ACUTE RESPIRATORY INFECTIONS

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ACUTE RESPIRATORY INFECTIONS

• VERONICA BAILEY
• KAREN BOATMAN

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Introduction

• Most young children worldwide have 4 to 8
  episodes of respiratory infections per year.
• Incidence of acute lower respiratory infections
  (pneumonia) is very high in developing countries.
• 4 million children die each year due to ARI

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ANATOMICAL CLASSIFICATION

• Upper Respiratory Tract Infections
• Pharyngitis
• Tonsillitis
• Sinusitis
• Otitis Media

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ANATOMICAL CLASSIFICATION

• Mid-respiratory Tract Syndromes
• laryngotracheobronchitis
• epiglottitis

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ANATOMICAL CLASSIFICATION

• Acute Lower Respiratory Tract Infections
• Bronchiolitis
• Pneumonia

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CLINICAL CLASSIFICATION

• No Pneumonia Cough or Cold
• Pneumonia
• Severe Pneumonia
• Very Severe Pneumonia

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RISK FACTORS

• Malnutrition
• Low birth weight
• Absence of breast feeding
• Vitamin A deficiency
• Indoor air pollution
• Low socioeconomic status
• Poor hygiene
• Missing EPI vaccinations

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ETIOLOGICAL AGENTS

• BACTERIA
• Streptococcus pneumoniea
• Haemophilus influenzae
• VIRUSES
• Measles
• Respiratory Syncytial Virus
• Influenza viruses

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MANAGEMENT OF ARI
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ISSUES FOR IMCI

• Individualized treatment guidelines per country
• Training and supervision of first level health
  workers
• Changing family behavior regarding care of the
  sick
• Availability and effectiveness of essential
  drugs
• Powell, J.,(1997), Improving Child Health IMCI
  the integrated approach, WHO, Geneva
• World Bank, Better health in Africa, Washington,
  D.C.

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LIMITATIONS OF IMCI

• Ineffective education of the mothers
• A limited education of first level health
  workers regarding drugs
• Procedure of waiting for patients to come to
  health facilities
• K Boatmans personal experience
• World Bank, Better health in Africa, Washington,
  D.C.

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ACTIVITIES FOR ARI CONTROL IN ONGOING MCH PROGRAMS

• IMCI expansion and emphasize breast-feeding and
  maternal nutrition
• Add vitamin A to EPIs
• Expand EDPs
• Powell, J.,(1997), Improving Child Health IMCI
  the integrated approach, WHO, Geneva

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Vitamin A and Child Mortality
Reduces infant mortality related to measles and
diarrhea WHO, (1997), Vitamin A Supplements,
Geneva
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RECENT DEVELOPMENTS

• Cochrane ARI Group
• Awareness of family and community behavior
• IMCI expansion
• WHO guide for using interventions at the
  community level
• Cochrane Collaboration Group on Acute respiratory
  infections
• Integrated Management of Childhood Illness (IMCI)
  by WHO

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CONTROVERSIES

• Drug donations
• Allowing community health workers to provide
  drugs
• Wehrwein, P. (summer 1999), Pharmaco
  Philanthropy, pp 32-39, Harvard Public Health
  Review, Harvard School of Public Health, Boston
• Pandora Case IH887 Fall 1999

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EMERGING CONCERNS

• Tobacco marketing change
• Hitchhiking microbes
• New viruses
• Drug resistance
• HIV infection as new risk
• Dumping of ineffective drugs