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HOME MANAGEMENT OF FEBRILE CONDITIONS IN CHILDREN BY CAREGIVERS BEFORE PRESENTING AT THE CHILDREN EMERGENCY CLINICS OF SELECTED HEALTH FACILITIES

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Topic Description

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:

  1. Determine the immediate actions caregivers take when children present with febrile conditions at home.
  2. Identify the various home remedies used by caregivers when children present with febrile conditions.
  3. Determine some of the demographic characteristics of the caregivers (such as education, occupation and parity) in relation to their use of home remedies.
  4. Identify the reasons for the actions caregivers take in the management of febrile conditions at home.
  5. 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

  1. What are the immediate actions caregivers take when children present with febrile conditions at home?
  2. What are the types of home remedies caregivers use in the management of febrile conditions?
  3. What are the demographic characteristics of the caregivers (such as education, occupation and parity) in relation to their use of home remedies?
  4. What are the reasons for the actions taken by caregivers in the management of febrile conditions at home?
  5. 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

  1. There is no significant relationship between the caregivers’ educational status and condition of the child when brought to the hospital.
  2. There is no significant relationship between the caregivers’ occupation and condition of the child when brought to the hospital.
  3. 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.

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