1. ARI CONTROL AND PREVENTION
NIKITA JOHANNA SOANS
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2. 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

3. 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

4. Physical examination
1: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

5. 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

6. 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

7. 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
reflex
3)Careful evaluation and
mangement

8. 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

9. 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 & Assessment
2. Case Classification
3. Institution of appropriate therapy

10. Step 1: Case finding & Assessment
• Cough & difficult breathing in children < 5 years
age
• Fever is not an efficient criteria

11. 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

12. 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

13. step 3:Institution of appropriate
therapy
 Antibiotics

14. 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.

15.  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.

16.  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

17. immunization

18. measles vaccine
 Pneumonia is a serious complication of measles
 Reducing the incidence of measles helps reduce
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death from pneumonia
Live attenuated vaccine
Freeze dried product
0.5ml dose subcutaneously also effective
intramuscularly
Schedule :9 th month

19. HIB vaccine
 Haemophilus influenza B most important cause of death



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

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

20. 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

21. 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

22. thank you 