Control of Acute Respiratory Infections (CARI)

Classification
A. No Pneumonia: Cough or Cold
  1. No chest in drawing
  2. No fast breathing ( <2 mos. - <60/min,2-12 mos. – less than 50 per minute; 12 mos. – 5 years – less than 40 per minute)
Treatment:
  1. If coughing more than 30 days, refer for assessment
  2. Assess and treat ear problems/sore throat if present
  3. Advise mother to give home care
  4. Treat fever/wheezing if present
Home Care:
1. Feed the Child
  • Feed the child during illness
  • Increase feeding after illness
  • Clear the nose if it interferes with feeding
2. Increase Fluids
  • offer the child extra to drink
  • Increase breastfeeding
3. Soothe the throat and relieve the cough with a safe remedy
4. Watch for the following signs and symptoms and return quickly if they occur
  • Breathing becomes difficult
  • Breathing becomes fast
  • Child is not able to drink
  • Child becomes sicker
B. Pneumonia
  1. No chest in drawing
  2. Fast breathing (less than 2 mos- 60/min or more ; 2-12 mos. – 50/min or more; 12 mos. – 5 years – 40/min or more)
Treatment
  1. Advise mother to give home care
  2. Give an antibiotic
  3. Treat fever/wheezing if present
  4. If the child’s condition gets worst, refer urgently to hospital; if improving, finish 5 days of antibiotic.
Antibiotics Recommended by WHO
  • Co-trimoxazole,
  • Amoxycillin, Ampicillin, (p.o)
  • or Procaine penicillin (I.M.)
C. Severe Pneumonia
  1. Chest indrawing
  2. Nasal flaring
  3. Grunting ( short sounds made with the voice)
  4. Cyanosis
    Treatment
  • Refer urgently to hospital
  • Treat fever ( paracetamol), wheezing ( salbutamol)
D. Very Severe Disease
  1. Not able to drink
  2. Convulsions
  3. Abnormally sleepy or difficult to wake
  4. Stridor in calm child
  5. Severe undernutrition
    Treatment
  • Refer urgently to hospital

Assessment of Respiratory Infection
Ask the Mother
  1. How old is the child?
  2. Is the child coughing? For how long?
  3. Age less than 2 months: Has the young infant stopped feeding well?
  4. Age 2 months up to 5 years: Is the child able to drink?
  5. Has the child had fever? For how long?
  6. Has the child had convulsions?
Look, Listen        1. Count the breaths in one minute.

 Age  Fast Breathing
 Less than 2 months  60/minute or more
 2 months- 12 months  50/minute or more
 12 months – 5 years  40/minute or more
 
    2. Look for chest in drawing.
    3. Look and listen for stridor. Stridor occurs when there is a narrowing of the larynx, trachea or epiglottis which interferes with air entering the lungs.
    4. Look and listen for wheeze. Wheeze is a soft musical noise which shows signs that breathing out (exhale) is difficult.
    5. See if the child is abnormally sleepy or difficult to wake. (Suspect meningitis)
    6. Feel for fever or low body temperature.
    7. Check for severe under nutrition

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