Download Fever By Naira Ali

Symptoms of yellow fever (fever, chills, headache, backache, and muscle aches) develop 3-6 days after infection. About 15% of people infected with yellow fever virus will develop severe illness that can lead to liver disease, bleeding, shock, organ failure, yellowing skin (jaundice), and sometimes death.

The Nigeria Centre for Disease Control (NCDC) is reporting yellow fever outbreaks in multiple states (Bauchi, Benue, Delta, Ebonyi, and Enugu) as confirmed by testing at the Nigerian National Reference Laboratory. Response activities are underway and mass vaccination campaigns are planned in the affected areas.

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Yellow fever is caused by a virus spread through the bite of infected mosquitos. Some patients can develop serious symptoms, including high fever and jaundice (yellowing of the skin and eyes), but the disease can be easily prevented by a vaccine that provides immunity for life.

To ensure this phase of the vaccination campaign runs smoothly, the Federal Ministry of Health, in collaboration with WHO with support from Gavi, has trained and deployed Management Support Teams (MST). The MSTs are overseeing preparations in the run-up to the campaign and, in partnership with WHO yellow fever experts, will act as supervisors and provide technical assistance during the campaign itself.

The first phase of this yellow fever preventive mass vaccination campaign (PMVC) took place in January and February 2018 in Kwara, Kogi and Zamfara states and parts of Borno state. Approximately 8.7 million adults and children between the ages of 9 months and 45 years of ages were vaccinated. A total of 26.2 million people are expected to be vaccinated against yellow fever this year.

Childhood fevers due to malaria remain a major cause of morbidity and mortality among under-five children in Nigeria. The degree of vulnerability perceived by mothers will affect their perception of the severity and threat of their child's fever and the patterns of health care use. This study was undertaken to compare maternal responses to childhood fever in urban and rural areas of Enugu, south east Nigeria.

Both urban and rural mothers are aware that malaria is the major cause of childhood fevers. Although rural mothers recognize childhood fever and danger signs better than urban mothers, the urban mothers' responses to fever seem to be better than that for rural mothers. These responses and differences may be important for geographical targeting by policy makers for malaria interventions.

Fever is a very common symptom in childhood illnesses with malaria accounting for most of the childhood fever in our environment [1], [2]. In Nigeria, childhood fevers presumed to be malaria remains a major cause of morbidity and mortality among under-five children accounting for 30% of all childhood deaths, 11% of maternal deaths and 50% of all out patient department attendance [3]. Also, about 50% of the population has at least one episode of malaria each year with children under the age of 5 years having 2 to 4 attacks of malaria a year [3]. All these have been attributed to ignorance and poor service delivery [4], [5]. Although, treatment often begins early and at home, a mother's inability to correctly recognize malaria has contributed substantially to child morbidity and mortality due to malaria [6]. In Nigeria, studies show that mothers were unable to recognize severe malaria despite perceiving the signs and symptoms of onset of childhood malaria as including high temperature and loss of appetite [7].

Parents especially mothers, most times get excessively concerned about their febrile child. Their misconception about fever, frequently prompt unnecessary contacts with the health care system and mishandling of fever generate a great deal of unwarranted parental anxiety resulting in avoidable medical complications, countless calls and costly visits to doctors' clinics and emergency rooms [8], [9] .

The study was a descriptive cross-sectional study to determine whether mothers perceive childhood fevers as a serious problem and to compare the knowledge, attitudes and treatment practices of urban and rural mothers with respect to childhood fevers.. Enugu South Local Government was chosen for this study by simple random sampling from a frame of 4 local Government Areas (LGAs) with both urban and rural communities. Within Enugu South LGA, Uwani and Amechi-Awkunanaw communities were purposively chosen because they are typical urban and rural areas respectively in the local government area. In Uwani, 10 neighborhoods were chosen from a sample frame of 15 neighborhoods and in Amechi Awkunanaw, 3 villages were chosen from a sample frame of 6 villages. Adequate sample size was computed to be able to detect statistical significant differences between urban and rural respondents and also to ensure a high precision of collected data using a power of 80%, 95% confidence level and a knowledge of fever as a danger sign of 51% [29]. The EPI-info software version 6.04 [30] was used to calculate the sample size. The allocation of this sample size into those for urban and rural areas was done using proportionate allocation method considering their population resulting in a sample size of 280 households for Uwani and 130 households for Amechi-Awkunanaw. These households were therefore selected by simple random sampling from a sampling frame of the primary health care house numbering system.

The household data were checked daily for inaccuracies and inconsistencies by the authors, before double entry using the Epi-info version 6.04 [30]. Associations between urban and rural caregivers' characteristics and responses to fever were analysed using Pearsons' chi-square and Fisher's exact tests for categorical variables and Mann Whitney two-sample non-parametric test for continuous variables. A p-value of 0.05 was considered to be statistically significant.

Table 2 shows that the respondents in both rural and urban communities were able to identify one form or the other of causes of fever as well as danger signs of childhood fever. Malaria was mentioned as the commonest cause of childhood fevers with rural mothers being more likely to mention malaria than urban mothers (84% urban vs. 100% rural). Rural mothers were also more likely to recognize danger signs and symptoms that warrant medical attention than urban mothers like convulsion, strange breathing and anaemia. The differences between the urban and rural respondents were statistically significantly different as shown in table 2. None of the mothers was aware of all the causes and danger signs listed and each mother was able to identify one form of cause and danger sign or the other.

The time before first action was taken for childhood fevers in urban (1.051.67 days with a 95% confidence interval of 0.99 to 1.11 days) was significantly shorter than in rural areas (2.320.82 days with a 95% confidence interval of 2.12 to 2.52). This trend was also found in the second action (urban, 2.811.06 days with 95% confidence interval of 2.65 to 2.97 vs. rural, 4.50.57 days with a 95% confidence interval of 4.1 to 4.9 days). .

As shown in table 4, the main anti malaria drugs taken at home for childhood fevers presumed to be malaria are Chloroquine (44.4% rural vs 48% urban), Coartem (an artemisinin-based combination therapy) (8.3% rural vs 5% urban), and SP (2.8% rural vs 3.5% urban). Aspirin (11.1% rural vs. 6% urban) and Paracetamol (87.5% rural vs 66.6% urban) are the main antipyretics drugs given at home. Other non-specific drugs given are cough syrups, multivitamins and haematinics. The statistical differences in usage between rural and urban respondents is shown in table 4. Rural respondents were more likely to use drugs from many sources than the urban respondents. Both used mostly drugs from the patent medicine dealers, but usage of the leftover drugs and drugs from neighbours were more popular options among the rural respondents than the urban respondents

Table 5 shows that the use of preventive measures against childhood fevers is common in both communities with urban respondents being more likely to use a preventive measure than the rural respondents (76.8% urban vs. 56.4% rural) which was statistically significantly different. The main preventive measures used were insecticide treated and ordinary nets, insecticide aerosols, mosquito coils, pyrimethamine and environmental management.

Recognition of childhood fever and danger signs is more pronounced in the rural mothers. This result could be attributed to the age and experience of most rural mothers who were found to be more elderly than the urban respondents. This is in contrast to the report elsewhere [15].

The use of formal healthcare services by the urban respondents could reflect the availability of these formal healthcare services in the urban setting. Other determinants could be the difference in educational level and occupational status of the mothers in both areas with the urban mothers being more educated and having higher occupational status than the rural mothers. In Kenya, despite marked differences between the rural and urban areas in population structures and access to treatment providers, rural and urban mothers treatment seeking pattern in relation to childhood fevers were similar [1], although, studies have shown that preventive and curative health-seeking behaviors for children are clearly better in urban than rural areas [44].

The commonest drug used by both rural and urban residents in treatment of childhood fevers was paracetamol. A common phenomenon is that patients and medicine sellers in Nigeria appear to confuse analgesics/antipyretics with antimalarials [45]. . Hence, there is need to educate mothers on the appropriate dosage of paracetamol to be given. Rural mothers are also more likely to use chloroquine, Nivaquine, sulfadoxine/pyremethamine (SP) and multivitamins than the urban mothers. This could be attributed to their less frequent use of modern health facilities like private, general hospitals and hence they relied more on the drugs bought from patent medicine dealers. The cost and availability of drugs may have also contributed to this as these drugs are known to be cheaper and readily available than other anti-malarial drugs like Halofantrine and artemesinin-based combination therapy (ACTs). However the use of an ACT in both areas despite their multi-dosage/multi-day regimens and high cost was surprising. This might be an indication that the community members are beginning to tolerate ACT products as this has now been officially introduced in Nigeria as first line antimalaria drugs. It will therefore be worthwhile to investigate the feasibility of deploying ACTs in the community either within the home management programs or through the private sectors like the patent medicine dealers. ff782bc1db