Control of Acute respiratory infection in Nepal 77/78

1. Control of Acute
Respiratory Infection
(ARI)
Prepared by:
Saloni Tamrakar
Monika Katuwal
Durga Oli

2. Family Welfare Division:
Child health and immunization
is one of the four sections of Family Welfare Division
This section has two programs:
1. National Immunization Program and
2. IMNCI program.

3. National Immunization Program
• Support the Ministry of Health and Population to prepare national policies,
strategies, directories, quality standards, and protocols regarding
vaccinations and child health.
• To prepare vaccine and vaccine supplies supply and distribution plan at
national level.
• Necessary assistance in new vaccinations involving regular vaccinations
program.
• Analyzing the vaccine and child health, and to provide technical assistance
to national level policy.
• National level work on child health according to national policy and
strategy

4. Integrated Management of Neonatal and
Childhood Illnesses (IMNCI)
• Focuses on the health and well-being of the child.
• aims to reduce preventable mortality, minimize illness and disability,
and promote healthy growth and development of children under five
years of age.
• also maintains its aim to address major childhood illnesses like
Pneumonia, Diarrhea, Malaria, Measles and Malnutrition among
under 5 year’s children

5. Major activities of IMNCI
• FB IMNCI Training for Medical Officer, nursing staffs and paramedics
• CBIMNCI training to health service providers
• Training on Routine Data Quality Assessment (RDQA)
• Procurement of various equipment, commodities, and medicines for
IMNCI programs
• Development of Preterm Care Guideline
• Revision of CBIMNCI and FB-IMNCI training package

6. Goals, targets, objectives, strategies,
interventions and activities
• Goal: Improve New-born child survival and ensure healthy growth
and development.
• Targets: Target for reduction of NMR, U-5MR & Stillbirths

7. Objectives
• To reduce neonatal morbidity and mortality by promoting essential
New-borncare services&managing major causes of illness
• To reduce childhood morbidity and mortality by managing major
causes of illness among under 5 years of age children

8. Strategies
• Quality of care through system strengthening and referral services for
specialized care
• Ensure universal access to health care services for New-born and
under 5 years of age children
• Capacity building of healthservice providers and FCHVs
• Increase service utilization through demand generation activities
• Promote decentralized and evidence-based planning and
programming

9. Major interventions
• New-born Specific Interventions
• Promotion of essential New-born care practices and postnatal care to mothers and New-
born
• Identification and management of non-breathing babies at birth
• Case management of children aged between 2-59 months for 5 major childhood diseases
(Pneumonia, Diarrhoea, Malnutrition, Measles and Malaria)
• Onsite coaching (guidelines development /revision, coach development, coaching
&mentoring)
• Routine Data Quality Assessment
• Behavioural change communications for healthy pregnancy, safe delivery and promotion
of personal hygiene and sanitation
• Improved knowledge related to Immunization and Nutrition and care of sick children
• Improved interpersonal communication skills of HSPs and FCHVs

10. Introduction
• Acute respiratory infection is a serious infection that prevents normal
breathing function. It usually begins as a viral infection in the nose,
trachea (windpipe), or lungs.
• Types
1. Upper acute respiratory infection (UARI)
2. Lower acute respiratory infection (LARI)

11. • According to the World Health Organization (WHO), respiratory
infections account for 6% of the total global disease burden. Around
6.6 million, under-five aged children years of age die each year
worldwide
• Acute respiratory infection (ARI) is responsible for about 30–50
percent of visits to health facilities and for about 20–30 percent of
admissions to hospitals in Nepal for children under 5 years old.
Incidence of ARI in children among under-five years of age is 344 per
1000 in Nepal.

12. Viruses that causes ARI
• respiratory syncytial viruses (RSVs),
• parainfluenza viruses,
• influenza virus A and B, and
• human metapneumovirus (hMPV)

13. Classification of ARI
• Severe pneumonia or Very severe disease
• Pneumonia
• No pneumonia (cough and cold)

14. Problems of ARI
• Congestive heart failure
• Respiratory arrest ,which occur when the lungs stop functioning
• Respiratory failure ,a rise in CO2 in your blood caused by your lungs
not functioning correctly .
• Pneumonia, meningitis, sepsis, and bronchitis

17. Management of ARI
• Clinical Assessment
• Physical Examination
• Classifying ARI according to sign and symptoms for different ages
Treatment accordingly
• Improved living conditions
• Better nutrition
• Better MCH care
• Immunization
• Health Promotional activities – Vulnerable areas

18. ARI control programme
• MoHP recognizes Acute Respiratory Infection (ARI) as one of the major
public health problems in Nepal among children under 5 years of age.
• Acute Respiratory Infection (ARI) Control Program began in Nepal in 1987.
• 1995/96 CB-ARI Program piloting
• 1997/98 CB-ARI intervention was combined with CDD and named as CB-AC
program
• Based on the recommendations from the pilot, it was decided to include a
community component and FCHV to provide CDD, ARI, Nutrition and
services to the community.
• The Community based ARI and CDD program was merged into IMCI in 1999
and was named the Community Based Integrated Management of
Childhood Illness (CB‐IMCI).

19. Activities to control ARI
• Establishing/Strengthening SNCU/NICU
• Procurement of various equipment, commodities, and medicines for
IMNCI programs (ORS, Zinc, Amoxicillin, Gentamycin, Chlorohexidine
gel) at provincial level.
• Implementation of Free New-born Care Program at federal,
provincial, district and local levelhospital.
• CBIMNCI training to health service providers
• Revision of CBIMNCI Coaching guideline and Equity and Access
Guideline

20. Problems/ constraints
• Increasing proportion of severe pneumonia cases
• No separate post of CB‐IMCI Focal Person in district, like EPI Supervisor.
• IMCI Protocol not used properly at all levels.
• Lack of designated Human Resource in Hospital for SNCU/NICU/KMCU
• New Health workers without CBIMCI training
• No provision of CBIMNCI dedicated officer at province & municipalities
• Inadequate resources to sustain and provide quality IMCI.
• Inadequate and poor quality supply of IMCI/NCP equipment and drugs.

21. Thank you