epidemiology of ARI.pptx..................

An acute respiratory infection (ARI) is a short-term infection of the respiratory tract, such as the nose, throat, or lungs, which can be viral or bacterial. Symptoms include fever, cough, sore throat, runny nose, and body aches, and while often mild, they can be severe, potentially leading to difficulty breathing or even death if untreated. Treatment depends on the cause, with viruses usually resolving on their own while bacteria-based infections may require antibiotics.

1. Prepared by Krupa Mathew. M, Assistant professor EPIDEMIOLOGY OF ARI & pneumonia

2. Infection of the respiratory tract is called ARI. ARI may cause inflammation of the respiratory tract anywhere from nose to alveoli with a range of combination of symptoms depending on the site of infection ARI is often classified by clinical syndromes depending on the site of infection ARI are the foremost cause of mortality among children aged less than 5 years especially in developing countries. Southeast Asia stands first in number for ARI incidence. Introduction

3. In India, pneumonia is found accountable for 13 – 16% of all deaths occurring in the pediatric hospitals. Statistics shows that on an average every child has five episodes of ARI/year and 3.5% of the global burden of disease caused by ARI. Around 20% of deaths in children of less than 5 years is attributed to respiratory tract infections.

4. ARI may be (AURI) – Acute Upper Respiratory Infection or (ALRI) – Acute Lower Respiratory Infection. The upper respiratory infection include common cold, pharyngitis and otitis media. The lower respiratory tract infections include epiglottitis, laryngintitis , laryngotracheitis , bronchitis, bronchiolitis and pneumonia. Classification of ari

5. EPIDEMIOLOGICAL FACTORS

6. The microbial agents' that cause ARI are numerous. They could be classified as bacteria, virus and other agents. Agent factors

7. Bordetella pertussis Cornybacterium diphtheriae Haemophilus influenzae Klebsiella pneumoniae Legionella pneumophilia Staphylococcus pyogenes Sreptococcus pneumoniae Sreptococcus pyogenes BACTERIA

8. Adeno Virus Entero Viruses Influenza (A,B,C) Measles Parainfluenza Respiratory Syncytial Virus Rhino Virus Corona Virus VIRUS

9. Mycoplasma Pneumonia Coxiellaburntti Chlamydia type B Other agents

10. HOST FACTORS

11. Small children succumb to the disease within a matter of days. Case fatality rates are higher in young infants and malnourished children. Adults are also affected and the symptoms tend to be more among females.

12. Environmental FACTORS

13. Climatic conditions and housing are noted as a major risk factor. Overcrowding, poor nutrition, Low Birth Weight and intense indoor smoke pollution underline the high rates. Children from low socioeconomic status tend to have more episodes of ARI. The infection is common in preschool children attending day care centers.

14. Infections tend to be more in urban communities than in rural communities. Maternal smoking has been linked to increased occurrence of respiratory tract infections during the first year of life.

15. Epidemiological triad Agent – Bacterial, viral others Environment – climate, poor housing, overcrowding, low birth weight Host – children, malnutrition

16. The organisms are transmitted by the airborne route. The chain of infection is maintained by direct person to person contact. MODE OF TRANSMISSION

17. Running nose Cough Sore throat Difficult in breathing Ear problem. Fever is also common in acute ARI General malaise Inability to drink. Clinical features

18. Most children have minor symptoms such as cold or cough. However some children may have pneumonia which is a major cause of death. Some times measles and whooping cough are important causes of severe respiratory tract infection.

19. History taking and clinical assessment is very important in the management. Age of the child. Duration of cough. Whether the child is able to drink (2-5 Months). Has the young infant stopped feeding well (child less than 2 Months) Any antecedent illness such as measles. If the child is excessively drowsy or difficult to wake. CLINICAL ASSESSMENT

20. Did the child have convulsions. Is there irregular breathing. Short periods of apnoea . History of child turning blue. History of treatment during illness. Fever if any. NOTE THE FOLLOWING

21. Look and listen to the following : 1 . COUNT THE BREATHS IN ONE MINUTE….. As the children get older their breathing rates slows down. Therefore the cutoff point used to determine if a child has fast breathing will depend on the age of the child. PHYSICAL EXAMINATION

22. 60 breaths /min or more in a child less than 2 Months. 50 breaths /min or more in a child aged 2 Months upto 12 Months. 40 breaths /min or more in a child aged 12 Months upto 5 years. Repeat the count for a young infant (age less than 2 Mo) if the count is 60 breaths /min or more. This is important because the breathing rate of young infant is often erratic . Occasionally young infants stop breathing for a few seconds, and then breath very rapidly for a short period

23. Look for chest indrawing when the child breaths in. The child has indrawing of the chest if the lower chest wall goes in while the child breaths in. Chest indrawing occurs when the effort required to breath in, is much greater than normal. 2. LOOK FOR CHEST INDRAWING

24. A child with stridor makes a harsh noise when breathing in. Stridor occurs when there is narrowing of the larynx, trachea or epiglottis which interferes with the air entering the lungs. These conditions are often called croup 3. LOOK AND LISTEN FOR STRIDOR

25. A child with wheeze makes a soft noise or shows signs that breathing OUT is difficult, wheezing is caused by narrowing of the air passage in the lungs. The breathing-out phase takes longer than normal and requires effort. If the child has wheezing, ask the mother if her child had a previous episode of wheezing within the past year. If so, the child should be classified as having recurrent wheeze. 5. See if the child is abnormally sleepy or difficult to wake. An abnormally sleepy child is drowsy most of the time when he or she should be awake and alert. 6. Feel for fever or low body temperature. 4. LOOK FOR WHEEZE

26. Malnutrition when present is a high risk factor and case fatality rates are higher in such children. In severely malnourished children with pneumonia, fast breathing and chest indrawing may not be as evident as in other children. A severely malnourished child may have an impaired or absent response to hypoxia and a weak or absent cough reflex. These children need careful evaluation for pneumonia as well as careful management 8.Cyanosis is a sign of hypoxia. Cyanosis must be checked in good light. 7. LOOK FOR SEVERE MALNUTRITION

27. A. Child aged 2 months upto 5 years 1. Very Severe Disease. 2. Severe Pneumonia. 3. PNEUMONIA (Not Severe). 4. No Pneumonia : Cough Or Cold. CLASSIFICATION OF illness

28. Signs Classification Treatment Chest indrawing , recurrent wheezing – go directly for treatment Severe pneumonia – refer urgently to hospital, give antibiotics Treat fever and wheezing if present If referral not possible treat with antibiotic No chest in drawing has fast breathing Pneumonia – give home care, antibiotic Treat fever and wheezing if present Ask mother to return after 2 days for reassessment or earlier if the child is getting worse No chest indrawing and no fast breathing No pneumonia ; cough or cold If coughing more than 30 days refer for assessment Assess and treat fever , ear problem , sore throat and wheezing

29. B. Illness of young infant (less than 2 months of age) Young infants can become sick and die very quickly from bacterial infections They show only nonspecific signs such as poor feeding, fever or low body temperature. These young infants must be referred to hospital without any delay considering any pneumonia in young infants is severe.

30. Unusually sleepy Stridor when calm Not feeding well Has wheezing Has either fever or subnormal temperature Danger signs of very serious disease in young infants <2 months of age)

31. Immunization is an important measure to reduce the incidence of ARI. Health promotional activities should be undertaken in vulnerable areas Facilitate good living conditions Advice to put appropriate seasonal clothing Provide better nutrition Avoid long poring baths in open air Try to avoid or reduce indoor smoke pollution Promote and maintain maternal and child care Assess the knowledge, attitude and behaviour of the mothers related to cause, spread, prevention and mangement of ARI and health educate them accordingly PREVENTION OF ARI

32. Vaccine hold promise of saving millions of children dying of pneumonia. Three vaccines have potential of reducing deaths from pneumonia. They are 1. Measles Vaccine - In India MMR – a trivalent vaccine is administered to infants on completing 9 months of age. 2. Hib Vaccine - Haemophilus influenza B (HIB) is an important cause of pneumonia and meningitis among children. It’s high cost has posed obstacle to its utilization in the developing countries. IMMUNIZATION

33. 3.Pneumococcal Pneumonia Vaccine - PPV23, a polysaccharide non conjugate vaccine containing capsular antigens of 23 serotypes against this infection is available. A dose of 0.5ml of PPV23 contains 25 micrograms of purified capsular antigen.PPV23 is administered as a single IM dose preferably in the deltoid muscle.

34. 1.Park’s Textbook of Preventive & Social Medicine, Banarsidas Bhanot publishers,22 Ed 2. Basawanthappa B.T, Community Health Nursing, Jayapee publications 3. Neelam Kumari , Text book of Community Health Nursing, S. Vikas Publisher, First Edn 4. Rao.B sridhar , Book of Community Health Nursing,AITBS publisher, New Delhi REFERENCES

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