Priorities and Strategies

Acute respiratory infections (ARIs) are among the principal causes of child sickness and death in emergency situations, particularly among children in refugee and other displaced populations. Susceptibility is increased by overcrowding, malnutrition, low birth weight and a decrease in immunity due to various other causes. Pneumonia is likely to be especially prevalent during cold and wet seasons. In developing countries, 25 to 30 per cent of deaths among children under five are caused by ARI and 90 per cent of them are attributable to pneumonia.

Among ARIs, pneumonia is the most dangerous form and the most important cause of death. Although a large proportion of pneumonia episodes are caused by bacterial infections that are treatable with antibiotics, case fatality rates are high in many situations. Young children with pneumonia, especially those within the first two months of life, may die within 3 days of the onset of the illness, often before any contact is made with the health system.

Many deaths caused by pneumonia may be prevented by early recognition of infection by mothers and health workers and by correct treatment.

Strategies to reduce ARI deaths and morbidity at first-level health facilities and through community-based practitioners include:

· training health workers to recognize and provide appropriate, standardized treatment for childhood pneumonia and other ARIs; and

· ensuring the availability and regular supply of necessary drugs to first-level health facilities and community-based practitioners;

· ensuring appropriate referral services for the treatment of severe cases of pneumonia;

· educating parents to recognize the danger signs and symptoms of pneumonia and to seek medical help;

· reducing susceptibility of infants and young children to ARIs by promoting breastfeeding, ensuring immunization, improving shelter and ensuring adequate warmth (heating, clothing and blankets).

Pneumonia requires prompt treatment with an antibiotic after assessment by a trained health worker. Antibiotics can be given at home, except in cases of severe pneumonia that require referral for in-patient care at a hospital or health centre. There is no simple remedy that parents or other caregivers can use at home and little they can do on their own to reduce the severity once pneumonia sets in. Many deaths occur because help is sought too late, others because inappropriate treatment is given.

Staff of primary care facilities (health centres, dispensaries, etc.) and community health workers should be trained to:

· recognize the severe and less-severe forms of pneumonia and distinguish them from other, milder forms of ARI (coughs and colds) (see Panel 1);

· provide treatment for and follow up non-severe cases;

· refer severe cases to a referral centre, wherever feasible.

Parents (and other caregivers) need to be taught to:

· recognize the signs of pneumonia (see Panel 1) and seek medical help without delay for any child who has a cough and fast or difficult breathing (this should be a priority element in health education efforts in any situation where ARIs are prevalent); and

· provide supportive home care to children under treatment, including continued feeding, adequate fluid intake, use of safe and appropriate cough/cold remedies, prompt referral if there are signs of deterioration.

The importance of breastfeeding and immunization, including the benefits in reducing susceptibility to ARIs, must be emphasized in general health promotion activities.