Prehospital Care of Children Presenting with Convulsions at a Tertiary Hospital in Port Harcourt, Nigeria: A Mixed Method Approach

Abstract

Introduction: Convulsions can be a sign of mild or severe illness. The causes are varied; it could be epilepsy, or from provoking causes including high fever, central nervous system (CNS) infections, metabolic disorders or use of illicit substances. This study is aimed at determining the prehospital care convulsing children receive and factors that influences it. Materials and Methods: This was a prospective observational study that utilized a mixed method approach conducted at the University of Port Harcourt Teaching Hospital (UPTH) from January 2024 to December 2025. Participants were 1255 parents/ caregivers of children who were admitted in the children emergency ward (CHEW) with a history of convulsion. Participants were consecutively recruited as they presented in the CHEW. A proforma was used to record the patients age and sex, the sociodemographic characteristics of parents/caregivers and the prehospital care given.  Quantitative data was analysed with SPSS version 26; descriptive and inferential analysis were carried out, the level of significance placed at 0.05. The key informant interview (KII) was transcribed verbatim using the content thematic approach, the qualitative data was triangulated with the findings obtained from the quantitative data. Results: One thousand two hundred and fifty-five parents/care givers of children that presented to the hospital with convulsion participated in the study. Majority, 1023(81.5%) were females, their ages ranged from18 years to 62 years with a mean age of 38.53 years ± 5.21 years. The parents were the major caregivers in 1131(90.1%) of cases and 902 (71.9%) of them practiced harmful prehospital care. The common prehospital care includes rushing the child to a chemist shop in 73.1%, application of crude oil/kernel oil on the skin in 64.7% and use of objects to gag the child’s mouth in 57.6%. Only 389 (31%) presented to the hospital without receiving any prehospital care. Predictors of use of harmful practices includes lower level of education (p; < 0.001, OR 0.48, CI 0.35-0.66), lower income (p 0.001, OR 10, CI 7.39-13.5) and residing in rural area (p 0.001; OR 1.85, CI 1.42 -2.41) Conclusion: Convulsions is a common symptom among children; the common prehospital care practices are harmful and associated with complications. The use of crude oil, kernel oil and gagging a convulsing child is still very common. Socioeconomic factors are predictors of harmful prehospital care. There is need for a swift community based educational intervention that can enhance the knowledge of seizure first aid in order to reduce the morbidity associated with harmful prehospital care.