-94e75eee06d5

5. Peru. Ministerio de Salud. Resolucio´n Ministerial N.° 082-2024-MINSA: Plan de prevencio´n y control del dengue 2024 [Internet]. Lima: MINSA; 2024 [cited 2024 Mar 26]. Available from: https://cdn.www.gob.pe/uploads/document/f ile/5813240/5156456-resolucion-ministerial-n-082-2024.pdf

6. Peru. Ministerio de Salud. Resolucio´n Ministerial N.° 175-2024/MINSA: Norma Te´cnica de Salud para la atencio´n integral de pacientes con dengue en el Peru´ [Internet]. Lima: MINSA; 2024 [cited 2024 Mar 10]. Available from: https://cdn.www.gob.pe/uploads/document/f ile/6007546/5323501-rm-175-2024-minsa-y-nts-211-dgiesp.pdf

7. Koonisetty KS, Aghamohammadi N, Urmi T, Yavaşoglu SI˙, Rahman MS, Nandy R, et al. Assessment of knowledge, attitudes, and practices regarding dengue among physicians: a web-based cross-sectional survey. Behav Sci (Basel). 2021;11(8):105. doi:10.3390/bs11080105

8. Laoprasopwattana K, Khantee P, Saelim K, Geater A. Mortality rates of severe dengue viral infection before and after implementation of a revised guideline for severe dengue. Pediatr Infect Dis J. 2022;41(3):211-216. doi:10.1097/INF.0000000000003411

9. Leo´n-Jime´nez FE, Inga-Chero JE, Mendoza-Farro NBF, Montoya-Rea´tegui A, Dioses-Dí´az K, Cavalcanti-Ramí´rez S, et al. Caracterí´sticas y errores ma´s frecuentes en el diagno´stico y tratamiento del dengue en un hospital del norte peruano, 2022. An Fac Med (Lima). 2023;84(2):210-212.

doi:10.15381/anales.v84i2.25494

10. Rodrí´guez J, Lastre G, Camargo J, Fuentes G, Bermejo J, Nieto V. Adherencia de los pacientes a la guí´a de pra´ctica clí´nica del dengue (GPC_Dengue) en una clí´nica de Barranquilla (Atl, Col). Cienc Innov Salud. 2015;3(2):23-30.

11. Valderrama Ardila M, Velasco M, Molina Lo´pez A, Perea Ayala M, Noguera Quin˜ones D, Rodrí´guez Arenas D, et al. Evaluation of the management of pediatric patients diagnosed with dengue in a medium-complexity children’s clinic, according to the new WHO guideline. Rev Colomb Salud Libre. 2011;9:33-44.

12. Peru. Ministerio de Salud. Estadí´stica poblacional [Internet]. Lima: MINSA; [cited 2024 Apr 18]. Available from: https://www.minsa.gob.pe/reunis/data/pobla cion_estimada.asp

13. Hospital de la Amistad Peru´ -Corea Santa Rosa II-2 [Internet]. Piura: Gobierno del Peru´; [cited 2022 Sep 23]. Available from: https://www.gob.pe/hsantarosa

14. Lake EA, Demissie BW, Gebeyehu NA, Wassie AY, Gelaw KA, Azeze GA. Knowledge, attitude and practice towards COVID-19 among health professionals in Ethiopia: a systematic review and meta-analysis. PLoS One. 2021;16(2):e0247204.

doi:10.1371/journal.pone.0247204

15. Carrera-Acosta L, Salvador-Salvador S, Torre-Maraví´ GE. Evaluacio´n de la adherencia de guí´as de pra´ctica clí´nica en el Seguro Social del Peru´. Rev Cuerpo Med HNAAA. 2021;14(4):430-431.

doi:10.35434/rcmhnaaa.2021.144.1355

16. Direccio´n Regional de Salud Piura. Capacitan al personal de salud para fortalecer las intervenciones sanitarias contra el dengue [Internet]. Piura: Gobierno del Peru´; 2023 [cited 2023 May 30]. Available from: https://www.gob.pe/institucion/regionpiura-diresa/noticias/752982-capacitan-al-personal-de-salud-para-fortalecer-las-intervenciones-sanitarias-contra-el-dengue

17. Direccio´n Subregional de Salud Morropo´n Huancabamba. Fortalecen capacidades de personal de salud para una mejor atencio´n de pacientes con dengue en el Alto Piura [Internet]. Piura: Gobierno del Peru´; 2023. Available from:

https://www.gob.pe/institucion/regionpiura-dsrsmh/noticias/768037-fortalecen-

capacidades-de-personal-de-salud-para-una-mejor-atencion-de-pacientes-con-dengue-en-el-alto-piura

18. Peru. Ministerio de Salud. Piura: me´dicos son capacitados para atender a pacientes afectados por dengue [Internet]. Lima: MINSA; 2024 [cited 2024 Mar 26]. Available from: https://www.gob.pe/institucion/minsa/notici as/843478-piura-medicos-son-capacitados-para-atender-a-pacientes-afectados-por-dengue

19. Direccio´n Regional de Salud Piura. Ma´s de 1,200 enfermeras son capacitadas para enfrentar al dengue en la regio´n Piura [Internet]. Piura: Gobierno del Peru´; 2024 [cited 2024 Mar 26]. Available from: https://www.gob.pe/institucion/regionpiura-diresa/noticias/900660-mil-200-enfermeras-son-capacitadas-para-enfrentar-al-dengue-en-la-region-piura

20. Fondo de las Naciones Unidas para la Infancia. Sí´ntesis metodolo´gica n.° 8: evaluacio´n de impacto [Internet]. Florencia: UNICEF Office of Research-Innocenti; [cited 2023 Jun 6]. Available from: https://www.unicef-irc.org/publications/pdf/MB8ES.pdf

21. Balkrishnan P, Panda PK, Pandey RM, Biswas A, Aggarwal P, Vikram NK, et al. Compliance of WHO guideline on dengue management among Indian patients: an interventional quality improvement study. J Assoc Physicians India. 2019;67(4):30-34. PMID:31299835.

22. Wharton-Smith A, Green J, Loh EC, Gorrie A, Omar SFS, Bacchus L, et al. Using clinical practice guidelines to manage dengue: a qualitative study in a Malaysian hospital. BMC Infect Dis. 2019;19(1):45. doi:10.1186/s12879-019-3680-5

23. Peru. Ministerio de Salud. Direccio´n de Prevencio´n y Control de Enfermedades Metaxe´nicas y Zoonosis. Evaluacio´n de adherencia a normas te´cnicas de salud [Internet]. Lima: MINSA; [cited 2024 Apr 15]. Available from:

https://lookerstudio.google.com/u/0/reportin g/695d47ab-cb34-48ee-b1dc-471925689515/page/xpKkD

24. Instituto de Evaluacio´n de Tecnologí´as en Salud e Investigacio´n. Evaluacio´n de adherencia a la Guí´a de Pra´ctica Clí´nica para la atencio´n de casos de dengue en el Peru´ en EsSalud, al 12/03/2024 [Internet]. Lima: EsSalud; 2024 [cited 2024 Apr 15]. Available from: https://ietsi.essalud.gob.pe/wp-content/uploads/2024/03/Reporte.pdf

Franco E. León Jiménez1,a,b; Nathaly BF. Mendoza-Farro2,c; Adriana Montoya Reategui1,d; Joel Emmanuel Inga-Chero3,4,e; Karim M.V. Dioses1,5,f; Moisés Barranzuela-Herrera1,g;Sofia Cavalcanti Ramírez1,h; Luz M. Moyano6,i from INERTROP working Group.

ABSTRACT

RESUMEN

INTRODUCTION

MATERIAL AND METHODS

RESULTS

DISCUSSION

REFERENCES