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!Belitung Nursing Journal , Volume 3, Issue 5, September-October 2017
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Astuti SCD, et al. Belitung Nursing Journal. 2017 October;3(5):595-602
Accepted: 11 March 2017
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ORIGINAL RESEARCH ISSN: 2477-4073
ALOE VERA BARBADENSIS MILLER AS AN ALTERNATIVE
TREATMENT FOR CHILDREN WITH FEVER
Siti Choirul Dwi Astuti1*, Suhartono2, Ngadiyono1, Supriyana1
1Magister Applied Midwifery, Politeknik Kesehatan Kementrian Kesehatan Semarang, Indonesia
2Medical Faculty of Diponegoro University, Semarang, Indonesia
*Correspondence:
Siti Choirul Dwi Astuti, MTr.Keb
Magister Applied Midwifery, Politeknik Kesehatan Kementrian Kesehatan Semarang
Jl. Tirto Agung, Pedalangan, Banyumanik Kota Semarang, Jawa Tengah, Indonesia (50268).
E-mail: sitichoirul13@yahoo.co.id
ABSTRACT
Background: Applying a cooling treatment from outside the body is one way to lower fever in children.
Midwives commonly perform a warm water compress in their care, but it is considered less effective. Thus,
compress with aloe vera barbadensus miller is proposed in this study as an alternative treatment.
Objective: To examine the effect of Aloe vera barbadensis miller compress in reducing body temperature in
children with fever.
Methods: This was a quasi-experimental study with pretest and posttest with control group design. Forty
children were recruited, with twenty of them assigned in each group. Purposive sampling was performed to
select the sample. A digital rectal thermometer was used to measure the temperature. Independent t- test and
paired test were used for data analysis.
Results: Findings showed that the aloe vera compress group showed a higher decrease of body temperature
compared to the warm water compress group. The difference of body temperature after 20 minutes in the
experiment group was 1.435 while in the control group was only 1.085. There were statistically significant
differences in body temperature between the experiment and control group (p=0.013).
Conclusion: Aloe vera barbadensis miller compress is an effective alternative therapy in reducing body
temperature in children with fever. It is recommended for midwives to apply this intervention to reduce body
temperature significantly.
Key words: Fever, Toddler, Aloe Vera Compress, Warm water compress
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INTRODUCTION
Change of condition from health to sick
causes the body reaction to increase the
temperature called fever (hyperthermia).1,2
Fever is a state that the body temperature
is higher than usual and is a symptom of a
disease. Body temperature exceeds the
fixed point (set point) more that 370C,
which is usually caused by external or
body conditions create more heat than
released by the body.3 Studies have shown
that 10-15% of mothers carrying toddlers
come to health services because of fever.4
Fever is the body's normal response to the
entry of microorganisms such as viruses,
bacteria, parasites and fungus.5 Fever is
generally caused by viral infections. Fever
can also be caused by excessive heat
exposure, dehydration or fluid deficiency,
and allergies or due to immune system
disorders.
Some research evidences suggest that the
positive effects of fever trigger the
increase in the number of leukocytes as
well as improve interferon function that
helps leukocytes fight microorganisms.6
Fevers are generally harmless but high
fever can be harmful. The negative effects
of fever include dehydration, lack of
oxygen, neurological damage and febrile
seizures. Fever should be handled
properly in order to minimize the negative
impact. Other research results show that
fever often causes anxiety in the elderly
person to make excessive efforts by
giving antibiotics and doing a blood
check.7
However, it requires the roles of midwife
in dealing with fever to prevent excessive
effort that precisely can harm. The role of
midwife in handling fever in toddler must
be in accordance with its authority. Based
on Regulation of Minister of Health
(Permenkes) Number 1464 / Menkes / Per
/ X / 2010, midwives have authority in
providing child health services, which
their scope of services in child health
services include providing newborn
services, infant care, toddler services and
pre-school services.8 In addition,
midwives also have the authority to take
care of infants and toddlers in accordance
with established guidelines and the
standard of IMCI (Integrated Management
of Childhood Illness), especially for
assessing and classifying fever before
doing interventions.9
The authority of midwives in caring
children with fever is by giving warm
water compress. 9 Physical therapy by
giving compress in fever management
according to World Health Organization
(WHO) can be done before giving drug
therapy. However, not all fever can be
treated with warm water compresses, it is
just only for intermittent type of fever.
This intermittent fever may fall to normal
levels within a day and may occur on the
first day. Warm water compress does not
fit with children with fever accompanied
by severe dehydration, consciousness loss
or a history of febrile seizures.
Warm water compresses can help dilating
the peripheral blood vessels in the skin
and opening pores to remove heat out of
the body.5,6 This also can reduce the
dependence of patients on antipyretics.10
However, the weakness of hot water is in
the media used, which is still using liquid
media in the form of warm water in the
wet cloth. The water in the wet cloth can
be widened to other parts of the body
causing discomfort. Moreover, if it is
excessively given will cause redness.
Warm water compress will be evaporated
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and should be done repeatedly for 2-3
minutes to maintain a sense of warm
water. The method of heat loss with warm
water compresses will occur when the
skin touches the liquid object, or when the
skin touches a solid object which is
actually 5 times more effective in moving
heat compared to liquid.11
Thus, this study used a compress with
solid media in the form of aloe vera to
increase heat exposure in children with
fever. The results of Mukhamad Rajin's
study12 showed that saponin content in
aloe vera can cause vasodilatation, thus
accelerating the decrease of phlebitis level
after 8 hours of giving aloe vera
compress. This research is also supported
study who found that aloe vera possesses
phytochemical compound in the form of
saponin and is used as a compress to
lower body temperature in burn patients.13
In addition, aloe vera also contains lignin
that can penetrate into the skin, which
helps preventing the loss of body fluids
from the skin surface.14 The content of
saponin compounds in aloe vera that
works dilate blood vessels can accelerate
the expenditure of heat. It makes the
blood circulation smooth so that the heat
from the body can be more easily
channeled to the peripheral blood
vessels.13Thus, aloe vera will be used to
handle the fever by peeling the leaves of
aloe vera and used as a compress. When
the aloe leaves used as a medium
compress, then the heat that exists on the
body will evaporate so that the fever will
slowly decrease because of accelerating
heat.11 Moreoer, aloe vera also includes
local crops that are cultivated so easy to
get it and the price is affordable.
The Community Health Center is one of
the health service centers providing
midwifery services in maternal and child
health. The standard operational
procedure in taking care of fever in this
center include giving explanation to
parents, rehydration, providing good air
ventilation of the room, loosening the
patient's clothes, and supine positioning,
compressing and recording in the medical
record. Data obtained from Department of
Health of Blora in 26 Community Health
Center located in 16 sub-districts showed
that the highest prevalence of fever in
under five years in 2015 was in the
Doplang Health Center as many as 439
cases.15 This number indicates an increase
of fever occurrence from the previous
year, which amounted to 324 cases in
2014. In addition, the Doplang Health
Center also applied a counseling to do
compress action if there is a child with
fever.
METHODS
Design
This type of research was a quasi
experiment with pretest and posttest with
control group design. This research was
conducted in the working area of Doplang
Blora’s Community Health Center from
January 1, 2017 to January 27, 2017.
Population and Sample
The target population in this study was all
children with fever in the working area of
the Community Health Center of Doplang
Blora. There were 40 samples selected
based in the hypothesis formula of the
mean of two independents. Purposive
sampling was used and 20 samples were
assigned in the experiment and control
group. The inclusion criteria of the sample
were: Children with intermittent fever
(37.30C-38.50C), first day of fever, and
aged 1-5 years. The exclusion criteria
were children aged less than 1 year or
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more than 5 years old, have been given a
medicine, uncooperative fever, moderate
or heavy dehydration, and have a history
of febrile seizures.
Intervention
The experiment group was given a
compress of aloe vera. Type of aloe vera
used was aloe vera barbarensis miller with
a width of ± 6cm and length ± 11cm. The
researcher chose a fresh and clean aloe
vera, then peeling the aloe vera by
removing the leaf skin and put it on the
forehead, armpits (axillary), and groin
folds for 15 – 20 minutes. While the
control group was only given a warm
water compress (37oC – 40oC) in the wet
cloth and put it on the forehead, armpits
(axillary), and groin folds for 15 – 20
minutes.
Instrument
A digital rectal thermometer was used to
measure the temperature. It is considered
a fever if the temperature is > 37.3oC. The
measurement was done for times (after 5
minutes, 10 minutes, 15 minutes, and 20
minutes of intervention).
Ethical consideration
Ethical clearance of the research was
obtained from the Ethics Commission of
Poltekkes Kemenkes Semarang with
No.057 / KEPK / Poltekkes-SMG / EC /
2017. The study permission was also
obtained from the National Unity and
Public Protection Body. Each participant
in this study signed the informed consent
prior to the data collection.
Data analysis
To examine the effect of aloe vera
barbarensis miller on fever, and
investigate its differences between the
experiment and control group,
Independent t-test and paired t-test were
used for data analysis.
RESULTS
The characteristics of the respondents as
shown in the table 1 showed that the
majority of children in this study aged 37-
38 months, female and had a good
nutritional status, with p-value > 0.05,
which indicated that there were no
significant differences of the
characteristics of the respondents between
the experiment and control group.
Table 1. Characteristic of the respondents and its homogeneity
Characteristics of the
respondents
Warm water
compress group
Aloe vera
compress group
P-value
Age (month)
0.802
Mean
37.55
38.2
Median
34.5
37
Min
27
22
Max
60
59
±SD
7.937
9.563
Gender
0.736
Female
14 (70%)
13 (65%)
Male
6 (30%)
7 (35%)
Nutritional status
0.705
Good
16 (80%)
15 (75%)
Poor
4 (20%)
5 (25%)
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Table 2. Time to reach normal temperature
Time
Warm water
compress group
Aloe vera compress
group
Total
N
%
N
%
n
%
5 minutes
1
5%
8
40%
9
22.5%
10 minutes
4
20%
18
90%
22
55%
15 minutes
12
60%
20
100%
32
80%
20 minutes
20
100%
20
100%
40
100%
Total
20
100%
20
100%
40
100%
Table 2 shows that most respondents in
the warm water compress group reached
normal temperature within 20 minutes,
amounted to 20 people (100%). While
most of the respondents in the aloe vera
compress group reached the normal
temperature within 15 minutes, amounted
to 20 people (100%). The respondents in
the aloe vera compress group reached
normal temperature faster than the
respondents in the warm water compress
group.
Table 3. Difference in body temperature before and after given intervention using paired t -
test
Time of measurement
Intervention
Warm water compress
Aloe vera compress
Mean Paired
Differences
P-value
Mean Paired
Differences
p-value
Before and after 5 minutes
0.26
0.001
0.55
0.0001
Before and after 10 minutes
0.44
0.001
1.065
0.0001
Before and after 15 minutes
0.71
0.001
1.415
0.0001
Before and after 20 minutes
1.085
0.001
1.435
0.0001
Table 3 shows that there was a significant
decrease of body temperature in the
experiment and control group in four times of
measurement with p-value <0.05. However,
the aloe vera compress group showed a higher
decrease of body temperature compared to the
warm water compress group in each
measurement. For instance, the difference of
body temperature after 20 minutes in the
experiment group was 1.435 while in the
control group was only 1.085. It could be said
that aloe vera compress was effective than
warm water compress.
Table 4. Difference in body temperature before and after given intervention in the experiment
and control group using Independent t-test
Time of
measurement
Mean;±SD; Median; Min±Max
p-value
Aloe vera compress
Warm water compress
Pretest
37.9±0.37; 38.0; 37.3±38.5
37.8±0.20; 37.8; 37.4±38.2
0.141
Posttest (5 min)
37.4±0.37; 37.4; 36.9±38.0
37.5±0.23; 37.6; 36.9±37.9
0.141
Posttest (10 min)
36.9±0.34; 37.0; 36.3±38.0
37.3±0.29; 37.4; 36.6±37.9
0.001*
Posttest (15 min)
36.5±0.24; 36.5; 36.2±37.1
37.1±0.34; 37.1; 36.4±37.9
0.001*
Posttest (20 min)
36.5±0.25; 36.5; 36.2±37.1
36.7±0.23; 36.7; 36.4±37.2
0.013*
Mean difference
1.43±0.32; 1.40; 0.80±2.20
1.08±0.14; 1.10; 0.90±1.40
0.001*
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The results of Independent t-test as shown
in the table 4 shows that there were no
significant differences in body
temperature in pretest and posttest (5
minutes) with p-value >0.05. However,
there were statistically significant
differences in body temperature between
the experiment and control group after 10
minutes (p=0.001), 15 minutes (p=0.001)
and 20 minutes of intervention (0.013).
There was a bit difference in body
temperature between the two groups,
which was only 0.2oC.
DISCUSSION
The purpose of this study was to examine
the effect of Aloe Vera Barbadensis
Miller in reducing body temperature in
children with fever. The findings of this
study revealed that there was a significant
effect of Aloe Vera Barbadensis Miller
compress on the decrease of body
temperature compared with the warm
water compress. This finding is consistent
with previous study13 who found that aloe
vera possesses phytochemical compound
in the form of saponin and is used as a
compress to lower body temperature in
burn patients. In addition, aloe vera also
contains lignin that can penetrate into the
skin, which helps preventing the loss of
body fluids from the skin surface. Thus,
the more aloe vera is given, the less
amount of time needed to lower the
temperature. However, another study
indicated that the original aloe vera is
more effective in lowering the
temperature compared with aloe vera
extract having no influence in temperature
reduction.16
The finding of this study is also in line
with Mc.Vicar's17 opinion that Botany is
used for cooling body temperature.
Another states that the use of aloe vera is
a traditional base that view fever as a hot
expression in response to an external
pathogen.18 The principle of treatment
seeks to help to completely eliminate
excess heat using herbs. 14
Although the principle of the two
interventions was the same as making
vasodilatation, but aloe vera has a saponin
and lignin content that will give a relaxant
effect thereby sending signals to the
posterior hypothalamus. The function of
the posterior hypothalamus is to reduce
heat production. While warm compress
only uses warm water as a medium to
provide a sense of warmth that will make
the anterior hypothalamus give a signal
for vasodilation. The function of the
anterior hypothalamus is to increase heat
expenditure.12
Both interventions equally give a signal to
the hypothalamus causing vasodilation
and decrease in temperature. But the
decrease in temperature by reducing heat
production through the posterior
hypothalamus gives more results than
through the anterior hypothalamus to
increase heat release. The results were
also influenced by the researchers who
used a minimal time of thermoregulation
process.13 Provision of this compress
intervention can only be used for fever
with temperatures that can be immediately
dropped because there is also a fever
whose temperature does not immediately
come down with the compress due to
infection.
The significant difference in temperature
reduction between the warm compress
group and aloe vera compress group gives
a significant effect on the decrease in
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body temperature of children. From the
descriptive analysis of time to reach the
normal temperature, it can be concluded
that aloe vera compress was faster to
lower body temperature of children
compared with warm water compress.
This fact occurs because the aloe vera
compress has saponins that can lower
body temperature, while there is no
additional other substances in warm water
compress although found enough
evidence to say that warm water compress
as the methods to control fever.19,20
CONCLUSION
There was a significant effect of aloe vera
compress in reducing body temperature in
children with fever, and significant
differences in mean value of body
temperature between the aloe vera
compress group and warm water compress
group. It could be concluded that aloe
vera compress was effective than warm
water compress in decreasing body
temperature in children with fever.
Therefore, it is suggested for midwives to
apply this intervention to reduce body
temperature significantly.
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Cite this article as: Siti Choirul Dwi
Astuti SCD, Suhartono, Ngadiyono,
Supriyana. Aloe Vera Barbadensis
Miller as an Alternative Treatment for
Children with Fever. Belitung Nursing
Journal 2017;3(5):595-602
