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Childhood acute respiratory infection in Pakistan.

Controlling acute respiratory infection (ART) becomes increasingly important for Pakistan as oral rehydration therapy lessens mortality from childhood diarrhoea. This paper first reviews the pertinent global and then the Pakistani situation in terms of epidemiology, intervention trials and other significant studies. The case management strategies outlined in the National ART Control Programme are neither complete nor perfect, but they are a thoughtful, urgently needed first step. ART is a major killer of children in the developing world. WHO and UNICEF estimate that over 4 million (30%) of the 14 million under five death annually are due to ART, including measles (L5 million) and whooping cough (0.5 million). Child health advocates liken this mortality to “one jumbojetful” of coughing, dyspneic children crashing every 45 minutes with no survivors. Acute respiratory infection is the term generally adopted to include both upper ("URI" or “AUTH”) and lower (“LRI" "LRTI" OR "ALRI") respiratory infections that last 2 weeks or less. Upper respiratory infections include conditions above the epiglottis (usually the common cold, tonsillitis, otsitis, sinusitis, conjunctivitis and combinations). Lower respiratory infections include epiglottitis, laryngitis, bronchitis, bronchiolitis, bronchopneumonia, pneumonia and less common conditions like lung abscess and empyema. When ART is used in the primary health care (P1-IC) programmatic sense, it usually targets children under five and focuses on prevention and treatment of lower respiratory infections, especially pneumonia. Pneumonia accounts for 70% of ARI deaths, measles and pertussis for 25% and croup or respiratory syncytial virus (RSV) disease (presumably bronchiolitis) for 5%, National programmes, including Pakistan’s, may also address reducing the morbidity due to upper respiratory infections, mainly otitis, streptococcal tonsillopharyngitis and mastoiditis. When used in this paper, ART will refer to the lower respiratory tract infections and is synonymous with ALRI, the less commonly used term.