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A community study of the application of WHO ARI management guidelines in Pakistan
M A Khan1, S A Qazi, G N Rehman
1Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad.
Insights
Most young children with acute respiratory infections (ARI) in Pakistan, particularly those with cough and cold, can be treated effectively without antibiotics. Pneumonia cases also showed good response to standard antibiotic treatment.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Acute respiratory infections (ARI) are a leading cause of mortality in children under five globally.
- Effective case management guidelines are crucial for reducing ARI-related morbidity and mortality in resource-limited settings.
- The World Health Organization (WHO) provides standardized ARI case management protocols.
Purpose of the Study:
- To assess the effectiveness of WHO ARI case management guidelines in a rural Pakistani community.
- To evaluate the proportion of children with ARI requiring antibiotic treatment.
- To determine treatment outcomes for pneumonia and non-pneumonia ARI cases.
Main Methods:
- A community-based study was conducted in four rural villages in Pakistan.
- 617 children under five with ARI were assessed and managed using WHO guidelines.
- Clinical classification included 'cough and cold', pneumonia, severe pneumonia, and otitis media.
Main Results:
- 82.5% of ARI cases presented with 'cough and cold' without pneumonia.
- 96.5% of non-pneumonia cases were successfully treated without antibiotics.
- 91.4% of pneumonia cases responded well to oral cotrimoxazole.
Conclusions:
- The WHO ARI case management guidelines are effective in a rural Pakistani setting.
- A significant proportion of children with cough and cold can be managed without antibiotics, conserving antimicrobial resources.
- Standard antibiotic therapy is effective for childhood pneumonia in this population.
Abstract:
During a community-based study in four rural villages in Pakistan, 617 cases of acute respiratory infections (ARI) in children younger than 5 years of age were assessed, classified and managed according to the WHO ARI case management guidelines. Of these, 509 (82.5%) had 'cough and cold' without clinical evidence of pneumonia, 95 pneumonia, two severe pneumonia and 11 otitis media. Of the 509 without clinical evidence of pneumonia but with cough and cold, 491 (96.5%) were successfully treated without antibiotics and only 18 (3.5%) of these children needed antimicrobial therapy on follow-up. Of the 95 cases of pneumonia, 87 (91.4%) showed a satisfactory clinical response to oral cotrimoxazole and only eight (8.4%) required a change of antibiotic.