Write the criteria for diagnosing pneumonia in children according to the 'Acute Respiratory Infection (ARI) Control Programme' (WHO). Write the treatment strategies of different types of pneumonia according to the ARI Control Programme.

Criteria for Diagnosing Pneumonia in Children (WHO ARI Control Programme)

The WHO's ARI Control Programme emphasizes clinical diagnosis, particularly for children under five years, using a combination of observable signs rather than complex diagnostic tests, which may not be available in all settings. The key diagnostic criteria are primarily based on respiratory rate and the presence of lower chest wall indrawing. The programme classifies the severity of illness into categories:

• No Pneumonia: A child with cough or cold but without fast breathing or lower chest wall indrawing.
• Pneumonia: A child with cough or difficult breathing, accompanied by fast breathing.
• Severe Pneumonia: A child with cough or difficult breathing, accompanied by lower chest wall indrawing, or any danger signs.
• Very Severe Disease: A child presenting with any general danger signs (e.g., inability to drink or breastfeed, persistent vomiting, convulsions, lethargy, unconsciousness, stridor in a calm child, central cyanosis).

Age-Specific Fast Breathing Rates:

Fast breathing is defined by the following respiratory rates:

• < 2 months old: 60 breaths per minute or more.
• 2 to 11 months old: 50 breaths per minute or more.
• 1 to 5 years old: 40 breaths per minute or more.

Other Key Diagnostic Signs:

• Lower Chest Wall Indrawing: The lower chest wall moves inward during inspiration, which is a significant indicator of severe pneumonia.
• General Danger Signs: These are critical indicators for severe and very severe disease and include:
  • Inability to drink or breastfeed
  • Persistent vomiting
  • Convulsions
  • Lethargy or unconsciousness
  • Stridor in a calm child
  • Central cyanosis
  • Apnea (cessation of breathing)

Treatment Strategies of Different Types of Pneumonia (WHO ARI Control Programme)

The treatment strategies are stratified based on the severity classification to ensure appropriate care, ranging from home-based management to urgent hospitalization.

1. Pneumonia (Non-severe)

This category generally refers to children with cough or difficult breathing and fast breathing, but without lower chest wall indrawing or danger signs.

• Treatment Setting: Outpatient (home care).
• Antibiotic: Oral Amoxicillin is the recommended first-line antibiotic, typically prescribed for 5 days. Historically, oral Cotrimoxazole was used, but Amoxicillin dispersible tablets (250mg twice daily for 5 days, or 3 days in low HIV settings) have replaced it.
• Supportive Care: Advise mothers on home care, including continued feeding and fluid intake. Treat fever if present.
• Follow-up: Advise mothers to return with the child in 2 days for reassessment, or earlier if the child's condition worsens.

2. Severe Pneumonia

Diagnosed when fast breathing is accompanied by lower chest wall indrawing or any general danger signs. This condition requires immediate medical attention.

• Treatment Setting: Urgent referral and hospitalization are required.
• Antibiotics: Injectable antibiotics are administered. Common choices include Ampicillin (for at least 5 days, or until the child is well for 3 days) or Benzylpenicillin. Gentamycin may be added in cases of very young infants or if there's suspicion of other bacterial infections.
• Oxygen Therapy: Oxygen is administered if the child shows signs of hypoxemia (e.g., respiratory rate > 70/min, severe chest indrawing, central cyanosis, or oxygen saturation below 90%).
• Supportive Care: Provide symptomatic treatment for fever and wheezing. Monitor fluid and food intake. Manage convulsions if present.
• Specific considerations for infants < 2 months with severe pneumonia: These infants are particularly vulnerable and often require broad-spectrum injectable antibiotics (e.g., Ampicillin and Gentamicin) and close monitoring for complications.

3. Very Severe Disease

This classification includes children with severe pneumonia symptoms along with critical general danger signs such as central cyanosis, inability to feed, persistent vomiting, convulsions, lethargy, or stridor in a calm child.

• Treatment Setting: Immediate and urgent hospitalization is critical.
• Antibiotics: Immediate parenteral (intravenous or intramuscular) antibiotic therapy with broad-spectrum antibiotics (e.g., Ampicillin and Gentamycin) is essential.
• Oxygen Therapy: High priority for oxygen administration, especially if oxygen saturation is below 90%.
• Resuscitation and Stabilization: Address immediate life-threatening issues, including airway management, breathing support, and circulatory support.
• Close Monitoring: Continuous monitoring of vital signs, oxygen saturation, and clinical progression is crucial.
• Management of Complications: Prompt management of complications such as seizures, severe dehydration, or other systemic infections.

The WHO's ARI Control Programme also emphasizes preventive measures, including immunization (against Hib, pneumococcus, measles, and pertussis), promoting exclusive breastfeeding, adequate nutrition, and addressing environmental factors like indoor air pollution. The Integrated Management of Childhood Illness (IMCI) strategy further integrates ARI control with other common childhood illnesses, offering a comprehensive approach to child health.