ACUTE RESPIRATORY

ILLNESS :
The National ARI Control Program was

launched in 1989 in order to reduce the

mortality attributed to pneumonia and
rationalize the use of drugs in the management
of patients with ARI.

Infant mortality rate: total: 67.36 deaths/1,000 live

births
male: 70.65 deaths/1,000 live births
female: 63.91 deaths/1,000 live births (2009 est.)

Year
2003
2004
2005
2006
2007
2008
2009
2010

Infant
mortality
rate
76.53
72.44
72.44
70.45
68.84
66.94
65.14
67.36

Percent
Change

Rank
33
36
37
37
33
32
32
28

-5.34 %
0.00 %
-2.75 %
-2.29 %
-2.76 %
-2.69 %
3.41 %

Date of
Information
2003 est.
2004 est.
2005 est.
2006 est.
2007 est.
2008 est.
2009 est.
2009 est.

Attention to counselling skills to promote exclusive

breastfeeding, complementary feeding & micronutrient
supplementation is a key strength of IMNCI

Other

Malaria*
Measles*
5%
7%

32%

Diarrhoea*
Malnutrition*
54%

Perinatal
18%

19%

Acute Respiratory
Infections*
19%

* Based on data taken from The Global Burden of Disease 1996, edited by Murray CJL and
Lopez AD, and Epidemiologic evidence for a potentiating effect of malnutrition on child
mortality, Pelletier DL, Frongillo EA and Habicht JP, AmJ Public Health 1993;83:1130-1133

Goals of IMNCI
Standardized case management of sick

newborns and children

Focus on the most common causes of
mortality
Nutrition assessment and counselling for
all sick infants and children
Home care for newborns to
promote exclusive breastfeeding
prevent hypothermia
improve illness recognition & timely care

seeking

The Components of the Respiratory

System

UPPER RESPIRATORY TRACT

INFECTION

LOWER RESPIRATORY TRACT

INFECTION

Viral
Bacterial

viral
bacterial

DOES THE CHILD HAVE THROAT

PROBLEM:
IF YES,ASK:

LOOK,AND FEEL:

Fever (temperature 37C)

Feel the front of neck for
Does the child have sore

throat?
Is the child not able to drink?
Does the child have fever?

tender and enlarged lymph

nodes
Look for red, enlarged tonsils
Look for exudates on throat

SIGNS

Sore throat AND not able to

drink

Fever and/or sore throat AND

atleast two of the following
signs
Tender ,enlarged lymph nodes
on neck
Red ,enlarged tonsils.
White exudate on throat

CLASSIFY

THROAT
ABSCESS

TREATMENT

Give first dose of appropriate

antibiotic
Treat the child to prevent low
blood sugar
Give paracetamol for high fever
or pain
Refer URGENTLY to hospital

STREPTOCOCCA Give benzathine pencillin or

L SORE THROAT amoxycillin
Give paracetamol for high fever
or pain
Give safe,soothing remedy for
sore throat
Advice mother when to return
immediately
Follow up in 5 days if not
improving

SIGNS

CLASSIFY AS

TREATMENT

Not enough signs to classify

as throat abscess or
streptococcal sore throat

VIRAL SORE THROAT

Give paracetamol for high

fever or pain
Give safe,soothing remedy
for sore throat
Advice mother when to
return immediately
Follow up in 5 days if not
improving

No signs present (with or

without fever)

NO THROAT PROBLEM

No addition treatment

GIVE AN ANTIBIOTIC FOR

STREPTOCOCCAL SORE
THROAT
Give single dose of intramuscular Benzathine

Penicillin
AGE

Benzathine penicillin (6 lac unit add in 5 ml sterile

water

< 5years

6 lac unit

OR
Amoxil

DOES THE CHILD HAVE COUGH

OR DIFFICULTY BREATHING ??
IF YES ,ASK?
For how long?
LOOK ,LISTEN
Count the breaths in one

CHILD MUST BE CALM

minute
Look for chest indrawing
Look and listen for stridor
Look and listen for
wheeze

Cutoff point for fast breathing!

If the child is
2months up to 2 years

12 months up to 5

years

50 breaths per minute or

more
40 breaths per minute or
more

SIGNS

CLASSIFY

TREATMENT

Any danger sign or

Stridor in calm child or
Chest indrawing or
(if wheeze then go
directly to treat
wheezing)

SEVERE
PNEUMONIA OR
VERY SEVERE
DISEASE

Give first dose of appropriate

antibiotic
Treat wheezing if present
Treat the child to prevent low
blood sugar
Refer URGENTLY to hospital

fast breathing
(if wheeze then go
directly to treat
wheezing)

PNEUMONIA

Give an appropriate antibiotic

for 5 day
Treat wheezing if present
Soothe the throat & relieve
the cough with safe remedy
Advice mother when to return
immediately
Follow up in 2 days.

SIGNS

CLASSIFY

TREATMENT

No sign of severe
pneumonia or
pneumonia
(if wheeze then go
directly to treat
wheezing)

NO PNEUMONIA
COUGH OR COLD

Treat wheezing if present

If cough more than 30
days,refer for assessment
Soothe the throat & relieve
the cough with safe remedy
Advice mother when to
return immediately
for wheezing now,follow
up in 2 days.
Follow up in

GIVE AN APPROPIRATE
ORAL ANTIOBIOTIC
FOR PNEUMONIA & EAR INFECTION
First line
antibiotic

amoxil

Second line
antibiotic

First generation
cephalosporin

90_100mg/kg/dy

twice for 5 days

Twice for 5 days

DOES THE CHILD HAVE EAR

PROBLEM:
IF YES,ASK:

Is there severe ear pain?

Is there ear discharge?
If yes,for how long?

LOOK,AND FEEL:

Look for pus draining from the

ear
Feel for tender swelling
behind the ear

SIGNS

CLASSIFY

TREATMENT

tender swelling behind MASTOIDITIS Give first dose of appropriate antibiotic

Treat the child to prevent low blood sugar
the ear
Give paracetamol for high fever or pain
Refer URGENTLY to hospital
Pus is seen draining
from the ear and/or
discharge is reported
for less than 14
days,OR
Severe ear pain

ACUTE EAR
INFECTON

Discharge is reported CHRONIC

for 14 or more
EAR
days(pus is seen or not INFECTION
seen draining from the
ear)

Give an appropriate antibiotic for 5 days

Give paracetamol for high fever or pain
Dry the ear by wicking
Advice mother when to return immediately
Follow up in 5 days if not improving
Dry the ear by wicking if pus seen draining
from the ear
Give paracetamol for high fever or pain
Refer to ear nose & throat specialist
Follow up in 5 days .

SIGNS

CLASSIFY AS

TREATMENT

no ear pain and no pus

draining from the ear

NO EAR INFECTION

if any other ear problem

give appropriate treatment
and refer to ear nose &
throat specialist