Attachments
1. Introduction
1.1 Classification, Worldwide case load and challenges due to Acute Respiratory infections
Acute Respiratory infections (ARIs) may be classified into Acute Upper Respiratory Infections (AURI) and acute lower respiratory infections (ALRI), depending on the main organs affected (nose, sinuses, middle ear, larynx and pharynx in AURI versus trachea, bronchi and lungs in ALRI). AURIs are generally mild in nature and most often caused by viruses, sometimes with a bacterial component as in some cases of sinusitis and Otitis media. The common AURIs can be categorized into Common Cold or Cough and Cold (CC) and Influenza like Illnesses (ILI). The overwhelming majority of ARI deaths and severe illness episodes are due to ALRIs, consisting mainly of pneumonia1 and Severe Acute Respiratory infections (SARI). Classification and natural course of ARI can be simply described as follow (figure1).
It’s obvious that, pneumonia is the ultimate complication of most of ARI. Every year about 150 million episodes of pneumonia occur among children in developing countries2. Pneumonia kills more children under the age of five years than any other illness in every region of the world. Of the estimated 9 million child deaths in 2007; around 20% or 1.8 million were due to Pneumonia3. The situation continues to be more or less same until now. According to the world health report 2010; Pneumonia was the first most cause of death and representing 18% of under the age of five years children worldwide. This would cause burden on families and health the system as well.
Recent increase of Influenza like illnesses falls under AURI are tending to be increasing the morbidity and mortality rates due to AURI and consequence increase of Pneumonia as well. At the same time newly emerging respiratory infections categorized into Severe Acute Respiratory Infections (SARI) falls under ALRI and develops into severe Pneumonia with high case fatality.
Ultimately ARI has been one of constrains to reach the Millennium Development Goal 4 of reducing two thirds of under the age of five years mortality rate by 2015.