Fever phobia: The impact of time and mortality--a systematic review and meta-analysis.

BACKGROUND: Fever phobia is a term that has been used to describe the exaggerated and unrealistic fear of fever expressed by parents and carers. Since the term was first used in the early 1980s, there have been numerous publications and guidelines stating that fever is not, in itself dangerous, however these fears persist.

OBJECTIVES: Investigate the extent of fever phobia and to explore potential associations with time, under-5 mortality rate and geography.

DATA SOURCES: Embase (1980 to week 1 2015) and Medline (1946 to week 1 2015) were searched using the terms 'fever' and 'phobia'; and 'fever phobia' as a free text term. One additional paper was published during the review period.

STUDY ELIGIBILITY CRITERIA: Studies giving proportion of parents, carers or professionals expressing fear of fever.

STUDY APPRAISAL AND SYNTHESIS METHODS: Meta-analysis and cluster analysis using metafor, meta and Cluster in R.

RESULTS: Fear of brain damage, coma, convulsions, death and dehydration was high across many of the studies; however there was significant variation as shown by the high I(2) scores which exceeded 95%. This was not explained by the two predictive variables of year of publication, or background mortality apart from a reduction in the fear of brain damage (-0.0185, CI -0.0313 to -0.0057, p=0.0046) and dehydration (-0.0831, -0.1477 to -0.0184, p=0.0118) associated with increased child mortality.

LIMITATIONS: Studies were all cross-sectional surveys with a high risk of bias. The pooled estimate, although statistically significant is not the outcome of interest and so should be interpreted with caution.

CONCLUSIONS AND IMPLICATIONS: Fever phobia is common and has not significantly declined over time. This may suggest that it is a cultural, rather than individually learned trait and that individual educational programmes are unlikely to be successful in the face of widespread cultural transmission.