Acute respiratory infections (ARI)
Instructional Objectives: At the end of the lecture the student would be able to: 1-Define ARI in children. 2-Point out the occurrence of the disease. 3-Define the methods of risk assessment. 4-List the management plan according to age and the result of clinical evaluation.ARI (Acute Respiratory Infections) Acute infections of Ear lasting <14 days &/or Nose ,Epiglottis, Larynx, Trachea, Bronchi, bronchioles ,&/or Lungs with cough lasting <30 days.
Control of acute respiratory infections (ARI) program . ARI is a world wide problem &is the third child killer after diarrhea &Malnutrition. ARI forms the main cause of mortality &morbidity among children in developing countries & contribute to 30-60% of all attendance to outpatient departments of child health facilities
70% of which are upper R.T.I The incidence of pneumonia is 3-4%in children <5 years in developing countries. The majority of ARI are mild &can be treated at home without antibiotics
The most important objective of ARI program is to be able to identify the serious cases . Common causes: viruses followed by bacteria
Standard case management : Assessment ,classification &management I Assessment : Ask: How old is the child ? 2 months-5years :is he able to drink? <2 months :has the child stopped B.F. well Is he coughing ? Duration ? (<30 days :acute ,>30 days chronic) Does the child have fever? duration? Did the child have convulsion during the current illness?
Look &listen :(calm child)Count: Respiratory rate /minute Tachypnea is considered a danger sign if:Age RR/minute<2months 60+2- <12 months 50+>=12 – 5 years 40+Chest indrawing:During child breathing look for the indrawing in the lower chest wallStridor: it indicates URT obstructionWheeze: it indicates LRT obstruction
Look: The child is abnormally sleepy or drawsy sings of Malnutrition Measure the Temp. Fever (38c) or low body temperature (35.5c)
Management related classification: Cough or cold (no pneumonia ) Cough No fast breathing No chest indrawing Pneumonia Cough Fast breathing No chest indrawing
Sever pneumonia Cough Fast breathing Chest indrawing Very sever disease Danger signs are: Convulsion Sleepy child Stopped feeding well Not able to drink Stridor Under nutrition
Group(1): 2 months-5 years
Very sever disease : Refer urgently hospital Give 1st dose of antibiotic Treat wheezing if present If cerebral malaria is suspected give antimalarial Sever pneumonia: Refer urgently hospital Give first dose of antibiotics Treat fever if present Treat wheezing if presentPneumonia : Advice mothers to give home care Give an antibiotics Treat fever if present Treat wheezing if present Advise mother to return with child in 2 days for reassessment ,or earlier if child get worsen
No pneumonia (cough or cold) If coughing more than 30 days refer for assessment Assess &treat ear problems & or sore throat Advice mother to give home care Treat fever &wheezing
Reassess in 2 days a child who is taking an antibiotics for pneumonia : If he gets worse: Not able to drink, has chest indrawing, has other dangerous signs (Refer urgently to hospital) If he remains the same: Change the antibiotics or refer If he improves: Breathing slower, no fever, Eating better (Finish the 5 days of antibiotics)
Group (2): age <2 months
Very sever disease: Stopped feeding well Convulsion Sleepy or difficult to wake Stridor Wheezing Fever or low body temperature Refer urgently to hospital Keep infant warm Give first dose of antibioticSever pneumonia: Severe chest indrawing or Fast breathing Refer urgently Keep infant warm Give first dose of antibiotic If referral is not feasible ,treat with antibiotic &follow closely
no pneumonia (cough or cold): No chest indrawing, No fast breathing Advice on home care: Keep infant warm Breast feeding frequently Clean nose if interferes with feeding Give extra fluid & sooth throat & relieve cough with a safe remedy
Advice the parents to return quickly if: Breathing becomes difficult Breathing becomes fast feeding becomes a problem The young infant becomes sicker The child is not able to drink (This child may have Pneumonia)
Antibiotics which can be used: Cotrimoxazol, Amoxicillin, Ampicillin, procaine penicillin. Antipyretic for fever: use Paracetamol Wheezing is treated with nebulized B agonists or oral salbutamol in mild cases