الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
Fever “pyrexia” is a common symptom, and a frequent sign of illness that occurs in childhood. All children experience fever at some time point during their development, and growth. Fever is a human body’s temperature above the normal temperature range values, and is defined as a body temperature equal to or exceeding 38°C. It occurs due to the rise of body’s temperature hypothalamic set-point as a vital part of the body’s controlled biological response to immunological, and inflammatory disorders, and infection, which accounts for most of childhood fevers. Fever in children is responsible for 20% to 30% of the parental visits to doctors, and is known to be the leading cause for medical consultation, and the most frequently encountered reason for pediatric emergency visits.
Despite being an effective natural defensive mechanism, fever is regarded by most of parents as a harmful condition, and a stressful event to be eliminated although it has been proven to be a benign defense mechanism that stimulates the immune system to work better in order to overcome infections. Parents become anxious regarding the control of their children’s elevated body temperature thinking that maintaining a “normal” temperature in their feverish children is crucial ignoring that fever itself is neither a harm nor a disease, it is a beneficial mechanism that helps the child’s body fight and beat infections.
The term “fever phobia”, created 40 years ago, shed the light on the unrealistic fears experienced by parents due to childhood fever. Researchers have highlighted that from 1980s until now childhood fever remains a disturbing, and a stressful event for the majority of parents, and that is a reflection of parental misconceptions and false beliefs that still exist in spite of the available educational resources.
It has been proven that parental knowledge regarding childhood fever definition, mechanism, signs, and symptoms, benefits, causes, complications, importance of proper body temperature measurement and fever management is inadequate in a lot of communities including developed and developing countries. That is a primary reason for parental mismanagement, and poor practices in childhood fever.
Misconceptions and negative beliefs about fever are wide-spread among parents in various cultures. Those false beliefs are mainly about fever consequences such as febrile seizures, brain damage, intellectual impairment, heart disease, meningitis, coma, blindness, disability, and even death. So, negative beliefs resulted in fever mismanagement practices as parents manage childhood fever in an aggressive way to lower body temperature in all possible ways. That indicates poor parental practices that could possibly lead to negative consequences on child’s health.
Poor practices among parents about childhood fever have been reported across the world. The use of non-pharmacological strategies as bathing, and cold compresses use may be harmful to children. Besides, a lot of parents give antibiotics to their feverish children without a prescription. Moreover, they may overuse one antipyretic or different antipyretics in a single fever episode in order to lower child’s body temperature.
Fever in children is usually detected by their parents. It is worth mentioning that it can be safely, and easily managed at home using many available supportive treatments. Home management includes rest, giving extra fluids, and using safe antipyretics if needed. However, the key to well managed childhood fever is to know how and when to manage it at home, and when to seek medical evaluation.
Health education programs directed to parents are crucial to reduce parental fear of fever, and to raise their knowledge about fever in children. In addition, enhancing parental knowledge about childhood fever and its proper management improves parents’ self-confidence. As a result, feverish children receive adequate home care. Educational programs should provide parents with all the information required for proper care for their feverish children.
This study aims to study knowledge, beliefs, and practices regarding childhood fever and its management among parents of children aged 2-12 years in Primary Health Care Centers, and units (PHCs) in Alexandria, and the specific objectives were:
1) To assess parental knowledge, beliefs, and practices regarding childhood fever and its management,
2) To investigate the relationship between parental knowledge, beliefs, and childhood fever management practices among parents.
This study was conducted in eight randomly selected family healthcare units and centers from four randomly selected health districts in Alexandria using a cross-sectional approach.
A predesigned structured interview-based questionnaire was prepared to collect the required information from participating parents of children aged (2-12) years. It included: socio-demographic data, data on parental knowledge, data on parental beliefs, and data on parental practices regarding childhood fever and its management. Three hundred and sixty parents (360) participated in the study, and were interviewed for evaluating their level of knowledge, beliefs, and practices regarding fever in children and its management.
The study revealed the following main results:
Section I: Sociodemographic characteristics of participating parents:
- The age of parents ranged between 20 – 58 years with a mean of 32.68 ± 6.80 years.
- The majority of parents were mothers (84.7%), and 15.3% were fathers.
- More than a third of parents (35.6%) had university education or post-graduate degree, more than one quarter of participating parents (28%) had primary or preparatory education. About 9% of parents were illiterate.
- Less than a fifth of parents (17.8%) had one child, about half of parents (45.8%) had 2 children, a quarter of parents (25%) had 3 children, 8.6% had 4 children, and only 2.8% had 5 children or more.
- The majority of mothers (84.6%) were not working (housewives), while only 5.5% of fathers were not working.
Section II: Assessment of parental knowledge regarding childhood fever and its management:
- More than half of parents (55.5%) had poor knowledge regarding childhood fever and its management, more than two fifths (42.8%) had moderate knowledge, and only 1.7% had good knowledge.
Section III: Assessment of parental beliefs regarding childhood fever and its management:
- The majority of parents (85.3%) had negative (false) beliefs regarding childhood fever and its management, 13.9% had undetermined beliefs, and only 0.8% had positive beliefs.
Section IV: Assessment of parental practices regarding childhood fever management:
- More than half of parents (55.3%) had poor practices regarding childhood fever management, more than two fifths of parents (43.3%) had moderate practices, and only 1.4% had good practices.
Section V: The relationship between parental sociodemographic characteristics, knowledge, beliefs, and practices regarding childhood fever and its management:
- Parental practices were significantly positively correlated with parental beliefs (rs=0.362, p<0.001) as well as knowledge (rs=0.561, p<0.001). Also, parental beliefs were significantly positively correlated with parental knowledge (rs=0.316, p<0.001).
- Parental knowledge was significantly correlated with older parental age (rs=0.326, p<0.001) higher education level (rs=0.420, p<0.001), higher family income (rs=0.681, p<0.001), and positive parental beliefs (rs=0.361, p<0.001).
- Parental beliefs were significantly correlated with higher parental education level (rs=0.251, p<0.001), higher family income (rs=0.361, p<0.001), and good parental knowledge (rs=0.316, p<0.001).
- Parental practices were also significantly correlated with older parental age (rs=0.331, p<0.001), higher parental education level (rs=0.434, p<0.001), higher family income (rs=0.643, p<0.001), good parental knowledge (rs=0.561, p<0.001), and positive beliefs about childhood fever and its management (rs=0.362, p<0.001).
- Significant positive predictors of parental knowledge were: parental age (B=0.237 (0.046 – 0.429), p=0.015), education level (B=6.190 (5.134 – 7.246), p<0.001), and family income (B=3.763 (0.878 – 6.648), p=0.011).
- A significant positive predictor of parental beliefs was the family income (B=3.275 (1.899 – 4.651), p<0.001).
- Significant positive predictors of parental practices were: parental age (B=0.079 (0.030 – 0.127), p=0.002), education level (B=1.065 (0.752 – 1.379), p<0.001), family income (B=1.137 (0.405 – 1.869), p=0.002), parental knowledge (B=0.053 (0.026 – 0.079), p<0.001), and parental beliefs regarding childhood fever and its management (B=0.024 (0.005 – 0.044), p<0.014).
Based on the results of the present study, the following can be concluded:
- Parents had poor level of knowledge, negative beliefs, and poor practices about childhood fever and its management.
- Parental practices were significantly positively correlated with parental beliefs as well as knowledge. Also, parental beliefs were significantly positively correlated with parental knowledge.
- Parental knowledge was significantly correlated with older parental age, higher education level, and higher family income.
- Significant positive predictors of parental knowledge were: parental age, education level, and family income.
- Parental beliefs were significantly correlated with higher parental education level, and higher family income.
- The significant positive predictor of parental beliefs was the family income.
- Parental practices were also significantly correlated with older parental age, higher education level, and higher family income.
- Significant positive predictors of parental practices were: parental age, education level, family income, parental knowledge, and beliefs regarding childhood fever and its management.
6.3. Recommendations
A. Recommendations for the Ministry of Health and Population (MoHP)
Educational programs directed to parents should be planned, and implemented at a national scale to improve parental knowledge, and practices, as well as to correct the wide-spread negative beliefs and misconceptions regarding childhood fever and its management.
Large-scale programs directed to pediatricians should be periodically implemented to provide them with the most recent guidelines regarding childhood fever to enhance, and update their knowledge and practice.
Programs targeting pediatricians’ communication skills are crucial to help them convey their medical information to parents and caregivers adequately.
Large-scale programs aimed at pharmacists have been urgently required; as in many Egyptian communities such as villages and slums, the pharmacist is often the first medical practitioners who can assist parents with feverish children. Pharmacists must receive proper training in order to effectively advise and guide parents.
Community Outreach Programs should be conducted with the help of highly qualified health care workers such as nurses and health counselors, who can directly engage
with parents and caregivers. These programs can include interactive workshops, group discussions, and one-on-one counseling sessions to address specific concerns and provide personalized guidance.
Pediatric pneumococcal vaccines are recommended to be included in the national routine immunization schedule for children according to the World Health Organization recommendations.(65)
B. Recommendations for pediatricians:
The syndicate of physicians should include private pediatric clinics in the national plans to update the overall pediatricians’ practice regarding childhood fever and its management.
C. Recommendations for pharmacists:
It is crucial for pharmacists to receive sufficient education and stay updated on the topic of fever in children, and how to manage it, so they can effectively advise and support parents.
The syndicate of pharmacists should include community pharmacists in the national initiatives to update their practice regarding childhood fever and its management.
D. Recommendations for parents:
Seek child’s health information mainly from pediatricians, and avoid taking medical information from non-medical persons or channels.
Follow the pediatrician’s instructions regarding your child’s health, and in case of having fears or concerns, discuss them with the pediatrician to receive the proper advice.
E. Recommendations for researchers:
Studies with larger sample sizes, and in various settings should be conducted in the future with long term follow up approach, in order to ensure the effectiveness of the interventions applied.