Parental knowledge, attitudes, and practices towards childhood fever among South-East and East Asian parents: A literature review

Aim The aim of this literature review was to identify, summarize, and critically appraise available empirical articles on the knowledge, attitudes, and practices towards childhood fever management among South-East and East Asian parents. Design A literature review following PRISMA. Methods Articles were limited to those available in the English language. Articles had to be empirical studies that used a qualitative or quantitative research design with full-text available; focus on parental knowledge, attitudes, and practices towards fever; and be published in South-East and East Asia. Searches were conducted with CINAHL, PubMed and Scopus from inception to June 2022, and eleven articles were included after removing duplicates and excluding irrelevant articles. Results Narrative synthesis was conducted according to four themes: source of fever information, knowledge level, attitudes, and practices towards childhood fever. Parents showed different fever knowledge needs and various information-seeking behaviors. A low level of fever knowledge was revealed in terms of temperature, fever causes, potential harms and influencing factors. South-East and East Asian parents mainly reported anxiety, concerns and fever phobia. Fever assessment methods and fever management strategies varied based on parents’ cultural background and beliefs. Conclusions The findings of this review highlight that inadequacy of fever knowledge and negative attitudes towards childhood fever exist in South-East and East Asian parents. Parents have diverse cultural practices during their children’s febrile episodes. However, some of them conflict with current medical guidelines, as they prioritize fever and body temperature reduction. This raises questions about their effectiveness and safety. Although some of them are medically discouraged, there are others that have been proven beneficial for the symptomatic relief of childhood fever. The results indicate an urgent need to develop a cultural-sensitive educational intervention for childhood fever management among South-East and East Asian parents. Unified educational interventions are needed to address parental concerns and fever-related knowledge needs.

diverse cultural practices during their children's febrile episodes.However, some of them conflict with current medical guidelines, as they prioritize fever and body temperature reduction.This raises questions about their effectiveness and safety.Although some of them are medically discouraged, there are others that have been proven beneficial for the symptomatic relief of childhood fever.The results indicate an urgent need to develop a cultural-sensitive educational intervention for childhood fever management among South-East and East Asian parents.Unified educational interventions are needed to address parental concerns and fever-related knowledge needs.

Background
Fever is a temporary elevation of body temperature above the average daily range of 36.6˚C-38˚C, as measured by a rectal thermometer [1,2].It is a common symptom experienced by almost every child at some point.Fever can be an indicator of benign (e.g., the common cold) or severe conditions (e.g., lethal diseases and meningitis) and is usually self-limiting in children [2].However, even in mild cases, most parents seek information about fever management and worry about the potentially severe consequences of fever, such as seizures, brain damage, and even death, although these outcomes are rare [2], leading to heightened anxiety.
Despite being common, a recent systematic review of 36 studies on information needs related to childhood fever found that parents have a low level of knowledge about fever [3].Furthermore, a review of scientific literature indicated that parental knowledge regarding the definition and management of fever is deficient [4].Parents rarely define fever correctly and tend to have misconceptions regarding fever and engage in practices which differ from recommendations [5][6][7].
Parental knowledge greatly influences attitudes and fever management in their children [8].A lack of knowledge regarding the pathophysiology and management of fever is an essential driver of fever phobia among parents; this can cause parents to become overly concerned about the height of the fever, how quickly the fever rises, the appearance and behavior of their child, and the underlying cause of the fever [9].Parents' inadequate knowledge about fever may also lead to unnecessary and inappropriate treatments, such as being unaware of the correct frequency of administering antipyretics at incorrect doses or intervals, which can increase healthcare-seeking behavior [10,11].These practices can negatively affect children's health, such as toxicity from supratherapeutic doses [12].
Parents' unscientific and irrational attitudes towards fever can significantly impact the management of childhood fever [13,14].Although appropriate levels of anxiety in parents are paramount to promoting health-protective behaviors in febrile children, which include close monitoring of symptoms and increasing fluid intake, studies have found that many parents (57%-68%) exhibit moderate to high anxiety levels during their children's febrile episodes [15][16][17][18].These findings align with the long-lasting phenomenon of fever phobia, which refers to an "unrealistic fear of fever expressed by parents" [19].Parents' fever-related anxiety and concern often lead them to practice non-evidence-based strategies to reduce temperature, which can cause further stress for children and parents [14] and increase emergency room visits [20].A study in Hong Kong showed that caregivers of paediatric patients with fever symptoms were more than twice as likely to consult more than one doctor during an illness episode without a referral [21].These actions inflict adverse psychological and financial consequences for families and burden the healthcare system unnecessarily [21].
Strategies for childhood fever management can vary in different countries.Thompson et al. conducted a first systematic review on childhood fever, and the results showed that treatments ranged from supportive care at home to seeking assessment in the emergency department [3].Using antipyretic medications, including acetaminophen and ibuprofen alone, in combination or alternating, was the most common response to a febrile episode, with adjunct fever management practices, such as light clothing and sponge baths, also being adopted.Other literature views indicated that parents' conceptualizations of fever in children and information-seeking behaviors in fever management differ according to country of origin [8,22].However, most studies and reviews have focused on Western or global populations [3,8,22], ignoring the impacts of cultural factors on parents' management of fever in different countries, especially cultural beliefs in South-East and East Asian countries.Growing evidence suggests that racial differences and cultural beliefs can influence parents' attitudes and management approaches to fever in children [3,18,23].One of the examples is alternative medicine, which is greatly influenced by traditional values.It has a different perspective on the pathophysiology and treatments of febrile diseases compared to modern Western medicine.For instance, in Traditional Chinese Medicine, fever is associated with warm-pathogen diseases involving the Taiyin meridian, and consuming Chinese herbal medication and a light diet are recommended to restore body equilibrium [24].On the contrary, conventional medicine focuses on managing the accompanying symptoms rather than targeting the fever itself and temperature reduction [10].
Unfortunately, the use of alternative medicine for fever management remains understudied.In a systematic review of 74 national and international guidelines regarding childhood fever management, only five studies investigated the use of alternative medicine, while most focused on conventional treatments such as antipyretic drugs and water baths [10].However, some traditional practices based on cultural beliefs (i.e., South-East and East Asia) may contradict the principle of modern Western medicine and harm children.For instance, some parents in Singapore give spirit water to their febrile children, but the effect is unknown [15].This highlights the need for further research on the potential benefits and drawbacks of alternative approaches to fever management.
To date, no scientific synthesis of the literature has been conducted, and the evidence regarding the knowledge, attitudes, and practices of South-East and East Asian parents towards childhood fever remains unclear.Data from Western populations may not represent the Asian region due to cultural differences.Therefore, it is essential to summarize the literature regarding fever management by South-East and East Asian parents regarding their knowledge, attitudes, and practice and improving scientific fever management for children outside the hospital setting.
This literature review aimed to identify and summarize the evidence related to knowledge, attitudes, and practices of South-East and East Asian parents towards fever in healthy children.The results may guide the development of future research and education programs specific to this population Asian parents.

Methods
This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (S1 File).

Objectives
This literature review aimed to identify, summarize, and critically appraise current evidence on (1) South-East and East Asian parents' knowledge, attitudes, and practices towards fever in healthy children and (2) factors associated with parents' knowledge, attitudes, and practices towards fever.

Literature search
Three English language databases (CINAHL, PubMed, and Scopus) were searched from inception to June 2022.The search terms include 'parents', 'children', 'fever', 'knowledge', 'attitude', and 'practice' were combined in each database using free-text terms and Medical Subject Headings (MeSH) where available.A sample search strategy in CINAHL is illustrated in the S2 File.A manual search of the references of the included articles was conducted to locate additional relevant articles.

Inclusion criteria
Articles were included if they (1) were empirical studies that used a qualitative or quantitative research design with full-text available; (2) focused on parental knowledge, attitudes and practices towards fever and (3) were published in East Asia (China including Hong Kong, Macau, and Taiwan, Mongolia, Japan and South Korea) or South-East Asia (Brunei, Myanmar, Cambodia, Indonesia, Laos, Malaysia, the Philippines, Singapore, Thailand, Timor-Leste and Vietnam).

Exclusion criteria
The following items were excluded: (1) studies focusing on other febrile symptoms, e.g.febrile convulsion and febrile seizure; (2) editorials, letters, case reports or commentaries; (3) in vivo or in vitro studies without human data and (4) conference abstracts or poster abstracts without full-text publication.Articles conducted in countries from the Middle East, South Asia, and Central Asia were also excluded because of economic, cultural, and social differences.Diverse religious beliefs can also significantly influence social norms, values, and traditions, bringing differences in medical practices.

Study selection
Two investigators (NHL and WCL) reviewed the search results independently on three successive levels.(1) the article titles were initially screened to find the potential studies relevant to this review's objectives (title stage).( 2) The abstracts of these articles were then further reviewed (abstract stage).(3) In the final stage, the full texts of the remaining articles were reviewed based on the inclusion and exclusion criteria (full-text stage).Any discrepancies were discussed with the third reviewer (LH) to reach a consensus.

Quality appraisal
The primary investigator (NHL) evaluated the selected articles and cross-checked them by a coinvestigator (LH) using the Joanna Briggs Institute Critical Appraisal Tool (JBI) for crosssectional studies [25], which was used to criticise cross-section study designs.The JBI critical appraisal checklist for cross-sectional studies includes eight items to assess inclusion criteria, study sample, measurements, confounding factors, and statistical analysis.Each item was evaluated using four responses: yes, no, unclear or not applicable.Disagreements were solved by consulting a third reviewer (CLW) to reach a consensus.A global rating of each study was examined by combining all component ratings (Table 1).No studies were excluded based on the quality assessment ratings.

Data extraction
Data were extracted by one investigator (NHL) and checked for accuracy by the other investigator (LH) independently.Discrepancies were resolved through discussion.The following details were summarized from all articles: author(s), year, region of research, study design, study setting, data collection method, eligibility/recruitment, sample size, characteristics of caregivers, characteristics of children and synthesis themes.

Data synthesis
Data synthesis is the process of integrating findings from the included articles.A narrative synthesis was used in this review to examine the study findings from the articles.A narrative synthesis framework was adopted, including the following steps: (1) developing a preliminary synthesis of findings of included articles, (2) exploring relationships in the data, and (3) assessing the robustness of the synthesis [26].

Results
After applying the inclusion criteria and excluding the duplicated articles, 11 articles were selected from the three English electronic databases.An article selection flow chart is presented in Fig 1 .These studies were conducted in different South-East and East Asian countries including China (n = 3), Japan (n = 3), Malaysia (n = 2), Indonesia (n = 1), Korea (n = 1) and Singapore (n = 1) (Table 2).All of the included studies were quantitative designs involving 3,429 participants.Ten included studies adopted convenience sampling, while one adopted purposive sampling.All studies collected cross-sectional data with either a self-administered survey or a structured interview questionnaire.Critical appraisal information is detailed in Table 1.

Narrative synthesis
The following four themes were established after applying the synthesis framework: (1) source of fever knowledge, (2) knowledge level, (3) attitudes towards childhood fever and (4) practices towards childhood fever (Tables 2 and 3).
Temperature.Regarding the definition of fever, a significant proportion of parents (48.6%-100%) could not correctly identify a febrile temperature.Except for the Korean study that reported the lowest incorrect rate at 14.2% [35], Japanese parents had the highest false rate, which ranged from 62% to 100%, as reported in two studies [29,30].In addition, a small proportion of Singaporean (4.3%), Korean (10.5%) and the majority of East Malaysian (84.7%) parents believed that fever could rise to 43.3˚C or infinitely if left untreated [15,33,35].
Cause of fever.Only two studies investigated parental knowledge regarding the cause of fever [27,33].Although most parents correctly identified it as an immune response, some still had different misconceptions.For instance, parents in Malaysia and Taiwan would explain fever from the perspective of Chinese medicine, e.g., the imbalance of heat and cold [27,33].

Attitudes towards childhood fever
Types of attitudes.Six studies investigated parental attitudes during a child's febrile episode and found that most of the parents expressed a high level of anxiety and concern [15,27,28,30,33,34].The majority of Asian parents reported moderate to high levels of anxiety (47%-86.6%)[15,27,28,30,33].Of note, in In China, Japan, and Singapore, nearly half of the parents reported being "very worried", while over one-third of the Chinese parents (34.3%) even reported being "extremely worried" [15,28,30].In addition, a significant proportion of Malaysian (72%) and Chinese (Taiwan) parents (86.6%) were found to have the highest concern level [27,33].The results illustrated that the phenomenon of fever phobia also exists in South-East and East Asia.
Influential factors.Bong and Tan [33] explored factors influencing parents' anxiety levels.High anxiety was associated with low parental knowledge levels [27].It also reported that discomfort of children (68.8%), persistently rising body temperature (68.2%) and fear of harm (63.7%) were the chief reasons for parental concern [33].Their concerns were mainly influenced by their own or a family member's previous experience with child fever (59.9% and 42%, respectively), not knowing the cause of the fever (39.5%) and doctor advice upon consultation (35.7%) [33].

Practices toward childhood fever
Assessments.Five studies investigated fever assessment methods performed by parents [28,29,[34][35][36].Most Malaysian parents (86%) reported using a thermometer to assess their children's temperature, while others reported using a touching technique [34].Regarding sites  of measurement, assessment strategies varied in different countries.In Malaysia and Korea, the eardrum thermometer was the most commonly used instrument, while the auxiliary was the preferred site of the Japanese [30,34,35].Both methods were popular in China [36].Nearly all parents in China (99.4%) and Japan (100%) would check their children's temperature at regular intervals [28,30].The majority of Singaporean (70.5%) and Korean parents (62.1%) would check their child's temperature every hour or less [15,35].Management strategies.A wide variety of fever management practices, which aimed to relieve discomfort, promote sleep, and prevent brain damage and seizure, were used by Japanese parents [30,31].Common practices included encouraging fluid intake, tepid sponging, and cooling the head and body [15,[27][28][29][30][31]36].
In addition, traditional medicine and folk treatments were applied.For instance, some Taiwanese parents in China adopted traditional Chinese medicine techniques and Taiwanese folk remedies, e.g., ingestion of "cold" and "hot" drinks, "Shou Jing", "scraping, Gua sha", and intake of Chinese herbal medicine [27].However, some traditional interventions were adopted by parents [37].For example, some Japanese parents warm their children's bodies, while a small proportion of Chinese parents would apply cold and wine sponging [28,29].The combined therapy of traditional treatment and modern Western treatment were also found.Some Singaporean parents consult a conventional medical practitioner, and 11.1% administer traditional medicine concomitantly with polyclinic consultation [15].
Nearly three-quarters of the Korean parents recognised the trade names of the antipyretics used, while only a few of them (9.4%) knew their generic names [35].The most common antipyretics chosen by Chinese parents were ibuprofen (79.4%), followed by acetaminophen (9.5%) [28].If the child remained febrile after having the antipyretic agent, common management adopted by parents included a tepid bath, visiting the hospital, alternating to diclofenac sodium suppository and readministering the same medication [35,36].
Chang et al. [36] further explored the common misunderstandings of parents toward antipyretics, which included side effects of overdose possibility (e.g., liver toxicity), the maximum number of doses during a day, medication dose and duration of taking medication.Grandmothers, immigrant mothers, and parents with lower academic qualifications and older age were found to have higher misconception rates [36].Over one-third of the parents misunderstood the drug package insert instructions and medication envelope instructions, which were attributed to the tiny words printed and the incomprehension of Chinese [36].It highlighted the insufficient knowledge of using antipyretics among parents.
Influential factors.Several factors affected parental management practices regarding childhood fever.For instance, Korean parents with an only child tended to seek medical attention more than those with more than one offspring [35].Parents worried about brain damage would check the child's body temperature more frequently [35].Of note, parents with poor knowledge of fever showed a four times chance of showing poor management strategies compared to those with good knowledge [32].

Discussion
This study is the first review summarising parental knowledge, attitude, and management regarding childhood fever in South-East and East Asia.The results highlight the unmet childhood fever information needs, inadequacy of fever knowledge, negative attitudes, and diverse fever management practices in South-East and East Asian parents.Our results indicated that educating them about childhood fever and providing psychological support are warranted for better decision-making on childhood fever management at home.

Parents' knowledge about fever
Consistent with previous Western studies [3], this review suggests that South-East and East Asian parents generally have insufficient knowledge about childhood fever, including diverse perspectives on febrile temperature and inadequate understanding of potential harm.Although different questionnaires were used across studies, making head-to-head comparisons was difficult because of the various definitions of fever concerning the site of thermometer measurement [38].Nevertheless, the current study's results consistently show that most parents could not identify febrile temperature correctly.The correct rate of fever temperature identification often ranged from ~0% to 50%, comparable to another systemic review (19%-45%) [3].The results highlight the lack of basic understanding of childhood fever for most South-East and East Asian parents.The possible reasons could be related to the information provided by healthcare professionals, traditional perspectives on the cause of fever, and the influential demographic factors.
On the one hand, the current review demonstrates that healthcare professionals are parents' most common source of information.It offers an excellent opportunity for them to deliver appropriate and effective education during clinical consultation while preventing parents from being exposed to unreliable information sources.However, some misconceptions (e.g., higher temperatures create more significant risks to the child) might be unintentionally reinforced through health consultations, especially when healthcare professionals ask about body temperatures.As such, temperature-focused questioning coupled with parents' misconceptions or fears may create a false sense of importance associated with numerical fever values rather than the child's overall well-being [3].Therefore, it is valuable to standardize the knowledge about childhood fever for healthcare professionals in the paediatric department, incorporating the health guidelines on fever management in their own country, which will help ensure the accuracy of parents' understanding of childhood fever.
On the other hand, certain traditional beliefs (i.e., the perspective of Chinese medicine on explaining fever) [27,33] may mislead parents into focusing on the level of fever instead of its origin (i.e., infection); it may lead to excessive temperature monitoring and overusing antipyretics [15].Therefore, additional studies are warranted to promote parental knowledge about fever's origin in different South-East and East Asian countries, providing insights for further education programs.Thus, the parents' abilities to identify fever should be enhanced [33].
In addition, studies reported that immigrants, old age, and low education levels were associated with a higher level of the misconception of fever and its management [27,29,31,32,34,36].Therefore, health literacy is suggested to be taken into consideration.Hospitals and paediatric clinics, and primary healthcare clinics can be an ideal platform for healthcare professionals to deliver tailored education concerning parents' abilities and needs.Developing accessible and easy-understanding educational interventions about childhood fever will benefit parents of different socio-demographic characteristics and levels, realizing their information-seeking.Hence, the impact of low health literacy can be minimised.

Parents' attitude towards fever
The current review demonstrates that the anxiety levels of South-East and East Asian parents towards childhood fever are comparable to Western studies.The majority of Asian parents reported moderate to high levels of anxiety (47%-86.6%),which is consistent with findings from another systematic review (57%-68%) [3,15,27,28,30,33].It reveals that fever phobia also exists in the South-East and East Asian population.Of note, a significant proportion of parents in Malaysia (72%) and China (Taiwan, 86.6%) expressed the highest level of concern [27,33].The reason behind the disparities in anxiety levels in different countries can be further investigated.Nevertheless, among all the perceived harms of childhood fever, South-East and East Asian parents were concerned more about brain damage and mental retardation [15,16,27,28,33,35,37,39,40].These findings are more apparent in China, Singapore and Malaysia.The possible reason is that South-East and East Asian parents, especially Chinese, emphasise children's academic attainment, which heavily relies on their intelligence level [15].Therefore, they would worry more about their children's intellectual development.Moreover, due to cultural impacts (e.g., endurance/control in Chinese Confucian culture), some parents tend to take excessive control of fever to alleviate their anxiety, such as alternatively using antipyretic drugs, ignoring children's health, and thus aggravating their anxiety [8].This phenomenon could be further explored, hence contributing to a theoretical framework for a culturally sensitive educational scheme to address parents' concerns in this area.Studies to compare groups from different social and cultural backgrounds are also paramount to identify the factors influencing fever phobia.
Of note, a study revealed that doctors' advice upon consultation contributed to parents' concerns, indicating that information provided may also heighten their anxiety level [33].In this regard, in addition to giving education, healthcare professionals should also focus on the psychological status of parents.Reassuring parents and reducing their mental burdens are essential.Otherwise, elevated anxiety levels may lead to the chain reactions of over-treatment and over-consultation, which are undesirable outcomes for the family and healthcare system.Psychological support designed in the future is suggested to emphasize the correct understanding of childhood fever and its harmfulness, focusing on the child's well-being rather than using irrational ways to relieve their concerns and increase children's burdens.

Parents' practices toward fever
Being influenced by cultural-bounded thoughts, parents in different countries share distinct cultural responses to fever.Some of them would adopt alternative medicine and seek advice from traditional medical practitioners instead of relying only on Western medicine.For instance, Taiwanese parents in China applied conventional Chinese medicine and Taiwanese folk remedies at home, such as the ingestion of "cold" drinks and "hot" drinks, "Shou Jing", and "Gua Sha".This could be deeply influenced by the tenets of traditional Chinese medicine [27].Singaporean parents would give talisman water for their children to drink and put oil on their fontanelles.This may be influenced by the inconsistent advice from information resources under the multicultural population in Singapore [15].In contrast, Western medicine upholds a different viewpoint regarding fever management practices.Treatments focus on reduction of distress rather than temperature [10].For instance, guidelines suggested giving antipyretics only in cases of discomfort [41].
Despite the prevalence of traditional fever management practices, there is a lack of evidence regarding their effectiveness.For instance, the practice of giving talisman water to febrile children in Singapore has not been studied, and evidence related to the effectiveness of warming children's bodies in Japan is also limited to a theoretical level [10,15,29].Although it is believed to reduce the energy needed to develop fever and, thus, alleviate the discomfort of the febrile child, this theory has not been supported by any empirical studies [10].Similarly, the effectiveness of Gua sha, a traditional Chinese practice, for fever discomfort is unclear as most studies focus on its use for sports injuries and pain relief [42].Additionally, the potential harm associated, such as bruising and soreness, raises doubts about its worthiness for fever management [42].Moreover, some traditional practices are discouraged by current medical guidelines, e.g., cold sponging and wine sponging by Chinese parents [10,28].These practices can result in a mismatch between the hypothalamic set point and skin temperature due to manual cooling, leading to discomfort in the child due to peripheral vasoconstriction, metabolic heat production, and increased shivering [10].The findings have highlighted the potential risks and consequences of various cultural practices.
On the contrary, some traditional management can indeed provide beneficial clinical effects.For instance, ingesting "cold' and "hot" drinks can foster fluid consumption, alleviating discomfort during a febrile episode [10].Some active ingredients in traditional Chinese medications, such as Bupleuri Radix (Chaihu) and Scutellariae Radix (Huangqin), have also been proven effective as antipyretic agents [43].However, being aware of the drug-drug interactions between traditional remedies and western medications is crucial.Despite this, by recognizing the positive impacts of these widespread practices, healthcare providers can enhance treatment effects and improve parents' adherence to the education given.Further research can focus on the effectiveness and contraindications of various cultural practices to facilitate their utilization.
As mentioned, healthcare professionals serve as the primary information source for parents.They inflict a significant impact on parents' management practices.Chang et al. [27] found that Taiwanese parents in China were prone to use an ice pack as a management practice instead of promoting comfort, a misconception rooted in earlier acceptance by medical professionals.However, this practice still existed over the previous decade [27,37].In addition, early Japanese nursing practice suggested that warming a febrile child could help manage the symptom [29,44].Although it would raise the child's body temperature, some Japanese parents still adhered to this practice [29].This discrepancy could be related to the core goal of improving fever guided by healthcare professionals and the personal experience of parents.Compared to Chinese parents, Japanese parents tend to rely on their personal experiences to accurately control seizures by warming the body when their child develops a high fever [29].In light of this, formulating a uniform, updated, evidence-based guideline for healthcare professionals in different countries is paramount to preventing inappropriate suggestions given to parents.It is also essential to implement tailored management strategies according to children's physical condition, unmet parental needs and cultural issues.

Limitations
The current literature review has some limitations.First, only studies published in English were included, and studies published in other languages were excluded.Nevertheless, the current review included studies from different countries, including China, Malaysia and Japan, which ensure the coverage of findings in various South-East and East Asian populations.Second, six studies showed low quality, resulting in a methodological weakness, especially on unreliable measurement.However, this study aimed to investigate the phenomenon of parental knowledge, attitude and management, and using a weaker quantitative design (crosssectional study) may only bring a trivial limitation to the adequacy of the study results.Third, no qualitative studies were included in this review.The current review suggests an absence of qualitative studies conducted in the South-East and East Asian region.Therefore, further qualitative research is paramount to know about parental unmet information needs on childhood fever and the potential cultural issues influencing their beliefs, hence providing insights for developing a culturally sensitive educational frame.

Research and practice implications
Implications for future research.The results of this review provide several meaningful implications for future research.Firstly, qualitative studies are warranted to explore the South-East and East Asian parent's experience managing childhood fever and their perspective in their cultural contexts.Secondly, as the current study is only a literature review, it is suggested to systematically summarize the scientific measurements of fever and effective management strategies for childhood fever in South-East and East Asian countries.Thirdly, as the review indicated, parents' access to information about childhood fever is multifaceted, especially through the internet and the media, so considering the convenience of the internet, designing a friendly-using online information platform about childhood fever will promote parents obtaining evidence-based information in real-time.
Implications for clinical practice.This review also indicates implications for clinical practice.As healthcare professionals are the primary source of information, and most parents would seek advice for managing childhood fever, they serve as an ideal platform for education with high credibility.Therefore, the results of the current study highlight the need to develop an educational framework to unify information, providing consistent knowledge and management approaches to parents.First, the theoretical knowledge about childhood fever must be regularly updated for clinical healthcare professionals in the paediatric department.Health education program services are highly recommended to be integrated into broader primary care systems.Second, culturally specific and evidence-based education programmes should equip parents with correct information, appropriate attitudes, and skills to manage mild to moderate fevers without emergency and medical consultation.

Conclusion
The current literature review provides a comprehensive understanding of parental knowledge, attitude, and management of childhood fever among South-East and East Asian parents.The results found that a low state of parental knowledge and negative attitudes toward fever exists in South-East and East Asian parents.Nevertheless, differences in perception and management of childhood fever still exist in South-East and East Asia compared to other countries.Evidence-based approaches based on cultural contexts to effectively manage childhood fever in South-East and East Asian countries warrant further systematic investigation.Evidence-based information also deserves attention from healthcare professionals.