Febrile convulsion (FC) in children below age five is a common childhood health condition particularly in deprived areas. FC is the commonest seizure disorder among children aged 9 months to 5 years  compared to about 5 percent of all children in developed countries . In 2015, FC accounted for 30 per cent of all under-five mortality cases in Ghana . An earlier report ranked FC the 8th leading cause of admission in the country with a total of 12,901 children. Although FC is one of the commonest emergency concerns received in health facilities in Ghana, several incidences are also not reported .
The direct cause of FC is unknown. It is associated with genetic, intrauterine, metabolic abnormalities, and vaccination related factors  as well as other socio-cultural factors [6,7]. In Ghana and Nigeria, most mothers from rural communities attributed FC to witchcraft, evil spirits and fever [6, 7, 8, 9]. In Turkey, the attribution of FC to supernatural spirits is reported as well . Further, family history of epilepsy and complex convulsions are known risk factors for FC [11,12]. As such, FC is a major source of worry for caregivers, particularly mothers [8,9].
Clinical and home diagnosis of FC include febrile confusion, twitching, increased body temperature, breath-holding attacks and evolving epilepsy syndrome [5,8,9,13,14]. Elsewhere, traditional healers attribute each sign to a spiritual force . Febrile convulsion, and its treatment can result in several neurological, cognitive and behavioural impairments [5,16,17]. Although, disease treatment is heavily influenced by beliefs about its cause, available studies in Ghana are health facility based [6,8,9], and centred on parents’ reflections, neglecting rural contexts including deprivation, influence of older relatives and traditional healthcare practitioners who are indigenous knowledge bearers and key illness decision makers in rural context. This study therefore explored the perceived causes and diagnosis of FC from a rural context. Also included are parents’ experiences during episodes of convulsion.
Contextual and Theoretical Issues
Context matters in the discussion of health and illness. Usually, the context defines the knowledge system that drives the conceptualisation of persons to define the causation of illness. In most local communities, such as the study areas of the present study, the local [indigenous] knowledge system influence the perceptions of and related practices of community members. These perceptions are usually handed over from the older to the younger generation. Typically, local knowledge relates to three main dimensions which are the natural, social or behavioural and spiritual dimensions. Thus, the perceptions and beliefs about the causes, and by extension, diagnosis of all forms or types of illnesses are underpinned by these three main dimensions, or their constellations . For instance, some local communities and people have the perceptions that diseases could be contracted from genetic factors [5,19], poor dietary practices and unacceptable social behaviour , and curses or witchcraft attacks [6,9].
From a theoretical perspective, the health belief model has been applied. The Health Belief Model (HBM) was developed by social psychologists in the United States to explain the common failure of people to participate in programmes aimed at preventing and detecting disease [21,22]. HBM contains key constructs that predicts why parents will take actions to prevent, diagnose or treat their children illnesses based on their beliefs about disease causes. The six (6) HBM constructs are perceived susceptibility, seriousness, benefits and barriers to behaviour, cues to action, and more recently, self-efficacy.
Since the early 1950s, the HBM has been one of the widely used frameworks in health belief research. It has been applied to study convulsion as well. For instance, HBM has been applied to study FC in Arak City [23,24,25). In Turkey and Vietnam, HBM was also applied to study convulsion [10,26]. Thus, parents/grandmothers who regard their children as susceptible to febrile convulsion (FC), believe that FC is dangerous and can have potentially serious consequences (perceived seriousness), believe that a course of FC action would be beneficial in preventing the consequences of FC such as complex seizures, mental retardations, disability and untimely death (perceived benefit), and believe the anticipated benefits of taking action which includes perceived benefit, outweigh barriers of action (perceived cost), experiences a cue to action such as past experience of FC, childhood fever, or reports of FC in the communities, and have the confidence to make personal decisions (self-efficacy) regarding childhood conditions are more likely to take actions based on these beliefs. This study will employ qualitative methods to explore the internal validity of the HBM constructs across multiple participants involved in FC care, and the sources of such beliefs.
The major limitation of HBM in relation to this study is that, the HBM constructs view parents or individuals as personal decision makers thereby failing to account for behaviours under social and affective control, of which FC is typical. For instance, the role of parental decisions or intentions, and the influence – approval or disapproval that significant others’ may have on the decision/intention.