25. Acute Respiratory Infections in Children

Abstract

Acute respiratory infections (ARIs) are the most common causes of illness and death in children under five (except neonates), with pneumonia alone responsible for about one–fifth of the estimated 10.6 million deaths per year in young children. Moreover, the severity and fatality of lower respiratory tract infections (LRIs) in this population are worse in developing countries, and children often lack access to effective therapy. Unlike upper respiratory tract infections (URIs) such as rhinitis, sinusitis, and ear infections, LRIs ?commonly, severe pneumonia and bronchitis?often do not respond to therapy. Complicating this picture is the increasing number of children infected by HIV/AIDS, which makes them not only more vulnerable to LRIs, but also more likely to succumb to these infections.

Interventions to control both LRIs and URIs are matters of basic health care and environmental health. Widespread use of vaccines against measles, diphtheria, pertussis, Hib, pneumococcus, and influenza has the potential to substantially reduce the incidence of ARIs in children in developing countries, as does simple, systematic case management to diagnose and promptly treat children with LRIs. In addition, improvements in nutrition and sanitation can help reduce the heavy toll these diseases exact on young life.

Despite the huge loss of life to pneumonia each year, the promise inherent in either the Hib vaccine or simplified case management has not been realized globally, in large part because children do not have access to appropriate health services and facilities. Some countries, including The Gambia, Honduras, Bangladesh, and Nepal, have established sustainable programs for treatment at the community level. Such programs, combined with accurate referral and treatment of children and the wider use of available vaccines, could reduce ARI mortality among children by as much as two–thirds in the coming years.