Prevention, care seeking and treatment for acute respiratory infection

Although coughs and colds are common among children, and most can be easily treated, sometimes coughs and colds are danger signs of pneumonia, which is the biggest killer of children. A child with cough and cold accompanied with rapid breathing, difficulty in breathing and fever may have pneumonia and require immediate attention. Many children die of pneumonia because the mother or caregiver does not recognise the seriousness of the symptoms. The danger signs of pneumonia include

• rapid breathing: for a child 2–12 months old, 50 breaths or more per minute

• difficulty in breathing: nasal flare 

• chest in-drawing: lower part of chest sucks in when child breathes

• child has cough for more than two weeks

• child is unable to breast-feed or drink, and vomits frequently.

A child with any of these danger signs needs to be taken to a health clinic or to a trained health worker immediately. Pneumonia cases can be reduced through exclusive breast-feeding for the first six months of life, vitamin A supplementation and complete immunisation—especially measles. Regular hand washing and reducing exposure to indoor smoke are also important in preventing ARIs.

Definitions:

• Prevention = Interventions 1, 6 and 9
• Recognise danger signs of pneumonia (rapid or difficult breathing, chest in-drawing, nasal flare and/or fever)
• Home-based management of cough, cold and fever
• Referral to health facility for high fever with danger signs

Target Behaviours/Results

• Prevention = Interventions 1, 6 and 9
• Caregiver recognises danger signs of pneumonia (rapid or difficult breathing, chest in-drawing, nasal flare, and/or fever)
• Caregiver seeks medical care and takes child to health facility immediately
• Caregiver continues to BF or CF, based on age
• Caregiver knows that the child is treated with appropriate antibiotics

Questions: 

What is the difference between ordinary coughs/colds and pneumonia? 

Children with ordinary coughs or colds, runny noses or sore throats do not have difficulty in breathing and they do not have a fever. 

A child with a cough and fever, and having difficutly breathing should be considered for pnuemonia and checked by a trained health worker immediatley. 

How dangerous is pnuemonia?

Very dangerous. Pnuemonia rematins one of the three leading infections causes of death in children younger than 5 years, and caused 1.3 million deaths in 2011.

The global case-fatality ratio for severe pnuemonia is 9%(9 out of 100 children with pneumonia die). 

What are the danger signs of pnuemonia? 

Some danger signs include: the child is breathing much faster than usual, the child is breathing with difficulty or grasping for air, the lower part of the chest sucks in when the child breathes in, or it looks as though the stomach is moving up and down, the child has a cough for more than 3 weeks, the child is unable to breasfeed or drink and/or the child vomits frequently. 

How do I know that a child is breathing too fast? 

Count the breaths per minute of the child and depending on the age, fast breathing can be determined as follows:

From birth to 59 days – more than 60 breaths a minute

 2 months to 12 months – 50 breaths a minute or more

 Over 12 months to 5 years – 40 breaths a minute or more 

How can I know the difference between pnuemonia and an asthma attack? 

Both diseases are grave and a child could die from either one of them; therefore bringing the child to the health facility is important. There are some differences, although both conditions affect the respiratory system.

Pneumonia is always accompanied by fever, asthma is not. Pneumonia is an acute disease, therefore is most likely accompanied by a general feeling of being sick (fatigue, headache, sweating or chills).

Asthma usually is a chronic disease and usually is not accompanied by these symptoms. Both diseases have cough, but this symptom has different quality. In Asthma, cough is usually DRY with no production of sputum; in Pneumonia cough is usually MOIST with production of green sputum. 

What are likely causes of pneumonia? 

Pneumonia can be caused by viruses, bacteria and fungi. A child who has a prolonged cough that persists for more than 3 weeks, may have tuberculosis, an infection in the lungs. 

Is pneumonia contagious? Can it be passed from one person to another? 

The germs that cause pneumonia are usually found in the mouth and nose of the infected person. They can be spread easily to another person, either through the air or by touching a contaminated surface. Typically, they enter the person's body through their mouth, nose, or eyes. When this happens, a battle begins -- the person's immune system tries to kill the germs, while the germs try to multiply.

Although a person with pneumonia is contagious, that person's germs are more likely to cause an upper respiratory infection in another person (such as the common cold) than pneumonia. This is because many of the viruses and bacteria that cause people to get pneumonia are the same ones that cause upper respiratory infections.

Who is at risk of pneumonia and other breathing illnesses? 

Children living in an environment with smoke such as tobacco or cooking fires are at risk

Children with weak immune systems (weak ‘soldiers’ in the body)

Malnourished children

Complications from other infections, for example measles, chickenpox 

What should I do if my child is suspected of having pneumonia? 

The child should be taken immediately to a trained health worker who can also provide a referral to a health facility if required. Do not try to just treat the child at home. 

7-11 HEALTH STRATEGY

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