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Acute Respiratory InfectionsSUDDEN ONSET OF AN INFECTION OF ANY PART OF RESPIRATORY SYSTEM RIGHT FROM NOSE TO ALVEOLI INCLUDING PAR NASAL SINUSES, MIDDLE EAR AND PLEURAL CAVITY IS DEFINED AS ARI

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3Continued

Common among under-five

Infants being hit hardest

50 times more contributing among infants morbidity and mortality in developing countries as compared with developed ones

Due to increased prevalence of low birth weight, malnutrition and indoor pollution

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4Magnitude of the problem

20% of infants in developing countries fail to survive their fifth birth day

30% child mortality is attributable to ARI

In India, about 2million deaths among under-fives every year

ARI constitutes 40% of total peadiatric OPD and 20% of hospital admissions

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5Continued

About 25% of ARI case can be managed at home by mothers

50% can be managed by trained Health Workers

So the timely intervention, correct treatment and referral services can save many lives

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6Classification of ARI

Etiological Classification

Viral : Adenovirus, Corona virus, Rhino virus, Influenza-V,Respiratory Synd. V. etc

Bacterial: streptococcus pneumoniae, Hem-influenzae

Fungal

parasitic

Allergic

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7Anatomical classification

First Group: Rhinitis,Coryza, Sinusitis,Ottitis media,Pharyngitis,Tonsillitis,Quinsy

Second Group: Epiglottitis, Laryngitis,Tracheitis,Bronchitis, Brochiolitis, Pneumonia, Pleurisy

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8WHO Classification

Acute Upper Respiratory infections(AURI) includes anatomical first group

Acute Lower Respiratory infections (ALRI) includes anatomical second group

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9Etiology

Invasion by one pathogen or variety of pathogens such as;

Viruses, Bacteria, Fungi, Parasites, Allergens

Simultaneously or primary infection leading to secondary infection

Usually Viruses cause mild URI and Bacteria cause severe LRI

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10Host Factors

Age : ARI is very common among under-five children, infants being hit hardest in developing countries

Sex: incidence is more among male children than among female children

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11Risk factors related to host are:

Low Birth Weight

Failure of Breast feeding

Under nutrition

Lack of primary immunization

Yong infant age

Vitamin A deficiency

Antecedent viral infection

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12Environmental factors

Air pollution following industrialization and urbanization predisposes people for ARI

Smoking both , active and passive predisposes for ARI

Season ; winter because of indoor living and over crowding

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13Social factors

Poverty

Illiteracy,

Ignorance,

Lack of personal hygiene

Overcrowding ,

Lack of sanitation

Poor living standard

Non-utilization of health services

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14Epidemicity of the disease

Most ARI are endemic

However some ARI such as Measles, Pertusis ,Influenza have the potentiality of occurring in epidemics, when the case fatality will be very high

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15Mode of transmission

Droplet infection

Epidemics occur through air borne route,i.e. by droplet nuclei

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16Neonatal pneumonia

Deserves special mention because;

it is highly fatal

Differs from pneumonia of older infants and children in etiology, mode of transmission and non specific features

Causative organisms isolated are; E.Coli, Streptoagalactiae (groupB) Pseudomonas,Klebsiella-pneumoniae, staph aureus

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17Mode of infection

New born may get infection :

Either transplacentally from mother during fetal life

By aspiration of amniotic fluid during birth

By droplet infection after birth

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18Clinical features of NP

Signs of toxemia

Respiratory distress(tachycardia ,tachypnea and hepatomegaly)

Neonatal pneumonia is very common among low birth weight babies because of their poor respiratory mechanism

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19Prevention & control of ARI

Measures can be taken at 1st three levels of prevention , namely health promotion, specific protection and early diagnosis and treatment

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20Health promotion

Efficient ante-natal care to reduce the incidence of LBW

Essential care of new born and special care of LBW newborn

Promotion of exclusive breast feeding for six months

Promotion of adequate nutrition for growing children

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21Continued

Improvement of living conditions (housing & sanitation)

Reduction of parental smoking & smoke pollution indoors

Limiting the size of the family to prevent over crowding

Health education of the mothers about correct ARI case management at home

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22ARI Case Management by mothers at home

To increase feeding & to keep the child warm

To clear the nose by instillation of breast milk, if runny nose interferes with feeding

To relieve cough with home made decoctations like tea, ginger ,lime juice etc.

To recognize danger signs like fast breathing and difficult breathing(chest indrawing)

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23Specific protection

Strengthening the existing routine primary immunization

Oral Vitamin A concentrate, 5mega doses, for children between 9 month to 3 years

Other vaccines which can be given are pneumococcal Vaccine and Hemophillus-B influenzae Vaccine

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24Early Diagnosis & prompt treatment

ARI can be classified as :

Mild

Moderate

Severe

Very severe

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25Mild ARI (no pneumonia)

Characterized by;

No fast breathing

No chest in drawing

Cough, cold , sore throat , ottitis media

With or without fever

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26Moderate ARI(Pneumonia)

Fast breathing

No chest in drawing

Cough with or without fever

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27Severe ARI (Severe Pneumonia)

Fast breathing

Chest in drawing

Flaring of alae-nasi

Grunting

Cyanosis

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28Very severe ARI(V S Pneumonia)

Fast breathing

Chest in drawing

Cyanosis

Cough with fever

Danger signs: inability to drink, convulsions, abnormally sleepy, stridor and severe malnutrition

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29Management of ARI

Mild cases can be treated at home by the home remedies like , ginger, tea and lime juice

Moderate cases need antibiotics and can be treated as out patients

Severe cases need immediate hospitalization

Very severe cases need admission in ICU

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30Fast breathing

60 per minute or more in a child below 2 months of age

50 per minute or more in a child between 2 to 12 months of age

40per minute or more in a child between 1 to 5 years of age

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