Professional Documents
Culture Documents
The beginnings
The most serious problem was that of high ARI mortality
in young children in developing countries, mostly
attributable to bacterial pneumonia.
Resp. rate
All of these studies suggested that
A single threshold of 50 was unsatisfactory as a sign of
pneumonia in children aged under 5 years.
The best combination of sensitivity (7882%) and
specificity (7389%) was achieved by using thresholds of
50 breaths per minute for children aged 211 mo
40 breaths per minute for 14 years
Resp. rate
WHO introduced the three age-related
definitions into the ARI protocol in order to
ensure the treatment of at least 80% of
children with pneumonia.
Resp. rate
The WHO definitions remained independent of
any other variable that might modify the
respiratory rate, such as the body temperature,
the nutrition status and the geographical altitude
Pneumonia - Recognition
Recognize pneumonia based on two simple
clinical end points:
fast breathing
lower chest wall indrawing
Severe Pneumonia
Lower Chest Wall Indrawing
multiple definitions of retractions
suprasternal retractions
intercostal retractions
xiphoid retractions
subcostal retractions
Amoxicillin
Least expensive
Expensive
Drug rashes
Diarrhea
Drug eruptions
BM suppression
Increasing resistance to S.
pneumoniae and H.influenza
S.pneumoniae
Antibiotics
Penicillin
Chloramphenicol
Inexpensive
PO, IV, IM
Widely available
H.influenza
meninges
SIGNS
No chest indrawing
No fast breathing
Respiratory rate
< 50/mt (2-12 months)
< 40/mt (12 mo - 5 yrs)
TREATMENT
If coughing > 30 days refer for
assessment
Assess and treat ear problem or
sore throat, if present
Assess other problems
Advise mother to give home care
Treat fever, if present
Treat wheezing, if present
SIGNS
No chest indrawing
No fast breathing
Respiratory rate
> 50/mt (2-12 months)
> 40/mt (12 mo - 5 yrs)
TREATMENT
Advise mother to give
home care
Give an antibiotic
Treat fever, if present
Treat wheezing, if present
(Return for reassessment after 2
days or earlier if the child is getting
worse)
PNEUMONIA
REASSESS in 2 days, a child who is
taking an antibiotic for pneumonia
TREATMENT
SIGNS
Chest Indrawing
If wheezing, go directly to
TREAT WHEEZING
SEVERE PNEUMONIA
REASSESS in 2 days, a child who is
taking an antibiotic for pneumonia
SAME
IMPROVING
SIGNS
SIGNS
SIGNS
THE SAME
Breathing slower
Less fever
Eating better
signs
Refer urgently to
hospital
Change antibiotic
or refer
Finish 5 days of
antibiotic
SIGNS
TREATMENT
Convulsions
Abnormally sleepy or
difficult to wake
Stridor in a calm child
Severe malnutrition
Improving
Change to oral drugs
Treat for 10 days
Not improving
Probable Staph pneumonia
Change to Clox + Genta
Supportive management
Oxygen
Central cyanosis
Child is not able to drink
Restlessness which improves on oxygen
Severe chest indrawing
Supportive management
Feeding
1. Breast mild should be given frequently to these
infants
2. If a baby is unable suckle at the breast expressed breast milk
3. Frequent small calorie rich food like dalia,
khichdi can be given
Supportive management
4.
5.
6.
7.
Supportive management
IV fluids
Cyanosis;
Excessive irritability;
Grunting
Unable to feed
Convulsions
Central cyanosis or
Not able to drink
ADMIT
Give oxygen
Give rapid-acting bronchodilators
Give an antibiotic chloramphenicol
Treat fever, if present
Supportive care
No respiratory distress +
Fast breathing
ADMIT
Give rapid-acting bronchodilators
Give an antibiotic benzylpenicillin
Treat fever, if present
Supportive care
No fast breathing
Treat at home
No antibiotics
Treat fever
Normal saline drops for nasal
block
No cough/cold remedies
Rule out ASOM, pneumonia
Sinusitis
Persistent purulent nasal
discharge
+
Sinus tenderness, facial
or
Periorbital swelling
or
Persistent fever
Cough
Sinusitis - treatment
Treat at home
Continue feeding
Antibiotics (cotrimoxazole, ampicillin or amoxycillin)
only if
suggestive of bacterial sinusitis
sinus tenderness
facial or periorbital swelling
persistent fever
Treat at home
Treat fever
Keep ear dry
Start antibiotics - cotrimoxazole, ampicillin or
Amoxycillin
Reassess after 5 days.
If pain, fever, pus discharge are present, antibiotics
are continued for another 5 days.
Refer if no response after 10 days
Mastoiditis
Painful swelling behind the ear
Or
Above the ear in infants
Admit
Start antibiotics
-chloramphenicol x 10 days
If the child has signs of brain
involvement refer for
neurosurgical evaluation
Pharyngitis
Fever
Throat ache
Treat at home
Treat fever
Antibiotics only if
streptococcal pharyngitis
suspected
Tender enlarged cervical
lymphnodes
White pharyngeal exudates
Absence of signs
suggestive of viral infection
Pharyngitis
Give benzyl penicillin single dose
0.6 lakhs in children < 5 yrs.
1.2 lakhs in children > 5 yrs of age
Or
Ampicillin.
Amoxycillin
Penicillin V
Not cotrimoxazole.
Acute epiglottitis
Fever
Drooling of saliva
Stridor
Admit
Antibiotics - chloramphenicol
Watch for signs of obstruction
Severe chest indrawing
Restlessness
Cyanosis
Objectives
The National ARI Control Programme aims at:
1.
Objectives
2.
Objectives
3. Prevention of measles, pertussis, diphtheria
and tuberculosis with effective immunization.
Programme implementation
ARI Control Programme is monitored by Ministry of Health
and Family Welfare with Joint Secretary (MCH) and
Dy.Commissioner (MCH) in the Ministry Head Quarters.
Programme implementation
The flag bearer of the programme in the community is the
health/anganwadi worker.
The implementation of the programme has been integrated
with the Child Survival and Safe Motherhood (CSSM)
programme after 1992.
Operational research is still underway to evaluate the actual
implementation and impact of the programme in the Indian
setting.