This study examined home management of febrile conditions in children by caregivers before presenting at the Children Emergency (CHER) clinics of secondary and tertiary health facilities in Anambra state. A cross sectional survey design was employed for the study. Every consenting caregiver whose child was between zero and five years, and had fever as one of the presenting symptoms were purposively selected and recruited for the study. Such children must have been presented at CHER clinics between June and September 2009 in secondary and tertiary health facilities that met the inclusion criteria for the study. The population studied was 131 caregivers who gave their informed consent prior to the study. A self-developed questionnaire and observation guide were used for data collection after the face validity and reliability were determined by experts. The reliability of the test instrument was obtained as 0.92. Descriptive and inferential statistics were used to analyze the data. The results were presented in tables as percentages, graphs, means and standard deviations. Chi-square was used to determine the level of independence of the independent variables at 0.05 level of significance while Z-test was used to determine proportional significance of the respondents. Results of the study revealed that a significant proportion (Zcal7.7085>Ztab1.96), comprising 123(93.9%) of the caregivers first treated their febrile children at home before reporting to the health facility. In addition, the immediate actions taken by a significant proportion (Zcal6.10>Ztab1.96) of the respondents, comprising 99(80.5%) of the caregivers were removing of clothing and exposing the child to air, and administering Syrup Paracetamol and antibiotics, respectively. The commonest home remedies used by caregivers were herbal preparations. However, the proportion of respondents comprising 84 (75.7%) caregivers that utilized home remedies were not statistically significant (Zcal1.85<Ztab1.96). The results further revealed that the condition of the child when brought to the health facility for management was not dependent on educational status (X2=5.090;df=3;P=0.165) and parity (X2=2.659;df=4;P=0.616) of caregivers; while occupation had a significant relationship (X2=26.818,df=4,P=0.000) with the condition of the child when brought to the health facility for management. A significant proportion (Zcal7.522>Ztab1.96) comprising 120(91.6%) caregivers specified their reason for treatment at home as a ‘first aid’ measure. The proportion of cases that survived when brought to the health facility for management was also statistically significant (Zcal7.279>Ztab1.96). Thus, the outcome of the study suggests that treatment practices at home by caregivers constitute major determinants of the outcome of management of febrile conditions at health facility.
Background to the study
A wide range of childhood illnesses are accompanied by fever which constitute a common presentation at health facilities in Nigeria and other countries in Sub-Saharan Africa. According to United Nation’s report, mortality rate amongst the under fives in Nigeria is put at 178 per 1000 (United Nations Organization, 2001). A major cause of this mortality is febrile conditions, which are not only preventable but also curable provided treatments are sought promptly and from appropriate centers (WHO/UNICEF, 2001). According to Feyisetan, Sola and Ebigbola (1997), the term febrile condition refers to a state of being feverish with body temperature above the normal, that is, above an oral temperature of 370 C (98.60 F) or a rectal temperature of 37.20 C (990 F) in children. It occurs when various infectious and non-infectious processes interact with the host’s defense mechanism (Behrman, Kliegman & Nelson, 1992). Febrile condition in children is usually associated with malaria, measles, acute respiratory infections especially pneumonia, whooping cough, and diarrhoea among others.
Oshikoya and Senbanjo (2008) reported that malaria and respiratory tract infections are the two common causes of fever in Nigerian children. Oshikoya (2007) posited that malaria accounts for over 60% of outpatient visit in Nigeria and other Sub-Saharan African countries. In a country like Nigeria where malaria is highly endemic, a recent history of fever is enough a criterion for diagnosis of uncomplicated malaria (WHO, 2001) and antimalarial drug treatment of all children with fever is recommended where the availability and use of laboratories are limited (Nicoll, 2000).
Most childhood febrile conditions are treated at home by caregivers prior to presentation at a health facility. A health facility in this context is either a general hospital which is a secondary health facility where early diagnosis and treatment to prevent further damage to the sick individual are made; or a teaching hospital which is a tertiary health facility where sick individuals from secondary health facility are referred to in order to reduce damage from disease and restore function). Home care of febrile conditions is a very common practice among caregivers in Nigeria (Fawole & Onadeko, 2001; Salako, Brieger & Afolabi et al. 2001). Deming, Gayibor, Murphy, Jones and Karsa (1989) in Oshikoya and Senbanjo (2008) stated that in Togo, only 20% of the children with suspected fever are seen at health facility while the remaining 80% are treated at home with an antimalarial drug. In Nigeria, Fawole and Onadeko (2001) reported that between 60% and 80% of children would have been treated at home prior to reporting at health facilities. Majority of these children are treated with antimalarial drugs.
Emeka (2005) posited that a significant disadvantage of treatment received outside health facilities is the absence of appropriate evaluation by trained health professionals which could result in missed alternative diagnosis and delays in appropriate treatment. Therefore, it is important to assess the type of management caregivers render to the children with febrile conditions at home before bringing them to a health facility since the type of management given at home may have an impact on the management outcome at the health facility.