UNIVERSITY OF GHANA, LEGON SCHOOL OF NURSING AND …

UNIVERSITY OF GHANA, LEGON

SCHOOL OF NURSING AND MIDWIFERY

COLLEGE OF HEALTH SCIENCES

EXPLORING THE BELIEFS AND PRACTICES OF MOTHERS

CONCERNING THE CARE OF CHILDREN WITH FEBRILE

SEIZURES AT PRINCESS MARIE LOUISE HOSPITAL

BY

MAWUSI NYAME-ANNAN

(10637169)

THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA,

LEGON IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR

THE AWARD OF MPHIL NURSING DEGREE

JULY, 2019

University of Ghana http://ugspace.ug.edu.gh

Beliefs and Practices of Mothers concerning Febrile Seizures in children

i

DECLARATION

I hereby declare that except for references to other people’s work which have been

accordingly acknowledged, this thesis is the original work of Mawusi Nyame-Annan

produced under supervision. None of the materials in this write-up has been presented

either in whole or in part to any other institution for the award of any degree or certificate.

Name of student: Mawusi Nyame-Annan

Signature ……………………….

Date …………………………….

The undersigned hereby certify that this thesis was duly supervised in accordance with

procedures laid down by the University of Ghana, Legon.

Dr. Patience Aniteye

Signature ………………………….

Date ………………………….........

Rev. Dr. Thomas Akuetteh Ndanu

Signature ……………………………

Date ………………………………....



ii

DEDICATION

This write-up is dedicated to the Almighty God for His mercies, grace, and wisdom given

me to successfully complete this work.

I also dedicate this work to my dear husband, Ernest P.K. Nyame-Annan and my lovely

children, Adom, Nyameye and Nyamensa.



iii

ACKNOWLEDGEMENT

I would like to acknowledge all those who contributed in one way or the other to make this

study successful.

I would like to express my heartfelt gratitude to my supervisors Dr. Patience Aniteye and

Rev. Dr. Thomas Akuetteh Ndanu for the great impact they made on this work.

Special appreciation also goes to the staff and all participants of the study at the emergency

unit of the Princess Marie Louise Hospital for their cooperation.

I would also like to express my sincere gratitude to the staff of the emergency unit at the

Korle-Bu teaching Hospital for their support during my pilot study.

I am also grateful to all staff of the School of Nursing and Midwifery, University of Ghana,

especially the lecturers for their nurturing and quality education throughout the two-year

programme.

To all I would say, God richly bless you.



iv

TABLE OF CONTENTS

DECLARATION .................................................................................................................. i

DEDICATION ..................................................................................................................... ii

ACKNOWLEDGEMENT ................................................................................................. iii

TABLE OF CONTENTS .................................................................................................... iv

LIST OF TABLE(S) ........................................................................................................ viii

LIST OF FIGURE(S) .......................................................................................................... ix

LIST OF ABBREVIATIONS .............................................................................................. x

ABSTRACT ........................................................................................................................ xi

CHAPTER ONE .................................................................................................................. 1

1.1 Background of the study ............................................................................................ 1

1.2 Problem statement ...................................................................................................... 5

1.3 Purpose of the study ................................................................................................... 6

1.4 Specific objectives...................................................................................................... 6

1.5 Research questions ..................................................................................................... 7

1.6 Significance of the study ............................................................................................ 7

1.7 Operational definition of terms .................................................................................. 7

1.8 Summary .................................................................................................................... 8

1.9 Organization of work ................................................................................................. 8

CHAPTER TWO ................................................................................................................. 9

LITERATURE REVIEW .................................................................................................... 9

2.1 Conceptual framework ............................................................................................... 9

2.2 Explanation of household decision making ............................................................. 11

2.2.1 Caregiver recognition and response .................................................................. 11

2.2.2 Seeking advice and negotiating access .............................................................. 12

2.2.3 Using the “middle layer” between home and clinic .......................................... 12

2.2.4 Accessing formal biomedical services .............................................................. 13

2.3 Justification of the model for this study ................................................................... 13

2.4. Caregiver recognition and response ........................................................................ 14

2.4.1 Temperature measurement ................................................................................ 16

2.4.2 Fever management ............................................................................................. 17

2.4.3 Antipyretics use ................................................................................................. 18

2.4.4 Other fever management practices .................................................................... 19



v

2.4.5 Traditional methods use ..................................................................................... 20

2.5 Seeking advice and negotiating access..................................................................... 20

2.6 Using the middle layer between home and clinic .................................................... 21

2.7 Summary and Conclusion ........................................................................................ 24

CHAPTER THREE ........................................................................................................... 25

RESEARCH METHODOLOGY....................................................................................... 25

3.1 Research Design ....................................................................................................... 25

3.2 Research setting........................................................................................................ 26

3.2.1 Study Location ................................................................................................... 26

3.2.2 Metropolitan Economy ...................................................................................... 26

3.2.3 Health Care Facility ........................................................................................... 27

3.3 Target Population ..................................................................................................... 28

3.3.1 Inclusion Criteria ............................................................................................... 28

3.3.2 Exclusion Criteria .............................................................................................. 28

3.4 Sample Size .............................................................................................................. 28

3.5 Sampling technique .................................................................................................. 29

3.6 Procedure for data collection.................................................................................... 29

3.7 Data Collection Tool ................................................................................................ 30

3.8 Pre-testing the interview guide ................................................................................. 31

3.9 Data management ..................................................................................................... 31

3.10 Data Processing and Analysis ................................................................................ 32

3.11 Methodological Rigour .......................................................................................... 32

3.12 Ethical considerations ............................................................................................ 34

3.13 Summary ................................................................................................................ 35

CHAPTER FOUR .............................................................................................................. 36

PRESENTATION OF FINDINGS .................................................................................... 36

4.1 Demographic Characteristics of Respondents .......................................................... 36

4.2 Organization of Themes and Sub-Themes ............................................................... 36

4.3 Identification of Signs and Symptoms of Febrile Seizures ...................................... 37

4.3.1 Fever .................................................................................................................. 38

4.3.2 Change in eye movement .................................................................................. 38

4.3.3. Change in body movement ............................................................................... 39

4.3.4 Clenching of teeth .............................................................................................. 39

4.4 Causes and Beliefs ................................................................................................... 39



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4.4.1 Physical .............................................................................................................. 40

4.4.2 Spiritual ............................................................................................................. 41

4.5 Home Remedies ....................................................................................................... 42

4.5.1 Medications ....................................................................................................... 43

4.5.2 Water/ oil ........................................................................................................... 44

4.5.3 Positioning ......................................................................................................... 44

4.5.4 Prayer ................................................................................................................. 44

4.6 Consultation of Significant Others ........................................................................... 45

4.6.1 Family ................................................................................................................ 45

4.7 Seeking care in the community ................................................................................ 47

4.7.1 Religious leaders................................................................................................ 47

4.7.1.1 Pastor/ Fetish Priestess ................................................................................... 47

4.7.1.2 Traditional healer/ herbalist ............................................................................ 47

4.7.2 Health professionals .......................................................................................... 48

4.7.2.1 Doctor/ Nurse ................................................................................................. 48

4.7.2.2 Pharmacist ...................................................................................................... 48

4.8 Healthcare Facility ................................................................................................... 49

4.8.1 Emergency ......................................................................................................... 49

4.8.2 Attitude of staff .................................................................................................. 49

4.8.3 Others................................................................................................................. 50

4.9 Mothers’ Reaction .................................................................................................... 51

4.9.1 Anxiety .............................................................................................................. 51

4.9.2 Devastation ........................................................................................................ 52

4.9.3 Crying ................................................................................................................ 52

4.9.4 Confusion........................................................................................................... 52

4.10 Ignorance ................................................................................................................ 52

4.10.1 Condition (febrile seizures) ............................................................................. 52

4.10.2 Management of febrile seizures ....................................................................... 53

4.11 Summary of findings .............................................................................................. 53

CHAPTER FIVE ............................................................................................................... 56

DISCUSSION OF FINDINGS .......................................................................................... 56

5.1 Demographic Characteristics of Respondents .......................................................... 56

5.2 Caregiver Recognition and Response ...................................................................... 57

5.2.1 Beliefs of mothers about febrile seizures .......................................................... 57



vii

5.2.2 Practices of mothers in response to febrile seizures .......................................... 58

5.3 Seeking Advice and Negotiating Access ................................................................. 60

5.4 Using the Middle Layer between Home and Clinic ................................................. 61

5.5 Accessing Formal Biomedical Services ................................................................... 62

5.6 Mothers’ Reaction .................................................................................................... 64

5.7 Ignorance .................................................................................................................. 64

5.8 Evaluation of the Study Model................................................................................. 65

5.9 Suggestion for Model Modification ......................................................................... 65

CHAPTER SIX .................................................................................................................. 66

SUMMARY, IMPLICATIONS, LIMITATIONS, CONCLUSION AND

RECOMMENDATIONS ................................................................................................... 66

6.1 Summary of the Study .............................................................................................. 66

6.2 Implications for Nursing Practice ............................................................................ 68

6.3 Nursing Education .................................................................................................... 68

6.4 Nursing Research ..................................................................................................... 68

6.5 Limitations of the Study ........................................................................................... 69

6.6 Conclusion ................................................................................................................ 69

6.7 Recommendations .................................................................................................... 70

REFERENCES .................................................................................................................. 73

APPENDICES ................................................................................................................... 82

Appendix A: Introductory letter to NMIMR-IRB ............................................................. 82

Appendix B: Introductory letters to GHS-IRB .................................................................. 83

Appendix C: Ethical Clearance from NMIMR-IRB .......................................................... 85

Appendix D: Ethical approval from GHS-IRB .................................................................. 86

Appendix E: Introductory letter GHS ................................................................................ 87

Appendix F: Introductory letter to Accra Metropolitan Health Directorate ..................... 88

Appendix G: Introductory letter to PML ........................................................................... 89

Appendix H: Interview Guide ............................................................................................ 90

Appendix I: Consent Form................................................................................................. 93

Appendix J: Participants information sheet ....................................................................... 95

Appendix K: Demographic Characteristics of Respondents ............................................. 99

Appendix L: Major Themes and Sub-themes .................................................................. 100



viii

LIST OF TABLE(S)

Table 4.1: Organization of Themes and Sub-themes ......................................................... 37



ix

LIST OF FIGURE(S)

Fig 2.1: Household Decision Making Model and Pathways of Care ................................. 10



x

LIST OF ABBREVIATIONS

AIDS ………………… Acquired Immune Deficiency Syndrome

AMA…………………. Accra Metropolitan Assembly

BM…………………… Behavioural Model

FSR…………………… Febrile Seizure Respondent

GCNM ………………. Ghana College of Nurses and Midwives

GHS…………………… Ghana Health Service

GHS-ERC…………….. Ghana Health Service - Ethical Review Committee

HBM………………...… Health Belief Model

HIV…………………….. Human Immunodeficiency Virus

ILAE…………………… International League Against Epilepsy

MOH…………………… Ministry of Health

NMIMR………………… Nugochi Memorial Institute for Medical Research

OPD…………………….. Out Patient Department

PML…………………….. Princess Marie Louise

WHO……………………. World Health Organization



xi

ABSTRACT

Febrile seizures are the most common causes of childhood seizures that occur in children

under five globally. Mothers’ care based on knowledge, beliefs and practices may reduce

the incidence and complication. Thus, the aim of this study was to explore the beliefs and

practices of mothers concerning the care of children with febrile seizures at the Princess

Marie Louise Hospital. This was an exploratory descriptive qualitative study where a semi-

structured interview guide based on the Household Decision Making Model was used. A

total of 12 mothers who attended the Princess Marie Louise Hospital at the time of the study

were purposefully sampled and interviewed. Each interview lasted between 35-60 minutes

and was recorded with permission from the respondents. Verbatim transcription of the

interviews was done and data analysis was done using thematic content analysis. The study

revealed that, although mothers had an idea about febrile seizures, they lacked adequate

knowledge about its management at home and hence use inappropriate methods to abort

the seizure or stop its recurrence. The researcher therefore recommends that, educative

programmes should be developed for mothers on febrile seizure that occur in children, its

associated signs and symptoms and how to effectively manage it at home before seeking

biomedical service.

Keywords: febrile seizure, fever, beliefs, practices, health seeking behaviour, biomedical

service.



1

CHAPTER ONE

This chapter presents the background of the study, problem statement, purpose of the

study, objectives of the study, research questions, significance of the study and the

operational definition of terms used in the study.

1.1 Background of the study

Febrile seizure or febrile convulsion is a sudden disturbance in the electrical

functioning of the brain occurring in the presence of a temperature above 38.0℃. It

normally occurs in children who are between six (6) months and five (5) years (Winkler,

Tluway, & Schmutzhard, 2018). Mostly, there is no associated intracranial infection, (Khair

& Elmagrabi, 2015). It is the most common neurological disorder in children. During

childhood, one out of every twenty-five (25) children in a given population will experience

at least one febrile seizure episode (Waruiru & Appleton, 2004). Signs of febrile seizures

in children may include staring, loss of consciousness, jerky movements or shaking of the

limbs and body and sometimes turning blue (Liano, Mencaroni, 2018).

Febrile seizure can be classified into simple or complex seizures depending on the

duration and the type of seizure. Simple febrile seizure occurs once in 24 hours and lasts

for 15 minutes or less and it is generalized in nature. Complex febrile seizure on the other

hand, lasts more than 15 minutes, it is mostly focal or happens in successions with durations

more than 30 minutes (Graves, Oehler, & Tingle, 2012). In approximation, 60 to 70% of

febrile seizures are simple and about 30 to 40% are complex in nature (Koyama, 2013). It

has been reported that, about 2% of children who experience simple febrile seizures are at

risk of developing epilepsy, whilst 25% of those with complex febrile seizures are at risk

of status epilepticus (Patel & Scott Perry, 2017). Similar findings were found in a study:

‘long-term risk of developing epilepsy after febrile seizures’ a prospective cohort study by

Neligan, Bell, Giavasi, Johnson, Goodridge, Shorvon, & Sander (2012). Children who



2

suffered febrile seizures were at increased risk of developing epilepsy, and an estimated

6.7% of people developed epilepsy after 20 years of febrile seizures. Additionally, some

retrospective studies indicated that, there is a link between a complex febrile seizure and a

temporal lobe epilepsy in about 40% adult patients (Patterson, Baram, & Shinnar, 2014).

A child with a past medical history of at least one episode of a simple febrile seizure, has

about 33% chance of another seizure episode following a subsequent fever, and a 50%

chance of a third febrile seizure if he/she had two simple febrile seizures (Carmant, 2015).

The International League Against Epilepsy, defined febrile seizure as a seizure that

occurs in association with a febrile illness in the absence of a central nervous system (CNS)

infection or acute electrolyte imbalance in children older than one month of age without

prior afebrile illness (Paediatric quideline, 2012). There is a risk of neurological illness

such as epilepsy, recurrence of seizures and death. However, parents must be reassured of

the fact that children who do not have any underlying developmental conditions or

problems have lower risks of suffering lasting neurological effects resulting from febrile

seizures (Graves et al., 2012).

Developmental delay, viral infections, certain vaccinations, a family history of

febrile seizures, zinc and iron deficiencies are some risk factors related to febrile seizures

(Graves et al., 2012). Febrile seizure is believed to occur either before or soon after fever

onset, (Seinfeld & Shinnar, 2017). There is a small possibility of mortality after complex

febrile seizure, predominantly febrile status epilepticus.

Although, the prognosis for febrile seizure was found to be normally good, quite a

number of children will experience some consequences (Seinfeld & Shinnar, 2017),

epilepsy will develop eventually in about 57% of children with prolonged, focal and

recurrent febrile seizures.



3

In high income countries, febrile seizure is a benign illness but this cannot be said

of middle in-come and low in-come countries due to increased mortality (Gordon, Dooley,

Camfield, Camfield, & MacSween, 2001). There is a high prevalence of febrile seizures in

children who have been admitted to hospital in rural Africa (Winkler et al., 2018).

The developing and immature brain may suffer immediate or long term

consequences following a seizure episode (Holmes, 2016). The exact cause of febrile

seizure is unknown, but some predisposing factors may include fever, head injury,

respiratory infections, low blood sugar levels, epilepsy among others (Carmant, 2015). In

addition, genetic or familial predisposition is key (Khair & Elmagrabi, 2015). Thus,

children with positive history of febrile seizures in their families are likely to experience

febrile seizures than those without such family history.

Febrile seizure occurs in 2-5% of children during their first five years of life but

most common during their second year [Kimia, Bachur, Torres, & Harper, 2015;Khair, &

Elmagrabi, 2015]. Again, it occurs in approximately 2-5% of the population worldwide,

with Japan having a rate of 6-9% and 14% in the Pacific Islands (Koyama, 2013). In the

United States 2-5% of children have febrile convulsion before their 5th birthday. It is the

commonest form of seizure accounting for 30% of seizure disorders in children, (Hu, Zou,

Zhong, Gao, Zhao, Xiao, & Kwan, 2014). Additionally, about 3-5% of healthy children

who are between nine (9) months and five (5) years will have a seizure caused by fever

which mostly occurs in the first 24 hours of an illness (Pediatrics, 2011).

However, there are limited data from low-income countries including Ghana on

febrile seizures. This may be due to the difficulty in differentiating between the types of

seizures, especially if is due to falciparum malaria infection.



4

Literature indicate that the traumatic nature of febrile seizures put most mothers in

fear and it is also a leading cause of paediatric emergency admissions at various health

facilities worldwide (Sajadi & Khosravi, 2017). Poor understanding of seizures that occur

in children among mothers contribute mainly to mortality and morbidity that result from

convulsion in low-income countries (Jarrett, Fatunde, Osinusi, & Lagunju, 2012). Health

seeking behaviours are largely determined by religious, social and cultural norms, beliefs

about the cause of disease, acceptability of interventions as well as local decision making

practices (Colvin, Smith, Swartz, Ahs, de Heer, Opiyo, … George, 2013).

Ethnic variations exist in the beliefs and practices regarding childhood fever (fever

being the main precipitating factor of febrile seizure) (Crocetti, Sabath, Cranmer, Gubser,

& Dooley, 2009). Delay in accessing medical care or treatment by mothers is as a result of

the perceptions about the cause of illness as well as cultural beliefs and practices

(Abubakar, Van Baar, Fischer, Bomu, Gona, & Newton, 2013). It has been noted that

mothers who see certain illnesses as not related to physical causes do not seek medical

treatment or sometimes delay in seeking medical care (Dillip, Alba, Mshana, Hetzel,

Lengeler, Mayumana, … Obrist, 2012). The choice of treatment options or modality by

many people in Africa is influenced by their beliefs about illness and health (Asare, 2017).

It has been acknowledged that traditional medicines are commonly used among Ghanaians

to treat various ailments (Nguta, Appiah-Opong, Nyarko, Yeboah-Manu, & Addo, 2015).

Literature indicate that most Ghanaians sought management for an illness depending on

their belief system on the cause (Asare, 2017). However, little is known about the practices

and beliefs of mothers concerning the care of children under five with febrile seizures in

the Accra Metropolis in Ghana.



5

1.2 Problem statement

Data from Princess Marie Louise Hospital indicated that, out of 4,414 admissions

in 2014, 251 (5.6%) were diagnosed with febrile seizures. However, there was a significant

increase in 2015 as 268 (7.2%) out of 3,708 admissions were diagnosed with febrile

seizures. From 2016 to the first half of 2018, there was a drop from 5.1% to 3.1%. However,

eight (8) deaths were recorded between 2016-2018 (P.M.L. Statistics, 2014-2018).

Febrile seizures represent a common cause of children’s admission globally,

(Winkler et al., 2018). In middle income countries such as Ghana where various incorrect

traditional beliefs about the etiology of sickness such as seizures exist, and detrimental

practices for seizure treatment abound, the outcome of seizure is poor [Asare, 2017; Jarrett,

Fatunde, Osinusi, & Lagunju, 2012)]. It is however imperative that mothers understand

febrile seizures and how their children should be managed appropriately at home before

sending them to the hospital. This is achievable if mothers’ beliefs and practices are known

(Sajadi & Khosravi, 2017). There is a higher risk of acute seizures in children in low-

income countries compared to those in high-income countries (Ciccone, Mathews, &

Birbeck, 2017a). Some reasons that may account for the higher risk of acute seizures in

children in low-income countries are poor parental care, parasites such as worm infestations

and other infectious diseases. Febrile Seizure has social, physical and cultural

characteristics which influence treatment and possible outcomes (Ciccone, Mathews, &

Birbeck, 2017b). In the African setting, care seeking timelines may also be delayed

(Ciccone, Mathews, & Birbeck, 2017c).

During the researcher’s period of 10 years’ practice as a nurse, she came across

mothers of children with febrile seizures who had many conflicting beliefs about the causes

of the disease and hence used diverse practices to manage the condition. One of the danger

signs of childhood illness is a seizure. There is however, the need to refer such cases to a



6

secondary level facility as suggested by the World Health Organization’s Integrated

Management of Childhood Illness (The World Health Report 2005). In Ghana however,

there is limited literature on the beliefs and practices of mothers of children with febrile

seizures.

The Princess Marie Louise (PML) Hospital is the only Paediatric hospital of the

Ghana Health Service, and one of the busiest hospitals in the country which serves as a

primary and secondary health facility. There is the need to identify the beliefs and practices

of mothers concerning the care of children with febrile seizures. The study was undertaken

using mothers who accessed healthcare in this facility to explore their beliefs and practices

concerning the care of children with febrile seizures so as to avert the untoward sequelae

of these seizures and to mitigate the incidence and reduce the negative outcomes.

1.3 Purpose of the study

The purpose of the study was to explore the beliefs and practices of mothers

concerning the care of children with febrile seizures.

1.4 Specific objectives

The specific objectives were to:

1. describe how mothers recognize and respond to febrile seizures in their children

under five.

2. explore where mothers seek advice for the care of their children with febrile

seizures.

3. define the role of Significant Others in the type of health care sought for the

children with febrile seizures.

4. Identify the factors affecting the mothers’ choice of biomedical services for their

children with febrile seizures.



7

1.5 Research questions

1. What are the beliefs of mothers with children who have febrile seizures and how do

they recognize the condition?

2. What are the practices of mothers who have children with febrile seizures?

3. What are the decision making practices of families who have children with febrile

seizures?

4. What practices do mothers of children with febrile seizures undertake before

bringing their children to the hospital?

5. What factors influence mothers’ decision to bring their children to the hospital?

1.6 Significance of the study

Assessing the beliefs and practices regarding febrile seizures would help spread the

awareness about febrile seizures and how it can be managed effectively by mothers at home

before seeking medical care. Furthermore, the study would inform the academic world and

policy makers about the need for future evidence based research on the beliefs and practices

of mothers concerning febrile seizures and subsequently develop suitable training/

educational programmes for these mothers. Lastly, the study will help minimize the

existing gap and also add to the research knowledge on the beliefs and practices of mothers

about the care of children with febrile convulsions or seizures in Ghana.

1.7 Operational definition of terms

1. Febrile seizures: The disruption in the electrical functioning of the brain of a

child under five (5) years caused by an abnormal rise in body temperature (fever).

2. Fever: A body temperature above 37.5℃.

3. Beliefs: One’s acceptance of something that exists.

4. Practices: The real application of one’s idea



8

5. Health seeking behaviours: The actions taken by mothers to access healthcare

for their sick children.

6. Biomedical services: Formal health care facility/services.

1.8 Summary

This chapter provided information on the study about the beliefs of mothers

concerning the care of children with febrile seizures at the emergency unit of the Princess

Marie Louise Hospital, Accra. A brief background to the research problem was given. The

chapter also discussed the significance of the study, objectives and operational definitions

of terms used. The next chapter presents a literature review on the conceptual framework

(Household Decision Making Model) and on mothers’ beliefs and practices concerning

management of febrile seizures in their children.

1.9 Organization of work

The study was organized into six chapters. Chapter one provided the background to

the study, presented the problem statement, the study objectives, research questions, the

significance of the study as well as the operational definition of terms used.

Chapter two provided relevant literature on the beliefs and practices of mothers of

children with febrile seizures and the conceptual framework guiding the study.

The research design was described in chapter three whilst chapter four presented

the results of the study findings.

The five chapter discussed the findings of the study and the sixth chapter presented

the summary, implications, limitations, conclusion and recommendations.



9

CHAPTER TWO

LITERATURE REVIEW

This chapter examined available literature on the beliefs and practices of mothers

concerning the care of children with febrile seizures. This involved reading, researching,

and gathering information from published works and written data that supported closely

the present study. The literature review looked at works that were relevant to febrile

seizures and the associated beliefs and practices. Based on the objectives of the study, the

literature review was organized on the various thematic areas. Various databases searched

included Medline, PubMed, Sci-Direct and CINAHL using the search terms such as fever,

seizure, beliefs, practices, convulsion, care, febrile seizure, children and mothers, either in

combination or as a single word.

2.1 Conceptual framework

The model used to organize this research was the conceptual model of Household

Decision Making and Pathways of Care. This framework was derived from the four modes

of household recognition and response to childhood illness proposed by Colvin et al.,

(2013). It was used to examine factors that predict treatment options mothers seek for their

ill children. This model was used by (Pierce, Gibby, & Forste, 2017), in a study: caregiver

decision-making, household response to child illness in Sub-Saharan Africa. The dynamic

nature of treatment choices made by caregivers was emphasized. They modeled whether

these three forms of treatments (no treatment, middle layer treatment such as traditional

healer, a pharmacist and or bio-medical treatments) were sought for a child with fever,

cough or diarrhea.



10

Fig 2.1: Household Decision Making Model and Pathways of Care

(Adopted from Colvin et al., 2013)



11

2.2 Explanation of household decision making

The model comprised four constructs namely; caregiver recognition and response,

seeking advice and negotiating access, using the middle layer between home and clinic

and accessing formal biomedical services.

2.2.1 Caregiver recognition and response

Caregivers, for that matter mothers are most of the time the first people to recognize

an illness in their children and respond accordingly. Such responses may include seeking

advice from family and friends, use of home remedies, going to traditional healers or

sending the child to a medical health facility (Pierce et al, 2017). The first step for a child

to get treatment is the ability of the mother to recognize the existence of an illness, and the

perception of such a mother adds to timely and proper interventions (Gadsden, Ford, &

Breiner, 2005). The type of treatment options sought after is influenced by the mothers’

understanding of the cause of illness (Pierce et al, 2017).

In addition, the severity of the illness as well as the signs exhibited by a child

influence to some extent, the response of the mother (Ellis, Winch, Daou, Gilroy, &

Swedberg, 2007). Other factors that may influence the recognition of an illness is the

mother’s level of education, knowledge about healthcare and the exposure to media (Pierce

et al, 2016). Vikram, Vanneman, & Desai (2012), reported that, one’s acceptance of

modern medical practice is dependent on the knowledge acquired through education. Thus,

the ability of a mother to recognize and respond correctly to illness is a critical first step in

treatment and is associated with her knowledge of illness and modern healthcare.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5546145/#R39


12

2.2.2 Seeking advice and negotiating access

It is not the sole responsibility of mothers in the African society to decide on the

actions taken in response to an illness. The mothers have the social obligation to inform

their in-laws, grandparents or neighbours (Nsungwa-Sabiiti, Källander, Nsabagasani,

Namusisi, Pariyo, Johansson, … Peterson, 2004). Mothers have to seek advice from their

husbands or the head of the family who is most of the time a male (Falade, Ogundiran,

Bolaji, Ajayi, Akinboye, Oladepo, … Oduola, 2007). There is usually a slow response time

as the mothers of such children have to ask for permission/ opinion from others before

decisions are taken. This may have an adverse effect on the children as treatment sought

may be delayed leading to dire consequences (Jones & Jacobsen, 2007).

Aside the risk of treatment delay, some key decision makers may oppose orthodox

medicine or modern healthcare, as they believe that the child may die when sent to the

hospital (Comoro, Nsimba, Warsame, & Tomson, 2003). Hence, the wellbeing of a child

and his/ her survival depend on the mother’s ability to make healthcare decisions to seek

for care outside the home (Gadsden, V, L., Ford, M., & Breiner, 2005). Furthermore, one

cannot seek quality healthcare without money. Access to medical healthcare is influenced

by both residential and socioeconomic status (Taber, Leyva, & Persoskie, 2015).

2.2.3 Using the “middle layer” between home and clinic

Caregivers most often commence with home treatments, and will only change to an

alternate treatment if the first treatment is unsuccessful, Pierce (2016). A study by Ellis et

al., (2007), conducted in Mali, indicated that if there is no improvement in the child’s

condition a few days after commencement of home treatment, the caregiver then seeks

treatment from pharmacies, traditional healers and community health workers. The reason

for choosing such treatment may be due to the fact that they are less expensive than the

biomedical services being rendered at the various health facilities although they differ in



13

their training, treatment and the type of medications given, (Pierce, 2016). Friend-du Preez,

Cameron, & Griffiths, (2009), posited that the middle layer is very alluring in instances

where the cause of the sickness is believed to be due to evil spirits or wizardries such that

their services are engaged to deal with such supernatural powers.

2.2.4 Accessing formal biomedical services

Seeking biomedical services is the best since they are able to treat the illness a child

may present with. However, in a study conducted in Burkina Faso, many ill children were

not sent to the hospital by their parents as a result of financial constraints (Beiersmann,

Sanou, Wladarsch, De Allegri, Kouyaté, & Müller, 2007). Other challenges may include;

cost of services provided, the quality of care, the trust of the facility as well as the distance

one has to cover to access health.

Notwithstanding the challenges aforementioned, willingness to access a biomedical

service is associated with the mother’s educational level and socioeconomic status

(Olaogun, Adebayo, Ayandiran, & Olasode, 2006). As a result, if the treatment outcomes

prove positive, mothers are likely to use the facility again or even recommend it to others.

2.3 Justification of the model for this study

A number of models have been used from literature to assess the beliefs of people

concerning decisions on health. One of such models is the The Health Belief Model (HBM),

as proposed by [Hochbaum, 1958; cited in Becker, 1974]. This model posited that

individual’s perception of health is influenced by beliefs about vulnerability to a health risk

and its consequences. This affects the individual’s readiness in taking decision or an action.

This model has been used to examine the utilization of preventive care (Carrmel, 1991).

The HBM model was not used in this work because it was more applicable to the prediction

of a broader range of health behaviours in lager populations. Three broad areas have been



14

identified in a study, they included: preventive health behaviours, such as health promotion

(example exercise and diet) and health-risk behaviours such as smoking as well as

vaccination and contraceptive practices: sick role behaviours, mainly adherence to

recommended medical treatments; and clinic use, which includes physician visits for

various reasons (Abraham & Sheeran, 2016).

Additionally, the second model that could be used for this study is The Behavioural

Model (BM) as proposed by [Anderson, 1968; cited in Abraham & Sheeran, 2016]. This

model consisted of three main components namely:

Predisposing factors such as education, family size, age, sex and employment.

Need factors such as symptoms of illness, disability and perceived health status.

Enabling factors such as insurance, income and residence.

The constructs of the behavioural model do not fit the objectives of the study and hence

could not be used for this study. However, the appropriate model for this study was the

household decision making model whose constructs were appropriate for the objectives of

this study. The model can be used to construct the link between the beliefs of mothers about

febrile seizures and practices they employed to abort the seizures. The model explains what

goes on at home, how mothers are able to recognize their children are sick, who is involved

in decision making at home concerning where to seek biomedical services and the remedies

used before finally arriving at the hospital.

2.4. Caregiver recognition and response

There is a spiritual involvement in the treatment of illness and healthcare in Ghana

(Asare, 2017). The reaction of mothers to febrile seizures that occur in children can lead to

psychological, behavioural and even physical manifestations. Psychological manifestations

may include apprehension, fear of recurrence of seizure, fear of possible development of



15

epilepsy and anxiety about fevers. Physically, mothers experience sleep disruptions, loss of

appetite and indigestion. As a result, such mothers may perceive that their children are now

susceptible to medical or developmental challenges (Hussein, El, Saboula, & Eldein, 2016).

In a study conducted in a community in Nigeria on the perception of childhood convulsion

among women, a greater number of the participants (90.8%) have the believe that fever

could be responsible for convulsion in children. However, in most homes in the community,

parents attributed the cause to be malaria fever, (constituting 58.4% of participants). Others

believed it was hereditary whilst 69.8% believed the children die and regain consciousness

or life afterwards (Anigilaje & Anigilaje, 2013). For some parents, a first febrile seizure is

a turbulent situation which they described as chaotic, others felt they had trouble thinking

straight while waiting for the seizure to pass and feeling unable to do anything (Westin &

Levander, 2018). Ethnicity, race and sociodemographic factors are known to influence the

beliefs and practices of parents regarding fever (Taveras, Durousseau, & Flores, 2004).

Some mothers believe that, fever may result in serious complications and this has led to

increase in fever phobia as well as increase overdosing of medications (Zyoud, Sa’ed, Al-

Jabi, Sweileh, Nabulsi, Tubaila, Awang, & Sawalha, 2013).

Febrile seizure has been reported to be one of the illnesses where the use of

antipyretics has strongly been encouraged (El-Radhi, 2012). Tepid sponging, use of

antipyretics or fanning which are measures of controlling body temperature, are believed

to prevent the occurrence of febrile seizures (Kelly, Sahm, Shiely, O’Sullivan, et al., 2016).

Literature has it that, simple febrile seizures are not harmful and does not cause any

neurological effect. Due to lack of evidence and the risk of adverse effect, neither

anticonvulsants or antipyretics are suggested for febrile seizure prevention [Graves et al.,

2012; Mittal, 2014].



16

However, despite the abovementioned, caregivers have a common idea that febrile

seizures lead to brain damage or developmental disorders (Sajadi & Khosravi, 2017). The

attitude towards fever and the dependence on antipyretics to reduce the fever and prevent

the occurrence of seizures as well, exists amongst healthcare professionals, [Demir &

Sekreter, 2012;Greensmith 2013;Martins & Abecasis, 2016].

First aid management at home aims at prevention of aspiration as well as reducing

the body temperature. These can be achieved by placing the child’s head on his/her side to

prevent aspiration and tepid sponging to control pyrexia (Aluka, Asibong, Gyuse,

Meremikwu, Oyo-Ita, & Udonwa, 2013). A study report says, in developing countries like

Nigeria, quite a number of children with febrile seizures are treated at home with traditional

medicines before presenting to the medical facility. Subsequently, there is a misconception

about the cause of illness and the use of these traditional medicines and practices used by

the parents were inappropriate and scientifically proven to be invalid and harmful to the

child (Deepika & VipinVageria, 2017). Administration of harmful traditional medicines,

delayed care, in resource poor settings complicates acute febrile seizures in the tropical

regions (Birbeck, 2010).

2.4.1 Temperature measurement

Most people including health professionals use body temperature to determine a

person’s health status (Obermeyer, Samra, & Mullainathan, 2017). Mothers measure

temperature by feeling, or palpating parts of the body as well as the use of various

thermometers (Singh, Pai, & Kalantri, 2003). For the accurate measurement of a child’s

temperature, one must consider the use of a thermometer whether at home or in the hospital

setting. However, whether mothers at home have acquired a thermometer or know how to

read or interpret its readings are areas that need research. The normal body temperature in

children ranges between 36.5-37.5℃ (Novak & Gills 2016). Literature has it that, although



17

parents may be worried about their children’s elevated body temperatures, not all may have

a thermometer at home. Nonetheless, the ability to accurately check or read a thermometer

cannot be predicted by owing one. Notwithstanding, if educated on how to accurately read

the thermometer, a section out of the large number of mothers may be able to read the

thermometer recordings (Robinson, Jou, & Spady, 2005). Additionally, factors such as

one’s socio-economic status, educational background, age of the mother may predict how

accurately temperatures are taken and interpreted or read (Gadsden, Ford, & Breiner, 2005).

2.4.2 Fever management

Fever is a common symptom that is associated with various childhood illnesses

including respiratory tract infections, malaria, diarrhea diseases, measles and urinary tract

infections (Adedire, Asekun-olarinmoye, & Fawole, 2014). Febrile illnesses have been

recognized to be the common cause of hospital admission, its accompanying infectious

causes have a great impact on childhood mortality and morbidity worldwide, particularly

in low and middle income countries (Iroh Tam, Obaro, & Storch, 2016). Not being able to

recognize fever as a sign of a serious infectious illness, can have dire consequences on the

child. Fever is reported to be one of the primary reasons parents seek medical care for their

children, with an estimated 30% seen by paediatricians having fever as their chief

complaint (El-Radhi, Carroll, & Klein, 2009).

Fever can be defined as a rise in body temperature above the normal range or

variation. For children, the normal value is between 36.5℃-37.5 (Howard & Westerby,

2011). Fever is one of the main symptoms of childhood illness causing febrile convulsion

or seizure. Parental worry about fever in children and resulting use of antipyretic is on the

increase (Zyoud et al., 2015).

Literature also has it that most parents have misconceptions about fever, its role in

ailment and its management (Crocetti et al., 2009). Ethnic or racial differences could play



18

a role in the belief systems and practices toward fever management (Affognon, Mburu,

Hassan, Kingori, Ahlm, & Evander, 2017). Temperature ranges that parents identified as

fever was between 37.5℃-39℃, and normal temperatures ranged between 36℃-38 in a

study by Kelly, Sahm, Shiely, Sullivan, et al., (2016). Understanding the role of fever in

illness is an important first step for education because this knowledge will help guide how

mothers monitor and treat their children with fever (Sajadi & Khosravi, 2017).

2.4.3 Antipyretics use

Fever is one of the most common complaints in children and the single non-trauma-

related case that causes mothers to send their children to an emergency unit or department.

This is as a result of mother’s concern about fever and its possible complications such as

febrile seizures or brain injury (Hussein et al., 2016). Hussein et al added that, most severe

childhood ailments are frequently associated with fever. This is considered by many parents

and clinicians as a major sign of illness and sometimes can be an illness by itself rather than

a symptom or a response to an illness. It is the fear about the consequences of fever that

mothers are convinced that antipyretics must be used to reduce fever. This fear is common

among parents and clinicians. However, antipyretics are ineffective in preventing febrile

convulsions or seizures ( El-Radhi et al., 2009).

Although most clinicians approve the use of antipyretics for fever relief symptoms,

many incline to prescribe antipyretics for children with fever. Being an essential precursor

of a febrile seizure, clinicians concluded that antipyretic measures would prevent febrile

seizures. Thus parents are advised that antipyretics administration to a child at risk of febrile

seizure may reduce further occurrences (El-Radhi et al., 2009). However, the correct

dosage of an antipyretic is another area that needs to be researched. A study suggested that

parents often abuse or misuse antipyretics by either under dosing or overdosing (Bilenko,

Tessler, Okbe, Press, & Gorodischer, 2006).



19

The most anxious moments for parents is when their children fall sick and are not

able to assess the severity of the illness. Thus, they become disappointed in situations when

they feel they do not give their best of care to their sick children. Although informative

programs that have been developed to support parents in fever management in children

have proven effective, some parents remain worried and some do mismanage fever,

literature says (Wirrell & Turner, 2001). However, since these parents become worried

in getting a better solution or cure for their sick children with fever, some seek advice and

reassurance from friends, family, health professionals, the internet, books among others,

about the management of fever (Kelly, Sahm, Shiely, O’Sullivan, et al., 2016).

Some parents use antipyretics such as paracetamol and ibuprofen to reduce fever in

their children especially during teething when their body temperatures become very high.

In the first 24 hours’ of fever antipyretics were given as first aid for fever and were viewed

as effective treatment for fever (Chibwana, Mathanga, Chinkhumba, & Campbell Jr, 2009).

It is important however to note that, febrile seizures cannot be prevented using cold

compresses, tepid bath, or using antipyretic medications, they can only reduce the fever

and make the child feel better (El-Radhi, 2012). The core indication for an antipyretic is

not for the reduction of body temperature but for the relieve of discomfort and anxiety (El-

Radhi, et al., 2009).

2.4.4 Other fever management practices

Some parents employed the use of cold water, cold or tepid sponging (Aluka et al.,

2013). Tepid sponging is the use of tepid (tap) water of a temperature between 24℃ - 33℃

to reduce high body temperatures. The body is not immersed in the water but a sponge or

towel is wet to wipe the body. This can be done at home or in the hospital setting. There

are however, techniques in doing it appropriately to avoid causing the patient to convulse

especially in children.



20

2.4.5 Traditional methods use

In a study conducted at Ho in Ghana on the knowledge, beliefs and practices

regarding febrile seizures, 20% of mothers believed that seizures can be stopped by

administering herbs or concoctions to a child with fever (Nyaledzigbor, Adatara, Kuug, &

Abotsi, 2016). Mothers in another study stated that they shook their children having

seizures in order to receive a reaction from the children and others percussed the back of

the children with the belief that they were choking (Westin & Levander, 2018). Mortality

can however arise from poor management or unorthodox management (Eseigbe, Eseigbe,

& Adama, 2012). In a cross-sectional survey conducted by Anigilaje and Anigilaje (2012),

on childhood convulsion in a community in Nigeria, 87.1% of mothers gave cow urine

concoction to their convulsing children whilst about 61.2% said, they put spoons or their

hands into the children’s mouth (Anigilaje & Anigilaje, 2012). These practices can lead to

aspiration and subsequent death of the children.

2.5 Seeking advice and negotiating access

Consultation of family members by mothers is one main method of sharing

responsibility and seeking for help (Kelly, Sahm, Shiely, Sullivan, et al., 2016). This may

be because some mothers think they are young and need advice from the elderly or more

grown-ups who may be more experienced when it comes to caring for sick children. To

some however, information received from the family is considered more important. It is

believed that taking decisions about a child’s health care are solely household decisions

where the decisions are influenced by factors such as relatives in the house/ family (Forry,

Tout, Rothenberg, Sandstrom, & Vesely, 2013).

Others access information about management of febrile children from the internet,

doctors, nurses, books and magazines, whilst others rely on intuitions, past experiences and

common sense (Sahm, Kelly, Mccarthy, Sullivan, Shiely, & Janne, 2016).



21

2.6 Using the middle layer between home and clinic

Febrile convulsions or seizures are the commonest causes of seizures that occur in

children with about 4% of children between one to six years having at least one episode of

febrile seizure. It is therefore important for mothers of such children to have correct and

sufficient knowledge about the relationship between fever and febrile seizures and its

possible outcomes (Hesdorffer, Benn, Bagiella, Nordli, Pellock, Hinton, & Shinnar, 2011).

Mothers see febrile seizure as a perceived threat to their children. To some, observing a

child having a seizure or convulsion is a very scary event. Research has shown that febrile

seizures in children create fear and grave concerns in mothers (Patterson, Carapetian,

Hageman, & Kelley, 2013). Some sources of fear include; mental retardation, physical

disability, repeated seizures, fear of death, low intelligent quotient (IQ) and an uncertain

future for the child (Mohsen & Hazaveyee Mahboobeh, 2013). In another study, it was

found out that mothers whose children have ever suffered febrile seizures even though,

have acceptable facts regarding the causes, symptoms and signs of febrile seizures, negative

beliefs still continue amongst mothers who point the cause of febrile seizures in children to

mystic forces. These beliefs of mothers informed their decision about the type of treatment

or remedy to be given to the child who has the febrile seizures (Nyaledzigbor et al., 2016).

Native concoctions, left over medications in syrup or tablet forms constituted more than

60% of home interventions mothers use to stop seizures in children (Udoh, Eyong, Okebe,

Okomo, & Meremikwu, 2014). In their study, they found out that, most care givers/ mothers

chose traditional healers over formal healthcare givers/ providers with the reason being the

cost of care. This can be true in middle income countries like Ghana where cost of living

is quite high for the unemployed. Other studies also identified financial constraint as a

major factor in choosing a provider for treatment of febrile seizures in children (Mbonye,

Buregyeya, Rutebemberwa, Clarke, Lal, Hansen, … LaRussa, 2017). The few that visited



22

formal health facilities did so because of proximity or following advice from neighbours

(Udoh et al., 2014). Middle layers in the community include; nurses, doctors, pharmacists,

pastors, fetish priests, herbalists and or traditional healers among others.

2.7 Accessing formal medical services

Every year, millions of children die of treatable and preventable conditions in low

and middle income countries because there is delay in accessing medical care (Grant,

2016). Care-seeking for children is the ability of the mothers to recognize the existence of

an illness in their children and the measures put in place to seek for treatment for the

children (Kagabo, Kirk, Bakundukize, Hedt-, Gupta, Hirschhorn, … Amoroso, 2018).

There is a strong awareness and advocacy for conditions such as Malaria, cholera,

tuberculosis, Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency

Syndrome (AIDS) in Ghana. Subsequently, measures are put in place to curb the occurrence

of such conditions. However, that is not the case for febrile seizures. As a result, most

mothers who have less information on the management of febrile seizures, end up

deploying erroneous health seeking behaviours and practices. In a study conducted by Diop

and friends (2003), febrile convulsion in children has been seen as a cause of epilepsy in

African societies including Ghana (Diop, De Boer, Mandlhate, Prilipko, & Meinardi,

2003).

Care seeking involves any care sought for a sick child outside the home. The

caregiver is mostly the mother (Geldsetzer et al., 2014). Parents bring their children with

simple febrile seizures to the emergency unit for medical care after the seizure has resolved

(Hageman, Kelley, Patterson, Carapetian, Hageman, & Kelly, 2013). Most often, nurses at

the emergency unit are the first healthcare professionals to attend to children with

convulsion. Thus, have a very important role to play in managing children with such

condition (Paul, Rogers, Wilkinson & Paul, 2015).



23

Some mothers may not be aware of the causes of febrile seizures. Febrile seizure

occurrence brings about different kinds of responses by mothers which are mostly defined

by their economic, social, cultural and educational backgrounds (Sajadi & Khosravi, 2017).

The outcome of febrile seizures may be determined by the causes as well as the immediate

responses of the parents to seek treatment (Patel et al., 2015). Literature indicate that, since

children are vulnerable to poor outcomes, unnecessary delays at home or inappropriate

interventions, delays in utilizing and accessing the appropriate medical facility may result

in neurological complications and sometimes death (Barbi, Marzuillo, Neri, Naviglio, &

Krauss, 2017).

Seeking a first level care from people such as nurses, paramedics, general

practitioners, medical and clinical officers who take action to improve health of the

individuals in the community and or seeking a secondary level care which includes

hospitals at the district or community levels that provide 24 hour services and have well

expertise staff to attend to the patients promptly, is very important in reducing the effect of

febrile seizures in children (Mosadeghrad, 2014).

In Ghana however, most health care facilities accept National Health Insurance but

as to whether all caregivers or mothers are able to enrol their children on the insurance

scheme in another cause of worry. Furthermore, the various health facilities must reduce

the cost of care so as to enable mothers/ caregivers of low financial standing to seek health

care in such facilities as well.

Insufficient financial resources and poorly-resourced health facilities are believed

to contribute to the delay in patronising a medical facility (Dillip, Alba, Mshana, Hetzel,

Lengeler, Mayumana, … Obrist, 2012). Other factors in earlier studies indicated low status

of women, cultural beliefs and practices, perception about the causes of illness also

contribute to the delays of mothers or caregivers to access medical treatment for their ill



24

children (Sisay, Endalew, & Hadgu, 2015). For the very first time a child experiences a

febrile seizure, the appropriate action was calling the paediatric emergency unit/ facility

directly, or seeking advice from a healthcare guide service where the parents were told the

actions to take (Westin & Levander, 2018), a study conducted in a developed country. In

another study in Nigeria, lack of money as a result of low household income levels, was a

key factor for not seeking healthcare irrespective of the severity of illness (Abdulraheem &

Parakoyi, 2009). In the African society, a major determinant of choice of treatment is

spiritual belief (Asare, 2017).

2.7 Summary and Conclusion

The chapter reviewed literature relevant to the study. Justification of the model for

this study was discussed. The second section of the chapter elaborated on the literature on

caregiver recognition and response, seeking advice and negotiating access, using the middle

layer between home and clinic and accessing formal biomedical services. The researcher

set out to look out for studies relating to the beliefs and practices of mothers concerning the

care of children with febrile seizures. However, there was paucity of literature in this area

as most of the literature searched focused on the biomedical aspects of febrile seizures such

as the incidence, diagnoses and management of febrile seizures. From the review, mothers

were the first to recognize illnesses in their children. The practices they employed in dealing

with the illnesses depended on their beliefs on the causes of the illness. The treatment

options were also influenced by factors such as cost, proximity, and recommendation from

friends and family. Due to the observed gap in the existing literature, the need arose for the

current study.



25

CHAPTER THREE

RESEARCH METHODOLOGY

This section discusses the research methodology used in studying the beliefs and

practices of mothers concerning the care of children with febrile seizures at the Princess

Marie Louise Hospital, Accra. It includes the following: research design, research setting,

target population, inclusion and exclusion criteria, sample size/ technique, data collection

method, data collection procedure, data management, data analysis, methodological rigour

and ethical considerations.

3.1 Research Design

The design of any research deals with detailed explanation of the basic approaches

adopted by the researcher to answer the research questions and the methods for data

collection, (Polit & Beck, 2010). This study employed a qualitative research design,

specifically descriptive exploratory design to ensure in-depth description of mothers’

beliefs and practices concerning the care of children with febrile seizures. The reason for

the qualitative approach was to ensure a comprehensive and in-depth information from a

small group of mothers (Lewis, 2015). A researcher makes meaning of information

gathered from participants in a qualitative study (Sutton & Austin, 2015). It is only through

qualitative inquiry that rich and deep insight could be obtained on the phenomenon being

studied.

Descriptive studies describe the various aspects of a phenomenon whilst

exploratory studies are done to discover the full nature of a phenomenon when there is

inadequate information in that area. This was to help provide a rich meaning, practices and

various views of participants about seizures in children (Bradshaw, Atkinson, & Doody,

2017). The sample size, sampling technique, data collection and data analysis were based



26

on the study design (Suresh, Suresh, & Thomas, 2012). The research design chosen by the

researcher helped described in a comprehensive manner, the beliefs and practices of

mothers concerning the care of children with febrile seizures.

3.2 Research setting

The study was conducted at the Princess Marie Louise Hospital, located in the

Accra Metropolitan Assembly (AMA).

3.2.1 Study Location

The AMA covers an area of 137sq km, located on longitude 05 35’ and latitude 00

06’. The metropolitan is bounded on the East by Dadekotopon Municipal Assembly, the

South by the Gulf of Guinea, the West by Ga South and Central Municipal Assemblies, and

the North by the Ga West and La-Nkwantanang Municipal Assembly.

In the 2010 population and housing census, the AMA population was estimated at

1.7 million. Additionally, it is estimated that on daily basis there is an influx population of

1 million to the city for various socioeconomic activities. The AMA has almost 42% of the

total population of the greater Accra Region with a population density for 112 per kilometre

squared (Population and Housig Census, 2010).

3.2.2 Metropolitan Economy

Accra, the capital of Ghana, has contributed immensely to the economic

development of the nation. It hosts a number of manufacturing industries, health

institutions, tourism sites, telecommunications industries, educational facilities and other

important establishments. These establishments or institutions provide employment

opportunities for the residents in the city. The presence of these institutions attract people

from all parts of the country and beyond to transact various businesses. As a result, they



27

contribute greatly to internally generated revenue of the Metropolitan assembly in the form

of business operating permit, property rates among others.

3.2.3 Health Care Facility

There are two (2) government hospitals, six (6) polyclinics and ten (10) smaller

health facilities which are under the Ghana Health Service that provide health care services

in the Metropolitan area. Four (4) quasi-governmental and quite a number of private health

care providers also offer clinical services. The services provided by these facilities include;

in-patient and out-patient services, public health services such as child health services,

reproductive health and nutrition, pharmacy, x-ray and laboratory services.

The Princess Marie Louise Hospital where the study was conducted is located at the

heart of the metropolis and serves as the children’s hospital for the Greater Accra Region.

It receives both referral and non-referral cases within and outside Accra. It is the only

Paediatric hospital of the Ghana Health Service. It is located within the Asiedu-Keteke sub-

metropolitan assembly of the Greater Accra Region of Ghana. Founded in 1926, it is one

of the few specialized children’s hospitals in West Africa and it was where kwashiorkor

and marasmus were first described (Tette, Sifah, Nartey, Nuro-Ameyaw, Tete-Donkor &

Biritwum, 2016). It provides medical care, offers reproductive and child health (RCH),

family planning (FP) and nutrition services. The hospital has at present, about 265 staff in

total. The framework of PML consists of 150-200 bed capacity for in-patient care. It also

has an out-patient department (OPD), emergency ward, laboratory unit, blood bank, X-ray

unit, diabetes and environmental health unit, mother’s hostel, disease control unit, family

and reproductive and child health units among others. Within the last decade, attendance to

the hospital’s out-patient department has increased from 45,000 in 1996 to nearly 73,000

per year.



28

The Emergency unit of PML is located on the ground floor of the Father Campbell’s

block. It admits children from birth to 17 years of age with various childhood illnesses. It

has a total bed capacity of 20 and receives both referred and un-referred cases.

3.3 Target Population

In a study, the target population includes the entire or total set of individuals or units

from which the sample size can be drawn or inferences made (Salkind, 2018). Therefore,

the target population included all mothers who brought their children to the Emergency unit

of P.M.L, at the time of the study. These were mothers whose children were diagnosed with

febrile seizures and under age five (5).

3.3.1 Inclusion Criteria

All mothers with children under five diagnosed with febrile seizures at the time of

the study and who were willing to take part in the study.

3.3.2 Exclusion Criteria

Mothers whose children were not diagnosed with febrile seizures but under five

years.

Children who were more than five years but diagnosed with febrile seizures.

Mothers who do not understand English language, “Ga”, “Ada” and “Twi”,

because these were the only languages the researcher could speak.

3.4 Sample Size

In a qualitative research, determination of a sample size depends basically on the

information needed. Thus, sample size is the number of people to be included in a study

(Bhalerao, & Kadam, 2010). Sampling on the other hand is the selection of a fraction from

a total population. Working with samples is easier than using the entire population due to

practical and economic advantages (Polit & Beck, 2010). Sample size is determined by the



29

research questions, the purpose of the study and saturation (Sim, Saunders, Waterfield, &

Kingstone, 2018). Sampling ends when data saturation is met. Saturation is said to be

reached when no new themes can be found in subsequent interviews (Fusch & Ness, 2013).

In this study, the data saturation was reached at the twelfth (12th) interview. It

included selection of mothers who had fair knowledge about the topic under study (Polit &

Beck, 2010). Hence, the researcher selected mothers of children diagnosed with febrile

seizures and on admission at the emergency unit of the Princess Marie Louise Hospital at

the time of the study and were willing to partake in the study.

3.5 Sampling technique

The purposive sampling method was employed in selecting Princess Marie Louise

hospital because it is a facility where majority of children are treated for various ailments

including febrile seizures. This method was appropriate for the study as the researcher

required respondents who could provide the needed information for the study (Elo et al.,

2014). The researcher purposively selected mothers who qualified for the inclusion criteria

and consented to take part in the study.

3.6 Procedure for data collection

A proposal was sent for review and approval was given by the Noguchi Memorial

Institute for Medical Research - Institutional Review Board (NMIMR-IRB) (appendix C)

and The Ghana Health Service Ethics Review Committee (GHS-ERC) (appendix D). A

copy of the approval letter from (GHS-ERC) and an introductory letter from the School of

Nursing and Midwifery, Legon, was sent to the Greater Accra Regional Health Directorate

(GARHD) (appendix E) and The Metropolitan Health Directorate, Accra (MHD) (appendix

F). A letter of introduction was given from the Metropolitan Health Directorate to the

Medical Superintendent of the Princess Marie Louise Hospital (PML) (appendix G) where



30

the researcher was introduced to the Head of the Emergency Unit. Respondents were

recruited during weekdays. Rapport was established by the researcher by asking the

respondents about their general health. The mothers were reassured and all questions

bothering their minds were answered accordingly. An information sheet was given to each

respondent (appendix J) and thorough explanation was given on the objectives and the

purpose of the study. Potential risks and benefits of the study were thoroughly explained to

respondents in English, “Twi’ and “Ga” Languages (Ghanaian local languages).

Respondents who met the inclusion criteria were made to sign a consent form (appendix I)

after agreeing to partake in the study. Respondents were informed about their willingness

to withdraw from the study at any point since participation was voluntary. The venue for

the interviews were determined by the respondents as well as the time. Collection of data

was done through face-to-face interviews which lasted between 35-60 minutes and were

audio recorded. Clarifications were sought for accuracy of data collected. Confidentiality

was ensured by informing respondents that the data gathered was mainly for academic

purpose and would not be used for any other research. Respondents identities were

protected by using codes. A field diary was kept during each interview to record

observations made and non-verbal gestures from respondents. Respondents were thanked

at the end of each interview. The interviews were conducted at the emergency room with

two interviews done on the first day of admission and the rest on either the second or third

days of admission. In all 12 mothers were interviewed.

3.7 Data Collection Tool

A semi-structured interview guide (appendix H) was used to collect data. This

enabled the respondents to comfortably talk about their beliefs and practices. The interview

guide consisted of two main sections. Section A, consisted of socio-demographic data such

as age of respondent, level of education, languages spoken, occupation, marital status,



31

number of children, religious affiliation, husband’s education, husband’s occupation,

child’s age, sex of child, and birth order. Section B consisted of questions formulated from

the research objectives and the Conceptual Model of Household Decision Making and the

Pathways of Care (Colvin et al., 2013).

3.8 Pre-testing the interview guide

The interview guide was pretested on two mothers with children diagnosed with

febrile seizures at the Emergency unit of the Child Health Department of Korle-Bu

Teaching Hospital, Accra, before the main study to ensure precision and clarity of the

questions (Hurst, Arulogun, Owolabi, Akinyemi, Uvere, Warth, & Ovbiagele, 2015).

Pretesting determines the strengths, weaknesses as well as possible threats of research

questions and helps modifications of the instrument before it is used. The recorded

interviews were transcribed verbatim and the research questions were modified ensuring

clarity and precision before the main study.

3.9 Data management

According to Surkis & Read (2015), data management must ensure that the process

for data collection is well organized and should be transparent and understandable. It

involves creating data, processing, analyzing, preserving data and giving access to the data.

The purpose of qualitative data management is to organize and store data for maximal

efficiency in retrieval and analysis (Guest, Namey, & Mitchell, 2010). Each respondent

was assigned an identification code as “FSR” from 1-12 for easy identification and

retrieval. The transcripts were saved and kept on the researcher’s computer with a secured

password known to only the researcher. These records will be stored for five years after

which they will be discarded.



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3.10 Data Processing and Analysis

What makes a study qualitative is that, it usually relies on inductive reasoning

processes to interpret and structure the meanings that can be derived from data (Thorne,

2000). Interviews were conducted in English, “Twi” and “Ga” languages (local Ghanaian

languages). The “Twi” and “Ga” interviews were translated into English during the

transcription. An individual who was fluent in the “Ga” and “Twi” languages was asked to

do a back translation of the transcripts. Each interview was coded from respondent one to

the last. Verbatim transcription of the audio-recorded interviews was done. Data collection

and analysis were done concurrently. Data analysis was done manually using thematic

content analysis. The researcher familiarised herself with the data by reading the transcripts

thoroughly. Similar ideas were put together to form codes. Similar codes were put together

to form themes. The themes were reviewed and grouped into major themes and sub-themes.

All the identified themes were named differently with their emerged sub-themes. Analysis

of data was done using the interviews and field notes.

3.11 Methodological Rigour

Rigour in qualitative research is the principles by which research is evaluated for

validity and reliability. According to Tobin, Begley, & Tobin, (2004), rigour is the measure

of trustworthiness of a research in terms of how data is collected, how data is analysed and

finally how it is interpreted. Rigour is viewed in terms of transparent and systematic

approaches for collection and analysis of data rather than statistical benchmarks for

construct validity or significance testing (Marquart, 2017). A qualitative research must be

authentic. The aim is mainly to gather an “authentic” understanding of people’s experiences

and it is believed that the open-ended questions are the most effective ways of achieving

this (Tobin et al., 2004). The criteria for ensuring rigour in this study included credibility,

dependability, confirmability and transferability (Lincoln & Guba, 1985).



33

Credibility ensures the findings of the research represent the original information

given by the respondents and correct interpretation of the views of the respondents (Anney,

Dar, & Salaam, 2014). It ensures the questions of the study are answered correctly as

intended by the researcher through the conduct of the study and the design used. It entails

how rich an information is rather than its quantity (Berger, Martin, Husereau, Worley,

Allen, Yang, … Crown, 2014).

Credibility was ensured by the researcher by recruiting respondents who met the

inclusion criteria with the purpose of gathering accurate data. Feedback was obtained from

respondents to ensure their exact views were captured. Interviews conducted were

transcribed verbatim and the coding was done separately by the researcher and the

supervisors and compared to ensure accurate data analysis. Respondents were engaged

between 35 to 60 minutes during the interviews to obtain detailed data.

Dependability involves ensuring the findings of a research are consistent and could

be repeated using the same data collection tools (Anney et al., 2014). Dependability was

ensured by the researcher by the consistent use of the interview guide to collect data from

all the 12 respondents. Also, the researcher provided a comprehensive description of data

collection procedure and data analyses, the research setting and the sampling methods.

Inclusion and exclusion criteria, background of the study, length of interview were all

outlined clearly. Documentation of information gathered during the data collection, the raw

data and field notes are being kept by the researcher.

Confirmability questions whether the findings of the research are consistent with

the collected data. It ensures the findings of a research represent the views of the

respondents and not that of the researcher (Tobin et al., 2004). Additionally, it helps

establish whether or not the researcher has been biased in the course of the study.



34

Confirmability was ensured by using probes to clarify information given by respondents.

The researcher’s preconceptions were considered and bracketed to prevent altering the

findings obtained from the study. An audit trail of raw data, field notes, notes from member

checks were used to provide information needed for enhancing data analysis.

Transferability refers to the extent to which the research findings can be generalised

or transferred to other contexts or settings. It entails provision of sufficient information

about the study to the readers to compare similar situations they are familiar with (Shenton,

2016). The researcher ensured transferability by outlining in detail the methods involved in

conducting the study. An audit trail of the transcribed documents was also kept by the

researcher. The background of respondents and their children, inclusion and exclusion

criteria were clearly outlined.

3.12 Ethical considerations

An ethical approval was sought from the Institutional Review Board of the Noguchi

Memorial Institute for Medicinal Research (NMIMR) and the Ghana Health Service Ethical

Committee (GHS-ERC). The approval letter from GHS-ERC, with an introductory letter

from the School of Nursing and Midwifery, Legon, were sent to the Ghana Health Service

Regional Health Directorate and forwarded to the Accra Metropolitan Health Directorate

for approval. The approval letters and ethical clearance letter were sent to the Medical

Director of Princess Marie Louise Hospital (PML) who gave the researcher permission to

recruit respondents for data collection. A memorandum was written to the head of the

emergency unit of PML to gain her cooperation.

The respondents were recruited by first checking the admissions and discharges

book for children diagnosed with febrile seizures and under five years. Their mothers were

identified and the purpose of the study, objectives, potential benefits and the risks of the



35

study were explained to them. Respondents who met the inclusion criteria and agreed to

partake in the study were allowed to sign a consent form. An information sheet was given

to each respondent after explanation of the research to them. Also, respondents were

informed that participation was voluntary, hence their refusal to take part in the study or

withdraw from it was without any consequences. Identification codes were used for

anonymity.

Respondents’ privacy was ensured by conducting the interviews in a serene area

provided by the nurse in-charge of the emergency room. A screen was used to prevent

others from seeing or interfering with the interviews being conducted. Other respondents

selected areas that were convenient to them. Additionally, audio recordings have been kept

securely with a password known to only the researcher. Consent forms, transcribed

documents and field notes have been kept under lock and key to prevent others from gaining

access.

3.13 Summary

This chapter has provided information on the research design, the study setting,

target population, sample size, sampling technique, procedure for data collection as well as

data collection tool, pretest, data management, data processing and analysis,

methodological rigour and ethical considerations. The next chapter elaborates on the study

findings.



36

CHAPTER FOUR

PRESENTATION OF FINDINGS

This chapter focuses on the presentation of findings of the study on the beliefs and

practices of mothers concerning the care of children with febrile seizures at the Emergency

Unit of the Princess Marie Louise Hospital, in the Greater Accra Region of Ghana. The

findings are presented according to the objectives of the study and preceded by the

demographic characteristics of the respondents.

4.1 Demographic Characteristics of Respondents

The study comprised Key Informant Interview of twelve (12) respondents. Among

those interviewed, the majority completed their primary education with only two

completing tertiary education. Only one respondent had no education. Eight respondents

were married and four were single. Most of them were in the age ranges of thirty-two to

thirty-seven (32-37) years with only two below thirty (30) years. Dominant languages

spoken were; “Twi”, “Ga” and English. Two respondents were Muslims and the rest were

Christians. The maximum number of children per mother was five with a minimum of one.

The age range of their children was between 4 months to 4 years. Two of the children were

males and the rest were females.

4.2 Organization of Themes and Sub-Themes

Eight major themes and twenty sub-themes were identified following data analysis.

Identification of signs and symptoms, causes and beliefs, home remedies, consultation of

Significant Others, seeking care in the community and health care facility were themes

found to be consistent with The Household Decision Making Model whilst the last two

themes, namely mothers’ reaction and ignorance emerged from the data. Table 4.2 shows

the themes and sub-themes from the data.



37

Table 4.1: Organization of Themes and Sub-themes

MAJOR THEMES SUB-THEMES

Identification of Signs and Symptoms of

febrile seizure

Fever

Change in eye/ body movement

Clenching of teeth

Causes and Beliefs Physical

Spiritual

Others (marital conflict)

Home Remedies Medications (antipyretics,

antibiotics, garlic)

Prayers/ positioning

Water/ oil

Consultation of Significant Others Family (husbands, In-laws,

mothers, brothers, sisters)

Neighbours/ friends

Seeking Care in the Community Religious leaders (pastors, fetish

priestess, traditional healers)

Health professionals (doctors,

nurses, pharmacists)

Health Care Facility Emergency

Attitude of staff

Others (recommendation,

proximity, expert care)

Mothers’ Reaction Anxiety

Devastation (crying, confusion)

Ignorance Condition (febrile seizures)

Management of Febrile Seizures (at

home and hospital)

4.3 Identification of Signs and Symptoms of Febrile Seizures

One of the major themes that emerged was identification of signs and symptoms of

febrile seizures which corresponded with the Recognition part of the Household Decision

Making Model. This theme sought to answer the question; ‘what are the beliefs of mothers

with children who have febrile seizures and how do they recognize the condition?’ Signs

and symptoms are any change in the normal functioning of the human body which is an



38

indication of a potential medical condition. Three sub-themes emerged. They were: fever,

change in body/ eye movement and clenching of teeth.

4.3.1 Fever

Fever is a body temperature above the normal range, mostly above 38℃. The

normal body temperature for children ranges between 36.5℃ - 37.5℃.

One mother used a thermometer to check the temperature of her child at home. She said

this;

“I have a thermometer at home. Sometimes when we check is 37.5℃ sometimes

38℃…...” FSR1

Other mothers did not use a thermometer at home to check their children’s

temperatures but they did so by feeling/ touching to recognize the rise in body temperature

of their children which deviated from the normal. Some of the mothers expressed the

following:

“I know she was warm to touch………” FSR2

“I realised he was warm, so during the night the temperature got high but I didn’t

check with a thermometer but like his body temperature was warmer than

before……….” FSR7

“Mostly she has a normal temperature but yesterday she started passing loose

stools and had a fever……….” FSR11

“She was very warm to touch, I did that by touching her with my hands to feel the

temperature, ………………...” FSR12

4.3.2 Change in eye movement

One of the signs of seizure is the abnormal eye movement which includes gazing

into the air, staring in one direction and rolling of the eyes. FSR2, FSR4, FSR10 and FSR11

had these to say;

“something happened to her and it was as if all her eyes were white…….” FSR2

“All of a sudden as if she has changed. The face has turned to one side with the

white part of the eye gazing in one direction…………” FSR4



39

“When it happens, she is not stiff nor shaky, only the eyes become static gazing at

one direction…………….” FSR11

“The black part of the eye was static, it never rolled to left nor right…………….”

FSR10

4.3.3. Change in body movement

Some of the children became so stiff during the seizure episode that they had to be

carried by men to the hospital. Their mothers said:

“Eiii, anytime it happens a lady cannot carry her, she becomes so stiff. He carried

her on his shoulder………...” FSR10

“She became very stiff with both arms straight. She was carried by a man on his

shoulder to the hospital………” FSR12

“I learnt when it so happens and the child becomes jerky, a man will carry the child

and send him/her to the hospital…...” FSR4

4.3.4 Clenching of teeth

Some of the mothers reported clenching of teeth as a sign of seizure. Some of the

respondents had these to say:

“The teeth were clenched together and saliva was coming from the mouth……...”

FSR10

“She clenched the teeth………………………………………………………………...”

FSR3

“She clenches the teeth together anytime the seizure occurs ………………...…….”

FSR12

4.4 Causes and Beliefs

Mothers attributed the cause of seizures to physical causes such as; fever, phlegm

and stomach ulcer. Others attributed the cause to spiritual forces such as witchcraft,

spiritual attack and consequences of un-performed rituals. One mother also attributed the

cause to marital conflict.



40

4.4.1 Physical

The majority of the respondents attributed the cause of the seizure to phlegm

because of what they have heard from others during or before the episode of the seizures.

A few number of the mothers said the cause could be due to fever or malaria, whilst others

were of the view that it could be due to stomach ulcer.

4.4.1.1 Phlegm

Some of the participants believed that their children’s condition was as a result of

phlegm. This is what they disclosed:

“Hmmm, almost everybody claim it is caused by phlegm. They said phlegm brings

about that condition…….” FSR2

“Since they started the medications I see a lot of phlegm in her stools. So I was also

thinking it could be that there is too much phlegm in her which caused the

seizure…...” FSR9

“Others also say it is phlegm as a result of the stomach ulcer. That is what the

elderly people say…………………………” FSR10

4.4.1.2 Fever/ malaria

Some of the mothers said the seizure was triggered by fever. They said:

“Yes, sometimes the seizure comes with temperature. When the body is very hot it

triggers the seizure………” FSR1

“my mother said if you have a high body temperature it brings about that………….”

FSR2

“the day she had the high temperature and I noticed she was convulsing. I learnt if

a child has a high body temperature, it brings about convulsion. I think it was the

high temperature.…….” FSR8

One mother said the cause of seizure could be malaria.

“May be it is malaria, I conceived that idea when she started convulsing because

there are a lot of mosquitoes in my area…….” FSR3



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4.4.1.3 Stomach ulcer

One respondent disclosed that, the cause of the seizure was due to stomach ulcer.

This she said, is obvious at the anal region when a close examination is carried on the

child.

“it is caused by an ulcer in the stomach which sometimes appears in the anal

region…...” FSR10

4.4.2 Spiritual

Some of the respondents also said the seizures were caused by either evil spirits,

spiritual attack or wizardry. The causes were mainly associated to spiritual forces.

4.4.2.1 Spiritual attack

One mother has this to say about her belief on the cause of seizure:

“This is not in my lineage, nobody has it in my family and my husband too nobody

has it. So when first of all I said sometimes it may be a challenge through the

ministry or attack, like spiritual attack. May be it may come from the attacks just as

I said, other attack or spiritual thing as a church mother you may face it either from

the members or from the church or from outside the family…….” FSR1

4.4.2.2 Evil spirit/ witchcraft

Some respondents said evil spirits were responsible for the seizures and that the

application of garlic casts out the evil spirits. FSR12 confessed this:

“I have mixed garlic with shea butter which I normally apply as pomade for my

child. I learnt it casts out evil spirits believed to be responsible for the

convulsion…….” FSR12

One respondent was told the seizure is not ‘a hospital sickness’. She had this to say:

“That was Tuesday, Monday it happened continuously till in the evening so I told

my husband let’s send the child to the hospital, but my mother in-law said it’s not a

‘hospital sickness’………” FSR2

FSR2 wanted to confirm the cause of sickness since the mother in-law said it was

not a hospital sickness. She went to a fetish priestess who told her that the child was be-

witched. Here is what she said:



42

“I went to the fetish priestess and she examined my child but she said somebody

has be-witched my child. She said the person be-witched her when I was pregnant

and that the person wanted to bewitch me and because the person couldn’t get me

that’s why it affected the child…….” FSR2

4.4.2.3 Consequences of unperformed birth rituals

FSR 11 believed that, the seizure which occurred more than once could be attributed

to unperformed birth rituals that needed to be performed for the older children. And as a

result, the younger child is facing the consequences.

“I learnt this condition is not treated in the hospital. You know the father is a Ga,

and they have a tradition that when you deliver twins they have to go through a

ritual but that has not been done for my twins. That is how it works. The

consequences will affect the next child, unless it’s reversed by performing the

rituals. So the elders in the family are saying that is what is affecting my child

………” FSR11

4.4.2.4 Others

One mother attributed the cause of the seizure to marital conflict between her and

the husband. This is how she puts it:

“I was wondering what happened and I was trying to link it to you know, my

husband is not here and is a lot of problems. The marriage has not been smooth, a

lot of problems, crying on my side worrying so ‘emm’ when he came a lot has

happened so I felt what went through my mind was I thought the child felt what was

going on. Yes, for that reason, usually that’s what our elder people would say that

children don’t like where there is quarrel. The convulsion made me think that it is

as a result of the quarrels, misunderstandings and the whole lot of issues that are

going on in my marriage that has resulted in this. Because it has not happened to

us before……...” FSR7

4.5 Home Remedies

Home remedies cover the interventions given at home or the actions taken to abort

the seizure or to reduce high body temperature. This theme tried to answer the question;

‘What practices do mothers of children with febrile seizures undertake before bringing

their children to the hospital?’ Mothers used medications such as anti-pyretic, antibiotics

and garlic. Others used water, oil, positioning, and prayer to abort the seizures.



43

4.5.1 Medications

Anti-pyretic was given by these mothers:

“Sometimes too if she is having temperature we inject the para on the buttocks

(insert the paracetamol into the anus) …………” FSR1

“When I realised she was warm to touch; I gave her paracetamol………” FSR12

“When we woke up I saw she was warm and I gave her paracetamol……” FSR10

“I realised he was warm, so during the night the temperature got high but I didn’t

check but like his body temperature was warmer than before. So errm, I gave him

suppository paracetamol, I inserted one……………” FSR7

Some mothers gave teething mixture to reduce the fever believed to be caused by

eruption of new teeth.

“The dad woke her from sleep and noticed her head was quite warm to touch but I

said it could be because she slept with that side of the head, so I didn’t take it

serious. But the following morning the temperature was still persisting, though not

too high. So I went to my mother in-law to ask for ‘Teedar’ (teething syrup).

Sometimes she has a temperature when a tooth erupts but I normally give ‘Teedar’

syrup for that and she is fine …………...” FSR9

Others gave garlic to abort the seizures. These were what they said:

“The first time she had a seizure I applied some garlic and gave her some to drink.

I learnt it will abort the seizure…………………………………………………...…”

FSR3

“The garlic helps that kind of sickness……...” FSR10

“Okay, I remember some time ago I went to visit my mother at Kwawu, yes and my

child had a seizure. They grinded garlic, smeared some on her body and inserted

some into her nostrils then she cried. Most at times when the seizure occurs, she

does not cry but this one she cried. In some few minutes, the seizure

aborted……………” FSR4

Two mothers gave antibiotics to treat the fever. They said:

“I initially thought it could be an abdominal infection so I gave her ‘flagyl’

(metronidazole)………………” FSR8

“She has been having fever for the past two weeks. I bought an antibiotic from a

pharmacy nearby……………….” FSR4



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4.5.2 Water/ oil

Water was believed to reduce high body temperatures, prevent seizure occurrence

or abort seizure and most mothers either bathed their children with water, or wet a towel

to tepid sponge them. Others used oil to abort the seizure.

“If that kind of thing happens, you use the oil and spoon and drop it in the mouth of

the child, the red oil……” FSR1

“I had an anointing oil and water which I got from a prayer meeting, so whilst my

mother in-law turned the child’s head upside down, I was also pouring the

anointing oil and the water over her at the same time………” FSR9

“She had a high body temperature, so I tepid sponged her……...” FSR5

“You know children today is about temperature, temperature, and I try to manage

it sometimes. I sponge him a lot……….” FSR7

“As for the water no body taught me but I poured it over her because I know she

was warm to touch and my mother said if you have a high body temperature it

brings about that. So I poured the water on her to reduce the temperature. So it

became normal…………” FSR2

“She came around and confirmed it was a seizure. So she advised I poured water

over my child, so I bought pure water and began to pour it all over her……………”

FSR8

4.5.3 Positioning

Putting a convulsive child in a particular position was believed to help abort the

seizure or make the child gain consciousness. A few of them said:

“Whilst the feet are raised up, the child is being rushed to the hospital. With the

two feet up and the head downwards……….” FSR2

“When it so happens, a man will carry the child and send him/her to the hospital.

He turns the head upside down with the feet up. Errr, the convulsion could abort;

it does abort in that position………” FSR4

4.5.4 Prayer

There is spiritual involvement in treating ailments in the African society. Some

respondents said they prayed that God will heal their children from the seizure. Others

consulted people who prayed for the children FSR1, FSR2, FSR6 and FSR8 had these to

say:



45

“There is nothing much, what I am just praying that God should heal her

permanently……...” FSR1

“…. I started praying for him, carrying him in my arms that God will

intervene………” FSR6

“…. So when she came she carried my child and prayed for her for a long time and

she became quite stable………………” FSR2

“So she put her hand on my child and began to pray for her whilst I also got the

water to pour over her…………………………...” FSR8

4.6 Consultation of Significant Others

This theme answers the question; ‘What are the decision making practices of families who

have children with febrile seizures?’ This was consistent with the second construct of the

Household Decision Making Model, seeking care and negotiating access. It involves

seeking advice from key decision makers in the family such as husbands and in-laws or

seeking for support or help from neighbours, friends and other family members.

4.6.1 Family

Family members the mothers consulted included husbands, in-laws, mothers, sisters

and brothers. They gave advice on what remedies to give to the convulsive children as well

as where to seek medical care.

4.6.1.1 Husbands

Husbands are the heads of the family in most cultures and hence they are the key

decision makers at home. The majority of the mothers said their husbands are the key

decision makers at home so they consulted them when their children had seizures.

“When it happened I called my husband and told him. I was there when he came

home…...” FSR2

“My husband takes the decision at home. He advised we bring our child to the

hospital ………” FSR1

“We were all at home, in the room, she was about to wake up from sleep when it

happened. The dad went out. But I called him……………...” FSR10

“When the seizure occurred my husband was not around, he went somewhere. But

I called to inform him………” FSR5



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4.6.1.2 In-laws

When the fathers are not at home to give the consent for further treatment, or decide

where to send the child, the in-laws are informed. Here are some of what the respondents

said:

“In case my husband is not around, I plan with my sister-in-law…….” FSR10

“Oooh after the initial management, my mother in-law advised we bring the child

to the hospital, you know she is an experienced woman and quite old so she might

have her reasons for asking us to come to the hospital………” FSR9

“I informed my mum and my sister in-law. They said it was convulsion so my sister

in-law accompanied me to the hospital……….” FSR12

Other family members who gave support and advice to the mothers with

convulsive children were mothers, sisters or brothers.

“My younger brother advised we go back to the pharmacist who first gave the

teething mixture to see her husband who is a medical doctor…….” FSR6

“The first time it happened my sister said it was a convulsion, so she accompanied

me to the hospital for treatment…….” FSR10

“My mum advised we bring my child to the hospital…….” FSR5

4.6.1.3 Neighbours/ Friends

Some mothers sought help from their friends and neighbours.

“My landlady gave me garlic to smear over my child’s body so she feels better, she

can be free a bit………” FSR2

“It was my friends in the market who are also mothers and have witnessed it before,

they advised I tepid sponge her and send her to the clinic……” FSR3

“I called the food vendor who is my friend to come and see what was happening to

my child, it looks like a convulsion. She came around and confirmed it was a

convulsion. So she advised I poured water over my child, so I bought sachet water

and began to pour it all over her. She immediately called a motor bike rider to bring

my child to children’s hospital, so I quickly followed them to the hospital………”

FSR8

“In the house we live like a family, the first episode happened at dawn whilst all

were asleep. So I poured water over him and went to inform my next door neighbour

about it…….” FSR6



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4.7 Seeking care in the community

This theme corresponds with the third construct of the Household Decision Making

Model, ‘using the middle layer between home and clinic’. The majority of the mothers

sought care from health care professionals and religious leaders in the community before

finally going to the hospital. They included religious leaders, traditional healers and health

professionals.

4.7.1 Religious leaders

They included a pastor/ fetish priestess, and a traditional healer/ herbalist. The

Pastor prayed for the convulsive children, whilst the traditional healer/ herbalist gave herbal

preparations or inflicted cuts on the children and applied medications to cast out the evil

spirits believed to cause the seizures. The Fetish priestess also did incantation to identify

the cause of the seizures.

4.7.1.1 Pastor/ Fetish Priestess

FSR2 sought help from a Fetish Priestess and a Pastor. She said:

“So I told my landlady that where things are getting to, I will not sit idle but will

go and enquire of what is happening to my child from the fetish priestess, I want to

know what exactly is wrong with my child. So we went to the Fetish Priestess and

she examined my child………” FSR2

“Within few seconds the seizure occurred again. At that time, I was awake and had

my bath with my bag ready, my husband said I should send her to our pastor……...”

FSR2

4.7.1.2 Traditional healer/ herbalist

Some of the mothers as well as members of the community sought the services of

the Traditional healers before reporting to the hospital when the condition persisted. Their

children were given herbal preparations or cuts were inflicted on the children and medicines

were applied into the wounds. These were what some of the mothers said:



48

“Well I tried herbal medication, I explain to the herbalist what happened to my

child then she gives me medicine according to what I tell her………...” FSR11

“The child was sent to a herbalist who inflicted several cuts to cast out the

convulsion…….” FSR9

Another mother confirmed that cuts were inflicted on a convulsive child in her

family. She puts it this way;

“The herbalist inflicted some cuts on the boy and put medicine over the

wound……………...” FSR11

4.7.2 Health professionals

Health professionals consulted by the mothers were doctors, nurses and

pharmacists. They eithers gave medications, referral or first aid to the convulsive children

in the community before they were brought to the hospital.

4.7.2.1 Doctor/ Nurse

FSR6 consulted a doctor who advised her to send the child to the nearest hospital.

She said:

“I went to see a medical doctor…. and I explained how my child was behaving

and he advised I send my child to a clinic he suggested………” FSR6

FSR4 consulted a nurse.

“My land lady has a daughter who is a nurse. So for a nurse, she knows how to

handle convulsive patient so she tried, stimulated the child but there was no

response before we brought her here……” FSR4

4.7.2.2 Pharmacist

Some of the mothers reported going to buy medications from the pharmacy or

explaining the condition to the pharmacist for medications.

“I went to the pharmacist to complain my child has a fever and because the actual

cause of the fever couldn’t be determined, an antibiotic was given. The pharmacist

said if there is anything causing the fever, the antibiotic will clear

it……………………...” FSR4

“I went to a nearby pharmacy to present the complain to the pharmacist and he

was given teething mixture………………………” FSR6



49

One mother would have sought the services of a pharmacist, but there was none in

the community. This was what she said:

“But for my mum she advised that since there was no pharmacy around, I should

bring her to the hospital because this is even beyond a

pharmacist………………...” FSR5

4.8 Healthcare Facility

In the quest to answer the fifth question; ‘What factors influence mothers’ decision to bring

their children to the hospital?’ Healthcare facility emerged as one of the themes which was

consistent with the last construct of the model (accessing formal biomedical services). three

sub themes emerged. There were; emergency, attitude of staff ad others such as

recommendation from friends, proximity and expert care.

4.8.1 Emergency

Mothers sent their children to the hospital because it was an emergency situation.

Others were referred by a doctor from their first clinic for advanced care.

“So they hurriedly went to get some medicine to inject her. So after the doctor

attended to her, he said we should bring her to Children’s emergency. So, an

ambulance conveyed us to the children’s unit…….” FSR2

“She was static at the market. I rushed her to the nearby clinic and was referred to

Children’s hospital………...” FSR3

“As we got there and was preparing the folder, the seizure occurred again but they

could not access his veins to administer intravenous medications. We spent the night

there without any progress so we were given a referral letter to PML………...”

FSR6

“And then my husband got up and carried him “gidigidi” (hurriedly) ran with him

into the emergency….” FSR7

4.8.2 Attitude of staff

Respondent FSR2, said she refused accessing medical care in a closer facility due

to the attitude of the staff there. Here is what she said:

“….. the health workers there are not matured enough and they have no patience

to attend to their clients. So those things discouraged me………” FSR2



50

One mother went to a first facility before referral was given to the Children’s

hospital and this was her observation;

“To me, I will say in the first hospital, their treatment is not good, the way they

maltreat the strangers they don’t have patience for the person. When they see

strangers they retaliate (react) so fast by shouting this and that without having

patience ……...” FSR1

4.8.3 Others

Some of the mothers said they decided on the facility of choice following the

recommendations from friends. Others considered the proximity of the facility to their

homes whilst others chose the facility because their children needed expert care.

4.8.3.1 Recommendation from others

A few mothers sent their children to the hospital of choice based on the

recommendations from others.

“my friends advised we send her to the nearby clinic…….” FSR3

“A friend of mine advised we bring my child to Children's hospital because they

give quality care……” FSR4

4.8.3.2 Proximity

The distance of the health facility from one’s home also played a part in the

decision to take a child for biomedical service.

“I went to a nearby Polyclinic because I stay at ‘Mataheko’ (a suburb of Accra)

and that polyclinic is closer to where I stay…...” FSR5

“The choice of the first hospital I went was due to the fact that the hospital was

closer to my house than where I would have preferred sending him during the early

hours of the day……” FSR6

“I first sent her there because that was the nearest polyclinic……” FSR10

4.8.3.3 Prompt/ expert care

Some of the respondents said the care rendered by the health workers in the hospital

of choice was rapid, thus their children were attended to without unnecessary delay. For



51

others, they were referred to PML because the first point of call had no specialized team to

give the appropriate management.

“Anytime we bring her here, their emergency response is very good. And they give

prompt care. For me I only bring my child to the hospital anytime it happens. The

health workers can determine the actual cause. As for the elderly they just

speculate, because our forefathers were not privileged to have hospital as we do

these days. So they resorted to herbal medications…...” FSR 10

“We were told to bring her to Children’s hospital without any delay, I think it was

beyond their management. That’s how I see it…….” FSR3

“…… because that was the first hospital she was diagnosed with seizures, althoug

h we were referred to another hospital, I decided to come to PML. There w

as no specialist there who could give my child the appropriate treatment…………

.” FSR4

“Their treatment is very good. I couldn’t have managed it better at home, they hav

e the knowledge on how to manage these children…...” FSR11

“I went to a polyclinic but was told the child was too young to be treated there, as

such there was no space for nursing babies. I even prepared a folder there to be

seen but when I got to the attending physician, he gave me a referral here………”

FSR5

4.9 Mothers’ Reaction

A new theme that emerged from the study is mother’s reaction. This talks about the

emotions of mothers when faced with the challenge of seizures especially for those seeing

it for the first time in their lives. Sub-themes emerged and they are as follows; anxiety and

devastation.

4.9.1 Anxiety

“When I saw her after the first episode in fact, when I thought of the whole thing I

asked how come this kind of thing happened to my child?........” FSR2

Others mothers said seeing the condition put fear in them.

“Errrmmm… Actually when the thing comes it puts fear in me. That fear means

because I have not experience this kind of thing before and for me seeing it is like

a burden …... so it gives me concern of having that kind of thing why it should

happen to me.” FSR1



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“As a mother I was afraid because this is the first time in my life I have ever

experience such a thing. I almost fainted when I first brought my child to the

hospital and saw the way he was suffering…” FSR6

4.9.2 Devastation

“I was overwhelmed because that was my first time of seeing such a condition. As

it is with everything one sees for the first time, is it not true?.............” FSR10

“I want to say truthfully that, before we got here things were very bad, I didn’t know

what was going on…….” FSR5

“I am interested in knowing what is going on with my child but the doctors know

what is wrong with my child. I am overwhelmed so I couldn’t ask…………...”

FSR12

4.9.3 Crying

“I am very happy about the way things are going here because I came

weeping…….” FSR6

“So finally before we got here it has stopped but I wasn’t still comfortable, I started

crying asking is my son okay?..........” FSR7

“In fact, I started crying because I panicked. The dad panicked as well but he

gathered courage to pull the child from my hands and ordered I bring the oil and

the water……………...” FSR9

4.9.4 Confusion

“It never occurred to me to send my child back to where I delivered her for

treatment. I was confused by then……….” FSR5

4.10 Ignorance

This is the second theme that emerged from the study which was not in the model.

Some of the respondents had no idea about the cause of seizure as well as management of

seizure either at home or in the hospital.

4.10.1 Condition (febrile seizures)

Some mothers could not identify the condition as seizure. These were their

responses:

“I did not know what was happening to her. So we brought her to the hospital for



53

care the first time it occurred. I never thought such a thing will happen again

because we don’t know what is happening, so we always bring her to the

hospital anytime it occurs and we were told what to do. I thought it was just a

mere sickness. Little did I know it was going to recur……” FSR4

“When it occurred, I did not know what was happening to him, I thought he was

just sick…….” FSR6

“I kept asking what could be wrong with my child since I don’t know how seizure

happens. I asked my granny too but I was not given any strong confirmation……

.” FSR11

4.10.2 Management of febrile seizures

Some mothers were ignorant about the management of seizures at home and also

had no idea what goes on in the hospital setting as a few of them could not mention the

medications given or the laboratory investigations carried out on their children.

“I don’t know the medications she is being given here, not at all. Whatever will

make my baby well is what I want………” FSR5

“Oh no I didn’t know, I don’t have idea about home management. All I know is they

will put spoon in the mouth……” FSR7

4.11 Summary of findings

This chapter analysed 12 interviews conducted among mothers of children with

febrile seizures receiving treatment at the Princess Marie Louise Hospital, Accra. Eight

major themes emerged from the study which included identification of signs and symptoms

of febrile seizures, causes and beliefs, home remedies, consultation of Significant Others,

seeking care in the community, health care facility, mothers’ reaction and ignorance. The

first six themes were consistent with the Household Decision Making Model adopted from

Colvin et al., 2013 which was used to organized the study. The last two themes, mothers’

reaction and ignorance emerged as new themes from the study. In all, twenty sub-themes

emerged.

Mothers recognized and responded to seizures in various ways in relation to the

signs and symptoms, causes and beliefs and home remedies. It was realized that, mothers



54

believed the seizures were caused by physical, spiritual and other means and their

responses and choices of treatment given depended solely on their beliefs about the cause

of seizures.

Seeking advice and negotiating access (consultation of significant others) was

explored using the following sub-themes: husbands, In-laws, neighbours/ friends and

family (mother, sister, brother). From the analysis, it was realized that mothers consulted

their husbands or in-laws before seeking biomedical services. The husbands are the key

decision makers in the house and in their absence, the In-laws can take the decisions.

However, neighbours/ friends and other family members gave support or advice to the

mothers in one way or the other during the seizure episodes of their children.

It was observed that mothers consulted specialists or professionals in the

community before seeking biomedical services in the various hospitals/ clinics. They

included: Pastor/ Fetish Priestess, Traditional healer/ Herbalist and Doctor/ Nurse who gave

assistance in the form of prayers, medications, spiritual interventions as well as physical

interventions. Mothers brought their children to the hospital after the interventions in the

community had failed or yielded no positive results.

Accessing formal biomedical services (healthcare facility) was examined under the

following sub-themes; emergency, attitude of staff and others such as recommendation

from friends, proximity and prompt expert care. Medical attention was sought by mothers

of children with febrile seizures because it was an emergency situation. Others go to

facilities for care following the recommendation from friends or due to the proximity of the

facility from their homes. Other factors they considered before visiting the health facility

was the attitude of the staff and their ability to give prompt care.



55

Mother’s reaction and ignorance were the new themes that emerged from the study.

Some mothers were anxious, devastated, confused, cried and panicked because the seizures

were their first experience. Other mothers could not identify the cause of seizure and its

management either at home or in the hospital.



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CHAPTER FIVE

DISCUSSION OF FINDINGS

This chapter discusses the findings of the study in relation to studies conducted

previously on the same subject matter. The background characteristics of respondents

precede the discussion of the themes and sub-themes which will be discussed in line with

the objectives of the study and based on the conceptual framework.

5.1 Demographic Characteristics of Respondents

A total of 12 mothers whose children were diagnosed with febrile seizures were

interviewed. The ages of their children ranged between four (4) days to 4 years. Out of the

twelve children, ten (10) were within one to four (1- 4) years, one was 8 months old, one

was five (5) months old and the lowest age was four (4) days old. These findings agree with

the research conducted on febrile seizures and febrile seizure syndrome which reported

that, febrile seizure or febrile convulsion is an event in childhood or infancy which usually

occurs between age six months and five years (Khair & Elmagrabi, 2015).

From the study, the median age was 2 years and it affirms a review by Kimia, Bachur,

Torres, and Harper, (2015) on febrile seizures emergency medicine perspective which

indicated that febrile seizure occurs in 2-5% of children during their first five years of life

but most commonly during their second year. Findings from the current study also revealed

that a 4-day old child and a 4 months old child were diagnosed with febrile seizures. Again,

from the current study, majority of the study children were females (10 out of 12).

The results from a study by Kumar and Mohanty (2011), showed that willingness to

access a biomedical service is associated with the mother’s educational level and

socioeconomic status. In terms of the educational level of the mothers influencing their

decision to seek prompt care or biomedical services, similar findings emerged from the



57

current study. Those with tertiary education sought care without delay whilst those with

either no educational background, primary or secondary educational level resorted to one

or two home remedies first before going to the hospital after the first intervention failed.

However, the socioeconomic status of mothers was not studied in this current study.

5.2 Caregiver Recognition and Response

Mothers are the first people in the family to recognize an illness in children because

they are mostly with their mothers. The ability to identify an illness leads to various

responses depending on the beliefs about the cause of illness. Such responses included use

of home remedies, seeking support or advice from family and friends, seeking care from

traditional healers or other professionals in the community or sending the child to a medical

health facility.

5.2.1 Beliefs of mothers about febrile seizures

From the study, respondents reported that fever was found to be the trigger factor of

a febrile seizure. This finding is supported by that of Seinfeld and Shinnar (2017), who

reported that febrile seizure is believed to occur either before or soon after fever onset. In

another study, fever was seen to lead to possible complications such as febrile seizure or

brain injury (Hussein et al., 2016). All the mothers testified to some degree of change in

body temperature of their children which was higher than the normal. The children’s

temperatures were taken by either checking the temperature with a thermometer or feeling

the child’s body by touch. This finding is also in line with that of a study on the accuracy

of touch and perception for detecting fever, a study conducted in a tertiary and rural hospital

in India. It was found out that, mothers’ reportedly measure temperature by feeling, or

palpating parts of the body and the use of various thermometers (Singh et al., 2003).



58

However, the study by Singh and friends (2003), recommended that fever can accurately

be detected by the use of a thermometer.

Other signs associated with febrile seizures identified by mothers from the current

study were clenching of teeth, body stiffness and rolling of eyes/ change in eye movement.

This finding is supported by a study on the management of febrile convulsion in children

where the signs and symptoms of febrile seizures were identified to include jerking or

twitching of legs and arms, loss of consciousness, rolling of eyes, as well as foaming at the

mouth (Paul, Rogers, Wilkinson & Paul, 2015). Additionally, the recognition of febrile

seizures included identifying the cause. From the study, causes of febrile seizures were

reported by the mothers as being associated with physical, spiritual and other causes. In

another study, it was found out that mothers whose children had ever suffered febrile

seizures even though, had acceptable facts regarding the causes, symptoms and signs of

febrile seizures, there was negative beliefs persisting amongst mothers relating the cause

of febrile seizures in children to mystic forces (Nyaledzigbor et al., 2016). Findings from

the current study indicated that, mothers believe seizures are caused by witchcraft, evil

spirits or as a result of spiritual attacks. The beliefs of the mothers about the causes of

seizures influenced their choice of treatment. These findings agree with the findings of a

study conducted by Asare, (2017), which showed that there is spiritual involvement in

healthcare in Ghana. This belief appears to be in existence since the days of Jesus Christ,

where a man cried out to Jesus to heal his only son whom he claimed a “spirit seizes him

and convulses him” (Luke 9: 38-39, NKV).

Phlegm was another physical cause of seizures according to the mothers in this study.

5.2.2 Practices of mothers in response to febrile seizures

Responses mothers gave or employed in dealing with seizures included giving

medications such as antipyretics, antibiotics and the use of garlic. The antipyretic



59

medications given were paracetamol and teething mixture (‘teedar’). This finding is

consistent with findings from a research conducted in Sub-Saharan Africa by Chibwana et

al., (2009) on febrile illness in children under five, which indicated that some parents used

antipyretics such as paracetamol and ibuprofen to reduce fever in their children especially,

during teething when their body temperatures became very high. In the first 24 hours of

fever, “antipyretics were given as first aid for fever and were viewed as effective treatment.

Another research finding however, disagrees with this finding noting that; “antipyretics are

ineffective in preventing febrile seizures” ( El-Radhi et al., 2009).

Herbal medications were also found to be part of the home remedies used by mothers

to abort seizures. A similar study conducted in the Volta Region of Ghana, Ho, reported

the use of herbs to abort seizures (Nyaledzigbor, Adatara, Kuug, & Abotsi, 2016). The most

common herb used in this study was garlic which was smeared over the children’s body or

mashed and given to the children to drink. This practice could lead to aspiration since the

children were forced to drink the garlic solution in the convulsive state. Some mothers

claimed the smell of the garlic casts out evil spirits believed to cause seizures in children.

Again, some mothers used positioning to abort the seizures. They held the children’s

legs up and their heads downward and shook the children to make them conscious. This

positioning was believed to abort the seizures. This finding is in consonance with the

findings of another study conducted by Westin and Levander (2018). Mothers in that study

stated that they shook their children having seizures in order to receive a reaction from the

children and others would percuss the children’s back with the belief that they were

choking.

Furthermore, water was another home remedy used by the mothers for dealing with

fever and seizures. Mothers either tepid sponged their children to reduce high body

temperatures or poured water over the children to abort the seizures. This finding is in



60

consonance with the findings of a study by Aluka et al.,( 2013) conducted in South Nigeria.

Here, mothers used cold water sponging and paracetamol to control fever among children.

Additionally, oil was also used as a home remedy. In such instances, either red oil is

given to the child to drink or anointing oil is used to brush the face of the child and poured

over the child’s body to abort the seizures. Giving anything by mouth to children during a

seizure episode can lead to aspiration and subsequent death of a child. It is a dangerous

practice and it is imperative for health professionals to educate the public against such

practices.

From the current study, the findings also indicated that, some mothers put spoons

or their fingers in the mouth of their children during the seizure episodes when the teeth are

clenched together to prevent them from biting their tongues. One mother recall her ordeal

adding that she will never forget that day she put her finger in the child’s mouth as she was

bitten severely. This was also observed by Eseigbe, Eseigbe and Adama (2012) in a study

conducted on febrile seizures in North Western Nigeria. Mothers in that study, thrusted

objects such as spoons or fingers in the mouths of their children during seizures.

Prayer was also an intervention used at home to abort the seizures. Spirituality

constitutes a common feature in most African cultures, including Ghana. Since spirituality

is part of the day to day living of an African and most Ghanaians, religiosity plays a vital

role in sickness (Asare 2017).

5.3 Seeking Advice and Negotiating Access

This theme focused on mothers seeking help or advice from family members such

as husbands, in-laws, siblings and neighbours/ friends. The aim was to ensure they received

guidance or permission from the key decision makers at home on where to send their sick

children for treatment. Respondents reported consulting or informing their husbands or

mother in-laws about their children who had seizure episodes. The decision to inform their



61

husbands or the mothers-in-law was found in similar studies where mothers had the social

obligation to inform their in-laws to decide on the actions to be taken in response to an

illness. Deciding on the actions to be taken during an illness is not the sole responsibility

of a mother in the African society (Nsungwa-Sabiiti, Källander, Nsabagasani, Namusisi,

Pariyo, Johansson, … Peterson, 2004). Mothers have to seek advice from their husbands

or the head of the family who is most of the time, a male (Falade, Ogundiran, Bolaji, Ajayi,

Akinboye, Oladepo, … Oduola, 2007).

Furthermore, from the study findings, some key decision makers opposed

biomedical services, (orthodox medicine) as they claimed that ‘seizure is not a hospital

sickness’. A previous study’s finding agrees with this finding (Comoro et al., 2003).

Consultation of other family members such as mothers, brothers or sisters is a way of

sharing responsibilities and seeking help. It is believed that taking decisions about a child’s

health care constitute household decisions where the decisions are influenced by people

such as relatives in the house or families (Forry, Tout, Rothenberg, Sandstrom & Vesly,

2013). The young mothers in the study said they were not experienced in child care since

that was their first child and they needed advice from the elderly who were more

experienced. This finding is similar to a finding from Kelly, Sahm, Shiely, Sullivan, et al.,

(2016) on parental knowledge, attitudes and beliefs regarding fever in children conducted

in Ireland. Contrary to these findings, some mothers in the current study took decisions on

their own since their husbands were not present at the time the seizures occurred. Again,

neighbours and friends were of great help to the mothers during the seizure episodes where

they gave advice on home remedies or where to send the convulsive children.

5.4 Using the Middle Layer between Home and Clinic

A middle layer in the community is a professional or specialist such as a doctor,

nurse and a pharmacist as well as religious leaders such as a pastor, fetish priest/ priestess,



62

a traditional healer and/ or a herbalist. A study conducted by Pierce (2016), posited that

caregivers begin with home treatment and will only change to an alternate treatment when

the first treatment is unsuccessful. In another study conducted in Mali by Ellis, Winch,

Daou, Gilroy, & Swedberg, (2007), similar findings emerged. It was found out that if there

is no improvement in the child’s condition a few days after commencement of home

treatment, the caregiver then seeks treatment from pharmacies, traditional healers and

health workers in the community. The current study showed similar findings. Mothers went

to pharmacists to get medications such as antipyretics and antibiotics for their children. A

doctor and a nurse were also consulted for interventions during the seizure episodes. Other

mothers who believed the cause of seizure was spiritual either went to a Pastor/ Fetish

Priestess or a Traditional healer/ herbalist. This finding is supported by that of Friend-du

Perez et al., (2009). The authors posited that the middle layer is alluring in instances where

the cause of the sickness is believed to be due to evil spirits and wizardries such that their

services are engaged to deal with such supernatural powers. This finding is also consistent

with that of another study by Asare (2017), which indicated that in the African society, a

major determinant of choice of treatment is spiritual belief. Furthermore, the findings from

this study indicated that, some children were sent to the herbalist/ traditional healer who

made scarification on the children and administered medicines in the wounds to abort the

seizures. The cuts were believed to allow the evil spirits to come out and the medicines

specifically cast out the evil spirits believed to cause the seizures.

5.5 Accessing Formal Biomedical Services

Formal biomedical service involves seeking care from a hospital or a clinic or a

health facility. Findings from this study showed that mothers accessed biomedical services

based on the fact that the situation was an emergency and needed urgent attention. Some of

the children were brought to the hospital in their convulsive states. This finding is similar



63

to findings from a study by Hageman et al., (2013) on febrile seizures. The results from

that study revealed that, febrile seizure was one of the reasons why parents visited the

emergency room since the event was terrifying to them. This is also in consonance with a

study by Galizia & Faulkner (2018), on epilepsy and seizures presentation and their

management in acute medical setting:. From that study, common presentations to

emergency units were seizure- mimics and seizures. On the other hand, parents brought

their children with simple febrile seizures to the emergency unit for medical care after the

seizure has resolved (Hageman et al., 2013). Additionally, a study by Hussein et al., (2016)

on the effect of an intervention on prevention of recurrence of febrile convulsion among

under five children also reported similar findings. Most children with febrile seizures are

brought to the medical facility after the seizure has resolved. However, a small number of

children present to the health facility while still convulsing (Paul & Chinthapalli, 2013).

This was found to be true in the current study where some mothers said the seizures aborted

before getting to the health facility whilst others were brought in a convulsive state. Febrile

seizures bring about significant anxiety in mothers and hence, it is essential that every child

should be referred to the hospital after having a seizure episode at home (Chung, 2014).

Furthermore, according to this study’s findings, the type of health facility visited was

influenced by factors such as recommendation from friends, proximity, attitude of staff and

the need for prompt care.

Proximity was found to be one major factor mothers considered when seeking

biomedical services. From the findings, attitudes of healthcare staff either discouraged or

encouraged mothers to seek biomedical services for their children.

Respondents also reported that their choice of biomedical services was influenced by

the fact that their children needed prompt or expert care. Others were referred from a

primary health facility to a secondary health facility.



64

5.6 Mothers’ Reaction

This theme focused on the way mothers responded emotionally or psychologically

when their children had seizures. The findings from this study indicated that, being the first

time experience for some mothers, they were anxious seeing their children go through the

seizures. This finding is consistent with findings from a study on parental anxiety and

family disruption following a first febrile seizure (Wirrell & Turner 2001). This finding is

also supported by a study conducted on febrile convulsion among children under five,

where behavioural, physical and psychological manifestations were identified to be

parental responses and reactions towards febrile seizures (Hussein, El, Saboula, & Eldein

2016). Some psychological responses included extreme anxiety about fever recurrence.

Again, although febrile seizures are not harmful to the affected children, the episode can

be very frightening for mothers. Thus, the need to sensitively address the anxiety of these

mothers so as to keep them calm (Paul et al., 2015).

Another finding from the study showed that, mothers were overwhelmed. They did

not completely understand why the seizures were happening to their children. They felt

helpless and hopeless since they could not do much to stop the seizures. Furthermore, fear

gripped some of the mothers as a result of the seizures. They claimed they feared because

it was their first experience. Crying was another reaction reported by some of the mothers

in this study.

5.7 Ignorance

It was observed from the current study that some mothers were ignorant about febrile

seizure, its signs and symptoms, causes and management either at home and or at the

hospital. To some, seeing the seizure was an event they could not comprehend whilst others

could not identify what exactly could be happening to their children. At home, giving the

children first aid was an idea from either friends or family members since their mothers had



65

no experience. At the hospital, some of the mothers were not informed about the

management given to their children and they were not bold enough to ask questions

concerning the care rendered to their children.

5.8 Evaluation of the Study Model

The Household Decision Making Model by Colvin et. al., (2013), served as a guide

for this study. It helped to explore the beliefs and practices of mothers concerning the care

of children with febrile seizures. The model guided the researcher to derive the objectives

and research questions for the study. Organization of the literature review, study design,

data collection tool and the discussion of findings were based on the model. Identification

of signs and symptoms of febrile seizures, home remedies, causes and beliefs were

considered as the caregiver recognition and response part of the model. Consultation of

Significant Others were in relation to seeking advice and negotiating access part of the

model. Using the middle layer between home and clinic in the model, covered seeking care

in the community whilst healthcare facility was considered accessing formal biomedical

care of the model.

The study supported the model in its entirety hence the model was not modified.

5.9 Suggestion for Model Modification

The Household Decision Making Model basically focuses on caregiver’s physical

variables of actions taken in relation to illness. The scope must therefore be expanded to

include the psychological aspects as well, as depicted by this study.



66

CHAPTER SIX

SUMMARY, IMPLICATIONS, LIMITATIONS, CONCLUSION AND

RECOMMENDATIONS

This chapter focuses on the summary of the study, its implications, limitations,

conclusion and recommendations based on the study’s findings.

6.1 Summary of the Study

The study utilized the Household Decision Making Model developed by Colvin et.al.,

(2013) to explore the beliefs and practices of mothers concerning the care of children with

febrile seizures at the Princess Marie Louise Hospital, Accra. Ethical approval was

obtained from the Noguchi Memorial Institute for Medical Research Institutional Review

Board (NMIMR-IRB) and the Ghana Health Service Ethical Review Committee (GHS-

ERC). Following the approvals, an introductory letter was given from the Accra Regional

Health Directorate and the Accra Metro Health Directorate to Princess Marie Louise

Hospital for the collection of data. The interview guide was pre-tested on two mothers

whose children were diagnosed with febrile seizures at the children’s emergency unit of the

Korle-Bu Teaching Hospital. After the pretest, the necessary corrections were made to the

topic guide before the actual data was collected. Twelve mothers whose children were

diagnosed with febrile seizures participated in the study. Consents of mothers were sought

before the commencement of the study. The study was carried out between May and June,

2019. Data analysis was done using thematic content analysis.

The study showed that some mothers identified seizures by the signs and symptoms

such as a rise in body temperature, change in eye movement and clenching of teeth. These

findings showed that some mothers had knowledge about the signs and symptoms of febrile

seizures. The causes of seizures were attributed to physical, spiritual and other causes. The

physical causes according to the mothers included fever, phlegm and stomach ulcer.



67

Spiritual causes were attributed to evil spirits, spiritual attack, witchcraft and consequences

of unperformed birth rituals. Another cause of seizure as identified from the study was

marital conflict between parents of a convulsive child. Some mothers believed the seizures

were caused by supernatural forces.

Again, some responses of the mothers towards the seizures were based on the perceived

causes. Water, oil, medications such as antipyretics, antibiotics and herbs as well as prayers

and positioning were interventions given at home to either reduce the fever or abort the

seizures. It was observed that some mothers used in-appropriate methods to abort the

seizures.

Additionally, some mothers consulted their husbands, in-laws, friends, neighbours

and other family members during the seizure episodes on either the choice of treatment or

the actions taken or the interventions given. They also consulted specialists in the

community such as pharmacists, doctors and nurses as well as religious leaders such as

Traditionalist/ herbalists, Fetish Priestess and Pastors in dealing with the seizures.

It could be inferred from the study that, the choice of biomedical services was

influenced by factors such as proximity, attitude of staff, emergency situation and the need

for expert care. The distance from one’s home to the nearest clinic was considered since it

was an emergency situation. The friendly or the rude attitude of the staff also influenced

the decision of the mothers to choose the health care facility.

Lastly, it could be noted that, the psychological reactions of the mothers towards

seizures were anxiety and devastation. This could be because it was their first time to

experience seizure episodes in their children. Some mothers were ignorant about seizures

and their management either at home or in the hospital setting.



68

6.2 Implications for Nursing Practice

The findings from this study call for the need for addressing some implications in

nursing practice. The findings indicated that febrile seizures were associated with both

physical and spiritual causes. It is therefore necessary to involve spirituality in the

management of children with febrile seizures. Thus, a holistic approach to care of children

with febrile seizures in the hospital setting should be employed. Additionally, the study

provided evidence that some mothers have misconceptions about febrile seizures and hence

use inappropriate methods to manage it at home. It is important to educate mothers at the

out-patient departments (OPD) whenever they come for hospital visits and on the wards,

for those on admission, about the management of children with febrile seizures especially

at home before seeking medical care. Also, it is of utmost importance to inform the mothers

about the care given to their children in the hospital and the treatment modalities. This the

researcher believes, will help involve the mothers in the care given at the hospital and to

gain their full cooperation.

6.3 Nursing Education

From the study, some of the mothers reported that, some staff members showed

negative attitudes towards them. It will be of great benefit if the staff in the various health

facilities are trained in customer care and satisfaction through in-service training.

Additionally, the Ghana College of Nurses and Midwives needs to train more specialist

paediatric nurses to give specialised care to the children at the various health facilities.

6.4 Nursing Research

The current study was conducted at the Princess Marie Louise Hospital in Accra

where the beliefs and practices of mothers on febrile seizures were explored. The results

suggest that, expanded research should be conducted on the beliefs and practices of mothers



69

concerning the care of children with febrile seizures in other facilities such as the regional

hospitals of the Eastern or Northern Regions of Ghana.

6.5 Limitations of the Study

It was observed that mothers were not fully composed during interviews conducted

at the emergency room on the first day of admission. However, there was no observed

difference in data gathered from those who stayed at the emergency room for more than

one day.

6.6 Conclusion

In conclusion, findings from the present study indicated that although mothers have

an idea about febrile seizures, they lacked adequate knowledge about its management at

home and hence use inappropriate methods to abort the seizure or stop its recurrence.

Some findings of the study were consistent with the constructs of the Household

Decision Making Model whilst other findings were identified outside the constructs. From

the study, findings that were consistent with the model’s constructs in relation to caregiver

recognition and response were identification of signs and symptoms of febrile seizures such

as fever, change in eye/ body movement, and clenching of teeth. Others included causes

and beliefs about febrile seizures such as physical, spiritual and other causes. Home

remedies such as the use of water/ oil, medications, positioning and prayers were employed.

Secondly, consultation of Significant Others such as In-laws, husbands and family

members (mothers, sisters and brothers), neighbours and friends was identified to have an

influence on the decisions about the care of children with febrile seizures.

Furthermore, before getting to the health facility, the mothers also consulted

pharmacists, doctor/nurse, traditional healer/ herbalist, Pastor and fetish Priestess. It was

found out that, proximity, attitude of staff, expert care, emergency situation,



70

recommendation from friends were factors that influenced the choice of biomedical

services sought.

Mothers’ reaction such as anxiety and devastation, were the emotional/

psychological factors that respondents stated they experienced in the current study.

Lastly, some mothers expressed worry about not being given information on the

care given to their children at the hospital. This indicated that mothers need to be educated

on the management of febrile seizures at home and also be updated on the care given during

the admission period so as to get them involved in the care of their children. Hence, there

is the need to develop educational programmes for mothers on the management of febrile

seizures at home.

The findings from this study can be used to develop interventions to help these

mothers manage seizure effectively at home. Information or education can also be given

to mothers during their OPD visits to the hospital on management of febrile seizures to

avert under-five mortalities as a result of use of inappropriate methods at home.

6.7 Recommendations

Based on the study findings, these recommendations were made to the Ghana

College of Nurses and Midwives, the Ministry of Health, Ghana Health Service, Princess

Marie Louise Hospital and for Research.

Ghana College of Nurses and Midwives (GCNM)

To train more specialist paediatric nurses to give specialised care to the children

admitted to the various health facilities, specifically in neurological nursing.



71

Ministry of Health (MOH)

The Ministry of Health should:

Employ more specialist paediatric nurses (specifically neurology nurses) to provide

effective care for paediatric patients (diagnosed with any neurological condition

such as seizures) at the various health facilities.

Educate the general public through the media on febrile seizure occurrence in

children through role play or drama, the associated signs and symptoms and how to

effectively manage it at home before seeking biomedical service.

Ghana Health Service (GHS)

The Ghana Health Service (training division) should:

Ensure every health facility has at least a specialist paediatric nurse (trained in

neurology and a paediatric neurologist) to provide the needed care for children who

are brought to such facilities diagnosed with a neurological condition.

Train the staff in the various health facilities in effective communication, patient

satisfaction and customer care through periodic in-service training.

Princess Marie Louise Hospital (PML)

Princess Marie Louise Hospital should:

Develop educational programmes focusing on the signs and symptoms of febrile

seizures and their management at home for mothers who seek care for their children

in the facility.

Educate mothers on the febrile seizures at the OPD as well as those with children

on admission on the wards through health talks and role play.



72

Recommendation for further research

It is important for future research to be conducted on the reactions of mothers

towards febrile seizures.



73

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APPENDICES

Appendix A: Introductory letter to NMIMR-IRB



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Appendix B: Introductory letters to GHS-IRB



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Appendix C: Ethical Clearance from NMIMR-IRB



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Appendix D: Ethical approval from GHS-IRB



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Appendix E: Introductory letter GHS



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Appendix F: Introductory letter to Accra Metropolitan Health Directorate



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Appendix G: Introductory letter to PML



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Appendix H: Interview Guide

DATA COLLECTION INSTRUMENT

TOPIC: EXPLORING THE BELIEFS AND PRACTICES OF MOTHERS

CONCERNING THE CARE OF CHILDREN WITH FEBRILE SEIZURES: A

STUDY IN THE ACCRA METROPOLIS.

A. DEMOGRAPHIC DATA

Participant…………..………………………………………….…..

Age of participant…………………………………………………….

Level of education……………………………………………………

Languages spoken………………………..…………………………..

Occupation……….………………………………….………………..

Marital status…………………………………………………….…….

Number of children……………………………….……………………

Religious affiliation…………………………………………….………

Husband’s education……………………………………………………

Husband’s occupation…………………………………………………..

CHILD’S PARTICULARS

Age: ……………………………………………………………...

Sex: ……………………………………………………….…..….

Birth order………………………………………………………...

B. INTERVIEW GUIDE

CAREGIVER RECOGNITION AND RESPONSE

Could you please tell me what happened to your child?.........................................

How did it come about?...........................................................................................



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What do you remember most?...........................................................................

What was mostly difficult during this time?......................................................

How did you feel during that moment?.............................................................

What did you do when you saw your child in such a state?...............................

What thoughts ran through your mind as you tried to understand what was

happening to your child?....................................................................................

SEEKING ADVICE AND NEGOTIATING ACCESS

What made you decide to seek help for your child?...........................................

How did you know that was the best option for your child’s condition?..............

What are your thoughts about the outcome of your child’s condition?.................

Who takes decision regarding health issues at home? …………………………...

How long has it taken you to derive at a decision?.................................................

USING MIDDLE LAYER BETWEEN HOME AND CLINIC

When you sense your child’s temperature was high what did you

do?....................

What happened to the child before the seizure started?..................................

What did you use at home to stop your child’s condition?....................................

What made you chose that option?....................................................................

Which other methods did you use?.............................................................

How effective was that method you used?.........................................................

Tell me more about the various methods you know in treating the condition of

your child……………………………………………………………………



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Which remedy was most helpful?..................................................................

ACCESSING FORMAL MEDICAL SERVICES

What made you decide to bring your child to the hospital?....................................

How long has the condition started before bringing your child to the hospital?

What do you know about the management of your child’s condition in the

hospital?................................................................................................................

What factors did you consider when choosing the health facility?.......................

Is there anything more you want to share about your child? Tell me about it.



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Appendix I: Consent Form



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Appendix J: Participants information sheet



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97



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Appendix K: Demographic Characteristics of Respondents

participant' age level of languages occupation marrital number of religion husband's husband's child's sex of birth

code education spoken status children education occupation age child order

FSR1 37 secondary English, Twi, Igbo Trader Married 1 Christian Secondary Pastor 4 years Female 1st

FSR2 32 primary Ga, Twi, Ewe, Ada Trader Married 3 Christian Primary Business 1.6 years Female 3rd

FSR3 35 primary Twi Trader Not married 3 Christian Not known Business 5 months Female 3rd

FSR4 32 tertiary English, Twi, Ga Caterer Married 2 Christian Secondary Driver 2.4 years Female 2nd

FSR5 36 primary Fante, Twi Hair dresser Married 5 Christian Secondary Business 4 adys Female 5th

FSR6 35 nil Twi, Kusasi, Hausa Trader Not married 1 Muslim Secondary Business 8 months Male 1st

FSR7 35 tertiary English, Ga, Twi Nurse Married 1 Christian Tertiary Driver 2.3 years Male 1st

FSR8 32 primary Fante, Twi Trader Not married 1 Christian Not known Tailor 2 years Female 1st

FSR9 23 secondary Ga, Twi, English Hair dresser Not married 1 Christian Primary Trader 2 years Female 1st

FSR10 28 primary Hausa, Fante, Fulani Unemployed Married 4 Muslim Secondary Plumbar 1.8 years Female 4th

FSR11 37 primary Twi, Ga, English Unemployed Married 3 Christian Tertiary Teacher 2.6 yaers Female 3rd

FSR12 36 primary Twi, Fante Farmer Married 5 Christian Primary Tailor 1.7 years Female 5th



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Appendix L: Major Themes and Sub-themes

MAJOR THEMES SUB-THEMES

Identification of Signs and Symptoms of

febrile seizure

Fever

Change in eye/ body movement

Clenching of teeth

Causes and Beliefs Physical

Spiritual

Others (marital conflict)

Home Remedies Medications (antipyretics,

antibiotics, garlic)

Prayers/ positioning

Water/ oil

Consultation of Significant Others Family (husbands, In-laws,

mothers, brothers, sisters)

Neighbours/ friends

Seeking Care in the Community Religious leaders (pastors, fetish

priestess, traditional healers)

Health professionals (doctors,

nurses, pharmacists)

Health Care Facility Emergency

Attitude of staff

Others (recommendation,

proximity, expert care)

Mother’s Reaction Anxiety

Devastation (crying, confusion)

Ignorance Condition (febrile seizure)

Management of Febrile Seizure (at

home and hospital)


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