NEW ARI CONTROL PROGRAM.pptx.pptx

ARI CONTROL PROGRAM

1. ARI CONTROL PROGRAM NITHYA G

2. In this session:  DESCRIBE MAGNITUDE OF PROBLEM OF ARI  CLASSIFICATION OF ARI  MANAGEMENT OF ARI  PREVENTION AND CONTROL OF ARI

3. DEFINITION INFECTION IN ANY PART OF RESPIRATORY SYSTEM LASTING LESS THAN 30 DAYS FOR OTITIS MEDIA LESS THAN 2 WEEK

4. PNEUMONIA IS THE DEADLIIEST CHILDHOOD DISEASE CAUSE DEATH OF CHILDREN UNDER 5 THAN ANY OTHER INFECTIOUS DISEASE 1 IN 6 CHILDHOOD DEATH WERE DUE TO PNEUMOINA IN 2015 IT IS THE NUMBER ONE KILLER AMONG LEADING INFECTIOUS DISEASE

5. Launched in 1990 Thereafter integrated with : National Child Survival And Safe Motherhood Programme ( CSSM ) Reproductive And Child Health Programme ( RCH-II ) Integrated Management Of Neonatal And Childhood Illnesses ( IMNCI ) ARI control programme in India

6. ETIOLOGICAL AGENT IS BACTERIAL IN 50 -60 % CHILDREN H.INFLUENZAE,S.PNEUMOINAE AND STAPHLOCOCCI

7. Streptococcus pneumoniae – m.c cause of bacterial pneumonia Haemophilus influenza type B – 2 nd m.c cause Measles and Pertussis – imp. causes in less developed countries RSV – m.c. viral cause HIV- Pneumocystis jiroveci (¼ th of all pneumonia deaths in HIV infants)

8. Management of child with cough or difficult breathing 1. Assessing the child by asking 2. Classifying the illness of the child 3. Decision for treatment 4. Follow up of cases

9. ASSESS • ASK: - HOW OLD IS THE CHILD? – IS THE CHILD COUGHING OR HAVING DIFFICULT BREATHING? – FOR HOW LONG?

10. 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 HAD CONVULSIONS? HAS THE CHILD HAD FEVER?

11. LOOK, LISTEN, FEEL for Danger signs – Chest indrawing Stridor Wheeze (? recurrent) (danger sign in young infant) Abnormally sleepy/difficult to wake? Fever/low body temperature? - Danger sign in young infant Severe malnutrition? Any Cyanosis / grunting / nasal flaring? Inspiration Expiration

12. CLINICAL CRITERIA FOR DIAGNOSIS OF PNEUMONIA INCLUDE RAPID RESPIRATION WITH OR WITHOUT DIFFICULTY IN RESPIRATION

13. RAPID RESPIRATION MEANS – count in one minute RR >60/MIN - <2MONTH RR>50/MIN -2MONTH TO 1YR RR>40/MIN -1 TO 5 YR DIFFICULTY IN RESPIRATION IS DEFINED AS LOWER CHEST INDRAWING

14. CHILDREN BELOW 2MONTHOF AGE PRESENCE OF ANY OF THE FOLLOWING INDICATE SEVERE DISEASE FEVER (38 OR MORE) CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO WAKE STRIDOR IN CALM CHILD WHEEZING NOT FEEDING TACHYPNEA CHEST INDRAWING ALTERD SENSORIUM CENTAL CYANOSIS GRUNTING APNEIC SPELL DISTENDED ABDOMEN

15. DANGER SIGNS IN > 2MONTHS NOT ABLE TO DRINK CONVULSIONS ABNORMALLY SLEEPY OR DIFFICULT TO WAKE SRIDOR IN CALM CHILD SEVERE MALNUTRITION

16. CLASSIFICATION The pneumonia classification and management guidelines had been developed based on evidence generated in 1970s and early 1980s But now with the emergence of new evidences, new recommendations had been made which lead to the revision of guidelines

17. CLASSIFICATION Pneumonia Fast breathing Chest indrawing Severe pneumonia -Danger signs present

18. CLASSIFICATION IN INFANTS <2 MONTH NO PNEUMONIA – COUGH AND COLD SEVERE PNEUMONIA – CHEST INDRAWING OR FAST BREATHING VERY SEVERE PNEUMONIA – DANGER SIGNS

19. Treatment Guidelines and Follow Up • Young infants (0-2 months) • Children 2 months to 5 years

20. < 2 months old (YOUNG infants)

21. NO PNEUMONIA-Cough and cold - <2month Advise mother: •Keep young infant warm •Breastfeed frequently •Clear nose if it interferes with feeding •Return quickly if: •Breathing becomes difficult; or fast •Feeding becomes a problem •Young infant becomes sicker

22. SEVERE PNEUMONIA •Refer URGENTLY to hospital •Keep young infant warm •Give first dose of an antibiotic

23. Treatment in a young infant – any pneumonia

24. TREATMENT IN 2MONTHS TO 5YR Fast breathing pneumonia, no chest indrawing or general danger signs Oral Amoxicillin (80mg/kg/day BD) 5days or 3 days if child is in low HIV prevalent area.(dispersible amox suitable) Who fail on first line treatment Referral to centre with facilities for second line management

25. Its safe to treat chest indrawing pneumonia at home with oral amoxicillin. AT HOSPITAL LEVEL- children with chest indrawing in low HIV prevalent area can be treated at OP level, no need of refferal . AT COMMUNITY LEVEL- children with chest indrawing pneumonia should be reffered to higher level.

26. Streptococcal pneumoniae and H.influen z a –serum level should be 40% more than MIC in order to achieve a bacteriological cure of 85-100%. Increases the bactericidal activity. Penicillin intermediate resistance- AMOXICILLIN & CEFUROXIME Penicillin resistant- AMOXICILLIN WHY HIGH DOSE AMOXICILLIN ?

27. SEVERE PNEUMONIA should be treated with parenteral ampicillin(or penicillin) and gentamicin as first line treatment

28. Firstline –AMPICILLIN + GENTAMICIN Second line –CEFTRIAXONE

29. Ampicillin 50 mg/kg or Benzyl penicillin 50000 unit/kg, IM/IV every 6 hr for atleast 5 days AND Gentamicin 7.5mg/kg IM/IV once a day for atleast 5 days Ceftriaxone should be used as a second line treatment in children with severe pneumonia having failed on 1 st line

30. HIV Infected and exposed children –Any of 1 ST or 2 nd line management. PCP –Empirical cotrimoxaole for children of 2months to 1 year. NOT recommended for children above 1 year of age.

31. For HIV infected and exposed infants and children with chest indrawing or severe pneumonia,who do not respond to treatment with ampicillin or penicillin plus gentamicin , ceftriaxone alone is recommended as treatment

32. Managing pneumonia at community level Recommended is oral daily amoxicillin 2 doses

33. Community management of chest indrawing pnemonia Community health workers when properly trained and supported can effectively and safely treat chest indrawing pneumonia at home with oral amoxicillin Otherwise referral to higher centre Severe pneumonia require injectable antibiotics and oxygen at the facility

34. Summary All children with fast breathing and/or chest indrawing are classified as “pneumonia” and treated with oral amoxicillin 80 mg/kg/day for 5 days. In areas with low HIV prevalence duration of treatment of fast breathing pneumonia can be reduced to 3 days

35. Its safe to treat chest indrawing pneumonia at home with oral amoxicillin. AT HOSPITAL LEVEL- children with chest indrawing in low HIV prevalent area can be treated at OP level, no need of referral.

36. Only those children who have either general danger signs or who are HIV positive and have chest indrawing need to be referred to to higher facility of IP treatment with injectable antibiotics Dispersible amoxicillin is the preferred form

37. BENEFITS OF CHANGE Oral amoxicillin is the most effective treatment for both fast breathing and chest indrawing pneumonia Increased access of antibiotic treatment closer to home Decreased need for referrals

38. Simplified pneumonia classification and management Simplified training of health workers Cost benefits at individual,household , community and health facility level

39. Decreased probability of hospitalization and thus the risk of hospital acquired and injection borne diseases Reduced probability of increasing antimicrobial resistance

40. PREVENTION OF ARI

41. Improved basic living conditions Better nutrition,adequate vitamin A supplementation Reduction of indoor pollution Better maternal and child health care Vaccines – Hib ,, PCV13, PPV23, DPT, Measles Hand washing, clean water and good saniatation

42. India launches PCV May 13 TH 2013 – A major public health milestone for India and the World Himachal Pradesh , Up , Bihar in the first year 2.1 million children in these 3 states in the first year to scale up to the entire country ultimately

43. IMPACT Significant reduction in morbidity and mortality due to pneumonia, meningitis, otitis media, sepsis Herd immunity Helps tackle antibiotic reisitance

44. By end of 2025 : 90% coverage of relevant vaccine ( PCV, Rotavac ) 90% access to appropriate health care At least 50% coverage of breast feeding during first 6 months of life Virtual elimination of pediatric HIV

45. THANK YOU