Module 4: Community Management of Pneumonia

Report
CDI Module 17: Community Management
of Pneumonia
©Jhpiego Corporation
The Johns Hopkins University
A Training Program on CommunityDirected Intervention (CDI) to Improve
Access to Essential Health Services
Module 17 Objectives
By the end of this module, learners will:
 Describe the global burden of pneumonia and
reasons it cannot be neglected
 Describe the signs and symptoms of pneumonia
and its relationship to other acute respiratory
infections (ARIs)
 Define pneumonia
 Describe methods for prevention and treatment
of pneumonia
2
Why We Cannot Ignore Pneumonia
in Efforts to Control Malaria
 Pneumonia kills more children than any other
illness
 Any effort to improve overall child survival must
make the reduction of pneumonia’s death toll a
priority
 More than 35 million childhood pneumonia
episodes occur in African children each year
 More than one million of these children die
3
Pneumonia Is Common in Africa
4
Relation Between Pneumonia
and Other ARIs
 Pneumonia and other ARIs share similar clinical
features such as presence of:





Fever
Cough
Vomiting (sometimes)
Chest pain/indrawing
Rapid breathing
 Zinc and vitamin A are useful in managing both
pneumonia and ARI, especially lower ARI
 Co-trimoxazole and amoxicillin are effective drugs
against pneumonias caused by some bacterial
pathogens, but these do not cure ARI caused by
viruses
5
Recognizing Pneumonia
 Bacterial pneumonia usually causes children to become
severely ill, with high fever and rapid breathing
 Viral infections, however, often come on gradually and
may worsen over time
 Some common symptoms of pneumonia in children and
infants include rapid or difficult breathing, cough, fever,
chills, headaches, loss of appetite and wheezing
 Children under five with severe cases of pneumonia may
struggle to breathe, with their chests moving in or
retracting during inhalation (known as “lower chest wall
indrawing”)
 Young infants may suffer convulsions, unconsciousness,
hypothermia, lethargy and feeding problems
6
Two Most Important Signs of Pneumonia
 Difficult Breathing
 Fast Breathing
Photo by WHO/M. Weber at
http://whqlibdoc.who.int/hq/2009/WHO_FCH_CAH_NCH_09.04_eng.pdf
7
Framework for Pneumonia Control
PROTECT
PREVENT
children by providing a healthy
environment
children from becoming ill with
pneumonia
Exclusive breastfeeding for six months
Vaccination against measles,
pertussis, Spn* and Hib**
Adequate nutrition
Prevention of HIV in children
Prevent low birth weight
Co-trimoxazole prophylaxis for
HIV-infected and exposed children
Reduce indoor air pollution
Handwashing
REDUCE
PNEUMONIA
MORTALITY
AND
MORBIDITY
TREAT
Zinc supplementation for
children with diarrhea
*Streptococcus pneumoniae
**Hemophilis influenzae b
children who become ill with
pneumonia
Case management in community,
health center and hospital
8
Protecting Children from Pneumonia
Protect children by providing a healthy
environment
 Reduce indoor air pollution
 Encourage handwashing
 Promote exclusive breastfeeding for six months
9
Protecting Children from Pneumonia
(continued)
Reduce low birth weight (LBW)—defined as weight
at birth <2.5kg—by:
 Preventing malaria in pregnancy
 Provide long-lasting insecticide-treated nets (LLINs) and
intermittent preventive treatment in pregnancy (IPTp)
 Ensuring good maternal nutrition
 Provide food that contains zinc (e.g., vegetables, eggs,
meat and fish) and iodine (e.g., fish, iodized salt and
okra).
 Using a hematinic (to prevent anemia)
 Optimizing maternal health
10
Preventing Pneumonia in Children
Preventing children from developing pneumonia in
the first place is essential for reducing child
deaths
 Key prevention measures include:
 Promoting adequate nutrition (including breastfeeding and
zinc intake)
 Raising immunization rates
 Reducing indoor air pollution
 Recent research also suggests that handwashing
may play a role in reducing the incidence of
pneumonia
11
Preventive Measures: Breastfeeding and
Handwashing with Soap
12
Countries That Have Introduced Hib Vaccine
against Pneumonia
 Vaccines can prevent
some forms of pneumonia
 Only around half of 193
countries worldwide have
adopted Hib3 vaccine and
implemented it up to 80%
coverage
 We still have a long way to
go with this strategy
13
Status of Global Pneumococcal Conjugate
Vaccine Introduction (2008)
Here we see slow progress
with a vaccine to prevent
another form of pneumonia
14
Preventing HIV in Children
Routine assessment for signs/symptoms of HIV
(persistent diarrhea, failure to thrive)
 HIV testing
 Pneumocystis carinii pneumonia (PCP) prophylaxis
(starting at six months)
 Prevention and treatment of TB or malaria
 Specific interventions to reduce mother-to-child
transmission (MTCT) of HIV include antiretroviral
(ARV) treatment and prophylaxis, safe delivery
procedures, counseling and support for safe infant
feeding
15
Treatment
16
Chart for Classifying and Treating
Respiratory Illness
SIGNS
•
•
CLASSIFY AS
Severe pneumonia
•
Fast breathing (see below)
Lower chest wall
indrawing
Stridor in calm child
•
Fast breathing (see below)
Non-severe pneumonia
TREATMENT
•
•
•
•
•
No fast breathing
What is fast breathing?
If the child is…
2 months to 12 months old
12 months to 5 years old
Other respiratory illness
•
Refer urgently to hospital for
injectable antibiotics and
oxygen, if needed
Give first dose of appropriate
antibiotic
Prescribe appropriate
antibiotic
Advise mother about other
supportive measures and
when to return for a follow-up
visit
Advise mother about other
supportive measures and
when to return if symptoms
persist or get worse
The child has fast breathing if you count…
50 breaths or more per minute
40 breaths or more per minute
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Treatment
 Co-trimoxazole and amoxicillin are effective
drugs against bacterial pathogens and are often
used to treat children with pneumonia in
developing countries
 Infants under two months of age, with signs of
pneumonia/sepsis:
 Are at risk of suffering severe illness and death more
quickly than older children, and
 Should be immediately referred to a hospital or clinic
for treatment
18
Medicine for Cough, Fast Breathing, Fever
 Give an appropriate oral antibiotic
 For pneumonia, acute ear infection, severe
classifications requiring first dose of antibiotics:
 First-line antibiotic co-trimoxazole
– Adult tablet = trimethoprim (80 mg) + sulfamethoxazole (400
mg)
– Pediatric tablet = trimethoprim (20 mg) + sulfamethoxazole
(100 mg)
– Syrup/per 5 ml = 40 mg trimethoprim + 200 mg
sulfamethoxazole
 Second-line antibiotic amoxicillin
– Tablet 250 mg; syrup 125 mg per 5 ml
 In all the children on co-trimoxazole prophylaxis,
give amoxicillin
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Cough, Fast Breathing, Fever
Give Appropriate Dosage by Age or Weight
Co-Trimoxozole
Give two times daily
for five days
Amoxicillin
Give three
times daily
for five days
Adult Tablet
80 mg trimethoprim +
400 mg
sulfamethoxazole
Pediatric Tablet
20 mg trimethoprim +
100 mg
sulfamethoxazole
Syrup/per 5 ml
40 mg trimethoprim
+ 200 mg
sulfamethoxazole
Two months
up to 12
months (4kg
to <10kg)
1/2
2
5 ml
1/2
5 ml
12 months up
to five years
(10kg‒19kg)
1
3
7.5 ml
1
10 ml
Age or
Weight
Tablet
250 mg
Syrup
125 mg
per 5 ml
This is a sample schedule and dose table for oral antibiotics
Users will need to confirm and comply with specific country treatment guidelines
20
Summary Points
 Infants under two months of age with signs of
pneumonia/sepsis:
 Are at risk of suffering severe illness and death more
quickly than older children, and
 Should be immediately referred to a hospital or clinic
for treatment
 Research evidence has shown that
handwashing and breastfeeding may prevent
pneumonia
 Use an appropriate oral antibiotic for treatment
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