ARI and Tobacco Hazards

Question 1

Define Acute respiratory infections.

Answer 1

ARIs is sudden onset of infection of any part of the respiratory system from nose to alveoli, including paranasal sinuses, middle ear and pleural cavity

Question 2

Why is there increased morbidity and mortality among infants ( under age 5 ) in the developing countries?

Answer 2

1- increased prevalence of malnutrition
2- low birth weight
3- indoor air pollution, due to poor living condition
4- overcrowding

Question 3

Fill in the blanks :
1. ___________ percent of infants born in developing countries ____________

2. _______ percent of child mortality is attributable to acute respiratory infection as an __________
3. __________ percent of total pediatric out patients has ARI
4. _________ percent of hospital admissions because of ARI

Answer 3

1. 20 percent of infants born in developing countries fail to survive their fifth birthday.
2. 30 percent of child mortality is attributable to acute respiratory infection as an underlying or a contributing cause.

The ARI constitutes about :

3. 40 percent of total pediatric out patients
4. 20 percent of hospital admissions

Question 4

Mention the following groups symptoms according to WHO classification:

1. Acute upper respiratory infections (AURI)—includes anatomical first group —-> ?
2. Acute lower respiratory infections (ALRI)—includes anatomical second group ——> ?

Answer 4

1. Acute upper respiratory infections (AURI)—includes anatomical first group ——-> Rhinitis, coryza, sinusitis, otitis media, pharyngitis, tonsillitis, quinsy (peritonsillar abscess)
2. Acute lower respiratory infections (ALRI)—includes anatomical second group ——-> Epiglottitis, laryngitis, tracheitis, bronchitis, bronchiolitis, pneumonia, pleurisy

Question 5

True or False :

1. Respiratory tract may be invaded by one pathogen or a variety of pathogens . _________
2. primary infection can not lead onto secondary infection. ________
3. Usually bacteria cause mild upper respiratory infections and viruses cause severe lower respiratory infections. ______
4. Pathogens can occur simultaneously or one prepares the way for another to invade. _______

Answer 5

1. True ; Respiratory tract may be invaded by one pathogen or a variety of pathogens such as viruses, bacteria, fungi, parasites or allergens
2. False ; primary infection leading onto secondary infection.
3. False ; Usually viruses cause mild upper respiratory infections and bacteria cause severe lower respiratory infections.
4. True ; Pathogens can occur simultaneously or one prepares the way for another to invade.

Question 6

Incidence of ARI is more among_______ than among _____ in the ratio of ________. The difference may partly be due to preferential treatment .

Answer 6

Incidence of ARI is more among male children than among female children in the ratio of 1.7:1. The difference may partly be due to preferential treatment to male children.

Question 7

Why failure of breastfeeding is a risk factor for ARI ?

Answer 7

This deprives the child of maternal antibodies, more so from colostrum, pre disposing the child for a great risk of many communicable diseases including ARI.

Question 8

What decreases the integrity of respiratory epithelium predisposing the child for ARI which becomes severe and persistent (chronic) ?

Answer 8

—> decrease immune mechanism and vitamin-A deficiency in case of undernutrition

Question 9

Lack of routine primary immunization as per the schedule constitutes a major risk factor for acquiring the respiratory diseases such as ?

Answer 9

1. tuberculosis
2. measles
3. diphtheria
4. whooping cough
5. Pneumonia being the commonest complication.

These are major killer diseases of children in developing countries.

Question 10

Aside from causing a decrease in the integrity of respiratory mucous membrane what else does Vitamin A deficiency does to the host ?

Answer 10

reduces the secretion of mucus in the respiratory tract, predisposing the bacteriae to stick to the mucous membrane easily resulting in the disease

Question 11

A child with measles has impairment in the bronchial epithelium due to secondary bacterial infection from invasion of a bacteria in the oropharynx to lower region . This is an example of ?

Answer 11

Antecedent viral infection

Question 12

During the _______ or ______ after birth the newborn is extremely vulnerable to ARI.

Answer 12

During the first one or two months after birth the newborn is extremely vulnerable to ARI.

Question 13

Mention all the risk factors of ARI released to the host

Answer 13

1. Low birth weight
2. Failure of breastfeeding
3. Undernutrition
4. Lack of primary immunization
5. Young infant age (i.e. neonatal period)
6. Vitamin A deficiency
7. Antecedent viral infection

Question 14

State the Environmental Factors + give a brief explanation

Answer 14

1. Air pollution: ARI incidence is more among urban children than among rural children.
2. Smoking: Both active and passive smoking predisposes the people for ARI. Thus, the children of smokers are more prone for ARI.
3. Season: The incidence of ARI is more in winter season because of indoor living and overcrowding.

Question 15

Mention the Social Factors of ARI .

Answer 15

1. poverty
2. illiteracy
3. ignorance
4. lack of personal hygiene
5. overcrowding
6. poor standard of living
   7 lack of sanitation
7. non-utilization of health services

Question 16

Most ARIs are_____ however some are ______

a. pandemic
b. Endemic
c. outbreak
d. epidemic

Answer 16

Most ARIs are endemic ; however, some ARI such as measles, pertussis, influenza have potentiality of occurring in epidemics, when the case fatality rate will be very high.

Question 17

What is the Mode of transmission of ARI?

Answer 17

• primarily transmitted by droplet infection

- Epidemics and pandemics occur through airborne route, i.e. by droplet nuclei

Question 18

How can a newborn get infected with ARI?

Answer 18

• Transplacentally from the mother during fetal life ( eg.rubella)
• Aspiration of amniotic fluid during birth
• Droplet infection from others after birth.

Question 19

What are the causative organisms responsible for ARI?

Answer 19

1. E. coli
2. Strep. agalactiae (group B)
3. Pseudomonas
4. Pneumocystis carinii
5. Klebsiella pneumoniae
6. Streptococcus pneumoniae
7. Staphylococcus aureus

Question 20

What are the measures implemented to prevent ARI ?

Answer 20

The measures can be implemented at first TWO levels of prevention, namely health promotion, specific protection and early diagnosis and treatment.

Question 21

Why are the other levels of prevention not implemented?

Answer 21

Because ARI is an acute condition and not a chronic condition.

Question 22

State all the Health Promotion measures.

Answer 22

• Efficient antenatal care to reduce the incidence of LBW.
• Essential care of the newborn and special care of LBW newborn.
• Promotion of exclusive breastfeeding up to the first six months of life.
• Promotion of adequate nutrition of the growing children.
• Improvement in the living conditions (Housing and sanitation).
• Reduction of parental smoking and smoke pollution indoors.
• Limiting the size of the family to prevent overcrowding.

Question 23

State all the Health Education measures.

Answer 23

Health education of mothers about correct ARI case management at home with the following points:

– To increase feeding and to keep the child warm.

– To clear the nose by instillation of breastmilk, if runny nose interferes with feeding.

– To relieve the cough with homemade drinks like tea, ginger, lime juice, etc.

– To recognize danger signs such as fast breathing (increased respiratory rate) and difficult breathing. (Chest indrawing)

Question 24

What is the “ Specific Protection”?

Answer 24

• Strengthening the existing routine primary immunization.
• Oral vitamin A concentrate, 5 mega doses for children between 9 months and 3 years.
• Other vaccines which can be given are pneumococcal vaccine and Haemophilus B influenzae vaccine.

Question 25

State the delayed effects of tobacco smoking

Answer 25

• Smoking harms nearly every organ of the body in general and respiratory and cardiovascular systems in particular.
• Smoking results in many diseases, disabilities, reduces the lifespan of the individual leading to premature death.
• The effects of smoking depends upon the frequency of smoking, duration of smoking and also upon the concentration of the tar content in the cigarettes.

Question 26

State the immediate effects of tobacco smoking .

Answer 26

• New smokers get the feeling of relaxation, sharpness, calmness and alertness.
• Unpleasant experience will be nausea, cough, dizziness, rapid heart beat. Generally these vanish over time.
• Once the smoker develops dependency on nicotine, he/she will become a chronic smoker.

Question 27

Primordial prevention of Smoking

Answer 27

• Health education of school children and the population at large about the hazards of tobacco smoking and tobacco chewing
• Smokers are motivated to quit smoking

Question 28

Specific protection of smoking

Answer 28

• Avoiding smoking, itself is a specific protective measure.
• The specific protective measures for tobacco workers are:

– Wearing masks, to avoid inhalation of tobacco dust

– Beedi rolling to be done in well ventilated rooms

– Wearing gloves to protect hands

– Wearing goggles to prevent absorption through eyes

Question 29

Procedures such as Amputation of legs, blindness, etc. physically, mentally, socially and vocationally. Is an example of which prevention and control ?

Answer 29

Rehabilitation

Question 30

Giving intensive treatment, when smokers or beedi workers come with advanced disease. Is under which control measure ?

Answer 30

Disability limitation

Question 31

“ Legislative Measures” of tobacco smoking

Answer 31

• Prohibition of smoking in public places.
• Prohibition of direct and indirect advertisement of cigarettes and other tobacco products like film heroes holding/smoking cigarettes or burning cigarettes, etc.
• Prohibition of sale of cigarettes and other tobacco products to persons below 18 years.
• Mandatory depiction of statutory warning including pictorial warning on tobacco packs.
• English or regional language to be used for health warnings on tobacco packs.
• Ingredients to be declared on tobacco product packages.

Question 32

Early diagnosis and prompt treatment for smokers & beedi workers

Answer 32

This is done by periodical screening of chronic smokers and the beedi workers for the hazards of tobacco and encouraged them not only to take the treatment correctly and completely but also to quit smoking (Smoking cessation clinics).