Knowledge, Attitudes, and Practices of Healthcare Workers Regarding the Management of Fever in Children

Background: Fever is among the most frequent presenting complaints in paediatric outpatient settings worldwide and across sub-Saharan Africa. Despite substantial evidence affirming the physiological role of fever in host defence, misconceptions about its management remain widespread among healthcare workers, contributing to irrational antipyretic use, fever phobia, and avoidable drug toxicity. In Zambia, no prior published study has assessed the knowledge, attitudes, and practices (KAP) of healthcare workers regarding paediatric fever management, representing a significant evidence gap with direct implications for national training policy and clinical guideline development. Objective: To assess the knowledge, attitudes, and practices of healthcare workers at University Teaching Hospital – Children's Hospital (UTH-CH), Lusaka, Zambia, regarding the management of fever in children, and to identify sociodemographic and professional factors independently associated with KAP outcomes. Methods: A quantitative, institutional-based cross-sectional study was conducted at UTH-CH over four consecutive weeks. A validated, structured, self-administered questionnaire adapted from Milani et al. (2022) was administered to 225 healthcare workers comprising nurses, medical doctors, pharmacists, and other clinical cadres (response rate: 90.0%). KAP scores were dichotomised as high (≥50% of maximum score) or low (<50%), and sub-domain scores for knowledge, attitudes, and practices were computed separately. Data were analysed using IBM SPSS Statistics (version and release number)., employing descriptive statistics, chi-square tests (with Fisher's exact test where indicated), and binary logistic regression. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Results: Of 225 participants, 78.7% (n = 177) demonstrated low overall KAP scores. Low scores were recorded across all cadres: nurses (78.1%), medical doctors (72.0%), and other health workers (94.1%). Among respondents, 74.2% acknowledged fever as a beneficial immune response, yet 91.1% endorsed immediate antipyretic administration for every febrile child; a paired analysis showed that X% of those who acknowledged fever's benefit still endorsed immediate antipyretics, indicating a knowledge–practice paradox. A total of 90.7% believed antipyretics prevent febrile convulsions, a belief unsupported by current evidence. Statistically significant predictors of higher KAP scores at bivariate level included older age (χ²(1) = 4.946, p = 0.026), greater clinical experience (χ²(2) = 11.116, p = 0.004), and receipt of formal fever management training (χ²(1) = 8.549, p = 0.003). Binary logistic regression identified clinical experience exceeding 10 years (OR = 4.252, 95% CI: 1.406–12.855, p = 0.010) and prior formal training (OR = 3.674, 95% CI: 1.760–7.668, p = 0.001) as the strongest independent predictors of higher KAP scores (model χ²(4) = 22.431, p < 0.001, Nagelkerke R² = 0.147). Conclusion: Significant and widespread KAP deficits regarding paediatric fever management exist among healthcare workers at UTH-CH across all professional cadres. A particularly concerning knowledge–practice paradox was identified, suggesting that knowledge alone is insufficient to change clinical behaviour. Receipt of formal training and accumulated clinical experience are independently modifiable predictors of higher KAP scores, identifying concrete entry points for evidence-based intervention. Urgent action is required at institutional and national policy levels to implement structured training programmes and develop context-specific clinical guidelines.