PRE-HOSPITAL MANAGEMENT OF FEBRILE SEIZURES IN CHILDREN SEEN AT THE UNIVERSITY COLLEGE HOSPITAL, IBADAN, NIGERIA

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O.O. Jarrett¹, O.J. Fatunde², K. Osinusi¹ and I.A. Lagunju¹

1. Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
2. Department of Paediatrics, Texas Tech University, Texas USA.

Abstract

Background: Febrile seizures are commonly encountered in emergency paediatric practice. Initial pre-hospital intervention given by caregivers has been shown to impact outcome.

Objectives: To describe the spectrum of pre-hospital interventions given for the treatment of childhood febrile seizures in Ibadan, Nigeria.

Methods: All consecutive cases of febrile seizures seen at the emergency room of University College Hospital, Ibadan over a period of 13 months were the subjects of the study. Details of history of illness including the interventions given before presentation were recorded. All the children had lumbar puncture and examination of their cerebrospinal fluid (CSF). All were followed up till discharge and the outcome was recorded.

Results: A total of 147 children, 83 males and 64 females with febrile seizures were studied. Harmful traditional practices were found to be common in the cohort studied. Fifty-nine (40.1%) of the children received at least one form of intervention believed to be capable of aborting the seizure during the attack at home. Herbal preparation was the most common form of pre-hospital treatment, given in 15 (10.2%) of the cases. Other forms of pre-hospital interventions given were application of substances to the eyes (6.1%), incisions on the body (2%) and burns inflicted on the feet and buttocks (1.4%). None of the children received rectal diazepam or buccal midazolam as home remedy for seizures. There was a statistically significant relationship between harmful cultural practices and the socioeconomic class of the caregivers (P=0.008).

Conclusions: Pre-hospital treatment of childhood seizures in Ibadan comprises mainly harmful traditional practices. There is a need for appropriate health education to reduce the morbidity and mortality associated with febrile seizures in the locality.

Keywords: seizures, febrile, cow’s urine, socio-economic status

Introduction

A febrile seizure refers to a seizure occurring in infancy or childhood usually between three months and five years of age as a result of elevated body temperature in the absence of pathology in the brain.¹ Febrile seizures are commonly encountered in emergency paediatric practice and have been described as the commonest cause of seizure in children under the age of five years.^2,3 Incidence has a wide variation amongst different population groups being as low as 2-4% in Caucasians and as high as 15.3% in Africa.^2-7 Common causes of febrile seizure in the tropics include malaria, pneumonia, urinary tract infection, septicemia and viral infections.^2-9

Seizures cause intense parental anxiety.¹⁰ This coupled with ignorance, is often responsible for the various forms of intervention offered by parents and caretakers when a child has an episode of seizure. These interventions include the administration of cow’s urine concoction ^2,3 and application of substances to the eyes and mouth such as palm oil, kerosene, eucalyptus oil etc.² Some make incisions on the body while others inflict burns injury on the child in an effort to rouse the unconscious child. In an earlier study about three decades ago, Familusi and Sinnette reported a high number of parents (52%) administering native concoction as home treatment for febrile seizures.²

Majority of parents have gross misconceptions about febrile convulsions and hence take inappropriate or even harmful actions in an attempt to control the convulsions.¹¹ It is believed that their social attitudes and behavior contribute immensely to the high morbidity and unfavorable prognosis of febrile seizures in the developing countries of the world.^1,11

It has been reported that parents often have several misconceptions about febrile seizures.^11,12 It has also been suggested that the socioeconomic status of the parents/caregivers of children with febrile seizures and the maternal level of education affect the interventions given at home and this could in turn affect the outcome of febrile seizures.^6,11 Prior awareness of febrile seizures and the appropriate measures to be taken in a convulsing child were found to be significantly higher in the upper and middle social class.¹¹

This study soughts to describe the spectrum of interventions given at home by caregivers to control febrile seizures and the influence of socioeconomic status on the type of pre-hospital intervention given to affected children.

MATERIALS AND METHODS
The study was carried out over a 13 month period at the Paediatric emergency ward in the University College Hospital, Ibadan, Nigeria. Ethical clearance was obtained from the University of Ibadan/University College Hospital ethical committee. Informed consent was obtained from the parents/caregivers of the children before they were recruited into the study.

All consecutive cases of fever (axillary temperature >37.50C) associated with seizures admitted were reviewed. Inclusion criteria included the following: age three months to five years, fever with seizures, no evidence of impaired consciousness following recovery from seizure attacks and a normal cerebrospinal fluid. Children with a febrile seizures, acute head injuries, congenital or acquired central nervous system abnormalities and those with abnormal cerebrospinal fluid were excluded from the study.

The past medical history, family and social history, detailed history of present illness including the type of pre-hospital intervention, type and duration of seizures were recorded. A thorough physical examination was performed on each patient at admission with emphasis on the central nervous system. Every child had a full blood count, lumbar puncture for cerebrospinal fluid (CSF) analysis, blood culture, urine microscopy, culture and sensitivity and blood film examination for malaria parasites done. Random blood sugar sample was taken before the lumbar puncture and cerebrospinal fluid sugar was estimated. The socioeconomic classification was done using Oyedeji’s method which considers the level of education and the occupation of both parents.13 All were followed up daily untill discharge from the hospital.

Data analysis was done using statistical package for social sciences (SPSS) version 16. Categorical data were compared using Chi-square test and Fisher’s exact test where applicable. Differences were deemed to be statistically significant where p< 0.05.