Introduction

“bitter are the tears of the child

Sweeten them
Deep are the thoughts of a child
Quit them
Sharp is grief of a child
Take it away from him
Soft is heart of a child
Do not harden it”

Children, the hope of tomorrow, the reason to smile and the dreams of future, who
has to be protected. Their tears and grief can not be admitted and the responsibility of
protecting them fall on our shoulders, we the grown-ups….Childhood the period of
disabilities and ailments as well as the period of their mental and social development.
Disturbance in the childhood can bring about various consequences with regard to the
growth and the development of the child both physically and mentally. Diseases play the
most terrific role in taking away the innocent smile from their faces. Among the disease
the acute respiratory tract infection contributes the major part.

It is a well recognized fact that acute respiratory tract infection among the
children is one of the serious diseases, which account s for high morbidity. It has been
estimated that 20%. If the infant’s born in developing countries fails to celebrate their 5th
birthday and 1/4th to 1/3rd of child morbidity is attributed to acute respiratory tract
infection as underlying and contributing causes.

Acute respiratory tract infections are the infection affecting the respiratory organs
which is mainly caused by bacterial and viral infection. Respiratory tract infections are
mainly 2 types: Upper respiratory tract and Lower respiratory tract infection. Specific
infections of the upper respiratory tract may be diagnosed during the toddler period
including pharyngitis, laryngits, infection of the trachea, retropharyngeal abscess.
Infections of the lower respiratory tract are such as acute bronchitis, asthmatic bronchitis
and pneumonia. Although weak infections of the lower respiratory tract may be
diagnosed in children of all ages they tend to occur most frequently in young children
who have not yet developed risk to infectious disease.

Acute respiratory tract infections are the leading causes of the death in Indian
children. Every year 12 million children are dying in developing countries sin the first
year of life. Out of which 90% constitute respiratory infections. Approximately 20 –
25% of acute respiratory tract infection death occurs below 2 months of age occurs in
infants 15 % of all hospitals admissions are due to acute respiratory tract infection. In
India about 7, 80,000 deaths among under five children annually are due to acute
respiratory tract infection. By using standard techniques, 70% of lives currently being
lost due to weak respiratory tract infection.
 Acute respiratory infections are the single most common infective causes of death
worldwide especially in tropical areas. A lack of diagnostic tests, limited access to
effective treatment and some traditional healing practices exacerbate the impact of
respiratory infections in tropical countries. The rapid urbanization of populations in the
tropics as increased the risk of transmitting respiratory pathogens. A combination of
poverty and overcrowding in the peri-urban zones of rapidly expanding tropical cities
promotes the epidemic spread of acute respiratory infections. The air that we breathe is
full of germs, so the infections of the respiratory tract are very common, especially those
affecting the upper tract.

Acute respiratory tract infections are mainly transmitted through air and droplets.
According to the source of infection it can be grouped into 2 categories that are Host and
Environment. Host factors include absence of breast feeding, malnutrition, low birth
weight, immunization status, young age etc. Environmental factors include air pollution,
overcrowded housing, poor personal hygiene and sanitation, low social economic status
and parenteral smoking.

Acute respiratory infections may cause the inflammation of the respiratory tract
anywhere, from nose to alveoli, with a wide range of combination of symptoms and
signs. Acute respiratory tract infection is often classified by clinical syndromes
depending on the site of infection and is released to as acute respiratory tract infection of
upper and lower respiratory tract. The upper respiratory infections include common cold,
pharyngitis and otitis media. The lower respiratory tract infections include epiglottitis,
laryngitis, laryngotrachitis, bronchitis, bronchiolitis and pneumonia.

Acute respiratory tract infections cause the death of 4 million children under the
age of five. The mothers should be aware about the symptoms which appear during the
infectious period. The main symptoms are running nose, cough, sore throat, difficult
breathing, fever, malaise, and headache and ear problem. Most children with these
infections have only mild infections such as cold or cough. However some children may
have pneumonia which is a major cause of death. In less developed countries measles
and whooping cough are the important causes of severe respiratory tract infection.

For identifying the acute respiratory tract infection there is no appropriate

diagnostic procedure. But for identifying the causative organism, throat culture will be
commonly used. For reducing the mortality it is essential to find out the danger signs by
care takers and provide access to appropriate treatment. The standard case management
of acute respiratory tract infection and prevention of death due to pneumonia is now an
integral part of RCH programme. Peripheral health workers are being trained to
recognize and treat pneumonia. Cotrimaxazole is being supplied to the health workers
through the CSSM drug kit.

Respiratory tract infection is an acute infectious disease which can be easily

transmitted. Immunization is the best measure to control the transmission. Primary
prevention through immunization could become a more important global strategy for
controlling the acute respiratory tract infection in the future. WHO has established key
indications for the assessment of correct respiratory tract infection management. These
indications were measured through health family surveys in India in 1992.

Performance indications of case management in India.

Indicator Percentage

Inappropriate antibiotics used for cough 65

and cold
Children with pneumonia not given 19
antibiotics
Respiratory rate counted 22
Chest indrawing checked 48
Caretakers (mother) knows correct home
care 4

These findings are an indicator quality of treatment given, while a lot has been
achieved, the survey indicates the need for further improvement especially in the area soft
training, communicating with care takers and regular monitoring of national programme.

Among the respiratory tract infection pneumonia is the major cause of death on
underfive. Most cases of pneumonia can be treated effectively with low cost antibiotics.
The main clinical problem is the speed of infections. Urgent treatment is often necessary,
but many parents do not understand how quickly severe respiratory distress can become
fatal and do not know that antibiotics are the only effective treatment. As a result, cases
of pneumonia that becomes fatal are usually first seen late in the course of illness.

Integrated management of childhood illness (IMCI) – an approach developed by

the world Health Organization and UNICEF. The overall objective is to improve the
degree and quality of survival and development of children of urban low income families.
As it is a major national public health problem, which gave initiative towards developing
a national acute respiratory tract infection control programme. This programme was
taken up as a pilot project in the country in the year 1990. Since 1992 – 1993 this
programme is being implemented a part of the child survival and safe motherhood
programme, which is now an integral part of the RCH programme.

Control of the acute respiratory infections is a major public health problem in

developing countries. Improved living condition, better nutrition and reduction of smoke
pollution indoors will reduce the burden of mortality and morbidity associated with acute
respiratory tract infection. The implementation of management protocol requires
community participation and health education.