“I kept bleeding. When I drank water, I could see blood in the bottle and taste it in my saliva,” recalls Hawiah vividly on her encounter with severe dengue.
Dengue fever remains a major public health concern in Malaysia, with thousands of cases reported annually. In 2024 alone, there were 122,423 cases and 117 deaths, continuing the upward trend in fatalities since 2021.[1] [2] [3] The country’s tropical climate and rapid urbanisation create ideal breeding conditions for mosquitoes, contributing to dengue’s persistence and placing individuals at constant risk of infection.
While dengue affects both men and women, emerging insights reveal that women may bear a disproportionate burden of the disease—not just physically, but also socially and economically.
Impact of Dengue on Women
Dengue may not discriminate, but its effects on women can be particularly severe due to physiological, social, and economic factors.
“Women are more likely to develop severe dengue and dengue haemorrhagic fever [4] due to physiological factors [5] – our immune system tends to mount a stronger response to the virus, leading to higher viral loads and increased inflammation,” explains Dr Hon Mun Cheng, a consultant paediatrician. “Additionally, women have lower blood volume [6], which makes them more susceptible to hypovolemic shock, a dangerous complication of severe dengue.”
Dr Hon also highlights the role of capillary leakage in dengue severity among women. As women’s blood vessels naturally allow more fluid to pass through their walls, they are more prone to bruising and internal bleeding. This is especially concerning for women who contract severe dengue while menstruating, as they are at risk of excessive bleeding [7], alongside other symptoms such as abdominal pain, persistent vomiting, mucosal bleeding such as gum and nose bleeds, and plasma leakage [8].
These factors significantly increase the risk of severe complications, requiring close medical monitoring, especially in women with low platelet counts or anaemia – conditions that are more common in women than in men.
Dr Hon explains that pregnant women face an even greater risk from dengue infection, which can have serious consequences for both mother and child. She noted that dengue during pregnancy can lead to low birth weight, premature birth, stillbirth, and an increased risk of maternal death. Additionally, the virus can be transmitted to the baby in the womb, potentially causing severe dengue with haemorrhagic symptoms in the baby. [9] [10] [11]
Beyond the physiological risks [12], women often carry a heavier social and emotional burden when it comes to dengue. As primary caregivers in many households, women are responsible for looking after children, elderly parents, and sick family members. However, when they themselves fall ill, they may have limited support or feel compelled to downplay their symptoms to continue their caregiving responsibilities.
“Delaying care can come at a high personal cost as dengue progresses rapidly, and without timely intervention, complications can become life-threatening,” says Dr Hon.
The situation can become even more challenging if access to healthcare services is limited by financial constraints, lack of childcare options and other socioeconomic factors. Women from lower income groups may lack the means to seek treatment while those in informal employment may face financial difficulties if they are unable to work. This may cause women to delay medical attention, choosing instead to prioritise their families over their own health.
These interconnected factors create a cycle where women are more vulnerable to severe dengue outcomes simply because they struggle to prioritize their health.
A Survivor’s Story: The Devastating Impact of Severe Dengue
For Hawiah Azit, a 45-year-old mother, her battle with severe dengue was one of the most traumatic experiences of her life.
“It started with just fever then severe headaches for a few days. My parents took me to a GP’s clinic near my house and I was only prescribed Paracetamol, without any further tests, and went home,” she recalls. “I knew little about dengue, so I just took Paracetamol, drank lots of water, and hoped it would pass.”
Despite feeling very sick, she travelled to her hometown for a wedding, where her condition worsened, and she was diagnosed with dengue at a nearby hospital.
“By then, I was bleeding from my nose and gums, and I collapsed in the bathroom. When they transferred me to Hospital Raja Permaisuri Bainun in Ipoh, I couldn’t even climb onto the bed by myself. My blood platelet levels kept dropping. I had a terrible headache and was shivering so badly I thought I was going to die.”
The days that followed were agonizing. “I kept bleeding. When I drank water, I could see blood in the bottle and taste it in my saliva. After two weeks, I was exhausted—physically and emotionally.”
Even after discharge, it was a long time before she regained her strength and appetite. “I used to play volleyball and work out on weekends but having severe dengue changed all that. I could barely eat, and I felt drained for weeks.”
“Now, as a mother and wife, I am constantly worried for my family. I have a 15-year-old daughter, and my husband is a high-risk individual with comorbid conditions, and he has already suffered dengue twice,” says Hawiah.
“When I was younger, I didn’t know any better, but now I do. I’ve realised how important it is for a primary caregiver to be empowered with knowledge. My experience has also made me vigilant about dengue prevention—so when I learned about vaccination, I got my family vaccinated.”
Empowering Women in the Fight Against Dengue
In light of the heavier burden women face, there is an urgent need to equip women with the knowledge and resources to protect themselves and their families.
Dr Hon emphasises the importance of education in recognising early symptoms of dengue. “Women need to be empowered with the right information so they can understand the risks and take action early. If you have persistent fever, severe body aches, bleeding symptoms, or prolonged fatigue, please seek medical attention immediately.”
Equally important is ensuring that women have the support they need to access healthcare. Supporting those affected by dengue are collective responsibilities that can be achieved through cooperation between neighbours and other community members. Whether it’s financial assistance, childcare support, or workplace flexibility, removing barriers to medical care can significantly improve outcomes for women affected by dengue.
While women often take the lead in dengue prevention at home, maintaining health is a shared responsibility – one that involves the entire family, the community, and every Malaysian in order to make an impact.
Community-driven efforts remain essential, such as keeping neighbourhoods clean and eliminating mosquito breeding sites, alongside personal measures such as covering exposed skin and the use of repellents to prevent mosquito bites. In addition to these measures, Dr Hon also recommends that patients speak to their doctors about vaccination, incorporating this measure as part of an integrated approach to prevention.
Experts suggest that increasing community vaccination uptake can help reduce severe dengue cases and hospitalisations, lessening the strain on both families and the healthcare system. In this way, vaccination can play a vital role in reducing the burden of dengue, particularly for high-risk groups, including young children, elderly persons, those with pre-existing medical conditions, and those who have previously suffered a dengue infection [13]. Those living in or travelling to areas with high rates of dengue infections would also benefit from protecting themselves through vaccination, added Dr Hon.
“Mosquitoes don’t recognise social or economic barriers—anyone can get dengue, and it is impossible to predict who will suffer the most. There is also no single means of protection that is completely effective, or any specific treatment for dengue,” says Dr Hon. “That’s why prevention is essential, and it must be a community effort – when we protect ourselves, we also protect others.”
Furthermore, tackling dengue is aligned with the aims of World Health Day to ramp up efforts to prioritise women’s longer-term health and well-being, including an end to preventable maternal and newborn deaths.
As Hawiah puts it, “We cannot take dengue lightly, and severe dengue takes a really heavy toll, especially on women. It’s painful, it’s dangerous, and it can change lives forever. But with the right prevention methods, we can protect ourselves and our loved ones.”
With ongoing education and empowerment, individuals and communities, as well as healthcare systems and government agencies, can work together more closely to prevent dengue. By adopting integrated preventive measures, from vector control to vaccination, we can move towards a future where dengue no longer weighs so heavily on women and other vulnerable communities.
**The views expressed in this article are those of the health expert and are based on her professional experience and opinion.
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[1] Kenyataan Media Kementerian Kesihatan Malaysia. Situasi Semasa Demam Denggi Di Malaysia Tahun 2024
[2] Kenyataan Media Kementerian Kesihatan Malaysia. Situasi Semasa Demam Denggi Di Malaysia Tahun 2022
[3] Kenyataan Media Kementerian Kesihatan Malaysia. Situasi Semasa Demam Denggi Di Malaysia Tahun 2021
[4] Sangkaew, Sorawat et al. Risk predictors of progression to severe disease during the febrile phase of dengue: a systematic review and meta-analysis. The Lancet Infectious Diseases, Volume 21, Issue 7, 1014 – 1026
[5] Huy NT, Van Giang T, Thuy DHD, Kikuchi M, Hien TT, Zamora J, et al. (2013) Factors Associated with Dengue Shock Syndrome: A Systematic Review and Meta-Analysis. PLoS Negl Trop Dis 7(9): e2412. https://doi.org/10.1371/journal.pntd.0002412
[6] Sharma R, Sharma S. Physiology, Blood Volume. In: StatPearls. Treasure Island (FL): StatPearls Publishing; April 10, 2023.
[7] Tangnararatchakit K, Chuansumrit Ampaiwan, Chaiyaratana W et al. Letters to the Editor: Excessive Menstrual Bleeding in Adolescents With Dengue Infection. The Pediatric Infectious Disease Journal 29(1):p 92-93, January 2010. | DOI: 10.1097/INF.0b013e3181bf5406
[8] The BMJ. Assessment and management of dengue | The BMJ
[9] Chong V, Tan JZL, Arasoo VJT. Dengue in Pregnancy: A Southeast Asian Perspective. Trop Med Infect Dis. 2023;8(2):86. Published 2023 Jan 27. doi:10.3390/tropicalmed8020086
[10] Centers for Disease Control. Dengue During Pregnancy | Dengue | CDC
[11] Malavige GN, Sjö P, Singh K, Piedagnel JM, Mowbray C, et al. (2024) Facing the escalating burden of dengue: Challenges and perspectives | PLOS Global Public Health
[12] Huy NT, Van Giang T, Thuy DHD, Kikuchi M, Hien TT, Zamora J, et al. (2013) Factors Associated with Dengue Shock Syndrome: A Systematic Review and Meta-Analysis. PLoS Negl Trop Dis 7(9): e2412. https://doi.org/10.1371/journal.pntd.0002412
[13] Centers for Disease Control and Prevention. Increased Risk of Dengue Virus Infections in the United States
