Knowledge of caregivers of febrile children about fever, paracetamol use and paracetamol induced hepatic toxicity in Lagos Nigeria.
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Abstract
Background: Fever is as a result of immune response to many pathogens. Paracetamol is widely and irrationally used at home for treatment of fever in children before presentation at the health facility but it is not clear whether caregivers are aware of the toxicity that can result from non-rational use of paracetamol.
Objectives: The aim of this study was to evaluate the knowledge of fever, the use of paracetamol, and paracetamol induced hepatic toxicity amongst caregivers of febrile children.
Methods: This was a prospective descriptive study in which we interviewed two hundred and ten caregivers who brought febrile children to Onwusikawa Children's Medical Center Okota Lagos over a period of one year (Jan 2013- Dec 2013). A pretested closed ended questionnaire was used to collect data on the use of paracetamol, knowledge about fever, and toxicity of paracetamol during routine clerking.
Result: Paracetamol in both syrup and tablet formulations was administered by the study population to febrile children before presentation in hospital . Majority of the respondents (61%) knew fever as an increase in body temperature. About 8% of those interviewed gave paracetamol to their children including neonates almost on a daily basis to prevent fever or because they felt the baby especially the head was hot. Ninety five percent of all respondents were not aware that paracetamol could cause adverse effects while 98% did not know that paracetamol could cause hepatic toxicity.
Conclusion: The knowledge regarding toxicity of paracetamol was poor. It is proposed that education of caregivers by health workers on dangers of paracetamol misuse should be routine. Pharmaceutical companies that manufacture paracetamol for children must provide a risk management plan.
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References
WHO Models List of Essential Medicines (2007.). World Health Organisation. 15 edition
WHO Model Formulary (2006). World Health Organisation...
Bleeker – Rovers CP, Vandermoer JWM, Beeching NJ. (2010), Fever. Africa Health. 33,1:34-42.
Axelrod YK, Dfringer MN. (2008) .Temperature management in acute neurologic disorders. Neurology Clinics 26 (2) 585- 603.
Karakitsos D, Karaabinis A.( 2008) Hypothermia therapy after traumatic brain injury in children New England Journal of Medicine 359, (11) : 1179-80.
Akpede GO, Abiodun PO, Sykes RM: (1992) Relative contribution of bacteremia and malaria to acute fever without localizing signs of infection in under five children. Journal of Tropical Paediatrics 38:295-298.
Gove S. (1997) Integrated Management of Childhood Illness by out-patient health worker: technical basis and overview. The WHO Working
group on guiding for integrated management of the sick child. Bulletin of World Health Organisation. 75 (1): 7-27.
Factor SH (2001) Diagnosis and management of febrile children using the WHO/UNICEF guidelines for IMCI in Dhaka. Bangladesh, Bulletin of the World Health Organisation 29 (12).
Oshikoya KA, Sebanjo IO, Fawole OI, Onadeko MO. (2001) Knowledge and home management of malaria fever by mothers and caregivers for under-five children. West African Journal of Medicine 20 (2): 2-7.
Salako LA, Brieger WR, Afolabi BM, , Agomo PU, Asa S, Adeneye AK, Nwankwo BO, Akinlade CO (2001).Treatment of childhood fevers and other illness in three rural Nigerian communities Journal of Tropical Paediatrics 47 (4) : 230-8.
Adeniyi JD, Falade CO, Oladepo O. (2001) Incorporating socio cultural and economic characteristics of mothers and caregivers in the
home management of malaria in children. A WHO / TDR /UNDP sponsored project Report submitted to WHO / TDR, Project ID No 980048.
Sule SS. (2003) Childhood morbidity and treatment pattern at the multipurpose health center. Ilesha, Nigeria. Nigerian Journal of Medicine 12 (3): 145-9.
Ansah EK, Gyapong JO, Agyepong IA, Evans DB. (1996). Improving adherence to malaria treatment for children. The use of pre-packaged chloroquine tablets vs chloroquine syrup. Tropical Medicine and International Health 6 (7): 496 – 504.
Nichol A. (2000) Integrated Management of Childhood Illness in resource – poor countries: an initiative from the World Health Organisation. Transactions of Royal Society of Tropical Medicine and Hygiene 94 (1): 9-11.
Oshikoya KA, Njokanma OF, Bello JA, Ayorinde EO. (2007) Family self-medication for children in an urban area of Nigeria. Paediatrics and Perinatal Drug Therapy 8:124-30.
Meremikwu M. Oyo H. Paracetamol for treating fever in children. (2008) British Medical Journal 337; 1302.
Brandts C, NdJave M, Graninfer W, KemsnerPG (1997) Effect of paracetamol on parasite clearance time in plasmodium falciparum malaria. Lancet 350:704-709.
Kluger MJ. (1992) Drugs for childhood fever. Lancet 339-70
Uhari M Rantala H, Vainiopaa L, Kurttila R.( 1995) Effect of acetaminophen and of low intermittent doses of diazepam in prevention of febrile seizure. Journal of Paediatrics 126: 991-995.
Meremikwu M. Oyo – Ita A. (2003) Physical methods for treating fever in children. Cochrane Database Systemic Review (2):CD004264...
Lesko SM, Mitchell AA. (1999) The safety of acetaminophen and ibuprofen among children younger than two years old.” Paediatrics
(4): 39.
Roland BW, Filippo M, Theodore MB and Emily W (2011) “Long-Term Use of Acetaminophen, Aspirin, and Other Nonsteroidal Anti-Inflammatory Drugs and Risk of Hematologic Malignancies: Results from the Prospective Vitamins and Lifestyle (VITAL) Study”. Journal of Clinical Oncology 29 (17): 2424-31.
Food and drugs administration (2013) “Acetaminophen linked to rare fatal skin reactions. Washington Post. 3:8
Rumack B, Matthew H (1975). “Acetaminophen poisoning and toxicity”. Paediatrics 55 (6): 871-76.
Garcĺa-Rodrĺguez LA, Hernández-DĺazS (2000). “The risk of upper gastrointestinal complications associated with nonsteroidal anti inflammatory drugs, glucocorticoids, acetaminophen, and combinations of these agents”. Arthritis Research & Therapy. 3 (2): 98- 101.
Rudolph AM (1981) “Effects of aspirin and acetaminophen in pregnancy and in the new-born”. Archives of Internal Medicine 141 (3): 358-63.
Mitchel JR, Jollow DJ, Potter WZ, Davis DC, Gillette JR, Brodie BB. (1973) Acetaminophen- Induced Hepatic Necrosis. I. Role of Drug Metabolism. Journal of Pharmacology and Experimental Therapeutics 187:185-194.
Peterson RG, Rumack BH. (1981) Age as a Variable in Acetaminophen Overdose. Archives of Internal Medicine 141:390-93.
Rumack BH. (1984) Acetaminophen Overdose in Young Children. Treatment and Effects of Alcohol and Other Additional Ingestatants in 417 Cases. Archives of Disease in Childhood 138: 428-33.
Alam SN, Roberts RJ, Fischer LJ. (1977) Age–related differences in salicylamide and acetaminophen conjugation in man. Journal of Paediatrics 90:130-35.
Meredith, TJ, Newman, B &Goulding, R. (1978) Paracetamol poisoning in children. British Medical Journal 2: 478-479.
Rumack, BH, Meredith, TJ, Peterson, RG, Prescott .LF and & Vale, JA. (1981) Panel discussionmanagement of acetaminophen overdose.
Archives of Internal Medicine. 141: 401-403.
Rumack, BH, and Peterson, RG. (1978) Acetaminophen overdose: Incidence diagnosis and management in 416 patients. Paediatrics 62 (S),
-903.
Arena, JM., Uoruk, MM. &Sibrack, CD. (1978) Acetaminophen: Report of an unusual poisoning. Paediatrics; 61: 68-72.
Nogen, AG. and Bremmer, JE. (1978) Fatal acetaminophen overdose in a young child. Journal of Paediatrics 92, 832-833.
Weber, JL and Cutz, E (1980). Diagnostic challenge .Canadian Medical Association 123: 112-117.
Peterson, RG. &Rumack, BH. (1981) Age as a variable in acetaminophen overdose. Archives of Internal Medicine 141: 390-393.
Greene, JW, Craft, L and Ghishan, F. (1983) Acetaminophen poisoning in infancy... American Journal Diseases of Children 137: 386-365.
Miller RP, Roberts, RJ and Fisher, LJ. (1976) Kinetics of Acetaminophen elimination in new-borns, children and adults. Pharmacotherapy.
: 284-294.
Abdukadir MB, Johnson WBR. (2013) Caregivers perception of childhood fever in Ilorin, North Central Nigeria. Nigerian Journal paediatrics;
(3): 270-274.
Obu HA, Chinawa JM, Ubesie AC, Eke CB, Ndu IK. (2012) Paracetamol use (and/or misuse) in children in Enugu, South-East, Nigeria. BMC Paediatrics 12:103.
Tagbo BN, Ibeneme, CA, Adimora GN, Ilechukwu CGA. (2010) Mothers perception and management of childhood fever at the University of Nigeria Teaching Hospital Enugu. Journal of College of medicine 15(1); 44-50.
Schmitt BD. (1980) Fever phobia: Misconceptions of parents about fevers. American Journal Diseases of Children 134:176-81.
Kramer MS, Naimark LE, Roberts-Brauer R, McDougall A, Leduc DG.(1991) Risks and benefits of paracetamol antipyresis in young children with fever of presumed viral origin. Lancet 337:591-4.
World Health Organisation (2000) Integrated Management of Childhood Illness. WHO document WHO/FCH/CAH/00.12 Geneva: WHO;
Arens E, Zang H, Huizenga C.(2006) Partial and whole body thermal sensation and comfort. Part 1. Uniform environmental conditions. Journal of thermal biology 31, 53-59.
Eyers S, Fingleton J, Eastwood A, Perrin K, Beasley R. British(2012) National Formulary for Children: the risk of inappropriate paracetamol prescribing. Archives of Diseases of Childhood 97(3):279-82.
Sztajinkrycer MJ, Bond GR. (2001). Chronic acetaminophen overdosing in children: risk assessment and management. Current Opinion
Paediatrics 13: 177-82.
Cranswick N, Coghlan D. (2000) Paracetamol efficacy and safety in children: the first 40 years. American Journal of Therapeutics 7:135-41.
Nahata MC, Powell DA, Durrell DE, Miller MA. (1984). Acetaminophen accumulation in paediatric patients after repeated therapeutic doses.
European Journal of Clinical Pharmacology 27:57-59.
Rivera-Penera T, Gugig R, Davis J, McDiarmid S, Vargas J, Rosenthal P, Berquist W, Heyman MB, Ament ME.(1997) Outcome of acetaminophen overdose in paediatric patients and factors contributing to hepatotoxicity. Journal of Paediatrics 130: 300-304.
Heubi JE, Barbacci MB, Zimmerman HJ. (1998). Therapeutic misadventures with acetaminophen: Hepatotoxicity after multiple doses in children. Journal of Paediatrics 132:22-7.
Kwok KL, Fu YM, Ng DKK. (2004). Hepatotoxicity and persistent renal insufficiency after repeated supratherapeutic paracetamol ingestion in a Chinese boy. Hong Kong Medical Journal. 10; 1: 61-64.
Tenenbein M. Acetaminophen: The 150 mg/kg myth (2004). Journal of Clinical Toxicology 42: 145-148.
Anderson BJ, Holford NHG, Armishaw JC, Aicken R.(1999) Predicting concentrations in children presenting with acetaminophen overdose. Journal of Paediatrics 135: 290-295.
Peterson RG, Rumack BH. (1978) Pharmacokinetics of acetaminophen in children. Paediatrics 62(2):877-9.