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Policies And Guidelines For Acute Respiratory Infections In Children By V. Khonje Presented to Nursing and Midwifery students 2023 cohort
Learning outcomes ? Define ARI ? Understand the global and local prevalence of ARI ? Know the principles for managing ARI ? Apply the preventive measurers for ARI ? Understand the role of nurses in ARI management and control
PRESENTATION OUTLINE ? Introduction ? Prevalence of ARI ? Causes of ARI ? Classification of ARI ? Strategies in the management of ARI ? Prevention of ARI ? Complications ? Conclusion
Introduction ? Acute respiratory infections (ARI) are infections that affect the upper and lower respiratory tract. ? They can be mild , moderate and severe ? Most ARI are mild, self limiting viral infections ? Mortality rates due to ARI are high in Malawi hence the need to have guidelines that will help reduce incidences of morbidity and mortality ? The policies and guidelines for ARI in Malawi are based on WHO guidelines
Introduction- ct/d ? The guidelines provide an overview on handling of these infections ? The Malawi ARI guidelines includes COVID-19 management ? The ARI guidelines are also incorporated in the Integrated Management of Childhood Illnesses (IMCI) guidelines ? The guidelines focus on 5 key areas on management of ARI problems
PREVALENCE AND INCIDENCE OF ARI ? ARI is emerging as one of the leading causes of morbidity and mortality in developing countries ? ARI affects approximately 32.6% of children under the age of 5 years (MOH, 2020). ? Of the 12 million death occurring annually under 5 years of age, ARI constitutes 19% of these deaths ? 20 to 25% 0f ARI deaths occur in children less than 2months ? 50 to 60% occur in those under 1 year ? Nearly 25 % of outpatients visits and 15% of all hospital admissions are due ARI
PREVALENCE AND INCIDENCE OF ARI ? Pneumonia accounts for 5.4% of all illnesses ? A study done in Mangochi on prevealnce of ARI showed that the annual prevalence of ARI was at 32.6% and risk factors included malnutrition, increased household density and sibling with ARI (Cox. et.al 2017)
Causes of ARI ? Bacterial pathogens- accounts for 60% of all ARI. Common ones be ?Streptococcus pneumonia ?Haemophilus influenzae ? Viruses ? Candida
Classification of ARI ? Classified according to location and severity 1. Upper respiratory tract infections (URTIs) ? Common cold: Runny nose, congestion, cough, sore throat ? Pharyngitis: sore throat, fever, swollen tonsils ? Laryngitis: hoarseness, cough, sore throat ? Sinusitis: facial pain, nasal congestion, headache2.
Classification of ARI 2. Lower respiratory tract infections ( LRTIs) ? Pneumonia: cough, fever, chest pain, difficulty breathing ? Bronchiolitis: in children less than 2 years, - wheezing, cough, difficulty breathing, apnea in severe cases ? Asthma: wheezing, cough, chest tightness, shortness of breath
Strategies in management of ARI ? The Malawi ARI control program has been established to work towards management of ARI ? It¨s main strategies include: ? 1. Integrated Management of childhood illnesses (IMCI)- ?This is the comprehensive approach to managing childhood illnesses including ARI ?Training healthcare workers on IMCI
Strategies in management of ARI ct/d 2. ARI Management guidelines -covers ?How to conduct assessment ?Classification of the ARI ?Treatment and referral criteria 3. Antibiotic therapy - ?Antibiotics are reserved for severe ARI ?The guidelines stipulates which antibiotic or antimicrobials to be used for a particular illness ? e.g use of cotrimoxazole as first line drug in pneumonia treatment
Strategies in management of ARI ct/d 4. Oxygen therapy- ?providing oxygen for children with severe ARI and hypoxemia ? Ensuring availability of oxygen concentrators and cylinders in health facilities 5. Fluid Management- ?oral rehydration therapy for mild ,moderate ?intravenous fluids for severe dehydration and those unable to drink
Strategies in management of ARI ct/d 6. Vaccination C ? vaccines for preventable ARI e.g Pneumoccocal conjugate vaccine (PCV). 7. Community based care ?Community healthcare workers (CHWs) are trained to identify, manage ARI cases ?Provide support education and support to caregivers
Strategies in management of ARI ct/d 8. Referral Criteria
Case management of ARI ? Assess the child ? Classify the illness ? Decision for treatment ? Follow up cases
ASSESS 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 convulsed Has she had fever Vomiting/ diarrhoea Look , listen and feel chest in drawing Listen to stridor/ wheezes Abnormal respiratory rate vs age of child Check if child is abnormally sleepy or difficult to wake up Less than 2 months- more than 60 b/min Count the breaths per minute 2- 12 months- 50 breaths or more Feel for fever or low body temperature 12months C 5 years-40 or more breaths Look for severe malnutrition
CLASSIFY and Manage ? Based on the clinical manifestation conditions are classified as ? Mild ? Moderate ? Severe ? Management ? Home care for mild illness ? Hospitalization for moderate and severe cases ? Antimicrobial therapy C oral or intravenous based on child condition ? Fluid management ? Oxygen therapy ? Manage fever ? Follow up care
Home care ? Mother or caregiver should ? Keep baby/child warm ? Continue b/feeding ? Increase feeding as recovery occurs ? Teach on dangers signs ? Adherence to prescribed drugs ? Review after 2 days or if no change in condition ? Home made therapies ? Use of humidified air
PREVENTION OF ARI ? Health education to parents and general population on ARI ? Breastfeeding infants exclusively for the first 6 months of life ? boost their immune response to infections ?Reduce incidences of diarrhea diseases and malnutrition ? Feeding children with nutritious foods to keep the immune system strong ? Infection prevention practices ?Hand hygiene, social distance, cough etiquette, avoid overcrowding
PREVENTION OF ARI ? Avoid irritation of the respiratory tract by ?Indoor pollution from smoke (fire, cigarette, cowdung ? Immunization ?Haemophilis influenza B ?Pneumoccocal conjugate vaccine (PCV) ?DPT ?Measles ?BCG
Role of nurse midwife Discussion
CONCLUSION ? Acute respiratory infections are a major cause of illness and death among children under 5 years of age. ? The application of appropriate preventive measures, correct case management, health education at community level can help reduce morbidity and mortality ? Nurses should take a leading role in the identification, management and prevention of ARI
REFERENCE ? Cox. M. et al, ( 2017). The Prevelance and risk factors for Acute respiratory Infections in children aged 0-59 months in rural Malawi: A cross sectional study. Influenza other respir viruses. 2017 Nov;11(6): 489-496. ? WHO, (2020). Basic Principles for control of Acute respiratory infections in children in developing countries. A joint WHO/UNICEF Statement

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Acute Respiratory Infections(ARI)__PRESENTATION[1].pptx

  • 1. Policies And Guidelines For Acute Respiratory Infections In Children By V. Khonje Presented to Nursing and Midwifery students 2023 cohort
  • 2. Learning outcomes ? Define ARI ? Understand the global and local prevalence of ARI ? Know the principles for managing ARI ? Apply the preventive measurers for ARI ? Understand the role of nurses in ARI management and control
  • 3. PRESENTATION OUTLINE ? Introduction ? Prevalence of ARI ? Causes of ARI ? Classification of ARI ? Strategies in the management of ARI ? Prevention of ARI ? Complications ? Conclusion
  • 4. Introduction ? Acute respiratory infections (ARI) are infections that affect the upper and lower respiratory tract. ? They can be mild , moderate and severe ? Most ARI are mild, self limiting viral infections ? Mortality rates due to ARI are high in Malawi hence the need to have guidelines that will help reduce incidences of morbidity and mortality ? The policies and guidelines for ARI in Malawi are based on WHO guidelines
  • 5. Introduction- ct/d ? The guidelines provide an overview on handling of these infections ? The Malawi ARI guidelines includes COVID-19 management ? The ARI guidelines are also incorporated in the Integrated Management of Childhood Illnesses (IMCI) guidelines ? The guidelines focus on 5 key areas on management of ARI problems
  • 6. PREVALENCE AND INCIDENCE OF ARI ? ARI is emerging as one of the leading causes of morbidity and mortality in developing countries ? ARI affects approximately 32.6% of children under the age of 5 years (MOH, 2020). ? Of the 12 million death occurring annually under 5 years of age, ARI constitutes 19% of these deaths ? 20 to 25% 0f ARI deaths occur in children less than 2months ? 50 to 60% occur in those under 1 year ? Nearly 25 % of outpatients visits and 15% of all hospital admissions are due ARI
  • 7. PREVALENCE AND INCIDENCE OF ARI ? Pneumonia accounts for 5.4% of all illnesses ? A study done in Mangochi on prevealnce of ARI showed that the annual prevalence of ARI was at 32.6% and risk factors included malnutrition, increased household density and sibling with ARI (Cox. et.al 2017)
  • 8. Causes of ARI ? Bacterial pathogens- accounts for 60% of all ARI. Common ones be ?Streptococcus pneumonia ?Haemophilus influenzae ? Viruses ? Candida
  • 9. Classification of ARI ? Classified according to location and severity 1. Upper respiratory tract infections (URTIs) ? Common cold: Runny nose, congestion, cough, sore throat ? Pharyngitis: sore throat, fever, swollen tonsils ? Laryngitis: hoarseness, cough, sore throat ? Sinusitis: facial pain, nasal congestion, headache2.
  • 10. Classification of ARI 2. Lower respiratory tract infections ( LRTIs) ? Pneumonia: cough, fever, chest pain, difficulty breathing ? Bronchiolitis: in children less than 2 years, - wheezing, cough, difficulty breathing, apnea in severe cases ? Asthma: wheezing, cough, chest tightness, shortness of breath
  • 11. Strategies in management of ARI ? The Malawi ARI control program has been established to work towards management of ARI ? It¨s main strategies include: ? 1. Integrated Management of childhood illnesses (IMCI)- ?This is the comprehensive approach to managing childhood illnesses including ARI ?Training healthcare workers on IMCI
  • 12. Strategies in management of ARI ct/d 2. ARI Management guidelines -covers ?How to conduct assessment ?Classification of the ARI ?Treatment and referral criteria 3. Antibiotic therapy - ?Antibiotics are reserved for severe ARI ?The guidelines stipulates which antibiotic or antimicrobials to be used for a particular illness ? e.g use of cotrimoxazole as first line drug in pneumonia treatment
  • 13. Strategies in management of ARI ct/d 4. Oxygen therapy- ?providing oxygen for children with severe ARI and hypoxemia ? Ensuring availability of oxygen concentrators and cylinders in health facilities 5. Fluid Management- ?oral rehydration therapy for mild ,moderate ?intravenous fluids for severe dehydration and those unable to drink
  • 14. Strategies in management of ARI ct/d 6. Vaccination C ? vaccines for preventable ARI e.g Pneumoccocal conjugate vaccine (PCV). 7. Community based care ?Community healthcare workers (CHWs) are trained to identify, manage ARI cases ?Provide support education and support to caregivers
  • 15. Strategies in management of ARI ct/d 8. Referral Criteria
  • 16. Case management of ARI ? Assess the child ? Classify the illness ? Decision for treatment ? Follow up cases
  • 17. ASSESS 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 convulsed Has she had fever Vomiting/ diarrhoea Look , listen and feel chest in drawing Listen to stridor/ wheezes Abnormal respiratory rate vs age of child Check if child is abnormally sleepy or difficult to wake up Less than 2 months- more than 60 b/min Count the breaths per minute 2- 12 months- 50 breaths or more Feel for fever or low body temperature 12months C 5 years-40 or more breaths Look for severe malnutrition
  • 18. CLASSIFY and Manage ? Based on the clinical manifestation conditions are classified as ? Mild ? Moderate ? Severe ? Management ? Home care for mild illness ? Hospitalization for moderate and severe cases ? Antimicrobial therapy C oral or intravenous based on child condition ? Fluid management ? Oxygen therapy ? Manage fever ? Follow up care
  • 19. Home care ? Mother or caregiver should ? Keep baby/child warm ? Continue b/feeding ? Increase feeding as recovery occurs ? Teach on dangers signs ? Adherence to prescribed drugs ? Review after 2 days or if no change in condition ? Home made therapies ? Use of humidified air
  • 20. PREVENTION OF ARI ? Health education to parents and general population on ARI ? Breastfeeding infants exclusively for the first 6 months of life ? boost their immune response to infections ?Reduce incidences of diarrhea diseases and malnutrition ? Feeding children with nutritious foods to keep the immune system strong ? Infection prevention practices ?Hand hygiene, social distance, cough etiquette, avoid overcrowding
  • 21. PREVENTION OF ARI ? Avoid irritation of the respiratory tract by ?Indoor pollution from smoke (fire, cigarette, cowdung ? Immunization ?Haemophilis influenza B ?Pneumoccocal conjugate vaccine (PCV) ?DPT ?Measles ?BCG
  • 22. Role of nurse midwife Discussion
  • 23. CONCLUSION ? Acute respiratory infections are a major cause of illness and death among children under 5 years of age. ? The application of appropriate preventive measures, correct case management, health education at community level can help reduce morbidity and mortality ? Nurses should take a leading role in the identification, management and prevention of ARI
  • 24. REFERENCE ? Cox. M. et al, ( 2017). The Prevelance and risk factors for Acute respiratory Infections in children aged 0-59 months in rural Malawi: A cross sectional study. Influenza other respir viruses. 2017 Nov;11(6): 489-496. ? WHO, (2020). Basic Principles for control of Acute respiratory infections in children in developing countries. A joint WHO/UNICEF Statement