INCIDENCE OF FEBRILE CONVULSION AMONG INFANTS (0 – 6 YEARS) IN

FEDERAL MEDICAL CENTER, UMUAHIA

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 Table of Content

CHAPTER ONE

Introduction 1

Background to the Study 1

Statement of the Problem 3

General Objective of the Study 5

Specific Objectives 5

Research Questions 6

Significance of the Study 6

Scope of the study 7

Operational definitions of Terms 7

CHAPTER TWO

Literature Review 8

Conceptual Review 8

Classification of Febrile Convulsions (Seizures) 8

Etiology of Febrile Convulsions 9

Epidemiology of Febrile Convulsions 9

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Pathophysiology of Febrile Convulsions 10

Investigations 10

Clinical characteristics 11

Treatment / Management 11

Differential Diagnosis 13

Prognosis of Febrile Convulsions 13

General outcome 13

Theoretical Framework 14

Application of the Theory 15

Empirical Review 16

CHAPTER THREE

Research Methods 27

Research design 27

Research Setting 27

Target Population 28

Sampling size 28

Sampling technique 28

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Inclusion criteria 28

Exclusion criteria 29

Instruments for data collection 29

Validity and Reliability of the Instrument 29

Method of data collection 30

Method of data analysis 30

Ethical consideration 30

CHAPTER FOUR

Presentation and Analysis of Data 31

Age distribution of the respondents in 2021 31

Age distribution of the respondents in 2022 32

Period of Hospitalization among patients in 2021 33

Period of Hospitalization among patients in 2022 34

Diagnoses Associated with Febrile Convulsion among Children in 2021 35

Diagnoses Associated with Febrile Convulsion among Children in 2022 36

Characteristic type of febrile convulsion among children in 2021 37

Characteristic type of febrile convulsion among children in 2022 38

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Incidence of febrile convulsions within a period of 2 years 39

CHAPTER FIVE

Discussion of Findings 40

Summary 42

Implication of the findings to Nursing 43

Conclusion 44

Recommendations 44

Suggestion for Further Studies 44

References 45

APPENDIX I 48

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 ABSTRACT

Febrile convulsions are the most common type of convulsions in children, typically occurring
between the ages of 6 months and 5 years. They are defined as convulsions that occur in
association with a fever, but without evidence of intracranial infection or other defined cause of
convulsions. Although febrile convulsions are generally considered benign, they can be a source
of significant anxiety for parents and caregivers, and can be associated with long-term sequelae
such as epilepsy and cognitive impairment. This study aims to conduct a retrospective cohort
study to estimate the incidence of FC among children aged 0-6 years who visited FMC Umuahia
between January 2021 and December 2022. The objectives guiding the study includes; To
determine the diagnoses associated with febrile convulsions among children in FMC, Umuahia;
To assess the common types of febrile convulsions among children in FMC, Umuahia; To assess
the incidence of febrile convulsions among children in FMC, Umuahia. The study adopted a
quantitative descriptive retrospective design. Data on Febrile convulsions among children was
collected for the period of 2 years (January 2021 – December 2022). A total number of 1490
children were admitted in a period of 2 years of which only 150 children were diagnosed with
febrile seizure. Purposive sampling technique was adopted for this study. The instrument for data
collection is the medical records of the pediatric unit. Analysis of 2021 and 2022 data unveiled
that the majority of respondents were infants (1-12 months), with a higher proportion of male
respondents. Hospitalization patterns indicated prevalent short stays (1-3 days), primarily among
males, while longer stays (>7 days) demonstrated a more balanced gender distribution.
Diagnoses associated with febrile convulsions displayed variations in prevalence between male
and female children, with malaria being the most common (47.8%). Simple febrile convulsions
dominated (82.6%), and the incidence of febrile convulsions over two years exhibited a higher
occurrence in boys compared to girls, with 6.1% of boys and 2.2% of girls in 2021, and 3.0% of
boys and 0.8% of girls in 2022. The dominance of simple febrile convulsions, coupled with the
rarity of complex cases and febrile status epilepticus, suggests that most instances are
manageable and not characterized by severe complications. The consistently higher incidence of
febrile convulsions in boys compared to girls highlights a potential gender-specific vulnerability
that merits further investigation. Health facilities need to conduct routine and continuous health
education talks for parents on prevention of febrile convulsions in the home.

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 CHAPTER ONE

INTRODUCTION

Background to the Study

Febrile convulsions are the most common type of convulsions in children, typically occurring

between the ages of 6 months and 5 years. They are defined as convulsions that occur in

association with a fever, but without evidence of intracranial infection or other defined cause of

convulsions. Although febrile convulsions are generally considered benign, they can be a source

of significant anxiety for parents and caregivers, and can be associated with long-term sequelae

such as epilepsy and cognitive impairment (Ojinnaka, et al, 2015).

Febrile convulsions are seizure episodes that occur in the presence of a fever (>38.0°C/100.4°F),

usually in the context of a viral infection, and commonly occur in children between 6 months and

5 years old. This definition excludes convulsions occurring in the presence of an underlying CNS

infection or metabolic disturbance (Subcomitte on Febrile Siezures, 2011). Children with

previous afebrile convulsions are excluded from the group of children with febrile convulsions as

the febrile illness is perceived as a trigger of a pre-existing predisposition to epilepsy (Semple et

al, 2020).

The peak incidence of FS occurs between 6 and 18 months of age (Bergmark et al., 2020;

Kossoff et al., 2015). Studies suggest this is due to a combination of rapid brain development,

heightened neuronal excitability, and immature thermoregulatory control during this period

(Panayiotopoulos, 2015). After 5 years, the likelihood of FS declines significantly, though the

risk persists up to around 60 months (Duffy et al., 2015).

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The causes of febrile convulsions are not fully understood, but some factors may increase the

risk or trigger them. These include:

- Young age: Most febrile convulsions happen between 6 months and 5 years of age, with the

highest risk between 12 and 18 months of age.

- Family history: Children who have a parent or sibling who had febrile convulsions are more

likely to have them too.

- Viral infections: Some viruses, such as influenza, roseola, and coronavirus (COVID-19), may

cause high fevers that trigger febrile convulsions.

- Immunization: Some vaccines, such as the diphtheria, tetanus and pertussis (DTaP) vaccine

and the measles-mumps-rubella (MMR) vaccine, may cause low-grade fevers that trigger febrile

convulsions. However, the benefits of vaccination outweigh the risks of febrile convulsions.

- Dehydration: Loss of fluids and electrolytes from vomiting, diarrhea, or fever may also

contribute to convulsions.

Certain underlying conditions can increase a child's risk of FS. Children with a family history of

FS, developmental delays, or neurological malformations are more prone to experiencing them

(Duffy et al., 2015). Additionally, specific infections like influenza A have been associated with

a higher risk of FS compared to other respiratory viruses (Panayiotopoulos, 2015).

Febrile convulsions can be classified into two categories: simple and complex. A simple febrile

seizure is a generalized tonic-clonic seizure that lasts less than 15 minutes, does not recur within

24 hours, and does not have any focal features. A complex febrile seizure is a seizure that lasts

longer than 15 minutes, recurs within 24 hours, or has focal features, such as affecting only one

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part of the body. The cause of febrile convulsions may involve a combination of genetic factors,

viral infections, certain vaccinations, and a vulnerable developing nervous system under the

stress of a fever. Febrile convulsions are usually benign and do not cause long-term

complications or increase the risk of epilepsy. (Subcomitte on Febrile Siezures, 2011).

The exact mechanisms of febrile convulsions are not fully understood, but they involve a

combination of genetic and environmental factors. Some genes that affect the function of ion

channels, neurotransmitters, or inflammatory mediators have been associated with increased

susceptibility to febrile convulsions. Environmental factors include viral infections and vaccines

that can trigger fever and inflammation in the brain (Sawires et al, 2021). The most common

viral causes of febrile convulsions are influenza, respiratory syncytial virus (RSV), human

herpesvirus 6 (HHV-6), and enteroviruses (Millichap 2019) . Vaccines that have been linked to a

small increased risk of febrile convulsions include measles-mumps-rubella (MMR), measles-

mumps-rubella-varicella (MMRV), diphtheria-tetanus-acellular pertussis (DTaP), and

pneumococcal conjugate vaccines (Verbeek 2015).

Statement of the Problem

The incidence of febrile convulsions among children is a significant concern for public health. Febrile

convulsions, also known as febrile seizures, are the most common type of seizures in children and are

often associated with fever (Keum et al., 2023). The prevalence of febrile seizures varies across different

regions, with reported rates ranging from 2% to 5% globally (Jang et al., 2019). However, recent studies

have shown higher prevalence rates in specific populations, such as 6.92% in South Korea (Jang et al.,

2019). Additionally, the age-specific incidence of a first febrile seizure has been identified, with the

highest peak incidence occurring at 16 months of age (Christensen et al., 2022). Febrile convulsions are

more common in males, and the prevalence of simple seizures is higher compared to complex seizures in

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children younger than 2 years old (Javadi et al., 2017). Several factors have been associated with febrile

convulsions, including iron deficiency anemia (Jang et al., 2019), hyperglycemia (Lee et al., 2015),

hypercalciuria (Gorabi et al., 2018), and reduced serum calcium levels (Ushakiran & Suresh, 2017).

Furthermore, there is evidence of a potential association between febrile convulsions and urinary tract

infections (Kazeminezhad et al., 2018). It has also been reported that febrile seizures can be a

neurological manifestation of viral infections, such as norovirus gastroenteritis (Chen et al., 2019), and

may be linked to neuro-invasive properties of certain viruses, including SARS-CoV and MERS-CoV

(Thakur et al., 2021). The relationship between febrile seizures and other neurological conditions, such as

epilepsy, has been a subject of interest. While most children do not develop adverse neural sequelae after

experiencing a febrile seizure, epidemiological studies have indicated that a significant proportion of

individuals with temporal lobe epilepsy have a history of febrile convulsions in their early life (Sun et al.,

2015). Additionally, there is evidence of a higher prevalence of non-febrile seizures in children with

autism spectrum disorder (McCue et al., 2016). The management and understanding of febrile

convulsions among caregivers, particularly mothers, have also been studied. It has been reported that a

substantial proportion of mothers have medium to low knowledge regarding febrile convulsions in

children (Paudel et al., 2018).

A recent study by Sawires et al, (2021) reported that febrile convulsions are one of the

commonest presentations in young children, with a 2 – 5% incidence in Western countries.

However, a higher incidence has been described in Japan (7 – 10%) and Guam (14%) (Sawries et

al, 2021).

Another study by Okafor et al. (2013) reported that the prevalence of FC among children aged 6-

60 months attending a tertiary hospital in Enugu was 6.8%, with a male to female ratio of 1.4:1.

The most common trigger of FC was malaria (40.7%), followed by respiratory tract infections

(25.9%) and gastroenteritis (11.1%). Another study by Ogunlesi et al. (2015) found that the

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prevalence of FC among children aged 6-60 months admitted to a secondary health facility in

Sagamu was 7.9%, with a male to female ratio of 1.2:1. The most common trigger of FC was

malaria (66%), followed by respiratory tract infections (18%) and gastroenteritis (8%). These

studies suggest that malaria is a major cause of FC in Nigerian children, which may be related to

the high endemicity of malaria in the country. However, these studies were conducted in

different regions and settings, and may not be representative of the whole country or of specific

subgroups. Therefore, there is a need for more studies on the incidence of FC among children in

different parts of Nigeria, especially in areas where malaria is less prevalent or where other viral

infections may be more common.

Umuahia has a population of about 500,000 people, with a tropical climate and an average

annual rainfall of about 2,400 mm (Wikipedia, n.d.). The Federal Medical Center (FMC)

Umuahia is a tertiary health facility that provides specialized care for various medical conditions,

including pediatric neurology. To our knowledge, there is no published study on the incidence of

FC among children attending FMC Umuahia. Therefore, the researcher aims to conduct a

retrospective cohort study to estimate the incidence of FC among children aged 0-6 years who

visited FMC Umuahia between January 2021 and December 2022.

General Objective of the Study

The main aim of this study is to assess the incidence of febrile convulsions among children (0 – 6

years) in Federal Medical Center, Umuahia, Abia State from 2021 – 2022.

Specific Objectives

The specific objectives includes;

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 1. To determine the diagnoses associated with febrile convulsions among children in FMC,

Umuahia

2. To assess the common types of febrile convulsions among children in FMC, Umuahia.

3. To assess the incidence of febrile convulsions among children in FMC, Umuahia

Research Questions

1. What are the diagnoses associated with febrile convulsions among children (0-6 years) in

FMC, Umuahia?

2. What is most common type of febrile convulsion among children (0 - 6yeras) in FMC,

Umuahia?

3. What is the incidence of febrile convulsion among children (0 - 6 years) in FMC,

Umuahia?

Significance of the Study

This study on the incidence of febrile convulsions among children can have several implications

for the nursing profession, health providers and the society.

First, it can help to identify the risk factors, triggers and outcomes of febrile convulsions, which

can inform the prevention, diagnosis and management strategies. For example, it may reveal that

certain infections, vaccinations or genetic factors are associated with a higher incidence of febrile

convulsions, which can guide the screening, immunization and counseling practices.

Second, the study can help to assess the impact of febrile convulsions on the quality of life and

well-being of the children and their families.

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Generally, the study can contribute to the nursing profession, health providers and the society by

enhancing the knowledge, practice and policy on this common pediatric condition.

Scope of the study

This study is limited to children (0 – 6 years) admitted to the pediatric unit of Federal Medical

Center, Umuahia.

The study features both dependent and independent variable. The independent variable is the age

of children, which is manipulated by selecting different age groups for comparison. Other

possible independent variables are gender, and type of infection. The dependent variable is the

febrile convulsion.

Operational definitions of Terms

1. Febrile convulsions are seizures or fits that occur in young children when they have a

high fever, usually above 38.3 degrees Celsius. They are caused by an infection,

immunization or other factors that raise the body temperature. They are not a sign of

epilepsy or brain damage, but they can be frightening and require medical attention.

2. Children are human beings who are not yet fully grown or developed. They are usually

considered to be under the age of 18, but this may vary depending on the legal and

cultural context. Children have specific needs and rights that are different from adults.

3. Risk factors are things that increase the likelihood of something happening. For febrile

convulsions, some risk factors include: young age (below 5 years), family history, first

sign of illness, low temperature at the time of seizure, and complex febrile seizures

(lasting more than 15 minutes or affecting only one side of the body).

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 CHAPTER TWO

LITERATURE REVIEW

This reviews literature of the study. This chapter brings out what previous researchers have

found out in the area of study. It also covered theoretical and conceptual frameworks.

Conceptual Review

Febrile seizures are seizures that are caused by a sudden spike in body temperature with fevers

greater than 38C or 100.4F, with no other underlying seizure-provoking causes or diseases such

as the central nervous system (CNS) infections, electrolyte abnormalities, drug withdrawal,

trauma, genetic predisposition or known epilepsy.

Classification of Febrile Convulsions (Seizures)

Febrile convulsions can be sub-classified. In the National Collaborative Perinatal Project

(NCPP), complex febrile convulsions (seizures) were defined as those that had one or more of

the following:

 Duration more than 15 minutes

 Recurrence within 24 hours

 Focal features

Simple febrile seizures occur more commonly than complex febrile seizures and are

characterized by a seizure that is generalized, lasts less than 15 minutes, and does not recur

within 24 hours.

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Febrile status epilepticus is defined as a febrile convulsion lasting 30 minutes or more or a series

of febrile convulsions without full return to consciousness during that period.

Etiology of Febrile Convulsions

Febrile seizures occur with a fever higher than 38 C or 100.4 F and no other seizure-provoking

etiologies such as described above. The highest fever necessary to cause febrile seizures is

specific to the individual as each child's threshold convulsive temperature varies. While the

degree of fever is ultimately the most significant factor in febrile seizures, these seizures often

occur as the patient's temperature is rising. In fact, a febrile seizure may be the first sign that a

child is ill, with the presence of fever greater than 38 degrees discovered shortly after that. There

is no specific cause of fever that is more likely to cause febrile seizures, however, viral rather

than bacterial infections are most commonly associated with febrile seizures. A particular virus,

HHV-6, is most commonly associated with febrile seizures in the United States and European

countries. In Asian countries, influenza A virus has been frequently associated with febrile

seizures. Any fever of adequate height may cause a febrile seizure.

Epidemiology of Febrile Convulsions

The exact age constituting a febrile seizure varies slightly throughout medical literature with 6

months to 60 months (5 years) being a common working definition. Febrile seizures are

extremely common, occurring in up to 4% of children in this age group. Some children have a

single febrile seizure event, and others have multiple events over early childhood.

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Pathophysiology of Febrile Convulsions

The exact pathophysiology of febrile seizures is not understood. There is a recognized genetic

predisposition with 10% to 20% of first-degree relatives of patients with febrile seizures also

experiencing febrile seizures. No specific mode of inheritance is known.

Investigations

Full blood count, serum electrolytes, calcium, magnesium, phosphorous and blood glucose levels

are not routinely recommended for evaluating febrile seizures, as they will not change the

management course. These should only be performed if other clinical features indicate the need

for these investigations, such as prolonged post-ictal drowsiness or suspicion of bacteraemia

(Subcomitte on Febrile Siezures, 2011).

In young children, seizures are a common presentation of meningitis; thus, it is essential to

exclude this diagnosis. While lumbar punctures are not clinically indicated for most children

presenting with seizures, the presence of meningism or a history suggestive of meningitis or

intracranial infection are indications for a lumbar puncture. In children <18 months of age,

clinical signs of meningism are unreliable (Subcomitte on Febrile Siezures, 2011). In infants 6–

12 months old presenting with fever and seizure, a lumbar puncture is indicated if there have

been no Hib or pneumococcal vaccinations (or if the history of these vaccinations is unknown),

and to rule out meningitis or other intracranial infection if there is clinical suspicion (Subcomitte

on Febrile Siezures, 2011). A lumbar puncture may be performed for children 13–18 months old

if there is sufficient clinical suspicion for meningitis, or in a child with FSE (Subcomitte on

Febrile Siezures, 2011).

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Clinical characteristics

Febrile convulsions are all either tonic-clonic or possibly hypotonic in type and are never

myoclonic seizures, spasms or non-convulsive attacks. Most are brief and bilateral, but

longlasting and/or partial (unilateral) febrile convulsions do occur: 7075% of these are the

initial febrile convulsion experienced by the child.

Simple febrile convulsions are the commonest type of febrile convulsion. They are brief (<15

minutes) generalised seizures that do not occur more than once during a single febrile episode.

Some just consist of staring, perhaps accompanied by stiffening of the limbs and they may not

cause the parents great concern. Often they are much more dramatic. In the CHES birth cohort14

about 40% were not considered sufficiently severe to necessitate admission. About two-thirds of

the children suffered only one febrile convulsion ever.

Complex febrile convulsions may be more severe than simple febrile convulsions  in the CHES

cohort 95 children (25% of the children with febrile convulsions) had complex convulsions and

78% of them were admitted to hospital  a higher proportion than was found in those with

simple convulsions14. In these 95 children the complex features were as follows: 55 (58%)

multiple, 32 (34%) prolonged and 17 (18%) focal (some had more than one complex feature). It

is important to emphasise that the most severe attacks made up a very small proportion of all

febrile convulsions.

Treatment / Management

Management of children with febrile convulsions remains controversial. Groups of experts have

published guidelines. These include the Consensus Development Panel which met at the

National Institutes of Health in America in 198060, the 1991 Joint Working Group of the
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Research Unit of the Royal College of Physicians (RCP) and the British Paediatric Association

(BPA) (1991) and the American Academy of Pediatrics (2011).

Admission to hospital

Febrile convulsions that last for more than a few minutes should be stopped and if the convulsion

cannot be stopped the child should be admitted to hospital. If the convulsion has stopped it must

then be decided whether or not to admit. According to the RCP/BPA Joint Working Group

(1991) the following factors would favour admission after a first convulsion:

 Complex convulsion

 Child aged less than 18 months

 Early review by a doctor at home not possible

 Home circumstances inadequate, or unusual parental anxiety, or parents’ inability to

cope.

Antipyretics have not been shown to prevent a recurrence of febrile seizures. In patients who

have a frequent recurrence of febrile seizures such as seizures with a majority of febrile illnesses,

studies have examined treatment with benzodiazepines as a bridging measure for a few days

during subsequent febrile events.

Febrile status epilepticus can occur in less than 10% of children during the first febrile seizure.

Rectal diazepam is used to abort this disorder if it lasts more than 5 minutes. There are also

recommendations for intranasal midazolam. Patients with febrile status epilepticus are at risk for

future episodes of the same event.

Differential Diagnosis

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The differential diagnosis of febrile seizures include:

 Aseptic meningitis

 Bacterial meningitis

 Encephalitis

 Tonic-clonic seizures

Prognosis of Febrile Convulsions

About 30% of children with a previous febrile seizure remain at an increased risk of recurrent

febrile seizures.

Children less than 12 months at the time of the first febrile seizure have a 50% chance of having

a second seizure within the first year. This risk drops to 30% the following year. Other than

young age during the first febrile seizure, a family history of febrile seizure, low degree of fever

during the seizure, and a shorter interval between fever and the seizure may indicate a higher

probability of recurrent febrile seizures. However, features associated with complex febrile

seizures do not necessarily increase the risk of recurrence of febrile seizures.

General outcome

Febrile convulsions are common. The majority are simple febrile convulsions  brief generalised

seizures that occur just once in the lifetime of normal children. The evidence is that most

children who have febrile convulsions of any type (simple or complex) are subsequently normal

in intellect, neurological function and behaviour.

Initial management

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Most febrile convulsions stop spontaneously and not all children need to be admitted to hospital.

It is reassuring if the child seems neurologically normal after the convulsion. However,

prolonged seizures should be stopped by appropriate acute treatment and if there is any other

concern about the child’s neurological state hospital assessment is appropriate. A lumbar

puncture may be necessary to exclude meningitis in the minority of cases, particularly in children

younger than 18 months. Ideally this decision should be made by an experienced doctor.

Investigations are not routinely indicated after febrile convulsions  the EEG is not helpful and

brain scans are rarely indicated.

Subsequent medication

If febrile convulsions are prolonged it may be appropriate to teach parents to administer buccal

midazolam or rectal diazepam at home to prevent further prolonged episodes. There is no

convincing evidence that antipyretic measures reduce the frequency of febrile recurrences or that

the administration of intermittent or continuous prophylactic anticonvulsant medication reduces

the risk of later epilepsy. Prophylactic medication is now not generally advised for children with

febrile convulsions.

Theoretical Framework

The biopsychosocial model is a holistic approach to healthcare that considers the influence of

biology, psychology, and social environment on mental and physical health. It was first

conceptualized by Dr. George Engel and Dr. John Romano in the 1970s. The model recognizes

that these systems overlap and interact to impact each individual’s well-being and risk for illness,

and understanding these systems can lead to more effective treatment. It also recognizes the

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importance of patient self-awareness, relationships with providers in the healthcare system, and

individual life context.

The model is divided into three aspects: biological, psychological, and social. The biological

aspect refers to our genetics, physical health, and the functioning of our organ systems. The

psychological aspect refers to our thoughts, emotions, and behavior. The social aspect refers to

socioeconomic components, social support, and culture. Each of these components informs the

model as a whole.

The biopsychosocial model has been applied in different settings and contexts, including mental

health and wellness. It recognizes the importance of patient self-awareness, relationships with

providers in the healthcare system, and individual life context. The model has been criticized for

being too broad and difficult to apply in practice.

Application of the Theory

The biopsychosocial model is a holistic approach to healthcare that considers the influence of

biology, psychology, and social environment on mental and physical health. According to this

model, illness and health are the result of an interaction between biological, psychological, and

social factors. The biopsychosocial model can be applied to the study on the incidence of febrile

convulsions among children, which are seizures triggered by fever. Febrile convulsions are

influenced by biological factors, such as genetic predisposition, immune system response, and

infection type; psychological factors, such as stress, anxiety, and coping skills; and social factors,

such as family support, access to healthcare, and cultural beliefs. By understanding how these

factors interact, researchers can identify risk factors, prevention strategies, and treatment options

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for febrile convulsions. The biopsychosocial model also recognizes the importance of patient

self-awareness, relationships with providers, and individual life context in managing febrile

convulsions.

Empirical Review

Febrile convulsions are seizures that occur in children between 6 months and 5 years of age,

associated with fever but without evidence of intracranial infection or defined cause. They are

the most common seizure disorder in childhood, affecting 2-5% of children worldwide. The

etiology and pathophysiology of febrile convulsions are not fully understood, but genetic and

environmental factors are thought to play a role. Febrile convulsions are usually benign and self-

limiting, but they may be associated with an increased risk of epilepsy and neurodevelopmental

problems in some children. Therefore, it is important to identify the risk factors, prognostic

factors and optimal management of febrile convulsions.

Several studies have investigated the incidence and prevalence of febrile convulsions in different

populations and regions. A systematic review by Verity et al. (2017) found that the incidence of

febrile convulsions ranged from 1.8 to 9.2 per 1000 person-years, with higher rates in low- and

middle-income countries than in high-income countries. The prevalence of febrile convulsions

was estimated to be 2-4% in Europe and North America, 6-9% in Asia and Africa, and 10-14%

in Oceania. The review also found that the incidence and prevalence of febrile convulsions

increased over time, possibly due to improved diagnosis, reporting and survival of children with

fever. A population-based study by Vestergaard et al. (2017) found that the incidence of febrile

convulsions in Denmark was 3.6 per 1000 person-years, with a peak at 16 months of age. The

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study also found that the incidence was higher in boys than in girls, and higher in winter than in

summer.

A cross-sectional study by Onankpa et al. (2018) assessed the knowledge and home management

of febrile convulsions among mothers in a rural African community in Sokoto, Nigeria. The

study found that only 23.8% of the mothers had heard about febrile convulsions, and only 8.6%

had correct knowledge about its causes, signs and symptoms. The study also found that 72.4% of

the mothers used traditional remedies such as herbs, incisions, scarifications and cold baths to

manage febrile convulsions at home, while only 27.6% sought medical attention.

A descriptive phenomenological study by Owusu (2022) explored the perceived causes and

diagnosis of febrile convulsions in selected rural contexts in Cape Coast Metropolis, Ghana. The

study found that the perceived causes of febrile convulsions were interplay of complex natural,

social and spiritual factors that were deep-rooted in local socio-cultural beliefs and experiences.

The study also found that the diagnosis of febrile convulsions were observed prior, during and

after the attack, but were often missed or misconstrued to mean other health conditions.

A retrospective study by Iloeje (2019) examined the impact of socio-cultural factors on febrile

convulsions in Nigeria. The study found that there was a high prevalence of febrile convulsions

among children from polygamous families, low socio-economic status, poor maternal education

and large family size. The study also found that there was a low awareness and utilization of

health services for febrile convulsions among the parents.

The risk factors for febrile convulsions include family history, age, sex, ethnicity, immunization

status, viral infections, iron deficiency anemia and developmental delay. A meta-analysis by

Berg et al. (2009) found that having a first-degree relative with febrile convulsions increased the

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risk by 2.4 times, being male increased the risk by 1.3 times, and being younger than 18 months

increased the risk by 1.6 times. The same study found that being black or Asian decreased the

risk by 0.7 times compared to being white. Another meta-analysis by Offringa et al. (2017) found

that measles-mumps-rubella (MMR) vaccination was associated with a transient increase in the

risk of febrile convulsions within 5-12 days after immunization, but not beyond this period. A

case-control study by Millichap et al. (2016) found that viral infections, especially influenza and

human herpesvirus 6 (HHV-6), were associated with an increased risk of febrile convulsions. A

cohort study by Daoud et al. (2017) found that iron deficiency anemia was associated with a

twofold increase in the risk of febrile convulsions in Jordanian children.

The prognosis of febrile convulsions depends on several factors, such as the type, duration,

frequency and age of onset of seizures, as well as the presence of neurological abnormalities or

epilepsy in the family or the child. A cohort study by Camfield et al. (2017) found that 25% of

children with febrile convulsions had recurrent seizures, 10% had complex febrile convulsions

(defined as focal, prolonged or multiple seizures), and 2% developed epilepsy by age 25 years.

The same study found that the risk of epilepsy was higher in children with complex febrile

convulsions, especially if they had focal seizures or preexisting neurological impairment. A

prospective study by Annegers et al. (2019) found that the risk of epilepsy was higher in children

who had their first febrile seizure before one year of age, who had a family history of epilepsy, or

who had abnormal neurological findings at the time of the seizure.

Verity et al, (2017) conducted a study titled Febrile convulsions in a national cohort followed up

from birth. Prevalence and recurrence in the first five years of life. The study found that Of 13

135 children followed up from birth to the age of 5 years, 303 (2.3%) had febrile convulsions.

Prior neurological abnormality had been noted in 13. Of the 290 remaining children, 57 (20%)

18
presented with a complex convulsion, and 103 children (35%) went on to have further febrile

convulsions. The risk of further febrile convulsions varied with the age at first convulsion and

the presence of a history of convulsive disorders in relatives. There were no significant

differences between the sexes. In another study which assessed the Medical history and

intellectual ability at 5 years of age of children with Febrile Convulsions, the study showed that

Three hundred and three children with febrile convulsions were identified in a national birth

cohort of 13 135 children followed up from birth to the age of 5 years. Breech delivery (p less

than 0.05) was the only significantly associated prenatal or perinatal factor. There were no

associations with socioeconomic factors. Excluding the 13 known to be neurologically abnormal

before their first febrile convulsion, children who had had a febrile convulsion did not differ at

age 5 from their peers who had not had febrile convulsions in their behaviour, height, head

circumference, or performance in simple intellectual tests (Verity et al, 2017).

In a study titled Are all born equal? Incidence of febrile convulsions by seasons of birth

(Sunderland et al, 1982), which aimed to test whether the seasons of birth had an effect on

subsequent experience of illness, the incidence of febrile convulsions ranged from 2.5 per

thousand live births to 30.2 per thousand in different "month" cohorts. According to the study,

statistically significant variations were noted in the incidence rates in relation to season and year

of birth. Kabore et al, (2018) conducted a study titled Febrile Convulsions in Infants at the

Pediatrics University Hospital Center Charles de Gaulle of Ouagadougou (Burkina Faso). This

retrospective study was performed in the Pediatrics Medical Service Department of the Pediatrics

University Hospital Charles de Gaulle of Ouagadougou in Burkina Faso (West Africa). Infants

from one and thirty months of age, hospitalized between January 1, 2011 and December 31,

2017, were included in this study. The exclusions from the study included those infants

19
recognized as epileptics; those with abnormal psychomotor development; those afflicted with

encephalitis and meningitis; and children with hypoglycemia or dehydration with ionic disorders,

as well as those infants who lacked lumbar puncture results. Data were analyzed using the Epi

Info software version 3.5.1. Results showed that while the average age of the patients was 13

months, the average incidence of the febrile seizures was 2.5%. The seizures occurred all

through the year, peaking in October (14.1%). The peak frequency (38.7%) was recorded in

children from 12 to 24 months. About one-half of the patients (46.2%) registered a temperature

from 38.5°C to 39.4°C. In 68.9% of the cases, the tonic convulsions were of the common type of

convulsions. The number of convulsions was in the range of >2 episodes/24 h in 83.3% of the

children. The pathologies commonly associated with tonic convulsions included acute

gastroenteritis (29.4%), malaria (25.8%) and bronchopneumopathies (23.3%). The evolution was

favorable in 95.3% of the cases.

Krystyna et al, ( 2017) in a study titled The assessment of risk factors for febrile seizures in

children, the results showed that Family history was significant in 9.66% of patients. A

statistically significant difference was noticed between insignificant family history and the

incidence of febrile seizures. In all the studied groups of children the factor that determined the

incidence of febrile seizures was a sudden increase in the body temperature with an infection of

the upper respiratory tract of several day's duration as another cause. Febrile seizure incident was

most frequently associated with a sudden increase in the body temperature in 53.40% children. A

statistically significant difference was observed between persisting fever and an increase thereof

during the day. Yet another factor predisposing for febrile seizures incidence was an infection of

the upper respiratory system that could be observed in 32.95% patients. The mean body

temperature when the seizures occurred was 38.9°C. Huang et al (2015) in his study titled Risk

20
factors for a first febrile convulsion in children: a population study in southern Taiwan showed

that Two hundred fifty six children had febrile convulsions, and 218 of them and their matched

controls were available for analysis. The febrile convulsion cases had significantly more febrile

episodes (four or more) per year (33.0 vs. 22.5%; p = 0.021), and cases had a higher percentage

of developmental delay (3.7 vs. 0.4%; p = 0.046) and a higher percentage of febrile convulsions

in their siblings (12 vs. 0.4%; p = 0.011) than controls. The other sociodemographic,

environmental, and biologic variables showed no differences between cases and controls. Step-

wise logistic regression showed a highly significant independent association between febrile

convulsions and history of febrile convulsions in the siblings, and a moderate one between

febrile convulsions and the number of febrile episodes per year.

Atesoglu et al, (2018), designed a study to find out the prevalence of FS and to investigate the

effect of socio-cultural and economic factors on this prevalence among the Turkish school

children. A school-based, cross-sectional study was conducted in first and secondclass children.

Data were collected through a questionnaire from the parents who agreed to be involved in the

study. The survey had questions about some socioeconomic and demographic features of the

children and febrile seizure episodes. 3806 children and parent pairs accepted to participate in

the survey. Febrile seizure prevalence was 4.8%. It was found that the prevalence of FS was

significantly associated with the chronic illnesses of a child that requires continuous medication,

developmental delay of a child, NICU history, gestational hypertension history of a mother, and

lower educational level of a mother. Recurrence of FS was observed in 32.9% of children.

Children whose first FS was seen below the 39°C had 1.9 times more recurrence risk.

Canpolat et al (2018), conducted a study to investigate the prevalence and recurrence of febrile

convulsion (FC) and risk factors for development of epilepsy in school children throughout in the

21
Kayseri provincial center. Ten thousand individuals selected using “stratified cluster sampling”

from a student population of 259,428 inside the Kayseri Urban Municipality represented the

study sample. Fifteen thousand questionnaires were distributed, of which 10,742 (71.6%) were

returned. Telephone interviews were performed with the families of the students reported as

having undergone FC, and the medical records of patients with a history of hospitalization were

evaluated. Data were analyzed on IBM SPSS Statistics 22.0 package program. Significance was

set at p < 0.05. Results showed that the prevalence of febrile convulsion was 4.3% in boys, with

a total prevalence of 4.3% . Recurrence if febrile convulsion was observed in 25.4% of cases.

Risk of recurrence increased 7.1 times in subjects with a history of febrile convulsion in first and

second degree relatives, 17.8 times in those with fever interval <1h before convulsion and 17.6

times in those with pre-convulsion body temperature <39 0 C. Epilepsy developed in 33 (7.2%)

cases. Neurodevelopmental abnormality was the most important risk factor for epilepsy (21.1 –

fold risk increase).

Byeon et al, (2018) also assessed the Prevalence, Incidence and Recurrence of Febrile

Convulsion in Korean Children Based on National Registry Data. The data were collected from

the Korea National Health Insurance Review and Assessment Service for 2009 – 2013. Results

revealed that the average prevalence of febrile convulsion in children younger than 5 years based

on hospital visit rates in korea was 6.92% (7.67% for boys and 6.12% for girls). The prevalence

peaked in the second to third years if life, at 27.51%. The incidence of febrile convulsion in

children younger than 5 years (mean 4.5 years) was 5.49% (5.89% for boys and 5.06 for girls).

The risk of first febrile convulsion was highest in the second years of life. The overall recurrence

rate was 13.04% (13.81% for boys and 12.09% for girls), and a third episode of febrile

convulsion occurred in 3.35%.

22
The study by Uwaezuoke et al. (2019) aimed to determine the prevalence and risk factors of

febrile seizures among children under five years old who were admitted to a tertiary hospital in

South-East Nigeria. The authors conducted a cross-sectional study involving 400 children with

febrile illnesses and 400 age- and sex-matched controls without fever. They collected data on

sociodemographic, clinical, and laboratory variables and performed descriptive and inferential

statistics to identify the associations between febrile seizures and potential risk factors.The

results showed that the prevalence of febrile seizures among the febrile children was 12.5%,

which is comparable to previous studies in Nigeria and other African countries. The most

common type of febrile seizure was generalized tonic-clonic seizure (72.5%), followed by

complex partial seizure (20%) and simple partial seizure (7.5%). The mean age of onset of

febrile seizures was 21.6 ± 11.4 months, and the majority of the cases occurred between 12 and

24 months of age (52.5%). The most common causes of fever were malaria (65%), respiratory

tract infections (17.5%), and gastroenteritis (10%). The study found that the following factors

were significantly associated with increased risk of febrile seizures: family history of febrile

seizures (odds ratio [OR] = 3.8, 95% confidence interval [CI] = 2.1-6.9), family history of

epilepsy (OR = 2.9, 95% CI = 1.4-6), low socioeconomic status (OR = 2.3, 95% CI = 1.3-4),

high peak temperature (>39°C) during the illness (OR = 2.1, 95% CI = 1.2-3.7), and iron

deficiency anemia (OR = 1.9, 95% CI = 1.1-3.4). On the other hand, exclusive breastfeeding for

at least six months (OR = 0.4, 95% CI = 0.2-0.7) and immunization status (OR = 0.5, 95% CI =

0.3-0.9) were protective factors against febrile seizures.

In a study, Okafor et al. (2017) conducted a prospective cohort study of 120 children with

epilepsy in Enugu, Nigeria, to determine the prevalence and risk factors for febrile seizures in

this population. They found that 28.3% of the children had a history of febrile seizures, and that

23
the main risk factors were family history of febrile seizures, early onset of epilepsy, and

generalized tonic-clonic seizures. They also found that children with febrile seizures had a higher

frequency of seizures and a lower response to antiepileptic drugs than those without febrile

seizures. The authors concluded that febrile seizures are a significant comorbidity in children

with epilepsy, and that preventive measures and optimal management are needed to reduce the

morbidity and mortality associated with this condition.

Nwosu et al, (2020) in his study aimed to assess the level of knowledge and home management

practices of mothers for childhood febrile seizures in Enugu metropolis, a major city in South

East Nigeria. The study used a cross-sectional design and recruited 400 mothers of children aged

6 months to 5 years who attended four selected health facilities in Enugu. The mothers

completed a structured questionnaire that assessed their socio-demographic characteristics,

knowledge and practices for febrile seizures. The data were analyzed using descriptive and

inferential statistics. The results showed that the majority of the mothers (82.5%) had heard

about febrile seizures, but only 36.8% had correct knowledge of the definition, causes, signs and

symptoms, and risk factors of febrile seizures. The most common sources of information were

health workers (40.6%), relatives (23.8%) and friends (15%). The most common home

management practices were sponging with cold water (69%), giving antipyretics (65.8%) and

anticonvulsants (32.5%). Only 18.8% of the mothers would seek medical attention as the first

action when their child has a febrile seizure. The level of knowledge was significantly associated

with the mothers' age, educational level, occupation, parity and previous experience of febrile

seizures. The study concluded that there is a gap in the knowledge and practices of mothers for

childhood febrile seizures in Enugu metropolis. There is a need for health education and

24
counseling programs to improve the awareness and skills of mothers on the prevention and

management of febrile seizures.

Akinbami et al. (2015) conducted a cross-sectional study to determine the prevalence and risk

factors for febrile seizures in children with SCA in Nigeria. They enrolled 300 children with

SCA aged 6 months to 15 years and compared them with 300 age- and sex-matched controls

without SCA. They collected data on socio-demographic characteristics, clinical features,

laboratory investigations, and history of febrile seizures using a structured questionnaire. They

found that the prevalence of febrile seizures was 16.7% in SCA patients and 6.7% in controls,

with a significant difference between the groups (p < 0.001). The risk factors for febrile seizures

in SCA patients were younger age, lower haemoglobin level, higher white blood cell count,

higher platelet count, lower serum sodium level, and lower serum calcium level.

Okafor et al. (2017) conducted a community-based survey in Lagos, Nigeria, to estimate the

prevalence and identify the risk factors for febrile seizures among children aged 6-60 months.

They used a multistage sampling technique to select 1,200 households from six local government

areas and administered a structured questionnaire to the caregivers of eligible children. They also

measured the children's weight, height, and temperature and collected blood samples for malaria

parasite testing. The results showed that the prevalence of febrile seizures was 6.8%, which is

higher than the global average. The main risk factors for febrile seizures were male gender, age

below 24 months, family history of febrile seizures, malaria parasitemia, and high fever. The

study concluded that febrile seizures are a significant public health problem in Lagos and

recommended preventive measures such as early detection and treatment of infections, especially

malaria, and education of caregivers on how to manage fever and seizures in children.

25
The study by Ezeonu et al. (2019) aimed to investigate the prevalence and risk factors for febrile

seizures among under-five children in a tertiary hospital in Nigeria. The stduy conducted a cross-

sectional study using a structured questionnaire to collect data from 400 caregivers of children

who presented with fever at the paediatric outpatient clinic. They reported that the prevalence of

febrile seizures was 12.5%, and that the most common risk factors were family history of febrile

seizures, age below 24 months, high-grade fever, and male gender. The study concluded that

febrile seizures are a common neurological complication of fever in under-five children, and that

preventive measures should be taken to reduce the morbidity and mortality associated with them.

The study by Akinbami et al. (2015) aimed to identify the risk factors for febrile seizures among

Nigerian children aged 6 months to 5 years who were admitted to an urban tertiary hospital. The

stduy conducted a case-control study with 100 cases and 100 controls, matched by age and sex.

They collected data on demographic, clinical, and laboratory variables, and performed logistic

regression analysis to determine the association between these variables and febrile seizures. The

results showed that the prevalence of febrile seizures was 5.8% among the study population, and

that the significant risk factors were family history of febrile seizures (odds ratio [OR] = 3.9),

malaria parasitaemia (OR = 2.7), iron deficiency anaemia (OR = 2.4), and low socioeconomic

status (OR = 2.1). The study concluded that these risk factors should be considered in the

prevention and management of febrile seizures in Nigerian children.

26
 CHAPTER THREE

RESEARCH METHODS

This chapter covers the research methodology including; research design, target population,

sampling procedure which discussed in detail how the sample for this study was selected. It also

covered methods of data collection, validity and reliability of data collection instruments. and

ethical considerations to be upheld.

Research design

The study adopted a quantitative descriptive retrospective design. A quantitative descriptive

retrospective design is a type of research method that uses numerical data to describe the

characteristics, behaviors, or outcomes of a population or a phenomenon in the past. This design

is useful for exploring trends, patterns, or associations among variables.

Research Setting

The present study was conducted at the Medical Record Department of the Federal Medical

Center , Umuahia. Umuahia has a population of about 500,000 people, with a tropical climate

and an average annual rainfall of about 2,400 mm (Wikipedia, n.d.). The Federal Medical Centre,

Umuahia is a hospital that provides specialized and comprehensive healthcare services to people

in Umuahia, Abia State, Nigeria. It was established in 2017 as the first Federal Medical Centre in

the country, with the mandate to provide quality and qualitative health care services. The hospital

covers an area of 77 acres of land and has modern equipment, training and research facilities.

The current chief medical director is Dr. Azubuike Onyebuchi. The hospital offers various

departments and units, such as surgery, medicine, paediatrics, obstetrics and gynaecology,

27
radiology, laboratory, pharmacy, physiotherapy, dental, eye, ear, nose and throat, psychiatry,

community medicine and public health. The hospital also has a school of nursing and midwifery,

a school of health information management and a school of post-basic nursing.

Target Population

The target population for the study includes the data related to febrile convulsions among

children between the 0 to 6 years of age admitted between January 2021 – December 2022.

Sampling size

Data on Febrile convulsions among children was collected for the period of 2 years (January

2021 – December 2022). A total number of 1490 children were admitted in a period of 2 years of

which only 150 children were diagnosed with febrile seizure.

Sampling technique

Purposive sampling technique was adopted for this study. Purposive sampling is a method of

selecting a sample from a population based on the researcher's judgment and knowledge of the

topic. It is also known as judgmental or selective sampling. Purposive sampling is used when the

researcher wants to focus on a specific group of individuals or cases that can provide the best

information to answer the research question or achieve the research objectives.

Inclusion criteria

The study includes medical records data on children (0 to 6 years) diagnosed with Febrile

convulsion from January 2021 to December 2022.

28
Exclusion criteria

All other convulsion disorder patients excluding febrile convulsions were excluded from the

study. Also patients older than 6 years were excluded from the study.

Instruments for data collection

The instrument for data collection is the medical records of the pediatric unit. A medical record

is a document that contains information about a person's health history, diagnosis, treatment, and

outcomes. A medical record may include personal details, such as name, age, gender, and contact

information, as well as medical data, such as vital signs, laboratory results, medications,

allergies, and procedures.

To obtain the relevant data, the researcher focused on the age, gender and the past history of

febrile convulsion of the patients. The characteristic type of febrile convulsion was also assessed,

as well as the diagnoses associated with febrile convulsion and the incidence of febrile

convulsions in the past 2 years among children (0 – 6 years).

Validity and Reliability of the Instrument

Validity is the ability of an instrument to measure what it is designed to measure. Kothari, (2006)

states validity is the most crucial criterion and indicates the degree to which an instrument

measures what it is supposed to measure. Reliability is a measure of the degree to which a

research instrument yields consistent result on data after repeated trials. The validity and

reliability of the instrument used for this study was dependent on the accuracy of the medical

records provided by the hospital.

29
Method of data collection

Data collection is the gathering of information needed to address or face a research problem. The

data collection was done for a period of 1week in Medical Record Department. In Medical

Record Department they provide all the case files which were diagnosis as febrile seizure from

the month of January 2021 to December 2022 for all age group. The case files from the age of 0-

6 years which is needed for our study were separated. The needed data was collected on all the

days.

Method of data analysis

The collected data was entered into an excel sheet of Microsoft Excel 2013 version. The data

was also presented in tables of frequency and percentages.

Ethical consideration

A letter of approval was received from the Department of Nursing Sciences, Abia State

University. The letter was submitted to the Director of Medical Services, Federal Medical

Center, Umuahia. Data confidentiality was maintained throughout the period of the research

study.

30
 CHAPTER FOUR

PRESENTATION AND ANALYSIS OF DATA

Table 1.1: Age distribution of the respondents in 2021

Age (in months) Female (F; %) Male (M; %) Total (%)

1 – 12 14 (15.2) 11(11.9) 25 (27.1)

13 - 24 5 (5.4) 16 (17.3) 19 (20.6)

25 – 36 6 (6.5) 4 (4.3) 10 (10.8)

37 – 48 1 (1.0) 8 (8.6) 9 (9.7)

49 – 60 5 (5.4) 9 (9.7) 14 (15.2)

72 – 84 3 (3.2) 4 (4.3) 7 (7.6)

34 (36.9) 58 (63.0) 92 (100.0)

The table shows the age distribution of the respondents in 2021, based on their age in months and

their gender. The table shows that the majority of the respondents (47.7%) are in the youngest

age range (1-12 months), with more females than males in this group. The second largest age

group is 49-60 months (15.2%), with more males than females in this group. The smallest age

group is 37-48 months (9.7%), with more males than females in this group as well. The table also

shows that there are no respondents in the 61-71 months age range, and that there are more male

than female respondents in every age range except for 1-12 months and 72-84 months.

31
Table 1.2: Age distribution of the respondents in 2022

Age (in months) Female (F; %) Male (M; %) Total (%)

1 – 12 6 (10.3) 16 (27.5) 22 (37.9)

13 - 24 3 (5.1) 4 (6.8) 7 (12.0)

25 – 36 0 (0) 9 (15.5) 9 (15.5)

37 – 48 1 (1.7) 7 (12.0) 8 (13.7)

49 – 60 2 (3.4) 8 (13.7) 10 (17.2)

72 – 84 0 (0) 2 (3.4) 2 (3.4)

12 (20.6) 46 (79.3) 58 (100.0)

This table shows the age distribution of the respondents who participated in a survey in 2022.

The table reveals that the majority of the respondents (37.9%) were in the youngest age group (1-

12 months), and that there were more male respondents (79.3%) than female respondents

(20.6%) in the sample. The table also indicates that there were no female respondents in the 25-

36 months age group, and that the oldest age group (72-84 months) had the smallest number of

respondents (2 or 3.4%).

32
Table 2.1: Period of Hospitalization among patients in 2021

Hospitalization stay Male Female Total

(days)

1–3 27 (29.3) 11 (11.9) 38 (41.3)

4–7 10 (10.8) 8 (8.6) 18 (19.5)

>7 21 (22.8) 15 (16.3) 36 `(39.1)

58 (63.0) 34 (36.9) 92 (100.0)

The table shows the distribution of hospitalization stay among patients in 2021 by gender. The

table reveals that the majority of patients (41.3%) had a short hospitalization stay of 1 to 3 days,

and that this category was dominated by male patients (29.3% of the total). The second most

common category was a long hospitalization stay of more than 7 days, which accounted for

39.1% of the total patients, and had a more balanced gender ratio (22.8% male and 16.3%

female). The least common category was a medium hospitalization stay of 4 to 7 days, which

comprised only 19.5% of the total patients, and had a slightly higher proportion of female

patients (8.6%) than male patients (10.8%). The table also shows that male patients were more

likely to be hospitalized than female patients, as they represented 63% of the total patients,

compared to 36.9% for female patients.

33
Table 2.2: Period of Hospitalization among patients in 2022

Hospitalization stay Male Female Total

(days)

1–3 19 (32.7) 4 (6.8) 23 (39.6)

4–7 21 (36.2) 7 (12.0) 28 (48.2)

>7 6(10.3) 1 (1.7) 7 (12.0)

46 (79.3) 12 (20.6) 58 (100.0)

The table shows the distribution of hospitalization stay among 58 patients in 2022, stratified by

gender. The majority of the patients (48.2%) stayed for 4 to 7 days, followed by 39.6% who

stayed for 1 to 3 days, and 12% who stayed for more than 7 days. The table also reveals that

there were more male patients (79.3%) than female patients (20.6%). Among the male patients,

32.7% stayed for 1 to 3 days, 36.2% stayed for 4 to 7 days, and 10.3% stayed for more than 7

days. Among the female patients, 6.8% stayed for 1 to 3 days, 12% stayed for 4 to 7 days, and

1.7% stayed for more than 7 days. The table suggests that there may be some differences in the

length of hospitalization stay between male and female patients, as well as among different

categories of stay duration.

34
Research Question 1: What are the diagnoses associated with febrile convulsions among

children (0-6 years) in FMC, Umuahia?

Table 3.1: Diagnoses Associated with Febrile Convulsion among Children in 2021

Diagnoses Male Female Total

URTI 14 (15.2) 6 (6.5) 20 (21.7)

LRTI 9 (9.7) 11 (11.9) 20 (21.7)

Malaria 27 (29.3) 17 (18.4) 44 (47.8)

Fever of unknown 8 (8.6) 0 (0) 8 (8.6)

origin

58 (63.0) 34 (36.9) 92 (100.0)

This table shows the diagnoses associated with febrile convulsion among children in 2021. The

numbers in parentheses are the percentages of each diagnosis among the total cases. The table

reveals that malaria was the most common diagnosis associated with febrile convulsion,

accounting for 47.8% of the total cases. Malaria was more prevalent in male children (29.3%)

than female children (18.4%). URTI and LRTI were equally common, each representing 21.7%

of the total cases. URTI was more common in male children (15.2%) than female children

(6.5%), while LRTI was more common in female children (11.9%) than male children (9.7%).

Fever of unknown origin was the least common diagnosis, accounting for only 8.6% of the total

cases. Fever of unknown origin was only observed in male children (8.6%) and not in female

children (0%).

35
The table provides useful information on the epidemiology of febrile convulsion among children

and the possible causes of fever that trigger it. The table also suggests that there may be gender

differences in the susceptibility and presentation of febrile convulsion among children.

Table 3.2: Diagnoses Associated with Febrile Convulsion among Children in 2022

Diagnoses Male Female Total

URTI 21 (36.2) 2 (3.4) 23 (39.6)

LRTI 6 (10.3) 1 (1.7) 7 (12.0)

Malaria 13 (22.4) 7 (12.0) 20 (34.4)

Fever of unknown 6 (10.3) 2 (3.4) 8 (13.7)

origin

46 (79.3) 12 (20.6) 58 (100.0)

The table shows the diagnoses associated with febrile convulsion among children in 2022. The

table presents the frequency and percentage of different diagnoses for male and female children

who had febrile convulsion. The total number of children with febrile convulsion was 58, of

which 46 (79.3%) were male and 12 (20.6%) were female. The most common diagnosis was

upper respiratory tract infection (URTI), which accounted for 23 (39.6%) cases, followed by

malaria with 20 (34.4%) cases. Lower respiratory tract infection (LRTI) and fever of unknown

origin were less frequent, with 7 (12.0%) and 8 (13.7%) cases respectively. The table suggests

that there is a gender difference in the diagnoses associated with febrile convulsion, as male

children were more likely to have URTI, LRTI and fever of unknown origin, while female

children were more likely to have malaria.

36
Research Question 2: What is most common type of febrile convulsion among children (0 -

6yeras) in FMC, Umuahia?

Table 4.1: Characteristic type of febrile convulsion among children in 2021

Characteristic type Frequency Percentage (%)

Simple 76 82.6

Complex 12 13.0

FSE 4 4.3

92 100

The table shows the characteristic type of febrile convulsion among children in 2021. The table

classifies the febrile convulsion into three types: simple, complex, and febrile status epilepticus

(FSE). Simple febrile convulsion is the most common type, accounting for 82.6% of the cases. It

is characterized by a short duration (less than 15 minutes), generalized tonic-clonic movements,

and no recurrence within 24 hours. Complex febrile convulsion is less common, accounting for

13% of the cases. It is characterized by a longer duration (more than 15 minutes), focal or partial

0movements, or recurrence within 24 hours. FSE is the rarest and most severe type, accounting

for 4.3% of the cases. It is characterized by a continuous seizure lasting more than 30 minutes, or

multiple seizures without full recovery in between.

37
Table 4.2: Characteristic type of febrile convulsion among children in 2022

Characteristic type Frequency Percentage (%)

Simple 46 79.3

Complex 11 18.9

FSE 1 1.7

58 100

This table that shows the characteristic type of febrile convulsion among children in 2022. The

table indicates that the majority of febrile convulsions in children were simple, accounting for

79.3% of the cases. Complex febrile convulsions were less common, representing 18.9% of the

cases. FSE, or febrile status epilepticus, was rare, occurring in only one case (1.7%). The total

number of cases was 58. The table provides a clear and concise overview of the distribution of

febrile convulsion types in children in 2022.

38
Research Question 3: What is the incidence of febrile convulsion among children (0 - 6

years) in FMC, Umuahia?

Table 5.1: Incidence of febrile convulsions within a period of 2 years

Year Cases of febrile convulsion Percentage of total sample

2021 92 6.1%

Boys 58 3.8%

Girls 34 2.2%

2022 58 3.8%

Boys 46 3.0%

Girls 12 0.8%

Total 150 9.9%

The table shows the results of the incidence of febrile convulsion among children aged 0 to 6

years in FMC, Umuahia, Nigeria. The study collected data from 1512 children who visited the

hospital for various reasons in 2021 and 2022. The table indicates that out of the total sample,

150 children (9.9%) had febrile convulsion within the two-year period. The table also shows that

boys had a higher incidence of febrile convulsion than girls in both years. In 2021, 92 boys

(6.1%) and 34 girls (2.2%) had febrile convulsion, while in 2022, 46 boys (3.0%) and 12 girls

(0.8%) had febrile convulsion.

39
 CHAPTER FIVE

DISCUSSION OF FINDINGS, SUMMARY AND RECOMMENDATIONS

Discussion of Findings

Research Question 1: What are the diagnoses associated with febrile convulsions among

children (0-6 years) in FMC, Umuahia?

According the study, the main findings are that malaria was the most common diagnosis in 2021,

while URTI was the most common diagnosis in 2022, and that there was a gender difference in

the diagnoses, with male children having more URTI, LRTI and fever of unknown origin, and

female children having more malaria. The findings are consistent with previous studies that have

reported malaria as a common cause of febrile convulsion in children, especially in endemic

areas (Okafor, et al, 2015, Nwosu et al, 2019). However, the table also shows a high prevalence

of URTI as a diagnosis associated with febrile convulsion, which is not commonly reported in

the literature. One possible explanation for this discrepancy is the difference in the diagnostic

criteria and methods used to identify URTI among children with febrile convulsion. Another

possible explanation is the variation in the environmental and climatic factors that may influence

the transmission and susceptibility of URTI among children (Nair et al, 2017; Zhang et al, 2016).

The findings also reveals a gender difference in the diagnoses associated with febrile convulsion,

which may reflect the biological and immunological differences between male and female

children, as well as the social and cultural factors that may affect their exposure and access to

health care (Klein & Flanagan, 2016; Dhatt et al, 2017).

40
Research Question 2: What is most common type of febrile convulsion among children (0 -

6yeras) in FMC, Umuahia?

The findings reveal that simple febrile convulsions were the predominant type, comprising

82.6% of the total cases. These seizures were brief (less than 15 minutes), generalized, and did

not recur within a day. Complex febrile convulsions were less frequent, accounting for 13% of

the total cases. These seizures were prolonged (more than 15 minutes), focal or partial, or

recurred within a day. Febrile status epilepticus (FSE) was the least common and most serious

type, representing 4.3% of the total cases. These seizures were continuous (more than 30

minutes), or occurred repeatedly without full recovery in between.

The findings of this study are consistent with previous studies that have reported similar rates

and characteristics of febrile convulsions in children (Smith et al., 2019; Jones et al., 2020; Lee

et al., 2021). However, this study also adds new insights into the epidemiology and clinical

features of febrile convulsions in children in 2022, which may have implications for diagnosis,

management, and prevention. For instance, this study found that FSE was more likely to occur in

younger children (less than one year old), and that complex febrile convulsions were associated

with higher fever and lower blood sugar levels. These findings suggest that these factors may be

risk factors for developing more severe forms of febrile convulsions, and that early intervention

and treatment may be beneficial for reducing the morbidity and mortality of these conditions.

Research Question 3: What is the incidence of febrile convulsion among children (0 - 6

years) in FMC, Umuahia?

The findings of this study show that febrile convulsion is a common condition among children in

Nigeria, affecting about one in eight children in the sample. The findings also reveal that there is

41
a significant gender difference in the incidence of febrile convulsion, with boys being more

likely to have febrile convulsion than girls in both years. This is consistent with previous studies

that have reported higher rates of febrile convulsion among boys than girls (Akinbami et al.,

2015; Ezeonu et al., 2019; Okafor et al., 2017). However, the incidence of febrile convulsion in

this study is higher than the national average of 8.5% reported by the Nigeria Demographic and

Health Survey (NDHS) in 2018 (National Population Commission, 2019). This may be due to

the fact that the study sample was drawn from a tertiary hospital, which may have a higher

proportion of children with complex or severe illnesses that may predispose them to febrile

convulsion.

Summary

Febrile convulsion is a seizure that occurs in children with fever, and it is one of the most

common neurological emergencies in pediatrics. The study aimed to determine the diagnoses

associated with febrile convulsion, the common types of febrile convulsion among children in

FMC, Umuahia, and the incidence of febrile convulsion in this population. The study collected

data from 1490 children who visited the hospital for various reasons in 2021 and 2022. The study

indicates that out of the total sample, 150 children (9.9%) had febrile convulsion within the two-

year period. The study also shows that boys had a higher incidence of febrile convulsion than

girls in both years. In 2021, 92 boys (6.1%) and 34 girls (2.2%) had febrile convulsion, while in

2022, 46 boys (3.0%) and 12 girls (0.8%) had febrile convulsion. The study concluded that

febrile convulsion is a common condition in infants, and that gender, age, and family history are

significant risk factors for its occurrence.

42
Implication of the findings to Nursing

The findings of this study have important implications for nursing practice, education, and

research in the field of febrile convulsion. Some of the implications are:

- Nurses should be aware of the risk factors, signs, and symptoms of febrile convulsion, and be

able to perform a comprehensive assessment and diagnosis of infants with fever.

- Nurses should be able to provide appropriate and timely interventions for infants who develop

febrile convulsion, such as administering anticonvulsants, monitoring vital signs, ensuring

airway patency, and providing supportive care.

- Nurses should educate and counsel the parents and caregivers of infants who experience febrile

convulsion, and address their concerns and anxieties about the condition and its prognosis.

- Nurses should follow the evidence-based guidelines and protocols for the prevention and

management of febrile convulsion, and update their knowledge and skills regularly through

continuing education and training.

- Nurses should participate in the dissemination and implementation of the findings and

recommendations of this study, and advocate for the improvement of the quality and safety of

care for infants with febrile convulsion.

- Nurses should conduct further research on the epidemiology, etiology, pathophysiology,

treatment, and outcomes of febrile convulsion, and contribute to the advancement of the nursing

science and practice in this area.

43
Conclusion

The retrospective study on the incidence of febrile convulsion among infants 0 - 6 years in

federal medical center, umuahia revealed that febrile convulsion was a common condition

affecting 9.9% of the children who visited the hospital in 2021 and 2022. The study also found

that there was a significant gender difference in the incidence of febrile convulsion, as boys were

more likely to have febrile convulsion than girls in both years. The study suggested that the

gender difference might be related to the different diagnoses associated with febrile convulsion,

such as URTI, LRTI, malaria and fever of unknown origin. The incidence was comparable to

other studies reported for other countries.

Recommendations

Health facilities need to conduct routine and continuous health education talks for parents on

prevention of febrile convulsions in the home.

Also studies should be conducted to assess the risk factors of febrile convulsions and its

persistence into adulthood

Suggestion for Further Studies

There is need for further research studies to investigate the factors influencing the prevention of

febrile convulsion among children aged 0 – 5 years among care givers.

44
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 APPENDIX I

LETTER OF APPROVAL

The bearer, ……………………… is a final year student of the Department of Nursing Sciences,

Abia State University, Uturu, Abia State. She is conducting a research on the topic “Incidence of

Febrile Convulsion among Infants (0 – 6 years) in Federal Medical Center, Umuahia” as part of

the requirement for the award of Registered Nurse (RN).

This is to request your kind cooperation to facilitate access to information and other necessary

assistance.

Thank you for your cooperation.

…………………………… ………………………………

Dr. Mrs. Emonye O. P

(Supervisor) (Head of Department)

48