The document outlines policies and guidelines for managing acute respiratory infections (ARI) in children, emphasizing their prevalence, causes, classification, and management strategies in Malawi. It highlights the importance of comprehensive approaches, including integrated management of childhood illnesses, vaccination, and community-based care to reduce morbidity and mortality rates associated with ARI. Nurses play a crucial role in identifying and managing ARI, along with educating communities about prevention and care strategies.

1. Policies And Guidelines For
Acute Respiratory Infections In
Children
By V. Khonje
Presented to Nursing and Midwifery students 2023 cohort

2. Learning outcomes
• Define ARI
• Understand the global and local prevalence of ARI
• Know the principles for managing ARI
• Apply the preventive measurers for ARI
• Understand the role of nurses in ARI management and control

3. PRESENTATION OUTLINE
• Introduction
• Prevalence of ARI
• Causes of ARI
• Classification of ARI
• Strategies in the management of ARI
• Prevention of ARI
• Complications
• Conclusion

4. Introduction
• Acute respiratory infections (ARI) are infections that affect the upper
and lower respiratory tract.
• They can be mild , moderate and severe
• Most ARI are mild, self limiting viral infections
• Mortality rates due to ARI are high in Malawi hence the need to have
guidelines that will help reduce incidences of morbidity and mortality
• The policies and guidelines for ARI in Malawi are based on WHO
guidelines

5. Introduction- ct/d
• The guidelines provide an overview on handling of these infections
• The Malawi ARI guidelines includes COVID-19 management
• The ARI guidelines are also incorporated in the Integrated
Management of Childhood Illnesses (IMCI) guidelines
• The guidelines focus on 5 key areas on management of ARI problems

6. PREVALENCE AND INCIDENCE OF ARI
• ARI is emerging as one of the leading causes of morbidity and mortality in
developing countries
• ARI affects approximately 32.6% of children under the age of 5 years (MOH, 2020).
• Of the 12 million death occurring annually under 5 years of age, ARI constitutes
19% of these deaths
• 20 to 25% 0f ARI deaths occur in children less than 2months
• 50 to 60% occur in those under 1 year
• Nearly 25 % of outpatients visits and 15% of all hospital admissions are due ARI

7. PREVALENCE AND INCIDENCE OF ARI
• Pneumonia accounts for 5.4% of all illnesses
• A study done in Mangochi on prevealnce of ARI showed that the
annual prevalence of ARI was at 32.6% and risk factors included
malnutrition, increased household density and sibling with ARI (Cox.
et.al 2017)

8. Causes of ARI
• Bacterial pathogens- accounts for 60% of all ARI. Common ones be
Streptococcus pneumonia
Haemophilus influenzae
• Viruses
• Candida

9. Classification of ARI
• Classified according to location and severity
1. Upper respiratory tract infections (URTIs)
• Common cold: Runny nose, congestion, cough, sore throat
• Pharyngitis: sore throat, fever, swollen tonsils
• Laryngitis: hoarseness, cough, sore throat
• Sinusitis: facial pain, nasal congestion, headache2.

10. Classification of ARI
2. Lower respiratory tract infections ( LRTIs)
• Pneumonia: cough, fever, chest pain, difficulty breathing
• Bronchiolitis: in children less than 2 years, - wheezing, cough,
difficulty breathing, apnea in severe cases
• Asthma: wheezing, cough, chest tightness, shortness of breath

11. Strategies in management of ARI
• The Malawi ARI control program has been established to work
towards management of ARI
• It’s main strategies include:
• 1. Integrated Management of childhood illnesses (IMCI)-
This is the comprehensive approach to managing childhood illnesses
including ARI
Training healthcare workers on IMCI

12. Strategies in management of ARI ct/d
2. ARI Management guidelines -covers
How to conduct assessment
Classification of the ARI
Treatment and referral criteria
3. Antibiotic therapy -
Antibiotics are reserved for severe ARI
The guidelines stipulates which antibiotic or antimicrobials to be used
for a particular illness
 e.g use of cotrimoxazole as first line drug in pneumonia treatment

13. Strategies in management of ARI ct/d
4. Oxygen therapy-
providing oxygen for children with severe ARI and hypoxemia
 Ensuring availability of oxygen concentrators and cylinders in health
facilities
5. Fluid Management-
oral rehydration therapy for mild ,moderate
intravenous fluids for severe dehydration and those unable to drink

14. Strategies in management of ARI ct/d
6. Vaccination –
 vaccines for preventable ARI e.g Pneumoccocal conjugate vaccine
(PCV).
7. Community based care
Community healthcare workers (CHWs) are trained to identify,
manage ARI cases
Provide support education and support to caregivers

15. Strategies in management of ARI ct/d
8. Referral Criteria

16. Case management of ARI
• Assess the child
• Classify the illness
• Decision for treatment
• Follow up cases

17. ASSESS
Age of child History for danger
signs
Age 2 months to 5
years
Is the child able to
drink?
Age less than 2 months Has the child stopped
feeding well
For how long
Has the child
convulsed
Has she had fever
Vomiting/ diarrhoea
Look , listen and feel chest in drawing
Listen to stridor/
wheezes
Abnormal respiratory
rate vs age of child
Check if child is
abnormally sleepy or
difficult to wake up
Less than 2 months-
more than 60 b/min
Count the breaths per
minute
2- 12 months- 50 breaths
or more
Feel for fever or low body
temperature
12months – 5 years-40 or
more breaths
Look for severe
malnutrition

18. CLASSIFY and Manage
• Based on the clinical
manifestation conditions are
classified as
• Mild
• Moderate
• Severe
• Management
• Home care for mild illness
• Hospitalization for moderate and
severe cases
• Antimicrobial therapy – oral or
intravenous based on child condition
• Fluid management
• Oxygen therapy
• Manage fever
• Follow up care

19. Home care
• Mother or caregiver should
• Keep baby/child warm
• Continue b/feeding
• Increase feeding as recovery
occurs
• Teach on dangers signs
• Adherence to prescribed drugs
• Review after 2 days or if no
change in condition
• Home made therapies
• Use of humidified air

20. PREVENTION OF ARI
• Health education to parents and general population on ARI
• Breastfeeding infants exclusively for the first 6 months of life
 boost their immune response to infections
Reduce incidences of diarrhea diseases and malnutrition
• Feeding children with nutritious foods to keep the immune system
strong
• Infection prevention practices
Hand hygiene, social distance, cough etiquette, avoid overcrowding

21. PREVENTION OF ARI
• Avoid irritation of the respiratory tract by
Indoor pollution from smoke (fire, cigarette, cowdung
• Immunization
Haemophilis influenza B
Pneumoccocal conjugate vaccine (PCV)
DPT
Measles
BCG

22. Role of nurse midwife
Discussion

23. CONCLUSION
• Acute respiratory infections are a major cause of illness and death
among children under 5 years of age.
• The application of appropriate preventive measures, correct case
management, health education at community level can help reduce
morbidity and mortality
• Nurses should take a leading role in the identification, management
and prevention of ARI

24. REFERENCE
• Cox. M. et al, ( 2017). The Prevelance and risk factors for Acute
respiratory Infections in children aged 0-59 months in rural Malawi: A
cross sectional study. Influenza other respir viruses. 2017 Nov;11(6):
489-496.
• WHO, (2020). Basic Principles for control of Acute respiratory
infections in children in developing countries. A joint WHO/UNICEF
Statement