PROJECT ABSTRACT
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.
CHAPTER ONE
Introduction
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.
Thus, this study examined the home management of febrile conditions in children by caregivers who attend Children Emergency (CHER) clinics in secondary and tertiary health facilities in Anambra state.
Statement of the problem
Febrile conditions in children constitute a common presentation at health facilities in Nigeria and other countries in Sub-Saharan Africa (Nicoll, 2000; Sule, 2003). The two major causes are malaria and respiratory tract infections (Oshikoya & Senbanjo, 2008). Fawole and Onadeko (2001) reported that home treatment for childhood febrile conditions is a common practice among caregivers in Nigeria while medical experts believe that high death rate ascribed to febrile conditions is due to wrong home management of these conditions (Iloeje, 1989).
From the researcher’s subjective experience as a practicing nurse, several cases of children with febrile conditions had been seen rushed into the Children Emergency unit often too late to be helped. This experience has often created a strain between the health personnel and the caregivers, one accusing the other of negligence. The question now arises: Since mortality associated with febrile conditions could be prevented, why do these children still die? What exactly are home management practices given by caregivers before coming to the hospital? Home management of children with febrile conditions may have significant effect on the outcome of care at the health facilities because such care is often inappropriate. It is critical to prevent wrong home management of febrile conditions by caregivers through evidence-based information. All these prompted the researcher to engage in this study.
Purpose of the study
The purpose of the study is to examine home management of febrile conditions in children by caregivers before reporting to CHER clinics in secondary and tertiary health facilities in Anambra state.
Specifically, the objectives of the study include to:
- Determine the immediate actions caregivers take when children present with febrile conditions at home.
- Identify the various home remedies used by caregivers when children present with febrile conditions.
- Determine some of the demographic characteristics of the caregivers (such as education, occupation and parity) in relation to their use of home remedies.
- Identify the reasons for the actions caregivers take in the management of febrile conditions at home.
- Determine the outcome of management of febrile conditions in children who had been managed at home prior to seeking care at health facility.
Research questions
- What are the immediate actions caregivers take when children present with febrile conditions at home?
- What are the types of home remedies caregivers use in the management of febrile conditions?
- What are the demographic characteristics of the caregivers (such as education, occupation and parity) in relation to their use of home remedies?
- What are the reasons for the actions taken by caregivers in the management of febrile conditions at home?
- What is the outcome of management of febrile conditions in children who had been managed at home prior to seeking care at health facility?
Hypotheses
- There is no significant relationship between the caregivers’ educational status and condition of the child when brought to the hospital.
- There is no significant relationship between the caregivers’ occupation and condition of the child when brought to the hospital.
- There is no significant relationship between the parity of the caregivers and condition of the child when brought to the hospital.
Significance of the study
Results of the study will provide information on the immediate actions taken by caregivers at home in the management of children with febrile conditions. Findings from the study will also enable the health personnel to identify the various home remedies used by caregivers at home when their children present with febrile conditions prior to seeking care in the health facility. These would highlight the possible dangers which such children are likely to face and prepare the health personnel to develop evidence based strategies for effective management of febrile conditions already treated at home and also for health education of caregivers on appropriate and effective ways of managing febrile conditions at home.
Findings from the demographic characteristics of the caregivers such as education, parity and occupation will be useful in understanding how these characteristics influence the caregivers’ use of home remedies and their effect to the child’s condition.
Also, findings from the study will reveal the reasons for actions taken by caregivers in the management of febrile conditions at home. This will give the health personnel an insight on the basis on which health decisions are made at home and therefore will inform further intervention(s) to either reinforce what they have or discourage it.
Findings from the outcome of home management of the child on presentation to the health facility will enable the health personnel to prepare them to target interventions to meet those needs.
Academically, this work will be of immense benefit to future researchers in related field because it will become a source of reference to them.
Scope of the study
The study is delimited to all home caregivers who bring their children to CHER clinics in secondary and tertiary health facilities in Anambra state at the time of the study.
The study is also delimited to home management of febrile conditions in children between zero and five years.
The variables included in the study are: immediate actions taken by caregivers at home before reporting to the health facility; types of remedies used at home and reasons for using them; demographic characteristics of caregivers as they relate to their use of home remedies as well as the outcome of home management of the child on presentation to the health facility.
Operational definition of terms
Caregiver: a person that takes care of a child at home such as mother, grandmother, father or house help.
Children: persons aged between zero and five years (0-5years).
Condition of the child: the severity (complicated or uncomplicated) of fever in a child
based on management given so far at home by caregivers.
Febrile condition: rise in child’s body temperature as reported by the caregiver such as feeling of hotness as caregiver places the back of her/his palm on child’s forehead
Home management: actions taken by caregivers for a child having fever such as exposing the child, fanning the child, bathing with cold water, use of drugs like paracetamol among others; home remedies such as herbal preparations, among others.
Home remedies: They are locally made preparations used at home for treatment of fever such as hibiscus tea, palm kernel oil- ‘udeaki’, Oscarium basihaum- ‘nchuanwu’ among others.
Immediate actions: initial treatment given to a child having fever at home by caregivers such as exposing the child, fanning the child, bathing with cold water, use of drugs like paracetamol among others.