Date post: | 27-May-2015 |
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ARI CONTROL AND PREVENTION NIKITA JOHANNA SOANS 32
ARI control
Improving the primary medical care services and developing better methods for early detection , treatment and prevention of acute respiratory infection is the best way to control ARI
mortality rate due to pneumonia is reduced if treated correctly
Education of mothers about pneumonia because compliance with treatment and seeking proper care when child suffers determine outcome of the disease
WHO recommendation for management of ARI
Clinical assesment History taking and management are very
important Note :1)age 2)feeding habits 3)fever 4)convulsions 5)irregular breathing 6)history of treatment during the illness 7)activity
Physical examination1:count the breaths in one minute Breathing count depends on the age of the child Count respiratory rate for a minute Fast breathing is present when RR is -60 breaths /min or more in a child less than two
months of age -50/min or more in child aged 2months upto 12
months-40 breaths/min or more in a child aged 12 months
upto 5 years
Chest indrawing Look for chest indrawing when child breaths IN Child has indrawing if the lower chest wall goes
in when the child breaths IN Occurs when the effort required to breath in ,is
much greater than normal
Stridor Harsh noise while breathing IN is stridor Occurs due to narrowing of
trachea ,larynx or epiglottis These conditions often called croup
Wheeze A child with wheeze makes a soft whistling
noise
OR shows signs that breathing OUT is difficult This is due to narrowing of the air passages
Fever Check for body temperature
Cyanosis Sign of hypoxia
Malnutrition
If malnutrition is present its high risk and case fatality rates are higher
In severely malnourished:1) children with pneumonia, fast
breathing and chest indrawing may not be evident
2)Impaired or absent response to hypoxia and a weak or absent cough
reflex3)Careful evaluation and mangement
ARI control programmes
ARI control in children• ARI is an episode of acute symptoms & signs
resulting from infection of any part of respiratory tract & related structures
• Constitutes 22-66% of outpatients & 12-45% of inpatients
• In India: 10-50 children die per 10,000 episodes of ARI
ARI control programmes
• Crux of the program is to identify children with ARI at the community level by training the field workers to recognize easily & reliably identifiable clinical signs of ARI & early reference
WHO protocol comprises 3 steps:1. Case finding & Assessment2. Case Classification3. Institution of appropriate therapy
Step 1: Case finding & Assessment
• Cough & difficult breathing in children < 5 years age
• Fever is not an efficient criteria
Step 2: Case Classification
• Children grouped into 2: Infants < 2months & Older children
• Specific signs to be looked: In younger children like feeding difficulty, lethargy, hypothermia, convulsions
In infants < 2 months
• Pneumonia is diagnosed if RR 60/min with other clinical signs
• All should be hospitalized• All should receive IV medications• Minimum duration of 10 days• Combination of Ampicillin & Gentamicin
step 3:Institution of appropriate therapy
Antibiotics
Prevention of ARI Breastfeeding infants exclusively (no
other food or drinks, not even water) for the first six months breast milk has excellent nutritional value and it contains the mother’s antibodies which help to protect the infant from infection.
Avoiding irritation of the respiratory tract by indoor air pollution, such as smoke from cooking fires; avoid the use of dried cow dung as fuel for indoor fires.
Immunization of all children with the routine Expanded Programme on Immunization
Feeding children with adequate amounts of varied and nutritious food to keep their immune system strong.
control the spread of respiratory bacteria by educating parents to avoid contact as much as possible between their children and patients who have ARIs.
people with ARIs should cough or sneeze away from others, hold a cloth to the nose and mouth to catch the airborne droplets when coughing or sneezing
Immunization also increases control, by reducing the reservoir of infection in the community and increasing the level of herd immunity
immunization
measles vaccine
Pneumonia is a serious complication of measles
Reducing the incidence of measles helps reduce death from pneumonia
Live attenuated vaccine Freeze dried product 0.5ml dose subcutaneously also effective
intramuscularly Schedule :9 th month
HIB vaccine
Haemophilus influenza B most important cause of death due to meningitis and pneumonia in developing countries
Available for more than a decade Expensive Included in the IAP immunization schedule combined preparation with DPT and poliomyelitis Three or four doses are given dependin on type of
vaccine Schedule : 6 ,10, 14 weeks booster dose 12-18
months Vaccine is not offered to children more than 24
months
Pneumococcal vaccine A)ppv23: polysaccharide non
conjugate vaccine containing capsular antigen of 23 serotypes against this infection
Children under two years and immunocompromised do not respond well to this vaccine
Select groups –sickle cell disease ,chronic heart disease , DM, organ transplants etc
Dose -0.5ml Administration –
intramuscular in the deltoid
Pcv-7: pneumococcal conjugate vaccine New vaccine suitable for infants and toddlers It is included in the IAP immunization
schedule Induces a t- cell dependent immune
response Prevents pneumococcal pneumonia and
meningitis moderately effective against otitis media
dose- 1)6,10,14 weeks ,booster after 12 months
OR 2)2, 4,6 months and booster after 12 months administration-intramuscular
thank you