What is it about?
The global epidemiology of lower respiratory infections in children has changed dramatically from bacterial infections caused by pneumococcus and H. influenzae to airways diseases caused by viruses. Although vaccines have contributed to this change, even in countries without vaccinations against these bacterial infections, there has been a dramatic shift towards viral infections (especially RSV) causing acute bronchiolitis in children under 2 years. The WHO IMCI programme has not accommodated this change and largely fails to differentiate these very different forms of LRTI
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Why is it important?
The IMCI programme is indirectly encouraging the inappropriate use of antibiotics for viral airways disease due to fast breathing and chest indrawing being considered indications for antibiotics.
Perspectives
There are serious limitations to protocol-driven clinical decision-making. However, the diarrhoeal protocol starts by distinguishing watery diarrhoea from dysentery. I would argue that the ARI protocol needs to start by differentiating parenchymal disease (pneumonia) from airways disease (acute bronchiolitis or asthma if recurrent). This is not always easy since airways disease is often comlicated by retained secretions, aspiration and occasionally frank pneumonia. But with proper clinical assessment and use of oxygen saturation, it is possible for health workers - and especially doctors - to avoid irrational use of antibiotics and incorrect diagnoses.
Professor David R Brewster
National Hospital, Dili
Read the Original
This page is a summary of: The failure of IMCI to recognise airways disease, Paediatrics and International Child Health, September 2014, Taylor & Francis,
DOI: 10.1179/2046905514y.0000000142.
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