This study assessed the knowledge of childhood fever and knowledge and practices on home management of a febrile child among 400 PCGs of children admitted with fever, together with their socio-demographic predictors. To the authors’ knowledge, this is the first study assessing knowledge and practice of different aspects of home management namely temperature measurement, antipyretic use, physical measures to reduce temperature and supportive care in Sri Lanka, a developing country.
Results were analyzed considering guidelines and recommendations (12, 13). It revealed that less than half of the PCGs correctly identified the normal body temperature, while 52% knew of the temperature changes during the day. Blumenthal reported that 30% of the parents in the United Kingdom (UK) did not know the normal body temperature (14). A national survey conducted by Bertille et al in France revealed that 11% of parent’s defined fever by a threshold lower than that recommended by the French drug agency and 66% of parents considered a lower cut off temperature for starting antipyretic drug treatment (15). The knowledge on the causes of fever was better than the knowledge on effects of fever. These findings highlighted that effective health education messages should be appropriately targeted based on evidence (15).
One major finding is that 40% had not used a thermometer for measuring the temperature although 96% have identified it as the best method. This might be due to lack of purchasing power of a digital thermometer, or simply due to the fact the PCGs think that touch method is also as effective. It was also seen that use of mercury (33%) thermometer and digital (27%) thermometers were comparable. In contrast a study in Iran showed that the most common method of temperature measurement was the forehead fever strip, the reason being that many mothers being unable to read a mercury thermometer (16). However, in India (Agrawal ) 75% of the parents used the digital thermometer and the rest used the mercury thermometer (10).
The recommendations in the NICE guidelines is to use axillary or tympanic method although, mainly based on safety issues (13). The national guidelines do not recommend oral temperature measurement (12). In this study 58.7% used the axillary method which is lower than the rate reported in India which was 80%. (10). Similarly, Polat et al in 2012 (17) revealed that the technique of measuring the body temperature by the caregivers in Turkey was not satisfactory as caregivers stated that they were not certain about the correct site (90%) and the best type of thermometer (95%) for body temperature measurement. Therefore, it is seen that although identifying temperature is seemed a simple technique there are gaps in correct practices in various parts of the world.
Fever reducing physical measurements techniques showed varying patterns and are comparable with Gunduz et al study in Turkey where around half of the mothers used fever-reducing techniques, such as the application of tepid cloths and cold baths, cologne and vinegar (18). Similarly in USA nearly 75% of the parents surveyed used sponging, although two thirds of them performed the technique incorrectly with alcohol, cold water or cold rags (19).
In the present study 99% of the study sample had given paracetamol to their children at home before visiting the medical practitioner. The use of antipyretics among children before accessing medical care with fever ranged (32.3%- 90.3%) across the globe (10,20, 21,22,23). Antipyretics are available over the counter in Sri Lanka. Considering the above it remains a doubt whether all these children needed paracetamol as the knowledge on normal body temperature values, fever temperature values, the practices on the method of identification of fever and the technique of measuring body temperature were inadequate among the PCGs as discussed earlier.
In this study, 6.5% of the PCGs had given a low dose of paracetamol while nearly 25% of them had given it in an unsafe manner (overdose or at potentially toxic level). Although only 1% of the study population thought that giving an overdose is not harmful, 4.7% had given a higher dose of paracetamol intentionally. Similar to this study, Chiappini et al showed that one third parents thought that a higher dose of an antipyretic is not dangerous (4). The carers may believe that a higher dose will bring the fever down faster, not realizing that it can harm the child. This may be due to the excessive worry and anxiety of the PCGs (20,21). Fever management education should highlight the correct dose of antipyretic, method of calculating it correctly, administrating at the correct frequency as well as the possible harmful effects if given in an overdose. It is prudent that parents are properly educated regarding fever management, to ensure that correct antipyretics are safely administered.
This study revealed that 31.5% of the study population determined the dose of paracetamol according to the advice obtained from friends, relatives or a previous visit to a medical officer or by their own experience. Bertille et al also reported that the parents administered the paracetamol according to a previous prescription for the same child (15). Since the current age of the child as well as the weight have increased since obtaining the previous prescription, this method can lead to an under dosing of the antipyretic. The present study showed that 49.7% of the study population gave paracetamol 4–6 hourly while another 48.2% gave at more than 6 hourly intervals, while only 0.8% gave at less than 4 hourly intervals in an unsafe manner. Bertille et al found that 24% of the parents who administered paracetamol and 14% who administered ibuprofen, complied with the recommendations (15).
Our investigation has potential limitations and interpretation of findings should be done accordingly. The findings of this study cannot be generalised to the entire population in Sri Lanka since the study population was the PCGs of children admitted to the premier government teaching hospital for children at a highly urbanised location. Rural areas were not well represented. The PCGs in this study who admitted their children to the government hospital may be different from those who admitted their children to certain private hospitals in Sri Lanka, where the level of comfort might be different. In Sri Lanka people coming to the government hospitals do not have to pay for the care they receive. Thus, some groups such as those with a high-income level, those in certain occupations and in high educational level may not be represented within this population due to difference in health seeking behaviour. Practices were assessed based on self-report and not on observations. Thus, the findings may be different to what was actually carried out at home.