Magnitude and control of acute respiratory infections in children
Benguigui, Y.
Salud Publica de Mexico 30(3): 362-369
1988
ISSN/ISBN: 0036-3634 PMID: 3187734 Document Number: 324815
Acute respiratory infections of viral or bacterial origin represent 1 of the 3 main causes of morbidity and mortality in children of developing countries, where they typically are responsible for 15-20% of deaths in children under 5. Mortality rates are higher in children under 1 year and decline with age. Fewer than 2% of children with pneumonia in developed countries die, vs. an estimated 10-20% in developing countries. Operational studies indicate that children dying of acute respiratory infections are those who do not receive health services or receive them too late, and those whose moderate infections are inadequately treated. Determining factors include inaccessibility of health services, socioeconomic problems, cultural factors limiting the frequency and acceptance of formal health services, and inadequate management of acute respiratory infections by the general health services. Immunizations, better case management and health education are 3 interventions for control of respirator infections that offer immediate potential benefits for primary health care in developing countries. Vaccinations against whooping cough, measles, and diphtheria are part of the Expanded Program of Immunization. Anti-pneumococcal vaccines and flu shots are not appropriate for use in children in developing countries. Health personnel should be trained to use antibiotics more rationally and efficiently and to make referrals to higher levels of care when needed. Oxygen treatment should be available in secondary and tertiary care centers. Health personnel should be trained to administer simple treatments for other possible complications of respiratory infections. Such measures have been applied sporadically in developing countries and data on their efficacy remain sparse. But mortality rates declined greatly in 1 rural community of India after introduction of the measures, and more proofs of their efficacy will become available as programs develop. It will be necessary to train health agents in differentiation of cases according to gravity, to recommend and apply treatment, to administer antimicrobial drugs, and to refer cases to hospitals. The main decision of the health agent concerns the gravity of the case and not the diagnosis of pneumonia or bronchitis. A classification based on the few most important signs and symptoms will facilitate the 2 principal decisions about treatment; whether to administer antimicrobial and whether to treat at home or refer to a higher level of care. A 3-part classification of acute respiratory infections if suggested for all outpatient care and community health agents: serious cases requiring hospitalization 2) moderate cases requiring antimicrobial but not hospitalization and 3) mild cases not requiring antimicrobial.