Today is our topic of discussion ARI Programme in Bangladesh
ARI Programme in Bangladesh
Started in 1992 under the fourth 5-year plan period and, essential drugs and equipment are being made available for the purpose. The programme objectives are –
1. To reduce morbidity, mortality and complications from ARI, especially in under-five
2. To rationalize the use of antimicrobials for the treatment of ARI in children.
Programme strategies include:
1. To institute standard case management including early diagnosis and timely administration in pneumonia, home care and referral.
2. To implement ARI programme activities through the PHC system.
Pneumonia in adults
Definition:
Pneumonia is the inflammation of the lung parenchyma associated with acute lower respiratory tract infection.
Classification of pneumonia:
According to anatomical location –
1. Bronchopneumonia
2. Lobar pneumonia
3. Segmental
According to immune status –
i. Primary pneumonia: Community acquired pneumonia
ii. Secondary pneumonia
1. Acute bronchopneumonia
2. Nosocomial or hospital acquired pneumonia
3. Aspiration pneumonia
4. Pneumonia in the immunocompromised personal
Aetiology:
The agents may be bacteria, viruses, fungi, mycoplasma & Chlamydia-
a) In previously healthy individual: S. pneumoniae
b) Pre-existing viral infection: Staph. aureus or S. pneumoniae
c) Chronic bronchitis: Haemophilus influenzae or S. pneumoniae
d) AIDS: TB
Organisms causing primary pneumonia:
1. Streptococcus pneumoniae (Pneumococci)
2. Staphylococcus aureus
3. Haemophilus influenzae
4. Streptococcus pyogenes
5. Pseudomonas aeruginosa
Risk factors:
Secondary to other conditions associated with reduced defence mechanisms –
– Viral infections (influenza, measles)
-Aspiration of food or vomitus
– Obstruction of a bronchus (foreign body or neoplasm)
– Inhalation of irritant gases
– Major surgery
– Chronic debilitating diseases & malnutrition
Symptoms:
a. Fever or lower-than-normal body temperature in older people
b. Cough (may be greenish or yellow mucus, or even bloody mucus)
c. Shortness of breath
d. Sweating and shaking chills
e. Chest pain that fluctuates with breathing (pleurisy)
f. Headache, muscle pain and fatigue
O/E:
a. Chest movement restricted on the affected side
b. Percussion note dull or impaired.
c. Bronchial breath sound.
d. Crepitation may be present
Characteristic feature of lobar pneumonia:
-Caused by Streptococcus pneumoniae.
-Previously healthy individuals.
-Abrupt onset.
-Unilateral stabbing chest pain on inspiration (due to pleurisy).
Investigations:
1. Blood TC, DC – Neutrophilic leucocytosis
2. Sputum for gram stain and C/S
3. X-ray chest: Homogenous opacity
Treatment of pneumonia:
1. Antibiotics: Initially empirical-
- Inj. Ceftriaxone (1-2 gm) IV OD or BD (according to severity)
- Amoxycillin: Oral or IV (10 mg/Kg/dose) TDS
- Cephradine: Oral or IV (10 mg/Kg/dose) QD
2. Bronchodilators
3. Oxygen therapy
4. Breathing treatments
5. Fluids
Complications of lobar pneumonia:
1. Abscess formation
2. Empyema
3. Failure of resolution with intra-alveolar scarring
4. Bacteraemia which may result in-
– Infective endocarditis
– Cerebral abscess / meningitis Septic arthritis
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