ARI PART lec12.pdf

Primary Health Care / LEC 12 Assist professor / Muna Abdul Kadhum Acute Respiratory Infection In Children Under five years (ARI) Definition :- ARI include any infection which occurs in any site of respiratory tract from the nose and ear t...

Primary Health Care / LEC 12 Assist professor / Muna Abdul Kadhum Acute Respiratory Infection In Children Under five years (ARI) Definition :- ARI include any infection which occurs in any site of respiratory tract from the nose and ear to the lung, and it may be manifested as different groups of signs and symptoms as fever, catarrh, cough, dyspnea, sore throat and nose ----etc. It causes a large group of diseases that can be caused by a large number of bacterial and viral pathogen, and they affect any site of respiratory tract and can be classified according to the site of infection, types of pathogens or manifestation. Classification:- A- according to site of infection: 1/ Upper respiratory tract infection: - common cold (coryza). - pharyngitis & tonsillitis. - otitis media. 2/Acute lower respiratory tract infection: These which affect the larynx, trachea, bronchi, bronchioles & lungs, they include: - Croup which causes stridor (epiglottitis). - Laryngitis. - Bronchitis. - Bronchiolitis. - Pneumonia. Measles, whooping cough and diphtheria can be considered as acute respiratory infections. Upper acute respiratory tract infections are more common and less dangerous, while acute lower respiratory tract infections are less common and more dangerous. Primary Health Care / LEC 12 Assist professor / Muna Abdul Kadhum B- According to pathogenic agent:- 1- Viruses:- Can be considered the causative agent for most respiratory infections especially in their first stages. 2- Bacteria:- Which play lesser role as causative agent for respiratory infections in developed countries, but they play important role as causative agent for severe lower respiratory infections in developing countries. 3- Other rare pathogens :- Gram –ve enteric bacteria (E. coli klebsiella, salmonella). Group A streptococcus, staphylococcus aureus, Chlamydia trachomatis. C- According to clinical manifestation:- It may be difficult to distinguish the site of infection because the possibility of infection more than one site simultaneously, or its causative agent due to multiplicity of causative agents, for this reason WHO has undertaken simplified classification which serves too much in clinical management which is dependent upon the signs and symptoms as a base for classification as such:- 1- The child who is affected with cough and shortness of breath. 2- The child who is affected with ear problem. 3- The child who is affected with pharyngitis. Size of problem:- International:- ARI in children was considered as international problem with economic and health importance as indicated in the followings:- Primary Health Care / LEC 12 Assist professor / Muna Abdul Kadhum 1- Mortality:- - It causes the death of 3-4 millions children annually, and this forms about 20-30% of the total number of deaths in children under 5 years of age which amounting to 15 million deaths. - 95% of these deaths occur in developing countries. - ⅔ of these deaths occur in infants (less than one year of age) especially in those less than 2 months of age. 2- Morbidity:- ARI was considered from the diseases which are most common health problem all over the world, it was estimated that each child under 5 years of age was exposed to 4-6 episodes of ARI annually. 3- The usage of health establishment :- ARI cases cause burden on the health establishments it causes 30-50% of outpatient visits, and about 10-30% of inpatient cases in hospitals. 4- Drugs consumption:- ARI cases were considered the most important causes for the use of antibiotics and other drugs in developing countries. Locally:- The size of problem in IRAQ can be laconized in the following data:- - ARI cases cause 22% of total number of deaths of children under 5 years of age - 80% of these deaths occur in infants below 1 year of age especially those below 2 months of age. - ARI cases lead to about 36% of outpatient visit and about 35% of inpatient cases in hospitals. -ARI cases were considered most important causes for antibiotics and other drugs consumption. Risk factors for ARI:- 1- Low birth weight:- Death due to pneumonia will be 3-8 times more in low birth weight babies. Primary Health Care / LEC 12 Assist professor / Muna Abdul Kadhum 2- malnutrition:- Which increases the incidence rate of pneumonia in children. 3- Artificial feeding:- Which increases the incidence rate of pneumonia more than 5 times and on the mortality rate as a result more than 3.6 times. 4- Vit. A deficiency:- Which increases the incidence rate of pneumonia vit. A has important effects in mucus secreting epithelia, in the respiratory tract. 5- Over-crowding:- Which facilitates the infection, thus increases the infection rate and the direct relationship between the overcrowding and mortality rate due to ARI cases. 6- Smoke & Air pollution:- Air pollution inside houses especially that due to smoking of the family individuals or due to smoke after combustion. 7- Exposure to coldness:- Especially in those below 2 months of age. 8- Non- immunized against measles, diphtheria and whooping cough. 9- The age of patient, the low age group, the more occurrence of ARI cases. Safe clinical management:- The symptoms of ARI cases can be summarized as such:- - The child with cough or shortness of breath. - The child with ear problem. -The child with pharyngitis. Clinical management includes:- 1- Assessment of child's condition. 2- Classification of the disease. 3- Treatment of the condition. The above (three ) steps in the management of a child with ARI are illustrated in the appendix. Primary Health Care / LEC 12 Assist professor / Muna Abdul Kadhum The most common micro-organisms which cause pneumonia in children in developing countries are Streptococcus Pneumonia and Haemophylus influenza, and accordingly the choice of antibiotics will be decided. The countries which have applied the clinical management of ARI cases (classification of cases, right use of drugs and antibiotics, right referral of cases to hospital, mother's advocacy to take their roles in the control of ARI cases) have accomplished the following results:- 1- Reduction of mortality rate in children which is due to ARI cases in a ratio ranging between 25% to 67% from its rate before the application of ARI programme. 2- Decrease of referral rate for children who are affected with ARI cases to the hospitals from 14% to 2.1%. 3- Decrease of rate of use of the antibiotics for ARI cases from 59.9% to 8.6%. 4- Saving money due to:- a- use of antibiotics with low prices and efficacious depending on the ARI programme. b- low use of unnecessary laboratory & radiological investigations. Education of mothers about the control of ARI :- - Household care for child with ARI has fundamental role in management. - Mother's advocacy (cooperation) is essential. The role of mothers can be summarized by:- 1- Recognition of important and dangerous signs especially the signs of pneumonia, so that the child can be transferred to the health center for appropriate management. Primary Health Care / LEC 12 Assist professor / Muna Abdul Kadhum 2- Provision of home care for ARI cases which leads to rapid recovery and prevention complication. 3- Avoidance the risk factors which increase the opportunities for ARI cases. 4- The appropriate use of antibiotics and other drugs according to the medical instructions.