Impact of a pilot acute respiratory infection (ARI) control programme in a rural community of the hill region of Nepal

Abstract

A prospective study was conducted to determine the magnitude of morbidity and mortality caused by acute respiratory infections (ARI) among children under 5 years of age and to assess the feasibility of reducing mortality owing to ARI by the use of community health workers. Villages selected for this study were situated on the south-west edge of Kathmandu Valley, about 24 km from the city centre. The study group consisted of 1019 children under the age of 5 years at the beginning of the study and followed for 3 years. During the 1st year, baseline information was collected. During the 2nd and 3rd years, intervention measures (health education, immunization and antibiotics for children with signs suggesting pneumonia) were taken and their effect assessed. There was a 59% reduction in the ARI-specific death rate among study children between surveillance year and intervention year I and a further 25% reduction in the ARI-specific death rate between intervention years I and II. Despite a substantial reduction in ARI mortality with the interventions, there was still an unacceptably high mortality from chronic diarrhoea, malnutrition and other factors. This implies that the programme to control ARI, diarrhoea, malnutrition and immunizable diseases should be integrated into one, within the framework of a primary health care strategy.

The health impacts of exposure to indoor air pollution from solid fuels in developing countries: knowledge, gaps, and data needs.

“…The range of reductions was larger for those older than 5 years and highly depended on the time-activity budgets of individuals. These reductions in infant and child ALRI, due to environmental management, are similar in magnitude to those achieved by more costly medical interventions (103)(104)(105)(106)(107)(108).…”

The effect of case management on childhood pneumonia mortality in developing countries

“…Two of the identified studies 10 , 20 did not report enough data, and therefore they were not included in the meta-analyses. In addition, although four studies reported data on the effect of community case management with antibiotics on incidence of moderate/severe episodes of ALRI, a morbidity analysis was not performed because the signs they used to identify ALRI were either reported by the child’s mother, 12 , 15 or were not based on the WHO classification (mild, moderate, severe), 17 or were not specified 9 …”

Acute respiratory infection: a global challenge.

“…The remaining 2 915 000 deaths are considered to be associated mainly with pneumonia. Although these estimates are based on broad evaluations, a study of available national registration data and of 22 longitudinal community based studies has confirmed ARI as the leading cause of childhood mortality in developing countries. '…”