Fever phobias, perception among caregivers across Nigerian states: A systematic review and meta-analysis

There is a need to synthesize the different patterns of fever treatment and phobias in Nigeria and to document these behavioral issues among caregivers. Although, fever is commonly seen in children and this make the mothers to seek medical care when all effort of theirs have failed. Yet, this behavioral and anxiety disorders among mothers still persists several years after the word "Fever phobia" was coined.

To document the knowledge of fever among Nigerian mothers and to determine heterogeneity in these practices across the nation.

A search of articles on fever phobias among mothers or caregivers in Nigeria was performed via the Cochrane Database of Systematic Reviews, PubMed, Google Scholar, and MEDLINE. Articles published between 2008, and 2023 were included in the study. The keywords used in the literature search included fever, phobias, perceptions, mothers, caregivers, perceptions, drugs, knowledge, and practices. Boolean operators were also used in the search for items, such as "fever AND phobia", "fever AND perception", "fever AND mothers", "fevers AND/OR phobia", "AND OR mothers/caregivers", to help narrow parameters in the search engine and enhance reproducibility. Studies that fulfilled the inclusion criteria were presented via the PRISMA model. I² statistics were used to assess heterogeneity.

The studies show wide variation in the reported levels of knowledge about fever, with proportions ranging from as low as 35% to as high as 94%. The pooled proportion estimate using the common effect model is 65% (95%CI: 64%-67%), assuming that all studies reflect a single underlying value. However, the random effects model, which accounts for differences among studies, yields a higher estimate of 70% (95%CI: 56%-82%). This divergence reflects significant heterogeneity in the data, with a Tau² of 0.7007, I² of 95.7%, and, an H statistic of 4.80, all indicating that most of the variability is due to actual differences among studies rather than random chance. The Q test further confirms this, with a P value less than 0.0001, reinforcing that the variability across studies is statistically significant. The subgroup analysis revealed that studies in Group A (six studies) reported a pooled knowledge proportion of 75%, with a confidence interval ranging from 56% to 88%, and relatively lower heterogeneity (Tau² = 0.5709, Tau = 0.7556), indicating greater consistency in their findings. In contrast, Group B (four studies) had a lower pooled estimate of 62%, but with a much wider confidence interval (27% to 88%) and greater heterogeneity (Tau² = 0.8380, Tau = 0.9154), suggesting greater variation across studies in that group. Fear of brain damage, convulsions, witches/wizards, and death was high in many of the studies. Herbal concoctions, and prayers were the mostly used measures to cure fever by mothers.

Mothers' knowledge of fever detection in children is low. There was heterogeneity in the sample size of the studies, which may have affected the knowledge of fever.