INTRODUCTION:

Viral fever is common among children as well as older people as their immunity is lower. The fever by itself is not an illness, it is a symptom of viral infection. The fever occur due to the infection. The high fever is usually a sign of weakened immune system of the body, fighting against the intruding viruses and “burning them off”.¹

Many people have tendency to self-medicate. Sometimes people take antibiotics, when they have an intermittent high fever with chills. Antibiotics cannot kill viruses.

They kill harmful bacteria. Antibiotics, if taken recurrently can affect the stomach lining, kill the good gut bacteria, cause acidity, damage liver and kidneys.¹

Viral fever is transmitted from one person to another through the contact with highly infected person’s bodily fluids. When the infected person yawns, sneezes, coughs, or even talks, tiny sprays of fluids are ejected from their bodies which may enter the body system. Once the virus enters the body system, it takes anywhere from 16 hours to 48 hours to turn to a full raging infection with fever in the body.¹

Some severe strains of viral fever which cause haemorrhage are spread by mosquitoes, tick bites, or by coming into contact with an infected person’s blood or semen. It can take up to 21 days to develop after the initial exposure to the virus. Some particular viral fever strains can also enter into the human body when one inhales near infected rat faeces or urine.¹

Viral fever or flu is caused by virus infections which can be contracted via inhalation, ingestion, vector-borne agents and bodily fluids.²Many strains of viral fever have now come together to create a fresh variant that can't be cured with the existing medications. They are difficult to treat because the symptoms of many strains are largely similar and so there might be significant increase in time for diagnosis and treatment.

The standard prescription for viral fever is to stay home and rest, drink plenty of fluids, and keep pain and fever under control with over-the-counter drugs like acetaminophen.³

Most parents knows that it is very essential to closely monitor children under 5 years for any signs their illness is getting more severe. It is important to pay even closer attention to babies and toddlers under 2, making sure they are getting enough liquids because they can easily become dehydrated.³

Certains symptoms that need immediate medical care are if a child’s breathing becomes labored, and he or she is taking rapid, shallow breaths or feels chest pain or pressure, if the child’s lips turn blue or dark purple, if he or she become less responsive than usual; if the child’s skin becomes clammy, or if the child refuses to eat or drink or has diarrhea and is vomiting, raising the risk of dehydration.³

For children under 5, parents must be alert about to make sure that the child is getting enough fluids, and watch for dark colour urine, that is a sign of dehydration that calls for immediate medical care. Other symptoms to watch for in infants are trouble in breathing, inability to eat, significantly fewer wet diapers than normal and crying without tears.³

National Influenza Centres (NICs) and other national influenza laboratories from 110 countries, areas or territories reported the data to FluNet for the time period from 07 January 2019 to 20 January 2019. The WHO GISRS laboratories tested more than 232140 specimens during this time period. 59457 were positive for influenza viruses, from which 58436 (98.3%) were influenza A and 1021 (1.7%) were influenza B. Of the sub-typed influenza a viruses, 24559 (77.7%) were influenza A (H1N1) and 7058 (22.3%) were influenza A (H3N2). of the characterized B viruses, 85 (34.6%) belonged to the B-Yamagata lineage and 161 (65.4%) to the B-Victoria lineage. At least 53 children across the country have died due to viral fever in 2018.⁴

In 2018, India has confirmed 5,651 cases and 464 deaths because of H1N1, the predominant flu strain across states. It is not considered a serious illness because it rarely causes hospitalisation in healthy people and kills causing complications and co-infections and aggravating existing illnesses. The cause of death is rarely recorded for influenza. It kills up to 650,000 people every year, estimates the World Health Organisation, with most deaths occurring from pneumonia, heart or brain inflammation and circulatory shock from organs not getting enough blood or oxygen.⁵

2018 marked the 100th anniversary of 1918 influenza pandemic popularly known as “Spanish flu”, which infected an estimated 500 million people worldwide, about one-third of the planet’s then population and killed around 20 million to 50 million people, including in India. The only decade in which India’s population did not register a decadal growth is 1910-1920, according to the Census of India, with experts assigning the reversal in population growth due to increased deaths from the flu. Flu caused over 80,000 American deaths, including the deaths of 180 children.⁶

Estimations suggests that nearly 60 million new cases of apparent dengue infections are present every year.In India, 5 lakh dengue patients are admitted in various hospitals every year.Nearly 10,000 deaths were attributed to dengue infection yearly.Secondary to rapid urbanisation and overcrowding ,temporal trends suggests that incidene of dengue nearly doubled in every decade since 1990.⁷

A multicentre study of aetiology and diagnostic accuracy of acute undifferentiated fever was conducted at various hospitals in India. A total of 1564 patients were included, with an average age of 34 years. Among these 632 (40%) were women and 895 (57%) were men, and 1219 (78%) lived in rural areas. purposive sampling method was used. Chi-square test was used to assess differences between proportions. Malaria positivity was found in 17%, dengue in 16%, scrub typhus in 10%, bacteraemia in 8%, leptospirosis in 7% and chikungunya in 6%. Among malaria cases, 54% were Plasmodium falciparum. Among bacteraemia cases, Salmonella typhi or S. paratyphi constituted 35%, Staphylococcus aureus 19%, E. coli 9% and Streptococcus pneumoniae 6% .⁸

A study was conducted regarding acute Febrile Illness Surveillance in viral hemorrhagic fever cases in Georgia. Purposive sampling method was used for Crimean-Congo hemmorhagic fever virus, case-fatality rates as high as 30%. Case-fatality rates were 0.2% and 12% for Puumala (PUUV) and Dobrava–Belgrade (DOBV) viral infections, respectively, whereas the case-fatality rates for other hantaviruses was 50%. Russia had the highest number of reported hantavirus infection cases annually (10,000–12,000 cases per year).⁹

Viral fever is most common in children and it spreads from one person to other leading severe difficulties in them. The investigator wants to conduct this study in order to impart knowledge to common people especially among mothers and to promote the health of their children. Hence Researchers felt the need to educate the common people especially at urban community area.

OBJECTIVES:

· To assess the knowledge regarding home remedies of viral fever among mothers.

· To find out the association between selected demographic variables and knowledge regarding home remedies of viral fever among mothers at selected community area, Kollam.

REVIEW OF LITERATURE:

1. Study related to knowledge regarding fever among mothers:

A cross sectional study was conducted among mothers of children aged less than 5 years in Hyderabad city in South India to assess knowledge regarding fever, management, practices and their correlates. The Institutional Ethical Committee approved the study. Four residential areas, having a population of 3497, were randomly selected. An interview schedule was developed using locally relevant questions from previous published international guidelines and literature. More than one third of the mothers did not know the correct temperature for fever (38.9%).47.9% considered fever to be present if the temperature exceeded 100 degrees F. Almost half (47%) perceived fever to be harmful for children, but almost a third of them (32%) could not mention any harmful effects or complications. 87% had correct knowledge about antipyretic drugs used for children. The most common fever management practice was administering antipyretics (89%), followed by wet sponging (75%) at home. Antibiotics were given to children after being prescribed by doctors by 81%. However, only 8% went to a doctor for complete fever management.¹²

A cross-sectional study was conducted among purposively selected 8 primary schools in Cork, Ireland to assess the knowledge, attitudes and beliefs when managing fever in children using a paper-based questionnaire. Data were collected using a cross-sectional internet-based questionnaire on a convenient sample of mothers with at least one child aged less than 5. Results were analysed using descriptive statistics and multivariable logistic regression. 1104 mothers contributed to this research, 121 from schools and 983 through an online questionnaire. Almost two-thirds (63.1%) identified temperatures at which they define fever, that were either below or above the recognised definition of temperature (38°C). Nearly two of every three (64.6%) alternate between two fever-reducing medications when managing a child’s fever.¹³

A study was conducted to evaluate the knowledge and practices of mothers about fever in Taif, Saudi Arabia.A pre-validated questionnaire was developed and administered to 1700 respondents using a non-probability convenience sampling technique. A total of 1487 completed and certain valid questionnaires were successfully obtained. All data were analysed using IBM SPSS version 22.0 at an alpha value of 0.05. The majority of respondents demonstrated poor knowledge about fever. Sixty-six percent of peoples says that antibiotics would cure the fever.24% believed that coughing and direct contact with patients secretions, suffering from the fever would spread this illness. A small number of participants, took precautionary measures.¹⁴

An interview study was conducted at six ante-natal clinics in the south west of Ireland during March and April 2015to assess the knowledge, attitudes and beliefs of mothers regarding fever in children. Semi-structured interviews were conducted with 23 samples. The Francis method was used to detect the saturation and also identify the sample size. A phenomenological approach was used to explore the lived experiences of parents when caring for a febrile child. Thematic analysis was used to analyse the data. Five themes emerged from the data: assessing and managed the high degree of viral fever; parental knowledge, beliefs and importance of treatment regarding viral fever; knowledge source; pharmaceutical products like certain drugs and new initiatives. Parents can gave a good knowledge regarding fever as a symptom. However, management practices varied between participants. Parents revealed a reluctance to use medication in the form of suppositories.¹⁵

A study was conducted to assess the knowledge of mothers of underfive children regarding childhood fever and it’s management at home.This was a descriptive designed study that used a simple random sampling technique to select 100 participants in Kwahu Government hospital,Atibie in Ghana over a period of six months.A structured questionnaire comprising of close ended questions were used to collect data.The mothers described fever as the hotness of body (63%), shivering (10%), child crying (8%),child being quiet (8%) and sleeping too often(10%). Home management of fever involved self medications (43%),consulting herbalist (20%) as well as tepid sponging (28%) and visiting nearby hospital (62%).¹⁶

2. Study related to knowledge regarding home remedies among mothers:

A Non experimental cross sectional descriptive study was conducted regarding the practice of home remedies among mothers of under five children with upper respiratory tract infection in pediatric outpatient departments in selected secondary care hospitals of Udupi district, Karnataka. Quantitative research approach was used. A total of 154 samples were selected by convienience sampling method. Majority 674 (3.5%) of the sample were using ginger and turmeric mixture to manage cough of the child at home and 71 (46.1%) sample were using ginger with turmeric powder to manage child’s running nose. Majority of the 56 (36.6%) were not practising any type of home remedies. Most of the 624 (0.2%) sample were using warm salt water gargle to manage their child’s sore throat, most 133 (86.3 %) of the sample were cconsulting the doctor when child had fever.¹⁷

A descriptive study was conducted to assess the knowledge regarding prevention and home care management of chickenpox in children among mothers having children below 10 years of age residing at Uttarahalli, Bangalore with a view to develop an information booklet. Sampling technique was non-probability convenience sampling. The sample consists of 60 mothers. A structured knowledge questionnaire was used to collect the data from the mothers having children between 1 to 10 years of age. The data collected will be analysed by using descriptive and inferential statistics.30 % had adequate knowledge, 55% had average and 15% had poor knowledge.¹⁸

A cross-sectional descriptive study was conducted in Ghana among 50 women with children under 5 years with the diagnosis of febrile seizures to investigate mothers' knowledge, beliefs and practices regarding febrile convulsion and it’s management in homes. Data was collected by the researcher using structured questionnaires. It was found that majority, 35 (70%) of the mothers were able to described and identified febrile convulsions and sickness in children which is seen by the child twitching or fitting, with eyes wide opened. Only 25(50%) of the mothers indicated that febrile convulsion is caused by high fever. The results also showed that, a substantial number 27 (48%) of the mothers had the belief that febrile convulsion is normally caused by witchcraft and evil spirits while 8 (16%) of the respondents hold beliefs that a sore in the child's abdomen can cause convulsions. Regarding the home management of febrile convulsions and viral fever included the tepid sponging of the child, bathing the child with luke warm water; putting spoon in child's mouth and using traditional and natural preparation of medicine are used to rub all over the child's body or it into the child's nostrils. The study concluded that about 90% of mothers have good knowledge regarding febrile convulsion and its first aid measures at home, a good number of mothers still have negative beliefs regarding the cause of the condition.¹⁹

A study was conducted to assess the knowledge about prevention of pneumonia among mothers of underfive children in Piparia, Vadodara city in Gujarat. An evaluative approach was adopted for the study to determine the effectiveness of structured teaching programme. The highest percentage (53.33%) of mothers belonged to the age group of 26-35.The post test knowledge was in the range of 17-23 than the previous test knowledge range of 6-12.The mean post test knowledge score 20 was also higher than the mean pretest score 11.58.The study findings concluded that structured teaching programme had great potential for accelerating the awareness regarding prevention of pneumonia in under five children.²⁰

3. Study related to knowledge regarding home remedies of viral fever among mothers

A study was conducted in a selected hospital at Nigeria to assess the knowledge and ability of mothers to recognize fever in their child as well as management instituted at home. 144 mothers whose children were less than 12 years old, had fever as one of the presenting complaints, and admitted to the children emergency room of Lagos State University Teaching Hospital between July and December, 2006, were interviewed with a structured questionnaire. Most of the mothers (83.3%) believed that fever is the high temperature of the whole body of the patient. Infection was the most underlying cause of fever identified by 43.8% mothers. Ninety six mothers (66.7%) managed the fever at home. Home treatment was majorly by reducing the clothing and exposing the child to air, tepid sponging, and use of paracetamol. Antimalarials (6.0%) and antibiotics (7.8%) group of drugs were rarely used.²¹

A cross sectional study was conducted to assess the mother’s knowledge and practice in home management of fever in their children in Riyadh, Saudi Arabia. Data were collected from 250 mothers attending three main family medicine centers at King Abdul-Aziz Medical City, Riyadh, using self-administered questionnaire. Most of the samples (64%) defined fever correctly and 56% identified high fever. 95% of mothers believed fever is harmful, and febrile convulsion was the most concerned complication of fever, followed by loss of consciousness, dehydration, brain damage, and hearing loss. 82% touch of their children to confirm fever, 68% use oral thermometer, and 63% use axillary thermometer. 84% applied cold compression, 75% gave their children nonprescribed medication such as antipyretics, analgesics, 61% gave their children plenty of fluids such as hot water, and 64% took their children to consult the doctor at right time.²²

A descriptive hospital based study was conducted to identify the knowledge regarding childhood fever and understanding of belief and attitude in the management of fever at home among mothers. The study was done in the pediatric wards of a public sector teaching hospital in Peshawar with different medical conditions. More than 93% of the samples were wrong about normal body temperature. About 37% don’t know about certain causes of high fever whereas 90% detect fever through tactile method or by hand touch, about 57% don’t know about the correct placing of thermometer to record accurate temperature and 40% visit chemist for treatment after detecting fever in their kids, about 37% brought their children to hospitals and only 13% of total treat their children at home.²³

A cross sectional study was conducted at Pediatric Emergency Unit at Kenyatta National Hospital (KNH), Kenya to assess the knowledge and home management of fever in children among mothers. The samples were 250 mothers of children under 12 years presenting with fever. Three quarters of the mothers defined fever correctly. 47.6% had knowledge on the normal body temperature. 95.2% identified that infection is the leading cause of viral fever (95.2%). 77.6% viewed brain damage and 65.6% indented dehydration as the most common complication of fever. Fever was treated at home by 97.2% of the caregivers and most of them used medication. Fever was determined correctly by 75.2% of the study participants, majority of them used tactile method.²⁴

MATERIALS AND METHODS:

Methods:

A quantitative research approach was adopted to assess knowledge regarding the home remedies of viral fever among mothers in selected areas of Pallithottam at Kollam. In the present study, non experimental survey method design which belongs to non experimental design, was selected to assess the knowledge of mothers regarding the home remedies of viral fever. The setting for the present study was conducted in Century Nagar in Pallithottam community area which is located in the prominent part of Kollam and is situated 2 km away from Kollam central Railway station. The sample selected for the study were 30 mothers who were residing at the selected community area of Pallithottam at Kollam. Sampling procedure selected was convenience sampling technique.

Tools/Instruments:

The instruments used for the present study are demographic proforma and structured questionnaire which were validated by experts.

Data collection:

The data collection was conducted from Community area of Pallithottam at Kollam.The data collected after obtaining administrative approval and permission from authorities of community centre. The subjects were collected based on inclusion and exclusion criteria. The mothers who were residing pallithottam area was selected. A total of 30 sample were selected using convenience sampling technique. The investigators introduced them to the subjects and purpose of the study was explained to them. Confidentiality was assured and a written consent was obtained. Structured questionnaire was used to find out the knowledge regarding home remedies of viral fever among mothers. After conducting the study pamplets were given to increase knowledge regarding home remedies of viral fever. The data collection was completed by thanking the respondents for their cooperation. The data collected were compiled for analysis.

RESULTS:

Description of sample characteristics:

This sections describe the percentage wise distribution of demographic variables.

(N=30)

Figure 1: percentage distribution of mothers according to their age.

(N=30)

Figure 2: percentage distribution of mothers according to their religion.

The data presented in figure 2 shows that 100% of mothers were Christians.

(N=30)

Figure 3: percentage distribution of mothers according to their education.

Figure 3 shows that 40 % had education below SSLC, 46.66% had SSLC education, 10% had higher secondary education and 3.33% were post graduates.

(N=30)

Figure 4: percentage distribution of mothers according to their occupation.

Figure 4 shows that 3.33% samples were private employed, 10% of the samples belongs to others and 86.66% were unemployed.

(N=30)

Figure 5: percentage distribution of mothers according to family type.

The data in figure 5 shows that 73.33% of the samples belongs to nuclear family and 26.66% belongs to joint family.

SECTION B:

Assessing the knowledge regarding home remedies of viral fever among mothers at community area, Kollam.

Table 1: Frequency and percentage distribution of score on knowledge regarding home remedies of viral fever among mothers.

(N=30)

Score	Score range	Frequency	Percentage
0-6	poor	3	10%
7-13	Average	24	80%
14-20	Good	3	10%

The data presented in table 1 shows that 10% of mothers had poor knowledge, 80% had average knowledge and 10% had good knowledge.

SECTION C:

Association between knowledge regarding home remedies of viral fever with selected demographic variables.

Table 2: Association between knowledge and selected demographic variables.

Sl No	Variables	Poor	Average	Good	df		Chi square value	S/ NS
1	Age
	20 -30 31- 40 41- 50 >50	1 0 2 0	7 9 6 2	1 2 0 0	6	56.726		S
2	Religion
	Christian Hindu Muslim Others	3 0 0 0	24 0 0 0	3 0 0 0	6	27		S
3	Education
	Below SSLC SSLC Higher Secondary Post Graduate	2 0 1 0	10 13 1 0	0 1 1 1	6	74.93		S
4	Occupation
	Government Private Others Unemployed	0 0 0 3	0 1 2 21	0 0 1 2	6	1551.79		S
5	Family type
	Nuclear family Joint family	3 0	16 8	3 0	2	322.706		S

S-Significant NS-Not significant

Table 2: The association was computed by using chi square test. It was inferred that the present study showed significant association between knowledge and selected demographic variables like age, religion, education, occupation and family type (calculated value greater than table value at 0.05 level of significance).

CONCLUSION:

The study helped to assess the knowledge regarding the home remedies of viral fever among mothers at community area, Kollam. The mothers got knowledge regarding remedial measures and its management of viral fever and also helped them to know about the incidence rate and treatment measures.The study was conducted in a small group of 30 mothers and it was very effective in improving their knowledge.So it can be conducted on a large group.

RECOMMENDATIONS:

· Based on the findings of the study, it is recommended that, A similar kind of study can be conducted for older adults

· The same study can be conducted for large group

· A structured teaching program can be planned for a large group.

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Received on 24.11.2019 Modified on 31.12.2019

Asian J. Nursing Education and Research. 2020; 10(2):194-200.

DOI: 10.5958/2349-2996.2020.00042.7