2. ACUTE RESPIRATORY ILLNESS(ARI) Most common Major cause of mortality and morbidity. Can affect anywhere from nose to alveoli. Can be classified into ALRI(Epiglottitis, laryngitis, laryngotrachietis, LTB, bronchitis, bronchiolitis, pneumonia) AURI(Common cold, pharyngitis,otitis media) In less developed countries measles and whooping cough are major cause of Respiratory tract infection.
3. PROBLEM STATEMENT ARI in young children is responsible for 3.9 million death world-wide. Bangladesh,India,Indonesia and Nepal together account for 40% of global mortality. 90% of ARI death is due to pneumonia. Most is bacterial in origin. Incidence of pneumonia in developed countries 3-4%, in developing countries 20-30%
4. ARI in below 5yrs child is responsible for 30-50% of hospital visit.. 20-40% of hospital admission. It is leading cause of deafness as result of otitis media.
6. Virus - Adenoviruses-endemic types(1,2,5),epidemic type (3,4,7) - Enterovirus (ECHO and Coxsackie) - Influenza A,B,C - Measles - RSV Others - Chlamydia type B - Coxiella burnetti - Mycoplasma pneumoniae
7. HOST FACTORS Small children are most vulnerable Fatality more common in young infants, malnourished children, elderly. In developing countries fatality more due to malnutrition and LBW. URTI is more common in children than adults. Illness rate more common in younger children and decreases with increasing age.
8. At third decade of life there is surge in infection due to cross infection from their children. Women are more affected due to their exposure to small children.
13. If possible preventionEducation of mother can be effective tool in reducing mortality and morbidity from ARI.
14. CLINICAL ASSESMENT - Access the child condition - Ask for: Age Duration of cough Is child able to drink (2mth-5yrs) Has child stopped feeding (<2mths) Had child suffered from any illness (e.g.: measles) Does child have fever Is child excessively drowsy Did child have convulsion Is there irregular breathing Short period of not breathing(apnea) Has child turned blue Any H/O T/t
18. CLASSIFICATION OF ILLNESS A. Child aged 2mths -5yrs 1. Very severe disease 2. Severe Pneumonia 3. Pneumonia 4. No Pneumonia- cough, cold
19. VERY SEVERE DISEASE SIGNS Not able to drink Convulsion Abnormally sleepy or difficult to wake Stridor in calm child Severe malnutrition CLASSIFY AS-VERY SEVERE DISEASE TREATMENT Refer urgently to hospital Give 1st dose of antibiotics T/t of fever if present T/t of wheezing if present If cerebral malaria give anti malarial
20. SEVERE PNEUMONIA SIGNS Childs RR(if exhausted child’s RR may not be raised) Chest indrawing plus wheezing OTHER SIGNS -Nasal flaring -Grunting (sound made with voice if difficulty in breathing) -Cyanosis CLASSIFY AS –SEVERE PNEUMONIA TREATMENT Refer urgently to hospital First dose of antibiotics T/t of fever T/t of wheezing
21. PNEUMONIA SIGNS Fast breathing Absence of chest indrawing CLASSIFY AS-PNEUMONIA TREATMENT Home care Antibiotics T/t of fever T/t of wheezing Advice for re-assessment after 2days or if condition of child worsen
22. NO PNEUMONIA Cough/cold If cough more than 30 days needs assessment Look for ENT problem Home care T/t for fever T/t for wheezing
31. B.2.IF NO IMPROVEMENT THEN FOR NEXT 48 HRS Change antibiotics If Ampicillin –Change to Chloramphenicol IM If Chloramphenicol-Change to Cloxacillin 25mg/kg/dose 6hrly with gentamycin 2.5mg/kg/dose 8hrly If condition improves continue t/t orally C. Provide symptomatic t/t for fever and wheezing D. Monitor fluid and food intake E. Advice mother on home management
32. VERY SEVERE DISEASE Should be treated in centre with respiratory support Chloramphenicol IM is drug of choice If condition improves Oral Chloramphenicol for 10 days If condition worsen Inj Cloxacillin plus inj gentamycin
