PROFOMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Miss: JASMINE KURIAN

FIRST YEAR M.SC (NURSING)

CHILD HEALTH NURSING

YEAR 2012-2014

IKON NURSING COLLEGE

BHEEMANAHALLI(H), B.M. MAIN ROAD

RAMANAGARAM [TALUK & DIST]

BIDADI,BANGALORE- 562109

1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,
KARNATAKA, BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSETATION

1 NAME OF THE MISS.JASMINE KURIAN

CANDIDATE AND I YEAR M.SC NURSING,
ADDRESS IKON NURSING COLLEGE
NO:32, BEEMANAHALLI

BIDADI-562109, B.M MAIN

ROAD,
RAMANAGAR TALUK,

2. NAME OF THE Ikon Nursing College

INSTITUTION

3. COURSE OF THE STUDY 1st year M.sc Nursing

AND SUBJECT
(Child Health Nursing)

4. DATE OF ADMISSION TO 25.06.2012

COURSE

5. TITLE OF THE TOPIC Knowledge And Practice

Regarding Fever Control
Measures To Prevent The
Occurrence Of Febrile
Convulsions Among The
Mothers Of Under Five
Children.

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6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

‘ ’Children are the world’s most valuable resource and its best hope for future’’

J F Kennedy

A child is precious not only to the parents, family, community, and Nation but also to
the world at large. In fact child is a citizen of world and thus it becomes the responsibility
of the wide population of the whole universe to look after the interest of children all
over. Children are the assets of our country1.

Children are future citizens of our country. Only healthy citizens can lead the
country in a successful manner to achieve the nation’s progress. Hence the children should
not suffer from any disease. The main primary symptom in any infection is fever . If any
disease is occur the first and foremost symptom is increasing the temperature. Fever is a
common manifestation of most of the infections and until other definitive causes are ruled
out2. These pyrogenes are released when phagocytic cells (macrophages) are stimulated by
micro-organism and endotoxins. A low grade fever is a temperature that is slightly
elevated that is 37.10c to 38.20c (or) 98.80F to 100.60F elevation 38.20C to 40.50C (100.60F
to 104.90F) is considered as high grade fever, and a temperature greater than 40.50C (or)
104.90F is referred as hyper pyrexia. Young children tend to get often high grade pyrexia
to hyper pyrexia. Older children are often prone to develop slight elevation of
temperature ,which is called low grade fever. Most of the mother do not know that the
fever can lead to convulsion or epilepsy3.

Epilepsy is one of the commonest neurological disorders affecting the children. It

is derived from the ancient greek word epilepsia which means “to seize’’. It is also known
as a fever fit, febrile convulsion or febrile seizure. It is characterised by recurrent
unprovoked seizures and it is associated significant rise in body temperature. They most
commonly occur in children between the ages of 6 months to 5 years (with only 10% of

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reported seizures occurring after the age of 3) and are twice as common in boys as in
girls.4

In many cases ,the family history is positive for febrile convulsions .Febrile seizures,
if untreated, have a high rate of recurrence, especially in the first year or two after onset.
Over 50%of infants with febrile convulsions have 2 to 4 episodes, and 20% experience
more than for febrile convulsions. A febrile seizure is the effect of a sudden rise in
temperature (>39°C/102°F) rather than a fever that has been present for a prolonged length
of time. Parents caring for children that may be febrile who wrap them up in warm
blankets in an attempt to give comfort unknowingly increase their fever and therefore the
risk5.

Febrile seizures occurs due to a hypersensitive hypothalamus in the brain.

The hypothalamus is responsible for homeostatic core temperature regulation, (amongst
other factors) and in younger children it is still a developing portion of the brain, meaning
it is susceptible to hypersensitive reactions to slight raises in body temperature.

Convulsions persist for just a minute or two, some can last for longer than 15 minutes
or as short as a few seconds. During simple febrile seizures, the body will become stiff and
the arms and legs will begin twitching. The patient loses consciousness, although their
eyes remain open. Breathing can be irregular. They may become incontinent (wet or soil
themselves); they may also vomit or have increased secretions (foam at the mouth). The
seizure normally lasts for less than five minutes.6

World Health Organization (WHO) has estimated that more than 10 million children
under five of age die each year in developing countries and seven in ten of these deaths are
due to acute respiratory infection, mostly Pneumonia, diarrhoea, measles, malaria, or
malnutrition, or combination of all these. It is further speculated that the deaths from these
diseases will be more if there is no intervention2.Almost all of these diseases are signalled
by rise in temperature of the children which is called fever and, if the fever is not
managed on time, it triggers a condition known as ‘febrile seizures’ or ‘febrile
convulsion’. 7

So every Mother should have an awareness to control the rise of temperature without
looking into the pathological cause of fever, controlling the pathological cause becomes
secondary which should be controlled by administering prescribed antibiotics to the

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 children. But the primary concept is to reduce the fever and prevent the occurrence of
febrile convulsions, thereby the complications of hyper pyrexia could be prevented and
early recovery could be made possible.

6.2 NEED FOR THE STUDY

Children are the future of our society and special gift to the
world. Mother’s knowledge on care of children greatly influences the health status of
child by reducing the mortality and morbidity rate. However supervision of health of
the children is important. Now the children’s care is more child centred.

Fever is one of the most common symptoms reported to Pediatrician. A

temperature of more than 1000f is considered as fever. Fever of more than 1010f should
be actively controlled.8 It is identified, every year globally 150/1000 children died
with a history of febrile seizures.8

As per 2011 census of India, it is stated that India has a population

of 1,210,193,422 (1.21 billion) people, among that 158,789,287 is
the under five population and 66/1000 is under five mortality rate.9

Febrile Convulsion that occur in early childhood and it causes lot of worries to the
parents and care givers. It accounts almost 50% of the convulsive disorders, According
to the World statistics, 50/100,000 children developed convulsions every year. In this
4% of convulsions occurs in first 6 months of life,90% of the children develop
convulsions between 6 months and 3 years of age. According to Shinner et al (2001)
children with febrile status epilepticus are more likely to have had neonatal seizures and
to have pre-existing neurological abnormalities10.

The general incidence of febrile seizures among children at Medical

College Hospital in a city was 37.2/1000. Among that 32% of the children were female.
Majority of the febrile convulsions occurred between the age group of 6 months to 5 years
which constitutes 75% of cases, 40% of the cases were found within 1 year of age and
36% cases found between 1-2 years of age, seizures occur within 24 hours in 88% of the
cases. At the onset of febrile convulsions, 77% of the cases had moderate degree of
temperature and 33% had high temperature. The study recommended that

5
the febrile convulsions could be prevented by providing parental education regarding the
therapy during a febrile episode (or) convulsions.11

A descriptive study was conducted in Karnataka to assess the mother’s awareness

regarding fever control measures to prevent the occurrence of febrile convulsions . By
simple random sampling technique 80 mothers were selected for the study. The study
result revels that 13.8% of the respondents have the knowledge about complications of the
fever,12.8%of the respondents have knowledge regarding the signs and symptoms of
dehydration. Only 8.7%of them have knowledge of measures to maintain hydration
status.28.8% of them have a positive response about administering of intravenous
infusion.5% of them have the awareness to prevent the occurrence of convulsions through
adopting fever control measures.15% of them have awareness about the first aid measures.
The study suggests that significant improvement can be achieved by giving adequate
information to the parents.12

A descriptive study was conducted on “the knowledge, attitude and practice of the
mothers regarding care of the children in febrile condition with view to develop
information guide sheet for mothers at Vanivilas children’s hospital, Bangalore city”. The
sample size is 50 mothers of children below the 5 years of age. The study revealed that the
mothers (55.56%) actually lacking in terms of knowledge on
managing children with fever and one of the most important finding was that they
(64.16%) also beliefs and misconception about fever, indicating that there is enough room
for the nurses to teach these mothers on managing the child with fever correctly. So the
development of the guide sheet was a necessary tool for the mothers for the proper
management of the febrile condition.13

The above stated studies reveal that an education regarding febricidal is very essential
in order to prevent the occurrence of febrile convulsions. The parents should be educated
to give the first aid measures. For this education ,we should assess the existing knowledge
of the mothers, so the deficient area could be concentrated more in our health education.
Hence based on the above studies and on personal interest the researcher has chosen this
topic to provide information to mothers of under five children regarding fever control
measures to prevent the occurrence of febrile children.

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 6.3 STATEMENT OF THE PROBLEM

‘’A Study To Assess The Knowledge And Practice Regarding Fever Control
Measures To Prevent The Occurrence Of Febrile Convulsions Among The Mothers
of Under Five Children In Selected Paediatric Hospital, Bangalore With a View To
Develop a Pamphlet.’’

6.4 OBJECTIVES

1.To assess the knowledge regarding fever control measures to prevent the occurrence
of febrile convulsions among the mothers of under five children.

2.To assess the practice regarding fever control measures to prevent the occurrence of
febrile convulsions among the mothers of under five children.

3.To find out the association between knowledge and practice regarding fever control
measures to prevent the occurrence of febrile convulsions with their selected socio
demographic variables.

4.To develop a pamphlet regarding fever control measures to prevent the occurrence
of febrile convulsions among the mothers of under five children.

6.5 OPERATIONAL DEFINITIONS

1.Knowledge

It refers to the correct response of the mothers of under five children which will be
measured by self administered questionnaire.

2.Practice

It refers to the measures carried out by the mothers to prevent febrile convulsions as
measured by written responses to self administered questionnaire.

3.Fever Control Measures

It refers to methods such as putting wet cloths on fore head and wiping the body with
warm water, which are followed by mothers to reduce the fever.

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4.Mothers

It refers to mother of under five children whose children are admitted with history of
fever.

5.Febrile Convulsion

It refers to seizure occurring in children between the age groups of 6 months to 5

years associated with high fever.

6. Pamphlet

It refers to written material containing information regarding fever control measures

to prevent the occurrence of febrile convulsions among the mothers of under five children.

6.6 ASSUMPTIONS OF THE STUDY

1.Mothers of under five children may have some knowledge regarding fever control
measures to prevent febrile convulsions.

2. Preventing febrile seizures in under five is a challenging task for the mother.

3.Pamphlet will improve the mothers knowledge.

6.7 HYPOTHESES

H1 :There will be a significant association between knowledge and practices

regarding fever control measures to prevent the occurrence of febrile convulsions among
the mothers of under five children with their selected demographic variable.

6.8 REVIEW OF LITERATUTRE

The review of literature is defined as a broad, comprehensive in depth,

systematic and critical review of scholarly publications, unpublished scholarly print
materials, audiovisual materials and personal communications. Review of literature is a
key step in research process. Review of literature refers to an extensive , exhaustive and
systematic examination of publication relevant to research project. One of the most
satisfying aspects of the literature review is the contribution it makes to the new
knowledge ,insight, and general scholarship of the researchers.14

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 In this chapter, the researchers presents the review of literature under the following
headings.

1.Review of literature related to causes and complications of febrile convulsions.

2.Review of literature related to knowledge, attitude and practice on prevention of febrile

convulsions.

1. Review of literature related to causes and complications of febrile convulsions.

An experimental study was conducted in Lucknow to find out the predisposing

factors contributing to febrile convulsion . The subjects for the study were comprised of
115 children of age 5-60 months with control group of 345 healthy children.The most
prominent finding of this study is that febrile convulsion was more common
among children with higher weight and family history of febrile seizures.15

A prospective cohort study was conducted in Netherlands to examine the association

between the number of fever episodes and the risk of febrile convulsions among children.
Analyses were based on 3033 subjects. In the age range between 6 and 36 months, we
observed a significant trend between the frequency of fever episodes and the risk
of febrile seizures (p-value for trend < 0.001). The result was association between the
number of fever episodes and the occurrence of febrile seizures was stronger
for children with recurrent febrile seizures.16

A cohort study conducted in children’s hospital of Eastern Ontaroio reports an analysis

of risk factors for epilepsy in children with radiologically confirmed periventricular
leukomalacia. Of 154 subjects,40(26.0%) had epilepsy. The study concluded
that children with cerebral palsy associated with periventricular leucomalacia will
frequently develop unprovoked epileptic seizures.17

A cohort study was done in Canada to determine the effect of pregnancy and neonatal
factors on the subsequent development of childhood epilepsy. Factors analyzed included
events during the prenatal, labour and delivery and neonatal time periods. The factors
significantly associated with an increased risk of epilepsy included eclampsia, neonatal
seizures, CNS anomalies, placental abruption, neonatal metabolic disorders, low birth
infant, infection in pregnancy, small for gestational age and not breast feeding infant at the
time of discharge from the hospital. There were 648 new cases of epilepsy diagnosed

9
among 124207 live births. The study supports the concept that prenatal factors contribute
to the occurrence of subsequent childhood epilepsy. 18

2.Review of literature related to knowledge, attitude and practice on prevention of

febrile convulsions.

A prospective study was conducted in Mumbai on knowledge, attitude and practices

of children with febrile convulsion. The study was conducted in a tertiary care centre with
a sample of 140parents of consecutive children and used prospective questionnaire for the
data collection. Correct preventive measures were known only to 41.Result revealed that
the parental fear of fever and febrile convulsion is a major problem with serious negative
consequences affecting daily familial life.19

A descriptive study was conducted in the Department of Paediatrics at G.S. Medical

College and K.E.M. Hospital ,Parel ,Mumbai ‘’Parental Anxiety and apprehension is
related to inadequate knowledge of fever and febrile convulsions’’. In the study conducted
for a period of 1 year,140 parents of convulsive children were the sample for the study.83
parents (59.3%) could not recognize the convulsions.124(90.7%) did not carryout any
intervention prior to getting the child to the hospital. The commonest immediate effect of
the convulsions were fear of recurrence and dyspepsia. The parents did not know that the
convulsions could occur due to fever. About 4% of children in the age group of 1-6 years
have had atleast one episode of febrile convulsions, and 30% have had recurrent
convulsions and many get admitted to the hospital.20

A cross sectional questionnaire survey was conducted in a hospital of Kuwait among

520 accompanying mothers of feverish children to assess their knowledge and fear of
fever and home management of fever. The result of the study revealed that 81.6% of
mothers believed that epilepsy can cause fever in children and approximately 60% of all
mothers believed an untreated fever could lead to convulsion.21

A comparative study was conducted in Tokyo among mothers of children who visited
health departments for a routine 18-month-old well baby check-up to compare
maternal knowledge and perceptions of fever, fever management practices, and
information sources of mothers of children with and without a history of febrile seizures
.A total of 386 responses were analyzed. Mothers of children with a history of febrile

10
 seizures demonstrated a higher rate of accuracy in their knowledge of fever than those in
the other group. Mothers of children with a history of febrile seizures used
personalcommunication22.

7. MATERIALS AND METHODS

7.1 SOURCES OF DATA

The data will be collected from mothers of under five children in selected paediatric
hospitals Bangalore.

7.2 METHODS OF DATA COLLECTION

I. Research approach

Descriptive survey approach

II . Research design

Non experimental descriptive design will be use

III. Research variables

a.Study variables -Knowledge and practice regarding fever control measures to prevent
the occurrence of febrile convulsion among the mothers of under five children.

b.Demographic variables

Section A: Mother -Age, religion ,education, occupation, number of children, type of

family, source of information on previous history of febrile convulsion, supersticious
practices.

Section B: Child -Age, sex ,previous history of febrile convulsions, degree of fever,
delayed milestones

IV. Setting of the study

The study will be conducted in selected paediatric hospitals , Bangalore.

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V. Population

Mothers of under five children whose children are admitted with history of fever in the
paediatric hospital Bangalore.

VI. Sample and sample size

The mothers of under five children who meet the inclusion criteria are considered as the
sample and the size of the sample is 60.

VII. Criteria for sample selection

Inclusion criteria:

1. Mothers of under five children whose children are admitted with history of fever in the
paediatric hospitals.

2. Mothers who are willing to participate in the study.

3.Mothers who are able to read understand English or kannada.

Exclusion Criteria:

1.Mothers of under five children are not available during data collection.

2.Mothers who have attended education programmes on fever control measures to prevent
the occurrence of neonatal convulsions.

VIII. Sampling technique

Non probability purposive sampling technique will be adopted to select the samples.

IX. Tool for data collection

Tool consist of two sections:

Section A

i - Self administered questionnaire to assess the demographic data.

ii -Self administered questionnaire to assess the knowledge regarding fever control

measures to prevent the occurrence of febrile convulsions among the mothers of under five
children.

12
 iii –Self administered questionnaire to assess the practice regarding fever control
measures to prevent the occurrence of febrile convulsions among the mothers of under five
children.

Section B

It includes development of pamphlet regarding fever control measures to prevent the

occurrence of febrile convulsion among the mothers of under five children.

X. Method of data collection

After obtaining formal permission from the significant authority and getting informed
consent from the subject, the investigator will administer the self administered
questionnaire to assess the demographic data, knowledge and practice regarding fever
control measures to prevent the occurrence of febrile convulsions among the mothers of
under five children and at end of study the investigator will distribute pamphlets to
mothers.

XI. Duration of the study

The study is limited only for 4 to 6 weeks.

XII. PLAN FOR DATA ANALYSIS

Data analysis will be through descriptive and inferential statistics.

Descriptive statistics:

1.Frequency and percentage distribution will be used to analyse the demographic

variables.

2.Mean and standard deviation will be used to assess the level of knowledge and practice
regarding fever control measures to prevent the occurrence of febrile convulsions among
the mothers of under five children.

Inferential Statistics:

Chi square test will be used to analyse the association between knowledge and
practice among the mothers with their selected demographic variables.

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 7.3 Projected outcome

This study will help the investigator to know the existing knowledge and practice
regarding fever control measures to prevent the occurrence of febrile convulsion on the
mothers of under five children. Afterwards the investigator will distribute information
guide sheet which helps to improve their knowledge and practice regarding fever control
measures to prevent the occurrence of febrile convulsions on the mothers of under five
children.

7.4 Does the study require any interventions to be carried out on patients or other
humans ?

Yes, the study requires assessment of knowledge and practice regarding fever control
measures to prevent the occurrence of febrile convulsions among the mothers of under five
children.

7.5 Has ethical clearance been obtained from your institution ?

Yes, Permission will be obtained from institution and ethical committee of

concerned authorities of selected settings and informed consent will be obtained from
samples. Privacy and confidentiality will be maintained.

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8. LIST OF REFERENCES

1. Marlow DR, Weller BF. Textbook Of Pediatrics Nursing. 6th ed. Philadelphia:
Elsevier Publications; 2001.

2. Smeltzer C Suzanne, Bare Brenda. Brunner & Suddharth’s Medical Surgical Nursing.
10th ed. Philadelphia: Lippincott Williams & Wilkins; 2004
3. .Varupi Jain. Epilepsy: defogging the demon: 2005, New Delhi. Available from
http://www.indiatogether.org/2005/feb/hlt-epilepsy.htm
.
4. .Kyle T. Essentials Of Pediatric Nursing. New Delhi; Lippincott Williams and
Wilkins; 2009
5. Finkelstein Robert , Willard Alan, Korn J Stephen. NINDS febrile seizures
information page. National institute of neurological disorders and
stroke.2011 Oct31[cited 2011 Dec 4]:Available from
;http://www.Ninds.Nih.Gov/Disorders/Febrile seizures/detail Febrile seizure.
6. .Reference Library of selected Material IMCI(Integrated Management of childhood
illness. Retrived on 2009 Nov 14thAvailable from
http://www.whqlibdoc.who.int/hq/2001/WHO FCH CAH O1.O8.pdf
7. Kitchen Rose. Febrile convulsions in infants. livestrong. 2011 jun 14[cited
2011 dec 5];Available from; http://www.livestrong.com/article/260141-febrile-
convulsion-in-infants/
8. . Available from http;//www.censusindia.gov.in/2011-prov-
results/data_files/india/tables- 2(1).pdf
9. .American Academy of Paediatrics .Febrile Seizures. Retrieved on 2009 Nov 10th
from http://www.intelihealth.com/IH/int.
10. .Ertan Kayserili ,Ayca Hursit,Murat.Parental knowledge and practice regarding febrile
convulsion in Turkish.Turk j med 2008;38(4);343-350 Available from
http://journals.tubitak.gov.tv/medical/issue/sag-08-38-4-9-0708-4.pdf
11. . Dr.Dhanalakshmi.Febrile Convulsions in Children,Bangalore Medical College,2001.
12. . Gordon KE, Dooley JM, Wood E, Brna P, Bethune P. Pediatrics. 2004 Oct[cited
2011 Dec 8]; 114(4):962-4.

13. . Lalitha, Study the knowledge, attitude and practice of mothers regarding care
of children in febrile condition with view to develop Information Guide Sheet for

15
 mothers at Vanivilas children’s hospital, Bangalore city[MSc. Dissertation].
Government College of Nursing, Fort, Bangalore-2; 2004

14. Basavanthappa BT. Nursing research. 2nd ed. New Delhi. Jaypee publications. 2007.

15. Nasab A H, Scheffer EI. Clinical Review. Febrile Seizures.2007, Vol-334:307-311

16. Generation R Study Group, Erasmus Medical Center, Netherland

17. Peter Humphreys, Raywat Deonandan, Sharon Whiting, Nick Barrowman, Mary Ann
18. Elizabeth J., Effectiveness of Paracetamol and Tepid sponging and Paracetamol alone
inreducing fever among children [MSc. Dissertation]. St. John’s College of Nursing,
St. John’s National Academy of Health Sciences, Bangalore; 2002.

19. .Parmar R.C. Journal Of Post Graduate Medicine. Department Of Pediatrics. Assessed
On 2002. 47(1):19-23.

20. .Pamar R.C., Sahu D.R., Bavedekar S.B. Knowledge ,Attitude and Practice of Parents
of children with Febrile Convulsions, G.S. Medical College, Mumbai,2001.
21. . Huda KA, Al- Abdel Jalil, Nadsa A Jumah. Mothers knowledge fears and self
management of fever: a cross sectional study from capital governorate
in Kuwait.Available from http//www.self management of fever.
22. .Sakai R. Pediatrics Emergency Care Department Of Public Health.2009
April,25(4):231-237.

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 9. Signature of the candidate

10. Remark of the guide

11. Name and designation of

guide

11.1. Signature of the guide

11.2. Head of the department

11.3. Signature of HOD

12. Remarks of the principal

12.1. Signature

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