Mothers' perceptions of fever in children

Knowledge, attitudes, and practices toward over-the-counter antipyretics among fever patients: a cross-sectional study in the context of a policy change KAP of OTC antipyretics

Background

On January 8, 2023, a change in the control policy for COVID-19 was implemented in China, whereby patient self-management of fever typically entails the utilization of over-the-counter fever-reducing medications.

Objective

This study aimed to investigate the knowledge, attitudes, and practices (KAP) toward over-the-counter (OTC) antipyretics among fever patients.

Methods

This cross-sectional study was conducted between October 2022 and February 2023 at author's hospital in Wuhan, China, among fever patients on OTC antipyretics, using a self-administered questionnaire.

Results

A total of 481 valid questionnaires were collected, with the age of 36.05 ± 12.10 years, including 240 (49.90%) males, and 209 (43.45%) collected before policy change. The knowledge, attitudes, precautions for medication administration and decision-making practices scores were 6.86 ± 3.30 (possible range: 0-12), 16.67 ± 2.46 (possible range: 7-35), 29.98 ± 5.41 (possible range: 7-35) and 27.87 ± 1.28 (possible range: 8-40), respectively. The multivariable logistic regression analysis showed that knowledge (OR = 0.83, 95%CI: 0.81-0.92, p < 0.001) was independently associated with positive attitude. Knowledge (OR = 1.41, 95%CI: 1.28-1.56, p < 0.001), attitude (OR = 0.87, 95%CI: 0.79-0.95, p = 0.004), suburban (OR = 0.45, 95%CI: 0.23-0.88, p = 0.019) were independently associated with proactive precautions for medication administration practices. Knowledge (OR = 1.14, 95%CI: 1.07-1.22, p < 0.001), attitude (OR = 0.90, 95%CI: 0.82-0.98, p = 0.018), responding after policy change, 2023 (OR = 1.70, 95%CI: 1.10-2.63, p = 0.016) were independently associated with proactive decision making practices.

Conclusion

Fever patients had moderate knowledge, negative attitude, proactive precautions for medication administration practices, moderate decision-making practices. After the policy change, there was a significant increase in knowledge regarding medication administration precautions and decision-making.

Understanding the context of healthcare utilisation for children under-five with diarrhoea in the DRC: based on Andersen behavioural model

BACKGROUND

Diarrhoea is one of the leading causes of death among children under 5 years old in the Democratic Republic of the Congo (DRC). Despite positive effects on prognosis, there is limited literature about the healthcare-seeking behaviours of children with diarrhoea, especially in the DRC. This study used the Andersen Behavioural Model, a theoretical framework, which was commonly adopted to study healthcare utilisation, to investigate and predict factors associated with the use of healthcare to treat diarrhoea in the DRC.

METHODS

Data collected from 2626 under-five children with diarrhoea in the last 2 weeks from the Multiple Indicators Cluster Survey conducted by the National Institute of Statistics in 2017-2018, in collaboration with the United Nations Children's Fund were used in this study. Both direct and indirect relationships among four latent variables: predisposing traits, enabling resources access, health needs, and health services use were measured using the structural equation modelling to test the Andersen behavioural model. The confirmatory Factor Analysis model was also modified based on the DRC context to explore this further.

RESULTS

The modified model had the goodness of fit index (GFI) of 0.972, comparative fit index (CFI) of 0.953 and RMSEA of 0.043 (95% CI: 0. 040, 0.047). Health needs (especially diarrhoea) had the largest positive direct effect on healthcare utilisation (standardized regression coefficient [β] = 0.135, P < 0.001), followed by "enabling resources" (β = 0.051, P = 0.015). Health needs also emerged as a mediator for the positive effect of predisposing on utilisation (indirect effect, β = 0.014; P = 0.009).

CONCLUSION

Access to improved water and improved sanitation, as well as socioeconomic factors like household wealth, were significantly associated with health-seeking behaviours for diarrhoea treatment in the DRC. Besides, caregivers who own higher levels of educational attainments were more inclined to have positive health services uses during the treatments. Efforts are needed to enhance the oral rehydration therapy coupled with educating caregivers on its appropriate use.

A Qualitative Study of Parents' Conceptualizations on Fever in Children Aged 0 to 12 Years

Many parents experience “fever phobia”, based on misconceptions regarding the repercussions of fever in their children. The aim of this paper was to explore the conceptualizations of parents who are health professionals and parents without health qualifications on childhood fever. This qualitative study was based on grounded theory using a triangulated sample (theoretical sampling and snowball sampling) of parents of children aged 0 to 12 years old who received care for fever in the Emergency Primary Care Services two in Spanish municipalities. Data collection was based on focus groups segmented by gender, place of residence and education. Data analysis followed the constant comparative method and involved a coding process. Results show that independently of the parents’ place of residence or education, their perceptions of fever were somewhat ambivalent, beneficial at times, but also harmful. Parents acknowledged feelings of concern, fear, being overwhelmed, freezing up and relief once the fever was controlled. Health professional parents considered they had an extra responsibility for caring. Finally, parents without health education demanded more information from professionals. These results provide key information for the design of interventions directed at the management of fever in children.

Beliefs, Practices and Health Care Seeking Behavior of Parents Regarding Fever in Children

Background and objectives: Fever in children is one of the most common reasons for seeking medical attention. Parents often have misconceptions about the effects to fever, which leads to inappropriate use of medication and nonurgent visits to emergency departments (ED). The aim of this study was to clarify the beliefs on the effects and management of fever and to identify healthcare seeking patterns among parents of febrile children in Latvia. Materials and Methods: Parents and legal guardians of children attending ED with febrile illness were included in the study. Participants were recruited in Children’s Clinical University Hospital (CCUH) in Riga, and in six regional hospitals in Latvia. Data on beliefs about fever, administration of antipyretics, healthcare-seeking behavior, and experience in communication with health care workers were collected via questionnaire. Results: In total, 355 participants were enrolled: 199 in CCUH and 156 in regional hospitals; 59.2% of participants considered fever itself as indicative of serious illness and 92.8% believed it could raise the child’s body temperature up to a dangerous level. Antipyretics were usually administered at median temperature of 38.0 °C, and the median temperature believed to be dangerous was 39.7 °C; 56.7% of parents usually contacted a doctor within the first 24 h of the illness. Parents who believed that lower temperatures are dangerous to a child were more likely to contact a doctor earlier and out-of-hours; 60.1% of participants had contacted their family doctor prior their visit to ED. Parental evaluation of satisfaction with the information and reassurance provided by the doctors at the hospital was higher than of that provided by their family doctor; 68.2% of participants felt safer when their febrile children were treated at the hospital. Conclusions: Fever itself was regarded as indicative of serious illness and potentially dangerous to the child’s life. These misconceptions lead to inappropriate administration of antipyretics and early-seeking of medical attention, even out-of-hours. Hospital environment was viewed as safer and more reassuring when dealing with febrile illness in children. More emphasis must be placed on parental education on proper management of fever, especially in primary care

Principles, practices and knowledge of clinicians when assessing febrile children: a qualitative study in Kenya

Background

Clinicians in low resource settings in malaria endemic regions face many challenges in diagnosing and treating febrile illnesses in children. Given the change in WHO guidelines in 2010 that recommend malaria testing prior to treatment, clinicians are now required to expand the differential when malaria testing is negative. Prior studies have indicated that resource availability, need for additional training in differentiating non-malarial illnesses, and lack of understanding within the community of when to seek care play a role in effective diagnosis and treatment. The objective of this study was to examine the various factors that influence clinician behavior in diagnosing and managing children presenting with fever to health centres in Kenya.

Methods

A total of 20 clinicians (2 paediatricians, 1 medical officer, 2 nurses, and 15 clinical officers) were interviewed, working at 5 different government-sponsored public clinic sites in two areas of Kenya where malaria is prevalent. Clinicians were interviewed one-on-one using a structured interview technique. Interviews were then analysed qualitatively for themes.

Results

The following five themes were identified: (1) Strong familiarity with diagnosis of malaria and testing for malaria; (2) Clinician concerns about community understanding of febrile illness, use of traditional medicine, delay in seeking care, and compliance; (3) Reliance on clinical guidelines, history, and physical examination to diagnose febrile illness and recognize danger signs; (4) Clinician discomfort with diagnosis of primary viral illness leading to increased use of empiric antibiotics; and (5) Lack of resources including diagnostic testing, necessary medications, and training modalities contributes to the difficulty clinicians face in assessing and treating febrile illness in children. These themes persisted across all sites, despite variation in levels of medical care. Within these themes, clinicians consistently expressed a need for reliable basic testing, especially haemograms and bacterial cultures. Clinicians discussed the use of counseling and education to improve community understanding of febrile illness in order to decrease preventable deaths in children.

Conclusion

Results of this study suggest that since malarial testing has become more widespread, clinicians working in resource-poor environments still face difficulty when evaluating a child with fever, especially when malaria testing is negative. Improving access to additional diagnostics, continuing medical education, and ongoing evaluation and revision of clinical guidelines may lead to more consistent management of febrile illness by providers, and may potentially decrease prescription of unnecessary antibiotics. Additional interventions at the community level may also have an important role in managing febrile illness, however, more studies are needed to identify targets for intervention at both the clinic and community levels.

Electronic supplementary material

The online version of this article (doi:10.1186/s12936-017-2021-7) contains supplementary material, which is available to authorized users.

La fiebre en el niño: una mirada reflexiva a las prácticas de cuidado

Objetivo: Realizar un análisis crítico-reflexivo de las prácticas rutinarias de los profesionales de enfermería y de los cuidadores familiares en el cuidado del niño con fiebre, a fin de incentivar un cuidado basado en evidencia científica que asegure el bienestar infantil.Síntesis de contenido: Se realizó una revisión bibliográfica de artículos científicos publicados entre los años 2007 y 2017, en las bases de datos ebscohost, ScienceDirect, medline, PubMed, cinahl, Web of Science y cuiden®, para lo cual se utilizaron los descriptores y sus combinaciones en español, portugués e inglés Fiebre; Cuidadores; Niño. Se elaboró un compendio de 45 artículos seleccionados y analizados que contenía las prácticas de cuidado con convergencias, divergencias y complementariedades.Los resultados se agruparon en los siguientes cinco temas: Concepción histórica de la fiebre; La fiebrefobia:una concepción en las actuales prácticas de cuidado; El baño de esponja:una práctica ancestral controvertida; El uso de antipiréticos: una rutina en contravía de la salud y la vidade los niños; La fiebre: en busca de una mirada desde su beneficio.Conclusiones: La concepción de la fiebre infantil centrada en el miedo y en el daño permanece. Las acciones de cuidado más comunes, como el baño de esponja y el uso/abuso de antipiréticos, son cuestionadas desde la evidencia científica, demostrando los efectos deletéreos que producen en la salud del niño. El cuidado del niño, después de una evaluación individualizada, deberá enfocarse en el confort, en un ambiente fresco y tranquilo y en el aumento de la ingesta de líquidos para evitar la deshidratación u otras complicaciones.

Mothers' Experiences about Febrile Convulsions in Their Children: A Qualitative Study

BACKGROUND

Febrile convulsion in children is a frightening experience for the mothers. This experience may have unknown aspects, which must be investigated in order to plan better support for the mothers and children. This study is conducted with the aim of exploring the experiences of mothers whose children suffer from febrile convulsion.

METHODS

This study was based on a qualitative content analysis. 12 mothers in Amir Kabir hospital of Arak city participated in the study and shared their experiences through semi-structured interviews. The gathered data were analysed using Graneheim and Lundman's (2004) method.

RESULTS

Exploring the experiences of mothers whose children suffered from febrile convulsion reflected three themes: perceived threat, seeking solution, and difference in adaptation.

CONCLUSION

Regarding the findings of this study, comprehensive supportive care plans can be designed for enabling the mothers to better cope with their children's febrile convulsion.