The document outlines acute respiratory infection (ARI) control measures, focusing on the classification, diagnosis, and treatment of ARIs in children, especially pneumonia. It details the signs of severity ranging from no pneumonia to very severe pneumonia, along with appropriate treatment protocols including referral to hospitals and antibiotic use. Additionally, it emphasizes preventive measures such as breastfeeding, immunization, and proper nutrition to reduce ARI incidence.

1. ACUTE RESPIRATORY INFECTION
CONTROL PROGRAMME

2.  Acute respiratory infection (ARI) may cause inflammation of
respiratory tract anywhere from nose to alveoli .
 ARI is often classified into ARI of upper (AURI )or lower (ALRI)
respiratory tract
 AURI -common cold , pharyngitis and otitis media
 ALRI-epiglottitis , laryngitis , laryngotracheitis , bronchitis ,
broncholitis and pneumonia
 ARI in young infants , small children and elderly increases
morbidity and mortality

3.  Acute lower respiratory tract infection (LRTI) is the chief
cause of mortality in children below 5 years of age.
 Most common etiological agent is bacteria
 Common bacteria causing LRTI in preschool children
(H.influenzae, S. pneumonia, staphylococci)
 The WHO has recommended criteria for diagnosis of
pneumonia applicable for countries where the infant
mortality rate is >40/1000 live births.

4. CLINICAL ASSESSMENT
HISTORY TAKING
• Age of child
• Cough: duration , nature , diurnal variation , postural variation
, productive or not
• Associated with rapid breathing or not during sleeping or
feeding
• Difficulty in breathing
• Fever : duration
• If associated with drowsiness : duration , regain of
consciousness
• Associated convulsions
• Cyanosis
• Past history of diseases such as measles
• History of any previous episodes and treatment

5. PHYSICAL EXAMINATION
1. RESPIRATORY RATE
Count the respiratory rate for full one minute by watching
abdominal movement or lower chest

6. 2. LOOK FOR CHEST INDRAWING
• THE CHILD HAS INDRAWING IF THE LOWER CHEST WALL
GOES IN WHEN CHILD BREATHS IN
• IT OCCURS WHEN EFFORT REQUIRED TO BREATHE IN
MUCH GREATER THAN NORMAL

7. 3.LISTEN FOR STRIDOR :
• Makes a harsh noise when breathing
• It occurs when there is narrowing of the
larynx , trachea or epiglottis which interferes
with air entering the lungs
4.LOOK FOR WHEEZING
• High pitched whistling sound while breathing.

8. 5.SEE IF CHILD IS DROWSY
6.CHECK BODY TEMPERATURE FOR FEVER OR LOW
BODY TEMPERATURE
7. CHECK FOR SEVERE MALNUTRITION
• High risk factor increases fatality rate
Severely malnourished children with
pneumonia may have impaired or absent
response to hypoxia and cough reflex
8. CYANOSIS
• Sign of hypoxia

9. CLASSIFICATION OF ILLNESS
• Child aged 2 Months upto 5 years
 Very severe disease.
Severe pneumonia.
 Pneumonia( not severe .)
No pneumonia:- cough or cold.

10. 1.NO PNEUMONIA:COUGH OR COLD
SIGNS:-
No chest indrawing
No fast breathing

11. TREATMENT
If coughing more than 30 days,refer for assessment.
Assess and treat ear problems or sore throat,if present.
Assess and treat other problems.
Advice mother to give home care.
Treat fever, if present.
Treat wheezing, if present.

12. 2.PNEUMONIA (NOT SEVERE )
SIGNS:-
Cough
No chest indrawing
Fast breathing

13. TREATMENT
Advice mother to give home care.
Antibiotic Cotrimoxazole is the drug of choice.
Treat fever, if present.
Treat wheezing, if present.
Advice mother to return with child in 2 days for
reassessment , or earlier if the child is getting worse .
Reassess in 2 days a child who is taking an antibiotic for
pneumonia.

14. 3. SEVERE PNEUMONIA
 SIGNS:-
 Chest indrawing .
 Fast breathing.
 Nasal flaring:- nose widens as the child breaths in
 Grunting:- short sounds made with the voice  difficulty in
breathing.
 Cyanosis.

15. TREATMENT
Refer URGENTLY to hospital.
Give first dose of an antibiotic . DOC is IM benzyl
penicillin ( after test dose), ampicillin or
chloramphenicol.
Treat fever, if present.
Treat wheezing, if present ( if referral is not feasible,
treat with an antibiotic and follow closely.)

16. 4.VERY SEVERE PNEMONIA
SIGNS:-
Not able to drink.
Convulsions.
 Abnormally sleepy and different to wake.
Stridor in calm child.
Severe malnutrition

17. TREATMENT
 Refer urgently to hospital.
 Give first dose of an antibiotics. Chloramphenicol IM is the
drug of choice . Treat for 48 hours - if condition improves
switch over to oral chloramphenicol Chloramphenicol – 10
days. If condition worsens switch to IM Cloxacilin and
gentamycin.
 Treat fever if present.
 Treat wheezing if present.
 If cerebral malaria is possible, give an antimalarial.

18. B.Young infant.
1) VERY SEVERE DISEASE.
• SIGNS:-
• Stopped feeding well.
• Convulsions
• Abnormally sleepy or difficulty to wake.
• Stridor in calm child , wheezing
• fever or low body temperature.

19. TREATMENT
Refer URGENTLY to hospital.
Keep young infant warm.
Give first dose of an antibiotic

20. 2.Severe pneumonia
SIGNS:-
Severe chest indrawing or fast breathing.( 60 per minute
or more)
TREATMENT:-
Refer URGENTLY to hospital.
Keep young infant warm.
Give first dose of an antibiotic.( If referral is not feasible,
treat with an antibiotic and follow closely.)

21. 3.NO PNEUMONIA
SIGNS:-
No severe chest indrawing and no fast breathing ( less
than 60 per minute).
TREATMENT:- Advise mother to give the following home
care.
Keep young infant warm.
Breast feed frequently.
Clear nose if it interferes with feeding.

22. Return quickly if:-
• Breathing is difficult.
• Breathing becomes fast.
• Feeding becomes a problem
• The young infant becomes sicker.

23. Prevention of ARI
 BREASTFEEDING :
• Excellent nutritional value
• Antibodies protect from infection
 AVOID IRRITANTS
• Smoke from cooking fires
• cow dung as fuel
 ADEQUATE NUTRIENTS

24.  IMMUNISATION
• MEASLES VACCINE
pneumonia is a serious complication of measles
Live attenuated vaccine
Freeze dried product
0.5 ml dose subcutaneously also IM is effective
Schedule 9th month

25. • HIB VACCINE
H.influenzae one the most important cause of death
due to pneumonia
Included in immunisation schedule
Combined preparation with DPT and poliomyelitis
3 or 4 doses are given depending on type of vaccine
Schedule: 6,10, 14 weeks , booster dose 12-18 months
Vaccine not offered to children more than 24 months

26. • PNEUMOCOCCAL VACCINE
PPV23 : polysaccharide non conjugate vaccine
Children under 2 years and immunocompromised do
not respond well to this vaccine
Dose -0.5 ml
IM in the deltoid
Select group – sickle cell disease , chronic heart
disease , DM , organ transplantation etc