Knowledge of group A streptococcal infections, acute rheumatic fever and rheumatic heart disease is essential in order for people to seek medical care and for integration in health policy However, awareness of these conditions is low in many settings and opportunities to seek care may be missed Education and awareness campaigns for different audiences may be effective in increasing knowledge Examples of different community education programs are presented Increasing community knowledge can also provide a basis for advocacy to engage policy makers in addressing rheumatic heart disease A structure to advocacy is presented and illustrative successes presented in this chapter

Awareness, Education, and Advocacy

Parents' and caregivers' non-evidence-based childhood fever management ‘fever phobic’ practices have remained relatively stable over more than 34 years despite successful educational interventions. This systematic review aimed to assess the information seeking behavior of caregivers managing fever in their children, as well as to compile the fever management practices undertaken by caregivers by investigating underlying factors influencing them. The electronic databases Pubmed, CINAHL, Medline, and International Pharmaceutical Abstracts were searched using key terms including, fever, child, caregiver, and management. Studies were included if they were written in English, published between January 1980 and January 2021, explored generalized childhood fever management practices of caregivers, and factors which influence fever management. Data extracted included study year and design, location, dimensions of fever management explored (i.e., knowledge, beliefs, detection, and/or treatment of fever), factors influencing management, and information sources used by caregivers. In total, 36 studies were eligible for inclusion in the study. Twenty-nine of the studies were designed as a cross-sectional survey, six studies were interviews and the remainder were pre-post studies. The review of studies found that parents and caregivers sourced childhood fever management information most commonly from friends and family or their own personal experiences, however, participants most commonly sourced doctors/general practitioners as their first line of information when required. Over the years, trends showed that doctors as well as the internet were more frequently being used as a first line source of information by caregivers. Despite decades of research, education and development of evidence-based guidelines caregivers continue to exhibit ‘fever phobia’ when caring for febrile children. This is demonstrated by their continued use of non-evidence-based methods and increasing reliance on, and incorrect use of antipyretics, alternating antipyretics if fever is not sufficiently reduced or returns. There is an increasing need for the development of easy to access digital resources for caregiver as internet use is rising which mirrors best practice taught to professionals. 

The information seeking behaviors of caregivers in the management of childhood fever - A systematic literature review.

Background: Despite inroads in treatment and prevention, childhood febrile illnesses remain global public health issues. Optimal care-seeking by mothers could influence health outcomes. Objective: To assess the differences in care-seeking patterns and practices for childhood febrile illnesses among mothers of under–fives in urban and rural areas of Anambra state, Nigeria. Methods: This was a comparative cross-sectional analytical mixed-method study. Multistage sampling technique was used to enrol 600 mothers of under-five children accessing child welfare clinics at the Primary Health Care facilities in Anambra state. Analysis of data was carried out using SPSS version 22; with alpha set at p-value ≤ 0.05.Triangulation of findings of the survey and thematic content analysis of the Focus Group Discussion was done. Results: Appropriate care was sought by 134 (44.7%) of the urban and 125 (43.2%) of the rural respondents (p = 0.458). Prompt appropriate care was sought by 122 (40.7%) of the urban and 98 (36.7%) of the rural respondents (p = 0.042). Distance to the health facility, determinant of place of care-seeking and possession of health insurance were significantly associated with appropriate and prompt care-seeking patterns among the mothers. Conclusions: Appropriate and prompt care-seeking is generally poor among the respondents in both localities. A reorientation of mothers on appropriate and prompt care-seeking practices through continuous health education and other awareness creation processes is needed.

/pdf/urban-rural-differences-in-care-seeking-for-childhood-3v5b5f3x.pdf

Urban-Rural Differences in Care-Seeking for Childhood Febrile Illnesses Among Mothers of Under-Fives in Anambra State, Nigeria

Abstract Background Fever 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. Methods This 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). Results The 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 &lt; 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 &gt; 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 &lt; 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 &gt; 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 &gt; 0.05) while there were significant intergroup differences after the intervention ( p &lt; 0.05). Conclusion The 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. 

/pdf/the-effect-of-simulation-based-education-on-parental-28hdrvnb.pdf

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

Abstract Background The rise in the indiscriminate use of antibiotics has become a major global public health problem and presents the biggest global health challenge in the twenty-first century. In developing countries, caregivers initiate treatment with antibiotics at home before presentation to a health facility. However, there is a paucity of evolving data towards surveillance of this trend in low-income countries. We investigated antibiotic use among febrile children presenting to a tertiary health facility in northern Uganda. Methods We conducted a cross-sectional study in a tertiary health facility in northern Uganda between March and September 2021. Children aged 6–59 months with fever were selected using systematic random sampling. A pre-tested interviewer-administered questionnaire was used the collect clinical data from the caregivers. Data were analyzed using SPSS version 23. Descriptive statistics and multiple logistic regression models were applied. P -value &lt; 0.05 was considered for statistical significance. Results Eighty-three (39.5%) of the 210 children with fever in this study used antibiotics prior to the hospital visit, 55.4% of which were on a self-medication basis, while 44.6% were empiric prescriptions. The most commonly used antibiotics were amoxicillin 33/83 (39.8%), erythromycin 18 (21.7%), metronidazole 14 (16.9%), ciprofloxacin 13 (15.7%) and ampicillin 6 (7.2%). The main sources of the antibiotics included buying from drug shops 30/83 (36.1%), issuance from clinics (33.7%), remnants at home (12.0%), picking from a neighbour (7.2%) and others (10.8%). The factors associated with antibiotic use among the febrile children were residence ( p &lt; 0.001); distance from the nearest health facility ( p = 0.005); caregivers’ gender ( p = 0.043); cough ( p = 0.012); diarrhoea ( p = 0.007); duration of fever ( p = 0.002); perceived convulsion complicating fever ( p = 0.026), and caregivers’ perception that fever ( p = 0.001), cough ( p = 0.003), diarrhoea ( p &lt; 0.001) and any infection ( p &lt; 0.001) are indications for antibiotics. Conclusions Inappropriate use of antibiotics for childhood febrile illnesses is prevalent in the study setting, facilitated by the ease of access and use of leftover antibiotics. There is a need to address communities’ health-seeking behaviour and the health providers’ practice alike. 

/pdf/pre-hospital-exposures-to-antibiotics-among-children-39p9o3ql.pdf

Pre-hospital exposures to antibiotics among children presenting with fever in northern Uganda: a facility-based cross-sectional study

Background : Fever is one of the most common complaints presented to the Paediatric Emergency Unit (PEU). It is a sign that there is an underlying pathologic process, the most common being infection. Many childhood illnesses are accompanied by fever, many of which are treated at home prior to presentation to hospital. Most febrile episodes are benign.  Caregivers are the primary contacts to children with fever. Adequate  caregivers’ knowledge and proper management of fever at home leads to better management of febrile illnesses and reduces complications. Objective : To determine the caregivers’ knowledge and practices regarding fever in children. Design : A cross-sectional study. Setting : Peadiatric Emergency Unit at Kenyatta National Hospital (KNH) Subjects : Two hundred and fifty caregivers of children under 12 years  presenting with fever in August to October 2011 to the PEU. Results : Three quarters of the caregivers’ defined fever correctly. Their knowledge on the normal body was at 47.6%. Infection was cited as the leading cause of fever (95.2%). Brain damage (77.6%) and dehydration (65.6%) were viewed as the most common complication. Fever was treated at home by 97.2% of caregivers, most of them used medication. Conclusions : Fever was defined correctly by 75.2% of the study participants and a majority of them used touch to detect fever. Fever was managed at home with medications. Public Health Education should be implemented in order to enlighten caregivers on fever and advocate for the use of a clinical thermometer to monitor fever at home.

/pdf/caregivers-knowledge-and-home-management-of-fever-in-4dyc1ajkvp.pdf

Caregivers' knowledge and home management of fever in children.

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Caregivers' knowledge and home management of fever in children.