Management Of Fever In Children Research Articles

Survey of knowledge, practice, and associated factors toward home management of childhood fever among parents visiting Gondar health facilities in 2022.

Fever is a typical symptom of many sicknesses, but for children under the age of five, fever can have devastating consequences and represents a source of worry for parents. To the best of our knowledge, no research on home management of fever in children has been conducted in Ethiopia. We aimed to assess knowledge, practices, and associated factors towards home management of childhood fever among parents visiting Gondar Town health facilities in 2022. This multicenter institutional-based cross-sectional study was conducted in Gondar public health facilities from June 1st-June 30th, 2022. Participants were fathers and mothers of children aged 0-5 years. A stratified random sampling technique was used. Data were collected through face-to-face interviews using a pretested structured questionnaire. Approximately, 40.2% (95% CI: 35.5%, 45.2%) of parents had good knowledge and only 12.8% (95% CI: 9.7-15.8) of parents practiced home fever management. Being married [Adjusted odds ratio [(AOR) = 2.1 (1.2, 3.2)], having a primary or higher level of education [AOR = 2.4 (1.17, 4.9)] [AOR = 2.0 (1.02-4.6)], respectively, and number of children [AOR = 1.8 (1.63, 2.03)] were factors associated with parental knowledge. Likewise, being married [AOR = 3.05 (2.27.50-3.83)], receiving counseling from health care providers [AOR = 2.12 (1.53-3.32)], and being male [AOR = 2.03 (1.50-3.00)] were significant predictors of practice. Inadequate levels of knowledge and numerous irrational practices related to home fever management were predominant among parents, which needs to be addressed. Evidence-based health education is essential for parents to enhance their level of knowledge and practice to effectively treat fever at home.

Fever education for caregivers in the emergency room (The FEVER study)-an interventional trial.

Despite the vast majority of fevers representing benign self-limiting illnesses, caregiver anxiety regarding fever is high. Empowering caregivers with knowledge to safely and appropriately manage fever at home has the potential to reduce demands upon healthcare services. To improve caregiver knowledge about fever and its management in children via an educational intervention. Caregivers of children over 6 months presenting with fever to a Paediatric Emergency Department were recruited. A pre-intervention survey was completed to ascertain caregiver knowledge about fever and its management. The intervention of (i) an infographic about fever, with (ii) a short video on fever was viewed. A post-intervention survey re-assessed knowledge. The primary outcome was the correct definition of fever as a temperature ≥38 °C. Caregivers (n = 51) who correctly defined fever increased from 41% (n = 21) pre-intervention to 94% (n = 48) post-intervention. There was a reduction in common misconceptions about fever, including a higher fever representing a more serious infection (76% vs. 8%). Caregivers reported they were less likely to seek emergency healthcare due to the height and nature of the fever alone. A simple brief educational intervention can rapidly increase caregiver knowledge about fever in children. There is a continuing need for clear, easily-accessible information for caregivers on this topic. Parental knowledge about fever and how to manage it in their children is low. A simple brief educational intervention can significantly increase caregiver knowledge about fever. A combined written and audiovisual approach is effective and well-received by parents. Educating caregivers has the potential to improve the management of childhood fever at home and to reduce the burden on healthcare services, as well as reduce unpleasant hospital visits for children and their caregivers.

Home Management of Fever in Under-Five Children: Knowledge, Attitude and Practice among Mothers Attending a Paediatric Outpatient Clinic in Port Harcourt, Nigeria

Fever is a common problem in children especially in under-fives. Most fevers start outside the hospital thus management of fevers at home may limit complications from febrile illnesses. This study assessed mothers’ knowledge, attitude and practice of home management of fever in under-five children. It was a cross-sectional study and data was analyzed using SPSS version 23. Of 219 respondents, majority were of age group 31-40 years 114(52.1%) and of middle social class 56(50.0%). Most respondents correctly defined fever 165(75.3%), knew the causes of fever 149(68.0%), and the correct site of measurement using a thermometer 114(52.1%) but did not know high body thermometer 132(60.3%). Majority knew fever could be managed at home 184(84.0%) and was harmful 207(94.5%). The commonest source of information about fever was obtained from health workers/hospitals 118(54.9%). more than half of respondents had thermometers 141(64.4%), knew how to use it 136(62.1%) and would measure their child’s temperature at home if fever was suspected 161(73.5%). Most would monitor their child’s temperature at home 191(87.2%), would manage child’s fever at home 171(78.1%), would visit the hospital because of child’s fever 204(93.2%) and would do so within 2-3 days of onset of fever 59(40.1%). Only about a third of respondents had good knowledge (39.7%) and good practice (33.2%) on the home management of fever in children while about half (59.8%) had good attitude. Massive enlightenment campaigns on home management of fever should therefore be carried out so as to reduce complications that could arise from unduly high temperature at home. Keywords: Knowledge, Attitude, Practice, Fever, Home management

Parental knowledge, attitudes, and practices towards childhood fever among South-East and East Asian parents: A literature review.

The aim of this literature review was to identify, summarize, and critically appraise available empirical articles on the knowledge, attitudes, and practices towards childhood fever management among South-East and East Asian parents. A literature review following PRISMA. Articles were limited to those available in the English language. Articles had to be empirical studies that used a qualitative or quantitative research design with full-text available; focus on parental knowledge, attitudes, and practices towards fever; and be published in South-East and East Asia. Searches were conducted with CINAHL, PubMed and Scopus from inception to June 2022, and eleven articles were included after removing duplicates and excluding irrelevant articles. Narrative synthesis was conducted according to four themes: source of fever information, knowledge level, attitudes, and practices towards childhood fever. Parents showed different fever knowledge needs and various information-seeking behaviors. A low level of fever knowledge was revealed in terms of temperature, fever causes, potential harms and influencing factors. South-East and East Asian parents mainly reported anxiety, concerns and fever phobia. Fever assessment methods and fever management strategies varied based on parents' cultural background and beliefs. The findings of this review highlight that inadequacy of fever knowledge and negative attitudes towards childhood fever exist in South-East and East Asian parents. Parents have diverse cultural practices during their children's febrile episodes. However, some of them conflict with current medical guidelines, as they prioritize fever and body temperature reduction. This raises questions about their effectiveness and safety. Although some of them are medically discouraged, there are others that have been proven beneficial for the symptomatic relief of childhood fever. The results indicate an urgent need to develop a cultural-sensitive educational intervention for childhood fever management among South-East and East Asian parents. Unified educational interventions are needed to address parental concerns and fever-related knowledge needs.

Determinants of caregiver's knowledge and practices regarding childhood fever management in a developing setting: a multi-centre cross-sectional assessment.

Fever is both a sign of various diseases (chief of which are infectious in nature) and an adverse effect of certain interventions (e.g. vaccines, drugs) in the pediatric population. It elicits anxiety among caregivers and healthcare professionals alike resulting in non-evidence based practices, adverse medication administration events, waste of scarce resources and overutilization of health facilities. The determinants of these practices among caregivers in the domiciliary contexts have not been well characterized in developing settings. We assessed the knowledge and practices of childhood fever and their determinants among caregivers in domiciliary settings in Northern Nigeria using a 41-item questionnaire between August 2020 and February 2021. The questionnaire is reliable (knowledge: Cronbach's Alpha = 0.689; practice: Cronbach's Alpha = 0.814) and collected data on a total of 2,400 caregiver-child pairs, who participated in the study. Over two-third (68.3%; 1,640) of the caregivers expressed fever phobic tendencies. Paracetamol was the most commonly used medication and constituted 31.3% of medication administration adverse events reported by the caregivers. Only one out of every six knowledgeable caregivers engaged in evidence-based home childhood fever management practices (7% vs. 41.6%) with being a primary caregiver [Knowledge: odd ratio (OR): 2.81, 95% CI: 0.38; 5.68; p value: 0.04; Practice: OR: 1.65, 95% CI: 0.09; 7.33; 0.02] and having a child/children aged ≤3 years (knowledge: OR: 7.03, 95% CI: 4.89; 9.67, p value: 0.003; practice OR: 3.11, 95% CI: 1.27; 8.59, 0.007) determining both the knowledge and practices of childhood fever management in a household. The knowledge and practice of childhood fever management among caregivers were sub-optimal with being a primary caregiver and having a child/children aged ≤3 years being the significant determinants of each domain. These gaps underscore the dire need for targeted strategies aimed at improving childhood fever management by educating caregivers.

Parents' management of childhood fever: An exploratory quantitative study in Malta

Every child will, at some stage in their development, experience a febrile episode that their caregiver will have to manage. Literature has reported that parents tend to misdiagnose fever, administer antipyretics incorrectly and become overly anxious about their child when febrile. This study aimed to explore the fever management behaviours of parents in Malta. A quantitative, explorative cross-sectional study was conducted in Malta's acute hospital, Mater Dei, by distributing questionnaires to parents of children aged 6 months–5 years. The results showed that although most Maltese parents diagnose fever at the correct temperature, many are not aware of the correct evidence-based practices for safe pharmacological and non-pharmacological fever management. It is concluded that more dissemination of information is needed to educate and empower parents to manage fever effectively through health professionals other than paediatricians.

Knowledge, attitudes, and practices of mothers regarding childhood malaria in southeastern Gabon

BackgroundIn Gabon, children under 5 years of age and pregnant women are the populations who are most at risk of malaria. Despite the presence of accessible health facilities, the community-based management of childhood fever remains a very common practice in Gabon, which may have serious consequences on child health. As such, the objective of this descriptive cross-sectional survey is to assess the mothers’ perception and knowledge of malaria and its severity.MethodsDifferent households were selected using the simple random sampling method.ResultsA total of 146 mothers from different households were interviewed in the city of Franceville, in southern Gabon. Among the households interviewed, 75.3% had a low monthly income (below the minimum monthly income of $272.73). Among the respondents, 98.6% of mothers had heard of malaria and 55.5% had heard of severe malaria. Regarding preventive measures, 83.6% of mothers used an insecticide-treated net as a means of protection. Self-medication was practiced by 68.5% of women (100/146).DiscussionThe use of health facilities was motivated by better care, the decision of the head of the family, but above all by the severity of the disease. Women identified fever as the main symptom of malaria, which could be beneficial for a quicker and more efficient management of the disease in children. Malaria educational campaigns should also increase awareness of severe forms of malaria and its manifestations. This study shows that Gabonese mothers react quickly when their children have fever. However, several external factors lead them to practice self-medication as a first resort. In this survey population, the practice of self-medication did not depend on social status, marital status, level of education, on the young age or inexperience of mothers (p > 0.05).ConclusionsThe data revealed that mothers may underestimate severe malaria and delay medical care by self-medicating, which can have detrimental effects for children and hinder the regression of the disease.

Supratherapeutic utilization of paracetamol versus ibuprofen among

Paracetamol and ibuprofen are the most preferred analgesics for pain and fever management in children. Prescribing of these drugs in supratherapeutic doses may predispose to their toxicity. We aimed to compare prescribing patterns and potential overdosing of paracetamol and ibuprofen in primary care for <12-year-old children. We analysed paracetamol- and ibuprofen-containing prescriptions (PCPs, n = 173,575 and ICPs, n = 145,655) of 1- to 11-year-old children, issued by 3:1 systematically sampled primary care physicians (n = 1,431) in Istanbul during 2016. We compared drug use parameters and prescriptions surpassing daily and single-use dose limits for paracetamol and ibuprofen. We identified that 29.9% of PCPs and 20.8% of ICPs were generated for those aged 1-2 years. Concomitant analgesic use was higher in ICPs than in PCPs (15.1% vs. 12.8%). We found that 4.4% of PCPs and 3.1% of ICPs exceeded maximum daily dose limit of paracetamol and ibuprofen, respectively (P < 0.001). This was more common in girls (5.1% and 3.3%, respectively) and at 1 year of age in both groups (9.2% and 8.5%, respectively). Single-use supratherapeutic dosing was encountered in 16.5% of PCPs and 13.2% of ICPs (P < 0.001, pessimistic model) and in 8.6% of PCPs and 10.6% of ICPs (P < 0.001, optimistic model). Paracetamol and ibuprofen were generally used in primary care for similar clinical conditions with subtle differences. However, more pronounced in younger children and girls, potential overdosing seems to be more practiced for paracetamol than ibuprofen both in terms of maximal daily and single-use setting.

Effectiveness of Tepid Sponging along with Antipyretic Drug versus Only Antipyretic Drug in the Management of Fever among Children – A Randomized Control Trial

Background: Childhood fever remains a very significant health issue among parents. A wide range of childhood illnesses is accompanied by fever, leading to varied attempts at treatment by parents at home before reaching to hospitals. Common methods of treatment include the use of Antipyretics and Physical methods like tepid sponging. These methods have created varied attitudes among community. Hence this study was conducted to assess the efficacy of both methods of treatment among children with fever.&#x0D; Objectives: To compare the effectiveness in reducing the body temperature between use of antipyretic drug versus tepid sponging with antipyretic drug.&#x0D; Materials and Methods: A randomized control study was conducted for a period 18 months among 100 children of 6 months -12 years presenting with complaints of fever. The children were randomly allocated to Tepid sponging with antipyretic group and antipyretic alone group. The children were monitored for the reduction pattern of the temperature and vitals at various time intervals. The unpaired t test was used to compare means between groups and ANOVA test was used to compare means before and after intervention.&#x0D; Results: There no significant difference in reduction pattern of temperature among the groups at admission, half an hour, one and half hours and 2 hours post intervention (p&gt;0.001).There is a significant reduction in temperature from baseline till 2 hours post intervention in both groups. Pulse and Respiratory rate showed the potential efficacy of proposed treatment to reduce the pyrexia. As there is gradual normalization of vitals as pyrexia beings to subside (p&gt;0.001).&#x0D; Conclusion: Antipyretics was found to be one of the easier and cheaper intervention for administration when compared to physical methods in management of fever in children. Physical method like tepid sponging can be administered along with antipyretic medications to reduce the body temperature, both at home and healthcare facility by the parents or caregivers or paramedics for better and earlier relief from fever among children who don’t experience any discomfort during the procedure.

New insights into fever phobia: a pilot qualitative study with caregivers and their healthcare providers

Despite the availability of clinical guidelines on the correct symptomatic management of fever in children, several studies have reported inaccurate knowledge about this symptom and inappropriate management behaviours among caregivers. There is evidence that caregivers’ management of fever is largely influenced by unrealistic and unwarranted concerns about the potential harm that elevated body temperature can cause, a phenomenon commonly referred to as fever phobia. Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the influence of the relationship between caregivers and the healthcare team. The aim of this pilot study was to explore and describe fever-related knowledge, experience and behaviour among a sample of caregivers, paediatricians and their medical assistants in the Canton of Ticino, Switzerland. We used a qualitative study design with semi-structured, one-to-one interviews with paediatricians employed in private healthcare facilities, their medical assistants and caregivers with at least one child between the ages of 0 and 3 years. We conducted individual interviews either in person or by phone, according to participants’ preferences, between October 2020 and February 2021. We performed an inductive–deductive analysis of the transcripts to identify the most meaningful themes from participants’ reports. The analysis of the transcripts yielded three main themes. The first theme refers to participants’ awareness of the emotional component in managing the child’s fever and the challenges this component presents. The second theme refers to the risk of overtreating when the child’s right to be sick is not recognized and respected. The third theme refers to the importance of the relational component, showing how a solid therapeutic alliance with the healthcare team helps caregivers develop self-confidence in managing the child’s fever. This study contributes to advance our understanding of fever phobia and to a better conceptualization and operationalization of this phenomenon.Conclusion: Our results point out to the importance of going beyond a knowledge gap paradigm and recognizing both the emotional and the relational component of fever phobia, the former being entrenched in latter, that is, the unique relationship caregivers establish with their child’s paediatrician and the medical assistant.What is Known:• Research on fever phobia has predominantly focused on the role of fever misconceptions in triggering anxiety and impeding a proper fever management, in terms of both concept and operationalization, with little attention to the relational component of this phenomenon.What is New:• Our results point out to the importance of recognizing the emotional component of fever phobia, beyond its declarative and procedural knowledge dimensions. They also suggest that overtreating is not necessarily and not only the result of a phobia but also of a particular conception of health and the relational component of this phenomenon, which is entrenched in the unique relationship caregivers establish with their child’s paediatrician and the medical assistant.

Perception, knowledge and attitude towards childhood fever: A survey among final-year medical students.

Undue concerns about the consequences of fever and its inappropriate management have been documented worldwide among physicians. However, no data exist on medical students. We investigated the perception, knowledge and attitude towards childhood fever among final-year medical students. Between June and September 2021, final-year medical students of six Italian universities were invited to complete an online survey on their conceptions and attitude towards pharmacological and non-pharmacological management of childhood fever. History of relevant personal or second-hand experience with childhood fever was also addressed. Both quantitative and qualitative approaches were used. Of 1095 (69%) final-year medical students, 756 completed the survey. Many students believe that high fever might cause brain damage, would recommend physical methods and alternate two drugs for fever. Most students do not think that fever has mainly beneficial effects. In Northern Italy, students are less likely to believe that fever might lead to brain damage (OR 0.55, 95% CI 0.33-0.94), and in Southern Italy students are more likely to advise physical methods (OR 1.77, 95% CI 1.22-2.57) and less likely to believe that fever has mainly beneficial effects (OR 0.55, 95% CI 0.39-0.77). History of a relevant personal episode of fever during childhood was not associated with these outcomes. Misconceptions about fever are common among final-year medical students in Italy. Cultural factors rather than individually learned traits might underlie these beliefs. Medical students are a promising target for educational interventions to improve childhood fever management.

Clinical management of fever in children in Brazil: practical recommendations from an expert panel.

ABSTRACTThe objective of this study was to answer several questions related to the assessment and treatment of fever, as well as other controversies that exist during its management in pediatric patients. First, an advisory board with medical experts was conducted to discuss the clinical journey of these patients, considering the main challenges and possible solutions. After this discussion, a non-systematic literature review was performed, between November 2019 and January 2020, to collect the most relevant evidence available in the scientific databases MEDLINE, Lilacs, and SciELO. A narrative review was carried out based on scientific evidence and on extensive experience of experts in clinical practice. The experts developed a set of recommendations and clarifications about the assessment of the severity of fever in pediatrics, the need for treatment and the choice of the most appropriate antipyretic. The most common controversies in the management of fever in pediatric patients were also addressed, such as alternating antipyretics, persistent fever, and dose equivalence. In primary management of pediatric patients, fever should be seen as a relevant symptom that requires treatment with antipyretics in potentially more complex or severe cases, when it causes discomfort to children or is associated with infectious diseases.

Perception and practice regarding management of childhood fever among parents of under five children in tertiary level of hospital, Nepal

Background: Fever is an extremely common occurrence in paediatric patients and the most common cause for hospital visit. Lack of knowledge regarding childhood fever can cause distress and anxiety among parents. It is one of the main reasons parents seek reassurance and advice from health care professionals. The objective of the study was to assess the perception and practice regarding management of childhood fever among parents of under five children.Methods: The analytical cross sectional study design was conducted among 135 parents of under five children admitted in medical ward of Kanti childrens’ hospital. Kathmandu Nepal, from December 2019 to January 2020. Face to face interview was done for data collection. Self-developed five points Likert scale was used for assessing perception and checklist was used for practice. Obtained data were analyzed by using SPSS version 20, descriptive and inferential statistics was used.Results: Study shows that majority of respondents were of age less than 30 years and 81% were female. Greater part of respondents 71.8% had fair perception on childhood fever. At the same time, half of the respondents 50.4% had poor practices on childhood fever management. The level of perception is strongly associated with educational status (p=0.002) while level of practices is strongly associated with number of children (p=0.040 and residence (p=0.001) of respondents.Conclusions: Overall findings showed that more than two third of the respondents had fair perception towards childhood fever and about half of the respondents had poor practices of childhood fever management which concluded the need of educational intervention and additional research regarding childhood fever.

The effect of simulation-based education on parental management of fever in children: a quasi-experimental study

BackgroundFever is a sign of illness in children and parents should receive educational interventions based on their needs to provide effective care for children. Simulation-based education provided by nurses for managing children’s fever can help improve the quality of parental care. Accordingly, this study aimed to explore the effectiveness of simulation-based education in the management of children’s fever by parents.MethodsThis quasi-experimental study was conducted using a pretest-posttest design with two groups on 90 parents of children with fever who visited Afzalipour Teaching Hospital in Kerman, Iran. The participants were randomly divided into two groups. The members of the intervention group received simulation-based fever management education and the parents in the control group received routine interventions. A demographic information form and the Parental Fever Management Knowledge and Practice Scale were completed by the participants in both groups before and after the intervention. The collected data were analyzed with SPSS 21 at a significant level of 0.05 (P = 0.05).ResultsThe results of the study showed that there was a statistically significant difference between the mean scores of fever management knowledge in the intervention group before and after the intervention (30.51 ± 1.50 vs. 54.79 ± 2.55) (p < 0.05), while the control group showed no statistically significant difference before and after the intervention (29.81 ± 4.1 vs. 29.95 ± 2.80) (p > 0.05). Furthermore, there was a significant difference between the mean scores of fever management practice in the intervention group before and after the intervention (24.32 ± 0.89 vs. 37.51 ± 1.09) (p < 0.05). In contrast, the control group showed no statistically significant difference before and after the intervention (23.03 ± 0.90 vs. 21.98 ± 0.02) in terms of fever management practice (p > 0.05). The results of the independent samples t-test also showed that the mean scores of fever management knowledge and practice were not significantly different between the two groups before the intervention (p > 0.05) while there were significant intergroup differences after the intervention (p < 0.05).ConclusionThe results of the study showed that simulation-based education was effective in improving the parents’ child fever management knowledge and practice. Accordingly, professional care teams can prepare simulation-based education packages to improve parental care at home for children’s fever management.

Analysis of Nurses' and Physicians' Attitudes, Knowledge, and Perceptions toward Fever in Children: A Systematic Review with Meta-Analysis.

Context: Fever is a common symptom in children that nurses and pediatricians treat. Although it is a common sign in clinical practice, fever instills irrational fears in parents that health professionals share. Objective: To investigate whether doctors’ and nurses’ knowledge, perceptions, and attitudes toward fever influence how this sign is managed. Furthermore, it intends to evaluate whether educational programs increase knowledge and change attitudes and/or perceptions of nurses about children’s fever. Data Sources: A systematic review with meta-analysis was conducted with PRISMA international standards and the Cochrane recommendations. Study selection: Articles examining health professionals’ (doctors and/or nurses) knowledge, perceptions, and/or attitudes toward fever in children and the use of antipyretics were selected for the study. Data extraction: The qualitative analysis was carried out by classifying the articles according to the applied educational programs for nurses related to fever care for children that evaluated different outcomes to determine their efficacies. Results: For the qualitative synthesis, 41 articles were included, and 5 of these were taken in meta-analysis, which measured the effectiveness of educational programs for fever management in nurses. Limitations: All of the included studies generally had a high risk of bias. Conclusion: According to the evidence reviewed, nurses’ and physicians’ perceptions and attitudes regarding fever management in children indicate an overtreatment of this sign. We can give a recommendation grade of D on the use of educational programs to modify attitudes, perceptions, and knowledge about fever in children and improve clinical practice in nurses.

Knowledge, attitudes and practices of a selected group of parents on pre-hospital management of fever in children in a dengue-endemic area of Southern Sri Lanka

Introduction: Dengue is one of the hyperendemic diseases in Sri Lanka with high morbidity and mortality. This study was aimed to assess knowledge, attitudes and practices of group of parents on pre-hospital management of fever in their children. Methods: A cross-sectional study was conducted incorporating either one of the parents of 86 children with fever admitted to two paediatric units in Teaching Hospital Karapitiya and District General Hospital, Matara over two months during a dengue epidemic. A self -administered pretested questionnaire with demographic data and questions to assess knowledge, attitudes and practices regarding pre-hospital management of dengue was used. Results: There were 81 (94.2%) females. The majority (69.76%) had educated beyond GCE O/L. Only 27.9% knew that they have a risk of dengue. The majority (66.28%) had excluded dengue due to the presence of respiratory symptoms. More than half of the parents (55.81%) knew that treatment with NSAIDs could aggravate dengue but 32.56% preferred NSAIDs, due to misconception of pyrexia related cerebral injury. A large majority (89.53%) knew proper hydration is needed and had hydrated their children. However, only 33.72% knew that hospital admission is needed if fluid intake is inadequate and only 19.77% knew that hospitalisation is needed if urine output is low. Only 30.23% knew that full blood count (FBC) should be done on day 3 of illness and 45.34% of the participants had got it done before admission. The majority (65.1%) knew dengue NS1 antigen test and out of them 75% had got it done before hospitalisation. Conclusions: Despite living in an endemic area, only a few parents knew that their children were at a risk of contracting dengue. Inadequate knowledge about the symptoms, when to hospitalize and misconceptions on treatment of fever were highlighted. Therefore, educating the parents on specific facts is effective.

Symptomatic fever management in children: A systematic review of national and international guidelines.

Divergent attitudes towards fever have led to a high level of inconsistency in approaches to its management. In an attempt to overcome this, clinical practice guidelines (CPGs) for the symptomatic management of fever in children have been produced by several healthcare organizations. To date, a comprehensive assessment of the evidence level of the recommendations made in these CPGs has not been carried out. Searches were conducted on Pubmed, google scholar, pediatric society websites and guideline databases to locate CPGs from each country (with date coverage from January 1995 to September 2020). Rather than assessing overall guideline quality, the level of evidence for each recommendation was evaluated according to criteria of the Oxford Centre for Evidence-Based Medicine (OCEBM). A GRADE assessment was undertaken to assess the body of evidence related to a single question: the threshold for initiating antipyresis. Methods and results are reported according to the PRISMA statement. 74 guidelines were retrieved. Recommendations for antipyretic threshold, type and dose; ambient temperature; dress/covering; activity; fluids; nutrition; proctoclysis; external applications; complementary/herbal recommendations; media; and age-related treatment differences all varied widely. OCEBM evidence levels for most recommendations were low (Level 3-4) or indeterminable. The GRADE assessment revealed a very low level of evidence for a threshold for antipyresis. There is no recommendation on which all guidelines agree, and many are inconsistent with the evidence-this is true even for recent guidelines. The threshold question is of fundamental importance and has not yet been answered. Guidelines for the most frequent intervention (antipyresis) remain problematic.

Quality of Care Provided by Pediatric Nurses for the Management of Fever in Children

Background: Fever is a common childhood health problem faced by health care personnel including doctors, nurses and others in both hospitals and community settings. Lack of knowledge and the presence of conflicting information regarding management of children having fever influences the quality of care and children’s health. Purpose: To assess nurses’ knowledge and practices regarding management of fever in children. setting: The study was conducted in Pediatric Medical Department and Pediatric intensive care unit in Menoufia University Hospital. Design: A descriptive research was utilized to conduct the study. Sample: All nurses (48 nurses) who were working in the previously mentioned settings were included in this study. Instruments: Two instruments were used. Instrument one was a structured interviewing questionnaire. Instrument two was nurses’ clinical performance observational checklist. Results: Two thirds of nurses (64.4%) had unsatisfactory knowledge about fever. Also, all nurses had low level of practice regarding fever management. Conclusion: Nurses had unsatisfactory level of knowledge and low level of practices regarding management of fever in children. Recommendation: The study recommended that there was a serious need for improvement of nurses’ knowledge and practices in relation to fever management in children.

Effect of an Evidence Based Protocol for Childhood Fever Management on Quality of Care Provided by Nurses

Background: Fever is a common childhood health problem. Meanwhile, nursing research suggests that management of children with fever is not based on updated scientific evidence. For this reason, Purpose of the study: To assess the effect of an evidence- based protocol for childhood fever management on quality of care provided by nurses. Setting: The study was conducted in Pediatric Medical Department and Pediatric intensive care unit in Menoufia University Hospital. Research design: A quasi experimental (pre and post) was utilized to conduct the study. Sample: All nurses (48 nurses) who were working in the previously mentioned settings were included in this study. Instruments: Two instruments were used. Instrument one was structured interviewing questionnaire. Instrument two was nurses’ clinical performance observational checklist. Results: Nurses had higher mean of knowledge level about definition of fever on posttest compared to pretest (38.2±2.8 Vs 21.3±6.8). Also, they had higher level of practices related to fever management on posttest than pretest (45.1±2.1 Vs 11.1±1.3) Conclusion: Implementation of an evidence- based protocol improved quality of care related to fever management. Recommendations: The study recommended that ongoing in-service education programs about evidence- based fever management must be designed and implemented in all pediatric departments and pediatric intensive care units to improve quality of care provided by nurses for children having fever.

#32: Quality Improvement Strategies in the Management of Fever in Children with Cancer in a Third-level Hospital in Bolivia

Abstract Background The care of children with cancer requires systematic and standardized management to avoid complications associated with treatment, one of which is infection. Fever is an important sign of infection in a neutropenic patient and requires early management to avoid unfavorable outcomes. Many factors contribute to delays in recommended steps of fever management. The objective of this project was to measure the delay times associated with key steps in fever management and identify challenges and opportunities to improve this care process. Methods A prospective quality improvement project was initiated between June and November 2019 at the 25-bed oncology service of the Dr. Ovidio Aliaga Uria Children’s Hospital in La Paz. A data collection sheet was constructed and implemented including times for fever identification, blood culture collection, antibiotic order, and antibiotic administration. In parallel, we worked with the health personnel of this unit to deconstruct the process of fever management using block and flow diagrams. We jointly constructed an impact/effort matrix to prioritize key interventions. These interventions were developed to be implemented to improve this process. Results During these 6 months, data from 29 neutropenic patients who had a fever was collected. The average time elapsed from fever identification until blood culture collection was 4.9 hours (n = 28), time elapsed from fever to antibiotic initiation was 7.3 hours (n = 27), time between antibiotic order and administration was 1.6 hours (n = 26), and time between blood culture collection and antibiotic administration was 2.3 hours (n = 26). The interventions proposed through the effort/impact matrix as low effort and of high impact were: priority attention of pediatric oncology patients in the emergency department through the implementation of a patient identification card to expedite the admission process, development of a fever management flowchart with a record of action schedule and improve the availability of bottles for blood culture. Conclusions Our results demonstrate that delays exist in the management of fever in children with cancer in our hospital. Identifying the gaps and pivotal steps in the process, and opportunities for improvement are the first key steps toward implementing strategies to improve the quality of care. Categorization, testing, and execution of standardized interventions will help to improve fever management and must be done as a collaborative effort between departments involved in pediatric neutropenic patient care such as infectious diseases, pediatrics, and oncology. Our next steps include (1) training of medical and nonmedical staff involved in the admission and discharge processes to implement the patient identification card distribution and usage, (2) improving interdepartmental communication, and (3) identification of new opportunities for quality improvement to be tested and implemented.