Combination of Red Onion Compress with Virgin Coconut Oil to
Reduce Children's Fever
Diah Evawanna Anuhgera*, Nikmah Jalilah Ritonga, Riris Sitorus, Dwi Handayani, Wilda Wahyuni
Siregar, and Damayanti
Institut Kesehatan Medistra Lubuk Pakam, Deliserdang,Sumatera Utara, Indonesia
Keywords: Red Onion Compress, virgin coconut oil, Children’s fever.
Abstract: Fever is a clinical symptom that is most common in children and makes parents feel worried. This study
aims to examine the effect of combination red onion compress with virgin coconut oil to reduce children’s
fever. The combination of red onion contains flavonoids and Allylcysteine sulfoxide (Aliin) compounds
while VCO has an anti-inflammatory and antipyretic effect that can reduce body temperature. The study
design uses quasi-experimental with pre and post test control group design. There were 30 participants
selecting using simple random sampling, with 15 assigned in the experiment and control group. Data were
analyzed using paired t test and unpaired t test. There is a decrease in body temperature after being given a
red onion compress for 15 minutes by 3.11% while in warm water compresses of 1.54% There were
ststistically significant differences in body temperature between the experiment and control group
(p=0.000). Combination red onion with VCO can be used as an alternative intervention in lowering a child's
body temperature during a fever. It is recommended for midwives to apply this intervention to reduce body
temperature significantly.
1 INTRODUCTION
Fever is an acute response to a disease that most
often occurs in children. WHO (World Health
Organization) states that the prevalence of fever in
the world reaches 16-33 million and results in 500-
600 thousand deaths annually (Lunze K et al, 2017).
One study in the United Kingdom in 2014 stated that
64.3% of parents bring their children to the doctor
due to fever (Narayan K et al, 2017). Fever is the
second biggest reason parents take their children to
the hospital (Chien YL et al, 2017).
The use of paracetamol and ibuprofen as
antipyretics is a pharmacological treatment for fever
that is often done. However, there are many
inconveniences caused by the use of this drug
(Chiappini, et al 2016). According to Kanabar, 2017,
paracetamol causes minor side effects of 10% while
ibuprofen by 8% (Kannabar, J Dipak, 2017). Simple
fever management that can be done by parents at
home is by physiological interventions such as
wearing baby clothes that are not thick, fluid or rest
intake and use of coolant (Chang LC et al, 2016).
Elvira, 2018 states that one time giving warm water
compresses (tepidsponge) can reduce fever in
children in the 6th minute until the 90th minute
(Hendrawati and Elvira M, 2018). Compress aloe
vera for 15 minutes effectively reduces fever by
2.86% in the 20th minute (Astuti et al, 2017).
In this study, researchers used a combination of
red onion compresses with VCO for 15 minutes for
children aged 2-3 years. Literature study at Henagan
et al states that onion contains flavonoid compounds
that function as antipyretics in the body by
preventing arachidonic acid metabolism to form
increased porstaglandin levels when fever (Henagan
et al, 2015). The results of the Pareek S et al. 2018
study stated that onions contain flavonoids and high
content of organo sulpur in the form of Aliin by 29%
(Parek S et al, 2018). Aliin compounds make red
onion easily evaporate when left at open
temperatures (Rachmad, Suryani S and Gareso,
2012). To reduce the evaporation of onions, the
researchers added 5 ml of virgin coconut oil to
reduce the evaporation of onions. Virgin coconut has
anti-inflammatory effects on the body so that it can
help decrease body temperature in children.
11.12
Mass onions used by 25 mg will reduce body
temperature by 88.50 seconds (Rachmad, Suryani S
and Gareso, 2012). Onion compress is applied to the
Anuhgera, D., Ritonga, N., Sitorus, R., Handayani, D., Siregar, W. and Damayanti, .
Combination of Red Onion Compress with Virgin Coconut Oil to Reduce Children’s Fever.
DOI: 10.5220/0009838204590466
In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 459-466
ISBN: 978-989-758-460-2
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
459

entire body through the surface of the skin because
the skin is an easily accessible area in the process of
drug absorption. In normal skin the onion compress
penetration pathway via the topical trans epidermal
route which targets treatment in the local system
(Chang LC et al, 2016). This red onion compress and
VCO will have a more effective fever-reducing
effectiveness.
2 METHODS
Research location in Karang Anyer Health Center
working area, Sidodadi Ramunia Village, Beringin
Lubuk Pakam Subdistrict, with a quasi-experimental
type of control group pretest and post test design.
This study was divided into two groups: an
intervention group with a combination of red onion
compresses and VCO oil while the control group
used warm compresses. The population in this study
are all children who have a fever at the age of 2-3
years while the sample in this study is a child who
has a fever at the age of 2-3 years according to
inclusion criteria. The sample size calculation uses
the mean different hypothesis test and the sample
obtained for each group is 15 respondents so that the
total sample is 30 respondents. The sampling
technique uses random sampling with a simple
random method. Inclusion criteria in the sample are
parents or families willing if the child is a research
respondent and is willing to sign an informed
consent, fever no more than 1 day, body temperature
37.2°C-38.5°C, children who have not taken
antipyretic drugs, not have a history of allergy to
onions, a history of previous seizures and good
nutritional status while the exclusion criteria are
allergic, uncooperative during the research process,
have infectious diseases.
The intervention group was given red onion
compress (Allium Ascalonicum var Ascalonicum) as
much as 3 cloves (25 mg) and 5 ml VCO while the
control group was given warm water compresses
using a wet cloth, temperature 37°-40 ° C for 15
minutes placed on the forehead, armpits and groin
folds. Provision of therapy is carried out at the same
time ie on the first day detected experiencing fever.
The material used in this study was the red onion
with Ascalonicum variety obtained from the market
in Lubuk Pakam and samples were identified at the
Botanical Laboratory of the Medistra Health
Institute. The study permission was also obtained
from the National Unity and public protection body .
Each participant in tihis study signed the informed
consent prior to the data collection.
The procedure in this research began with the
permission to conduct a research location and
through the village head to obtain family data. The
researcher made a meeting at the village head's hall
to the community who had a baby at the age of 1-2
years and explained the aims and objectives of this
research. In the implementation process, the
researcher has two enumerators who are tasked with
helping researchers to obtain data on the community
whose children are experiencing fever in accordance
with the inclusion criteria. Researchers will divide
the two groups based on random sampling
techniques. In the intervention group was given red
onion compress and VCO Red onion while the
control group was given warm water compresses.
Researchers do the assessment in the first 5 minutes,
10 minutes, and 15 minutes. After that, all data is
collected for reprocessing (the research procedure
can be seen in the block figure 1 below).
A digital thermometer was used to measure the
temperature and mechanical thermometer to measure
water temperature. The measurement was done for
times (after 5 minutes, 10 minutes, 15 minutes of
intervention)
Data analysis to examine the effect of
combination red onion and virgin coconut oil on
fever and investigate its differences between the
experiment and control group, Independet t-test and
paired t-test were used for data analysis.
3 RESULT AND DISCUSSION
Table 1 shows that the mean body temperature of
respondents in the experiment group was 38 C and
the control group was 37,8 months with p-value 0.74
, which indicated that there was no difference
characteristics of respondents based on body
temperature between two groups. The majority of
respondents in both groups was female with p-value
0.43.The mean age of respondents in the experiment
group was 26 and 28 months and the control group
was 27 and 32 months with pvalue 0.74, which
indicated that there was no diffrences
characteristics of respondents based on age between
two groups. In conclusion, there was no significant
differences of the characteristics of the respondents
in the experiment and control group.
The results in table 2 show that body temperature
before being given a combination of red-bottom
compresses and a VCO of at most 38.4 ° C and at
least 37.6 ° C. In the first 5 minutes, the assessment
of body temperature is 37.9 ° C and the lowest is
37.3 ° C, the first 10 minutes is 37.7 ° C and the
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
460

lowest is 37 ° C, and the first 15 minutes is
temperature assessment the body is 37.2°C and the
lowest is 36.4°C. In giving warm water compress
before being given the greatest 38.4 ° C and the
smallest 37.6°C. The first 5 minute body
temperature assessment is 38.4°C and the lowest is
37.5 ° C, the first 10 minutes is 38.1°C and the
lowest is 37.3°C, and the first 15 minutes is
temperature assessment the body is at most 38 ° C
and the smallest is 36.9°C.
Table 2 concludes that after 15 minutes compress
red onion with VCO there were 14 respondents who
had reached normal body temperature while for
warm water compresses there were 5 respondents
who reached normal body temperature. Both
interventions provided a decrease in body
temperature.
Table 3 shows that there was a significant
decrease of body temperature in the experiment and
control group in three times measurement with p
value < 0.05. However, combination red onion and
VCO showed a higher decrease of body temperature
compared to the warm water compress in each
measurement. For instance, the difference of body
temperature after 15 minutes in the experiment
group was 1.180 while in the control group was only
0.585. It could be said that red onion compress was
effective than warm water compress.
Fever is the body's reaction to an illness. Fever
can be both beneficial and detrimental. When a child
has a fever, there will be an increase in phagocytosis
in the body so that the ability to live germs decreases
but the effects of the fever make the baby become
fussy, anxious and have no appetite (Chiappini et al,
2017). Research by JR Wilyanto (2018) proves there
is no significant difference in temperature between
administration red bottom ethanol extract and
administration of paracetamol to white rats induced
by the DPT vaccine (Willyanto JR, Hamid IS and
Widodo, 2018).
Research by JR Wilyanto (2018) proves there is
no significant difference in temperature between
administration red bottom ethanol extract and
administration of paracetamol to white rats induced
by the DPT vaccine (Willyanto JR, Hamid and
Widodo, 2018).
This is in line with the research of Hadian et al.
Which states that the use of botany can sweat and
cool down the body. Herbal medicine combined
with the principle of hydrotherapy can be used as a
compress for handling fever (Krishna S and
Thileepan T.A, 2018). Non-pharmacological
treatment with the use of herbal plants has been
tested to contain anti-microbial and
immunomodulating pathogens (Huang et al, 2018).
Intervening with 25 mg of onion and 5 ml of
VCO resulted in a decrease in body temperature in
each study respondent. This proves that this therapy
is the right combination of dosage and application
time. Table 2 shows that there was a significant
decrease in body temperature by giving a
combination of red onion and VCO compresses and
warm water compresses at 3 measurements with a
value of p = 0,000. Examination of body
temperature after 15 minutes given the intervention
gave a significant decrease in body temperature with
mean differences in the combination of red onion
compresses at 1.020 while in warm water
compresses at 0.585 and p = 0.000.
In table 3, the mean temperature of the child
before being given the intervention 37.933 ° C, the
first 5 minutes 37.633 ° C, the first 10 minutes
37.340 ° C and the first 15 minutes after the
intervention 36.993 ° C. The results of the analysis
showed that there were significant differences in the
body temperature of children who were febrile
before and after given an onion compress with an
average increase of 0.94 with a value of p = 0.000.
This research states that there is a difference in
body temperature before and after given an onion
compress with a significance value of p = 0.000. Red
onion compress given with virgin coconut oil
reduces the body temperature of children who have a
fever by 3.11% and warm water compresses by
1.54%. Upadhyay RK's research (2016) states that
red onion content in the form of Allium will inhibit

genotoxins thereby reducing the entry of pyrogens to
the body (Upadhyay RK, 2016). Red onion contain
flavonoid compounds, saponins, alkaloids and
Alliins which prevent the increase of the
cyclooxygenase enzyme to inhibit the release of the
hormone prostaglandin. This hormone is a mediator
that must be lost in order to decrease the temperature
(Willyanto JR, Hamid IS and Widodo, 2018).
This is in line with the research of Pareek S et al
(2018) that red onion have kaemferol, quersitin,
floroglusin which are derivatives of flavonoids and
can be used to reduce fever in children. (Cueva SM,
2015). Big red onions are more effective in lowering
temperature faster. Rachmad's study (2012) states
that extracted onions will reduce the benefits to
reduce temperature (Rachmad, Suryani S , dan
Gareso P.L, 2012). Research conducted by Riyady et
al also stated that there was a difference in body
temperature after being given an onion compress
with a mean difference of 1.09 (PR Riyady et al,
2016). Cahyaningrum (2017) said an onion
compress was effective in reducing fever in children
by 1.94% (Cahyaningrum, Etika, 2017).
Combination of Red Onion Compress with Virgin Coconut Oil to Reduce Children’s Fever
461

Figure1: Flowchart of progress though the trial.
Figure2: Procedure of onion compress with VCO.
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
462

Table 1: Frequency distribution of the characteristics of respondents based on age and gender (n=30).
Variable Experiment Group Control Group p-value
N % N %
Body
Temperature (°C)
37.6
37.7
37.8
37.9
38
38.1
38.2
38.3
38.4
Total
2
3
1
1
4
1
1
1
1
15
13.3
20.0
6.7
6.7
26.7
6.7
6.7
6.7
6.7
100
3
1
4
1
3
1
1
1
1
100
20
6.7
26.7
6.7
20
6.7
6.7
6.7
6.7
100
0.74
Gender
Female
Male
Total
9
6
15
60
40
100
11
4
15
73.33
26.66
100
0.43
Age (months)
25
26
27
28
30
31
32
34
Total
2
3
2
3
2
1
1
1
15
13.3
20
13.3
20
13.3
6.7
6.7
6.7
100
1
2
3
3
1
1
3
1
15
6.7
13.3
20
20
6.7
6.7
20
6.7
100
0.74
Table 2: Differences in Body Temperature before and after given Intervention Onion Compress and Warm Compres.
Respon
dents
Before Time of Measurement
T5 T10 T15
Intervensi Control Intervensi Control Intervensi Control Intervensi Control
S.1 37.8
37.7
37.5
37.6
37.3
37.4
36.7
37.3
S.2 37.6
37.9
37.4
37.8
37.0
37.7
36.6
37.5
S.3 37.9
38.2
37.8
38.0
37.7
37.9
36.8
37.8
S.4 38.0
38.4
37.8
38.4
37.7
38.1
36.9
38.0
S.5 38.3
37.6
37.9
37.5
37.5
37.3
36.8
37.0
S.6 38.0
37.8
37.7
37.6
37.4
37.5
36.8
37.2
S.7 38.0
38.0
37.6
37.8
37.2
37.7
36.4
37.3
S.8 37.7
37.6
37.3
37.3
37.0
37.2
36.7
36.9
S.9 37.6
37.8
37.4
37.5
37.0
37.3
36.6
37.0
S.10 38.2
37.8
37.7
37.7
37.3
37.4
36.7
36,8
S.11 38.4
37.6
37.9
37.5
37.6
37.3
36.8
37.2
S.12 38.1
37.8
37.8
37.5
37.4
37.3
36.9
37.0
S.13 37.7
38.0
37.6
37.7
37.5
37.6
37.2
37.3
S.14 37.7
38.0
37.5
37.8
37.2
37.7
36.6
36,9
S.15 38.0
38.1
37.6
37.9
37.3
37.6
36.8
37.4
Combination of Red Onion Compress with Virgin Coconut Oil to Reduce Children’s Fever
463

Red onion compress can reduce body
temperature due to onion contains Allylcysteine
sulfoxide (Aliin) compounds which are volatile and
produce heat when crushed and produce Aliin
compounds within 10-60 seconds (Pareek S et al,
2018). These compounds are useful for decreasing
temperature. useful for removing allin compounds.
So that the heat released by onions does not
disappear too quickly, it is recommended to add oil
(Henagan et al, 2015).
The skin is an area of the body surface that has
many blood vessels, especially the hands, feet, and
ears. Blood flow through the skin will reach 30% of
the blood that will be pumped to the heart (Chetak
KB, Gowri PS and Ravi MD, 2017). Transfer of heat
through the walls of blood vessels to the surface of
the skin and into the environment resulting in a
decrease in body temperature. In principle, red onion
compresses are more effective in lowering a child's
body temperature than warm compresses because
red onion compresses are given throughout the body
which will accelerate the vasodilation of perifier
blood vessels throughout the body so that heat
evaporation from the skin to the surrounding
environment will be faster than administration of
warm compresses that rely on the hypothalamus
(Lim et al, 2018). The difference body surface with
onion compress that come in contact with peripheral
blood vessels vessels from the febrile body
temperature of children before and after given onion
compresses with an average increase of 0.94 with a
value of p = 0,000.
This research states that there is a difference in
body temperature before and after this intervention
with a significance value of p = 0,000. Red onion
compress given with virgin coconut oil reduces the
body temperature of children who have a fever by
3.11% and warm water compresses by 1.54%.
Upadhyay RK's research (2016) states that the
content of red onions in the form of Allium will
inhibit genotoxins thereby reducing the entry of
pyrogens into the body (Upadhyay, 2016). Red
onion /red onion contain flavonoid compounds,
saponins, alkaloids and Alliins which prevent the
increase of the cyclooxygenase enzyme to inhibit the
release of the hormone prostaglandin. This hormone
is a mediator that must be lost in order to decrease
the
 temperature (Willyanto JR, Hamid IS, and
Widodo, 2018).
This is in line with the research of Pareek S et al
(2018) that red onion have kaemferol, quersitin,
floroglusin which are derivatives of flavonoids and
can be used to reduce fever in children (Cueva SM
et al, 2015). Big red onions are more effective in
lowering temperature faster. Rachmad's study (2012)
states that extracted onions will reduce the benefits
to reduce temperature (Rachmad, Suryani S , dan
Gareso P.L,2012). Research conducted by Riyady et
al also stated that there was a difference in body
temperature after being given an onion compress
with a mean difference of 1.09 (Riyady PR et al,
2016). Cahyaningrum (2017) said an onion
compress was effective in reducing fever in children
by 1.94% (Cahyaningrum and Etika Dewi, 2017).
The result of independent t-test as shown in the
table 4 shows that there were no sognificant
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=0.03), 15 minutes
(p=0.00) There was a difference in body
temperature between the two groups.
Table 3: Differences in body temperature before and after given intervention in the experiment and control group using
paired t-test.
Time of Measurement Mean Paired Differences P-value
Onion Compress Warm Compress Onion Compress Warm Compress
Before and After 5 minutes 0.313 0.180 0.000 0.000
Before and After 10
minutes
0.600 0.353 0.000 0.000
Before and After 15
minutes
1.180 0.585 0.000 0.000
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
464

Table 4: Diffrences in body temperature before and after given intervention in the experiment and control group using
unpaired t-test.
Time of Measurement Mean,±SD p-value
Onion Compress Warm Compress
Pretest 0.24±37.93 0.23±37.88 0.6
Posttest ( 5 minutes) 0.18±37.62 0.26±37.7 0.3
Posttest ( 10 minutes) 0.23±37.33 0.25±37.53 0.03*
Posttest (15 minutes) 0.18±36.75 0.3±37.3 0.00*
The literature study of Henagen et al the use of
red onion as a traditional treatment contains
flavonoids which have antipyretic effects. At the
time of fever, prostaglandin hormone levels will
increase so that the inflammatory process occurs in
the body resulting in an increase in body
temperature. The content of onions in the form of
flavonoids will inhibit the enzyme cyclooxygenase
which plays a role in the formation of arachidonic
acid into prostaglandins (Henagan et al, 2015).
Warm water compresses reduce body
temperature by 1.54%. In line with the Chetak KB
research (2018) that by giving compresses water
effectively provides a decrease in temperature if
added to the administration of antipyretics with a
mean difference of 0.017 (Chetak KB, 2017). Warm
water compress utilizes a high thermoregulation
system. Warm water compresses will send an
impulse to the hypothalamus that the surrounding
environment is in a state of heat. This results in the
hypothalamus responding so that it regulates body
temperature to be higher by means of the production
and conservation of body heat (Chetak KB, 2017).
Decreased temperature on compresses of red onion
due to the evaporation process of the body area by
compress. The heat produced by onion will give a
signal to the hypothalamus to stimulate the nerves
that are sensitive to heat experience vasodilation in
the size of blood vessels. This causes heat to escape
through the pores of the skin resulting in a decrease
in body temperature (Willyanto JR, 2018).
Salgado PO et al results revealed that of the 34
respondents given warm compresses there were 32
people who experienced a decrease in temperature
while 2 of them did not experience a decrease.
Warm compresses can reduce fever by sending
signals to the anterior hypotalamus so that the blood
vessels experience vasodilation (Salgado PO et al,
2015).
Wardiyah and Romayati's 2016 research
concluded that warm compresses and tepid sponges
for 15 minutes were effective at reducing body
temperature by 2.06% (Lim et al, 2018). Clinical
studies comparing the effectiveness of thermal
blankets using an air-cooling system with antipyretic
administration were able to reduce the body
temperature of adult patients experiencing fever due
to infection. However, studies with this design have
not been done by many other researchers (Chetak
KB, 2017).
Comparative studies using pharmacological
methods obtained that ibuprofen can reduce fever in
42 minutes while paracetamol 71 minutes (Narayan
K et al, 2017). The dose of ibuprofen is 10 mg / kg
every 6-8 hours. Paracetamol given intravenously
can quickly cross the nervous system when the 57th
minute is given. Fever will experience a rapid
decline in the first hour of administration in children
aged 6 months and 6 years (Cheelo M et al, 2015).
The average reduction in fever by 71 minutes. The
half-life of paracetamol elimination in neonates born
at term is between 2.5 and 4 hours, postdate 1 hour
longer than term (De Bont et al, 2015). In premature
neonates, the average elimination half-life is longer;
one study found 11 hours for neonates aged 28-32
weeks (for paracetamol given rectally) and 4-5 hours
in neonates aged 32-36 weeks (Kannabar, 2017).
4 CONCLUSION
There were significant effect of combination of red
onion with virgin coconut oil in reducing body
temperature in children with fever, and significant
differences in mean value of body temperature
Combination of Red Onion Compress with Virgin Coconut Oil to Reduce Children’s Fever
465

between red onion compress with virgin coconut oil
and warm water compress. It could be concluded
that combination red onion and virgin coconut oil
was effective than wrm water compress in
decreasing body temperature in children with fever.
Compress onion red is suggested for midwifes to
apply this intervention to reduce body temperature
significantly.
ACNKNOWLEDGEMENT
The researcher would like to thank all those who
helped during the research process and all staff of
the Lubuk Pakam Medistra Health Institute and
Karang Anyer Health Center, Sidodadi Ramunia
Village, Beringin Lubuk Pakam District.
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