Fever in children: What African parents need to know

 

By Ibironke Taiwo. Datelinehealth Africa Volunteer Freelance Writer, with medical review and editorial support from The DLHA Team

 

Child having a temperature check

 

 

INTRODUCTION

 

Core body temperature is determined in units of measurement referred to as degree Centigrade/Celsius (°C) or Fahrenheit (°F). It is kept within a normal range from 36.1°C to 37.2°C (97°F to 99°F) by complex physiological processes in the body.

 

Fever or pyrexia occurs whenever the body temperature is higher than the upper limit of normal.

 

The rise in the body's core temperature that is associated with fever is usually due to the release of inflammatory products called pyrogens from infectious or non-infectious sources that trigger the temperature regulating centers in the brain. 

 

Human normal temperature varies throughout the day by 0.5 degree Celsius due to normal physiological activities in the human body such as the chemical process that maintain life (metabolism), the sleep and wake cycles, daily activities, etc. In the case of fever, the increase in temperature is often greater than 0.5 degrees Celsius.

 

 

TYPES OF FEVER

 

Fever can be  categorised on how severe it is, and includes 
 

• Low-grade fever: 99.1 to 100.4°F (37.3°C to 38°C)

• Moderate-grade fever: 100.6 to 102.2°F (38.1°C to 39°C)

• High-grade Fever: 102.4 to 105.8°F (39.1°C to 41°C)

• Hyperthermia: Greater than 105.8°F (41°C)

 

Fever can also be  classified into five main types based on how long it lasts and how high the  temperature gets. For example:
 

• Intermittent fever

This kind of fever comes with an inconsistency  or fluctuation in the body temperature from normal to extreme (fever level) over the day.
 

• Remittent fever

This type of fever also comes with temperature fluctuation but in this case, the temperature follows an on-and-off pattern, when the temperature falls it still doesn't get to the normal temperature.
 

• Hectic fever 

The rise of temperature or the on-and-off pattern of temperature is said to be hectic when the temperature range changes widely throughout the day, with a difference of 1.4°c between the highest and lowest temperatures. It is often associated with chills and sweats.
 

• Continuous fever

This is also known as sustained fever. It continues with little or no change in the body temperature throughout the day.
 

• Relapsing fever

This is the kind of temperature that is most experienced from animal bites and diseases like malaria. It is characterized by a rise in temperature after days or weeks of normal temperatures.

 

 

EPIDEMIOLOGY OF FEVER

 

Globally as in African countries the burden of febrile illness has been difficult to quantify but it is clear that fever is a common symptom and may be a major associate of severe illness and even death.

 

Although fever has been identified as a common symptom of malaria, many other non-malaria infectious diseases like respiratory and urinary tract infections, gastrointestinal infections, and meningitis are also common causes of fever in sub-Saharan Africa.

 

The cause of fever can also be due to non-infectious causes like autoimmune disorders, drug reactions, heatstroke, and other systemic inflammatory conditions.

 

The occurrence of fever depends on age, having other underlying conditions, being hospitalized, or being able to move about. 

 

Over the years the diagnosis and management of fever has been a challenging one in most of sub-Saharan Africa due to certain conditions present in the region like the common presentation of the various causes of fever and lack of diagnostic tests. Notwithstanding, having clarity about the epidemiology of the causes of fever helps patients and caregivers manage febrile illnesses better.

 

 

CAUSES OF FEVER 

 

Fever can be caused by various factors which include:
 

• Infections, which could be a viral or bacterial infection such as chickenpox, flu, pneumonia, etc.

• Overexposure of the skin to ultraviolet rays, the Sun

• Inflammatory conditions such as rheumatoid arthritis, the inflammation of the lining of your joints (synovium).

• Certain medications like antibiotics, drugs used to treat high blood pressure or seizures.

• Reaction to some immunizations, such as diphtheria, tetanus and acellular pertussis (DTaP), pneumococcal or COVID vaccine

• Abuse of drugs like amphetamine.

 

 

RISK FACTORS OF FEVER

 

If you suffer from underlying chronic health conditions, you are at risk of fever, especially low-grade fever. 

 

The following is a list of common health conditions that are associated with fever in children.
 

• Malaria

• Allergic rhinitis

• Ear infection

• Upper respiratory tract infection (URTI)

• Bronchitis

• Pneumonia

• Sinusitis 

• Juvenile rheumatoid arthritis

 

 

SYMPTOMS OF FEVER 

 

The symptoms of fever vary depending on the cause of the fever, they include.
 

• Warm or hot to touch 

• Sweating

• Flushed skin 

• Rapid heartbeat 

• Shivering and feeling cold even when no one is.

• Dehydration 

• Loss of appetite 

• Being sensitive to pain 

• Presence of goose-bumps on the skin.

 

 

DIAGNOSIS 

 

Fever is diagnosed following clinical evaluation by a healthcare provider after:
 

• The health care provider takes a history of your present illness and asking questions about the symptoms you are feeling and past and present medical conditions.

• Physical examination

• Checking for respiratory infection by testing samples from your throat or nose.

• Conducting several tests such as blood tests, chest X-rays, CT scans etc., are carried out as considered necessary.

 

.

TREATMENT OF FEVER 

 

Fever can go from unconcerning to being severe if immediate medical intervention is not carried out. When fever gets to the severe stage in a child it puts the child at risk of developing health complications, brain damage, coma, or even death. Therefore there is a need for prompt and effective treatment.

 

The treatment of fever varies, depending on the cause of the fever. 

• Antibiotics are commonly used for fever caused by bacterial infection e.g. strep throat.

• Over-the-counter drugs (OTC) such as aspirin, acetaminophen and anti-inflammatory drugs like ibuprofen are also used for the treatment of fever. Children aged 2 months and above can be given acetaminophen, but ibuprofen should only be given to children aged 6 months and above. Be sure to keep to the dosage on the medicine label.

• It should be noted that children shouldn't be given aspirin as this causes a condition called Reye's syndrome.

• Get a lot of rest.

• Keep the body cool with lightweight clothing or ice packs.

• Take a lot of fluid. 

• Bath with water at room temperature.

 

 

CHALLENGES OF TREATMENT IN CHILDREN

 

The challenges in the treatment of fever in African children are mostly attributed to a lack of proper diagnosis. 

 

Below are some of the key challenges faced in the treatment of fever in African children.

 

1. CULTURAL BELIEFS AND PRACTICES

The cultural beliefs and practices of people in certain parts of African countries influence how they seek medical care, as a great number of parents would rather receive care from traditional healers or give home remedies before or alongside formal medical care and this can lead to delays in appropriate treatment.

 

2. LIMITED HEALTHCARE ACCESS

The lack of access to healthcare facilities in certain parts of Africa especially the rural areas contributes greatly to the delay in diagnosis and treatment of fever in African children.

 

3. LOW DIAGNOSTIC RESOURCES

The low availability of diagnostic resources like laboratory tests make it difficult to determine the exact cause of fever and guide appropriate treatment.

 

4. SOCIOECONOMIC FACTORS

Certain socioeconomic factors like poverty, low educational status, lack of access to clean water, and a clean environment contribute to the challenges faced in managing fever in African children as these socioeconomic factors increase the risk of infections and make effective treatment and implementation of prevention strategies pretty difficult.

 

5. NUTRITION AND NUTRITIONAL PRACTICES

Inappropriate feeding habits, malnutrition, and other associated health conditions make African children more susceptible to infections.

 

6. HIGH BURDEN OF INFECTIOUS DISEASES

Rampant infectious disease also contribute to the challenge of managing fever in African children as these infections present with similar symptoms thereby making it difficult to differentiate and treat them effectively.

 

7. ANTIMICROBIAL RESISTANCE

Resistance to antibiotics is also a major challenge in combating fever in African children leading to an increase in treatment failure.

 

 

PREVENTION 

 

The best way to prevent fever in African children is to limit exposure to infectious agents, the reason being that these Infectious agents are leading causes of the rise in body temperature. 

 

The following are some prevention tips:

• The most important prevention measure is to get your child vaccinated against common and major infectious diseases.

• Teach your child to wash their hands correctly before or after each activity such as before eating, after eating, after the use of the toilet, after being around people, etc.

• Where it is available and affordable, the use of hand sanitizer also helps to eradicate germs from your child’s hands in cases where access to water is limited.

• Train children to cover their mouth whenever they cough or sneeze and when someone does the same near them.

• Teach your child to avoid the use of utensils like cups, spoons, etc., with other people especially when you do not know their health status 

 

 

FREQUENTLY ASKED QUESTIONS (FAQ) 

 

• HOW DO I TAKE MY CHILD'S TEMPERATURE AT HOME 

 

To check your child's temperature at home, a thermometer is used and it is advisable to use a digital thermometer for easy reading.

You can obtain your child's temperature from different parts of the body which are:

• From the axillary (armpit) region. This helps in a quick check. Place your thermometer under your child's armpit tightly closed. 

• Rectal. To do this, you insert a rectal thermometer into the anus of the child (temperature taken here is considered the most accurate).

• The forehead. An infra red thermometer is used for this location. Place the thermometer close to the forehead and leave it to read. It is the next best after the rectal route.

• Orally through the mouth. In  case your child just finished taking a hot or cold fluid you have to wait for about 30 minutes before measuring the temperature orally

 

• AT WHAT LEVEL IS FEVER OF CONCERN IN CHILDREN? 

 

Fever in children becomes a concern when:

• Your child's temperature is about 40°C and doesn't come down with home remedies.

• Fever in your child lasts for more than 5 days.

• Your child finds it difficult to stand or carry out their normal daily activities like eating, drinking water, metabolism

 

• IS FEELING THE SKIN A GOOD WAY TO CHECK FOR FEVER IN A CHILD?

 

This may be a useful screening tool to discover if a child has fever. Be mindful however that some children feel warm even when they have a normal body temperature. If you suspect that a fever is present, it is best to take your child’s temperature with a digital thermometer to verify the fever and take note of the number.

 

• HOW CAN I REDUCE MY CHILD'S FEVER AT HOME? 

 

Here are ways to reduce your child's fever at home.

(i) Ensure your child drinks plenty of fluids like water, diluted juice, etc.

(ii) Get them to take a rest until the fever goes down and the temperature is normal.

(iii) Warm bath or tepid sponge by placing wet flannels on the child's forehead.

(iv) The use of Over-The-Counter fever relieving medications like acetaminophen at a dose that is appropriate for the age of the child. 

(v) Dress or cover the child with light clothing 

If these home remedies do not work after several hours to reduce your child's fever, please get your child to the hospital or a doctor’s clinic.

 

• HOW DOES FEVER AFFECT CHILDREN?

 

The following are common consequences of fever in children:

• Dehydration.

• Dry mouth and lips.

• The cheeks or eyes fall inwards.

• The child looks ill generally.

• Fatigue. (General weakness).

• In some cases, there may be a febrile seizure also known as a febrile convulsion.

 

 

CONCLUSION

 

Fever also known as pyrexia is an increase in the body's core temperature above its normal range of 36.1°C to 37.2°C (97°F to 99°F). There are different types of fever depending on severity and characteristics.

 

The major cause of fever is infection which makes prevention of infectious agent the best way to reduce or manage fever and this is done by washing hands before and after eating, after visiting the toilet, covering the mouth when coughing or sneezing, etc.

 

Children having underlying health conditions are at risk of having fever.

 

Being warm to the touch, dehydration, shivering, loss of appetite, fatigue, irritability and or loss of interest in daily activities etc., are some of the significant symptoms that help to indicate that your child has a fever.

 

Fever is treated in various ways depending on the cause. Some of these include the use of common over-the-counter fever reducing drugs, bed rest, drinking lots of fluids, taking warm baths and the use of antibiotics.

 

As much as health care professionals are trying to curb the burden of fever, there are still many regions in sub-Saharan African where there are lots of challenges in the management of fever. Some of the challenges include socioeconomic factor like poverty, lack of access to clean water, as well as lack of facilities for diagnosis, certain cultural practices and beliefs and resistance of these children to antibiotics 

 

 

REFERENCES

1. Bali S, Shumway KR and Sharan S.: Pathophysiology. Fever. StartPearls. .[Internet]. Sept. 11 2022. National Center for Biotechnology Information,  Bethesda, MD) USA. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562334/. Accessed Sept. 8, 2023.

2. Dall L, and  Stanford JF. Chapter 211 Fever, Chills, and Night Sweats in Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.  [Internet.1990]. National Center for Biotechnology Information, Bethesda. MD, USA, Available from: https://www.ncbi.nlm.nih.gov/books/NBK324/. Accessed Sept. 8, 2023.

3. Maze MJ, Bassat Q, Feasey NA, Mandomando I, Musicha P, Crump JA. The epidemiology of febrile illness in sub-Saharan Africa: implications for diagnosis and management. Clin Microbiol Infect. 2018 Aug;24(8):808-814. doi: 10.1016/j.cmi.2018.02.011.

4. Coalson JE, Cohee LM, Walldorf JA, Bauleni A, Mathanga DP, Taylor TE, Wilson ML, Laufer MK. Challenges in Treatment for Fever among School-Age Children and Adults in Malawi. Am J Trop Med Hyg. 2019 Feb;100(2):287-295. doi: 10.4269/ajtmh.18-0687.

5. Fever in children: An Overview. [Internet. Last updated June 6 2019]. InformedHealth.org. Natinal Library of Medcine. National Center for Biotechnology Information, Bethesda, MD, USA. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279455/. Accessed Sept. 8, 2023.

 

 

Published: September 19, 2023

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