Management Of Acute Respiratory Infections Research Articles

Social Science Lessons from Diarrhea Research and Their Application to ARI

Acute respiratory infection (ARI) is one of the chief causes of morbidity and mortality in the Third World. Community-based ARI programs have recently been called for by international health agencies. At this initial stage of program development, it is prudent to consider a series of lessons learned by anthropologists during over a decade of research on diarrheal disease. Following a brief description of the nature and magnitude of ARI as an international health problem, 15 lessons are highlighted. Existing data on ARI recognition, management, and evaluation are presented as a means of suggesting why these lessons are relevant for the planning of ARI-related interventions and education programs. The relevance of these lessons extend beyond ARI.

A community study of the application of WHO ARI management guidelines in Pakistan

During a community-based study in four rural villages in Pakistan, 617 cases of acute respiratory infections (ARI) in children younger than 5 years of age were assessed, classified and managed according to the WHO ARI case management guidelines. Of these, 509 (82.5%) had 'cough and cold' without clinical evidence of pneumonia, 95 pneumonia, two severe pneumonia and 11 otitis media. Of the 509 without clinical evidence of pneumonia but with cough and cold, 491 (96.5%) were successfully treated without antibiotics and only 18 (3.5%) of these children needed antimicrobial therapy on follow-up. Of the 95 cases of pneumonia, 87 (91.4%) showed a satisfactory clinical response to oral cotrimoxazole and only eight (8.4%) required a change of antibiotic.

THE QUALITY ASSURANCE PROJECT: INTRODUCING QUALITY IMPROVEMENT TO PRIMARY HEALTH CARE IN LESS DEVELOPED COUNTRIES

Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems.

Diagnosis and management of acute respiratory infections in Lesotho

Diagnosis and management of acute respiratory infections in Lesotho

Acute respiratory infections in Kangra district: magnitude and current treatment practices.

A review of medical records of health centres in Kangra districts, Himachal Pradesh during October 1984 to September 1985 revealed that of 3,72,000 attendances, 18% were for acute respiratory infections (ARI) and 12% for diarrheal diseases. The annual incidence of visits for ARI among children below five was higher than that of general population (8·2/1000 vs. 6·7/1000). ARI was more common during the post-monsoon period and among people living in mountainous areas. The case fatality rate in hospitalised ARI patients was 10·5%. Interview of health centre physicians regarding ARI management practices indicated that chest indrawing (considered by WHO as pathognomonic of severe ARI) was not recognised as an important sign by majority of physicians. Ninety-one per cent of physicians disagreed (69% in strong terms) with the idea of providing health workers with antimicrobials for management of ARI at the community level.

Inadequacies in management of acute respiratory infections.

Acute respiratory infections (ARI), malnutrition and diarrheal diseases are responsible for the majority of deaths in pre-school children in developing countries./ There are many reasons for this high mortality, but some of these are often over-emphasised to the extent that an erroneous impression has been created that until ~he socio-economic conditions improve, reduction in mortality and morbidity rates cannot be achieved. This is not strictly true2, 3. For instance, it is not realised that better utilisation of existing health facilities alone would automatically result in improvement in the health of the community. Experience in the treatment of acute diarrheal disease has shown that once convinced, the pattern of utilisation of health care by the community can be greatly improved and with very gratifying results. 4 By thus strengthening the health services at community level, both the delays in treatment as well as the burden on referral facilities can also be reduced--and all this at no extra cost to the exchequer. But before this can be done it is necessary to become

Acute respiratory infection in low birth weight infants.

Acute respiratory infections (ARI) related morbidity and mortality in low birth weight (LBW) infants in India is reviewed. The mortality related to ARI amongst LBW infants is higher than in normal birth weight (NBW) infants. The information on morbidity is variable. Standard case management of ARI leads to a reduction in mortality caused by ARI. On the basis of current information, a reduction of LBW incidence to 10% will lead to prevention of 248,000 deaths while the institution of standard case management will reduce 275,706 deaths. A simultaneous adoption of preventive and therapeutic strategies is recommended to reduce high ARI related mortality in LBW infants.