Control of acute respiratory infections in the Americas.

s and Reports 275 pediatric hospitalizations. Thus, the smoking) are frequent risk factors in the countries are committing a large proporRegion’s developing countries which tend tion of their health care resources to ARl to increase the incidence and severity of cases. However, this high expenditure AR1 episodes in children. does not translate into a large impact on the problem for several reasons, especially inaccessibility of health services and REGIONAL PROGRAM FOR THE deficient quality of care. CONTROL OF AR1 In the developing countries of the Region, an estimated 130 million people do Because of the magnitude of the AR1 not have access to health services. Lack problem among children in developing of access means that many children with countries, in the late 1970s PAHO/WHO pneumonia do not receive the necessary began a search for strategies to achieve care early enough, or that they die at four principal objectives: home. In many countries, between 20% and 60% of deaths from pneumonia among children under five occur at home. Even where geographic access to health services is adequate, the care given to cases of AR1 is often not. This problem, which contributes to elevated mortality rates from pneumonia in developing countries, is also reflected in the high rates of complications, such as hypoacusis and deafness or rheumatic fever, as a consequence of inadequate treatment of some acute infections of the upper respiratory tract (acute otitis media and streptococcal pharyngitis). Problems pertaining to quality of care also are expressed in the excessive or inappropriate administration of antibiotics for treatment of ARI, which is associated with an increase in bacterial resistance, the risk of producing toxic side effects in the child, and an increase in the cost of treatment without any increased benefit. In addition, the inappropriate use of antibiotics exhausts the reserves of the health services, making these drugs unavailable when they are really needed. For this reason, many who suffer from pneumonia run a grave risk of dying for lack of timely access to effective antibiotics. Malnutrition, low birth weight, lack of breast-feeding, lack of immunization, and contamination of household air (with smoke from cooking or parental cigarette 1. Reduce mortality from pneumonia in children under five; 2. Reduce the inappropriate use of antibiotics and other medications in the treatment of AR1 in children; 3. Reduce the severity and avoid complications of acute infections of the upper respiratory system in children (deafness subsequent to otitis media; rheumatic fever subsequent to streptococcal pharyngitis); 4. Reduce the complications of acute infections of the lower respiratory tract (pneumonia, bronchiolitis) through early diagnosis and effective treatment. PAHO and the countries of the Americas played an important role in studying and investigating these strategies, since this Region was a pioneer in establishing activities to control ARI, beginning in Costa Rica in 1970 and Par& Brazil, in 1980. The experiences of both countries were important in the analysis carried out by WHO in the late 198Os, which led to the design of control strategies. At the beginning of the 1990s and as a result of studies and research by WHO, two main strategies have been defined to achieve the objectives for controlling ARI: standard case treatment for ARl in the primary health care services and first re276 Bulletin of PAHO 26(3), 1992 ferral hospitals, and immunization against measles and whooping cough, which will prevent cases of pneumonia that occur as complications of these diseases. Given that immunization is an activity specific to the Expanded Program on Immunization (EPI), the PAHO ARI control program proposed to concentrate its efforts on effective implementation of standard case treatment and to strengthen immunization coverage by supporting the regular activities of EPI in the countries. As the principal objective of its activities, the PAHO ARI program has selected the reduction of pneumonia in children under five, in accordance with the goals of the World Summit for Children held in New York in 1990. Two additional objectives, as described above, concern reducing the inappropriate use of antibiotics and other medications in children with ARI and lessening the severity and complications of acute upper respiratory tract infections. To achieve these objectives, the Regional Program has proposed the following lines of work: l Assistance to the countries in preparing technical norms that are compatible with the PAHO/WHO proposed guidelines for AR1 case management in primary health care establishments. l Training of national and regional-level ARI control personnel in organizing control activities within the framework of comprehensive child health care. l Support in preparing and designing plans of operation to implant the strategy of standard case management for ARI in the health services. l Training of supervisors in implementing control activities at the health