Interventions for Lower respiratory tract infections (LRTI)

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Age Cohort: Pregnancy and newborn

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on respiratory tract infections including prevention measures (hand feeding, bottle feeding) Distribution of IEC materials on lower respiratory tract infections Advocacy for proper sanitation and good housing Community mobilisation for routine immunisation especially for the pneumococcal vaccine Breast feeding promotion	Exclusive breastfeeding Adequate nutrition for mothers and children Good hygiene practices including hand washing Avoidance of smoking within the household Avoidance of secondary exposure to smoke Avoidance of biomass combustion (particularly indoor cooking fires) and Avoidance of air pollutants Immunizations, e.g. Pneumococcal and pentavalent vaccinations Pneumococcal vaccine Haemophilus influenza type B vaccine Use of cleaner liquid fuels Use of solid fuel stoves	Recognition of LRTI signs and symptoms	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility Treatment of nonsevere clinical pneumonia at the community level Zinc supplementation
Primary Care
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Avoidance of smoking and secondary exposure to smoke Avoidance of air pollutants Full immunizations, e.g. Pneumococcal and pentavalent vaccinations Pneumococcal vaccine Haemophilus influenza type B vaccine	History Physical examination Pulse Oximetry	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility Facility based case management Zinc supplementation Standard of care (hospitalization+ low-flow oxygen and antibiotics) Bubble continuous positive airway pressure (bCPAP)
Referral Facility: General
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Full immunizations, e.g Pneumococcal and pentavalent vaccinations	History Physical examination Pulse Oximetry Full blood count, Chest radiography	Parenteral antibiotics Oxygen supplementation IV fluids Facility based case management Zinc supplementation Standard of care (hospitalization+ low-flow oxygen and antibiotics) Bubble continuous positive airway pressure (bCPAP)
Referral Facility: Specialist
Create awareness on respiratory tract infections including prevention measures Distribution of IEC materials on lower respiratory tract infections Advocacy for proper sanitation and good housing Health workers training on lower respiratory tract infections including prevention measures and management	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Full immunizations, e.g. Pneumococcal and pentavalent vaccinations	History Physical examination Pulse Oximetry Full blood count Chest radiography	Parenteral antibiotics Oxygen supplementation IV fluids ICU services for severe disease Facility based case management

Age Cohort: < 5 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on respiratory tract infections including prevention measures (hand feeding, bottle feeding) Distribution of IEC materials on lower respiratory tract infections i.e. danger signs like chest indrawing fast and difficult breathing. Advocacy for proper sanitation and good housing Community mobilisation for routine immunisation especially for the pneumococcal vaccine Create awareness on respiratory tract infections including prevention measures (hand feeding, bottle feeding) Distribution of IEC materials on lower respiratory tract infections i.e. danger signs like chest indrawing fast and difficult breathing. Advocacy for proper sanitation and good housing Community mobilisation for routine immunisation especially for the pneumococcal vaccine	Exclusive breastfeeding for the first 6 months of life and for up to two years Adequate nutrition for mothers and children Good hygiene practices including hand washing Avoidance of smoking within the household Avoidance of secondary exposure to smoke Avoidance of biomass combustion (particularly indoor cooking fires) and Avoidance of air pollutants Immunizations, e.g. Pneumococcal and pentavalent vaccinations Healthy nutrition including breastfeeding including exclusive breastfeeding for the first 6 months of life and for up to two years Good hygiene practices including hand washing and feeding utensils Avoidance of smoking within the household and secondary exposure to smoke to the under 5s Avoidance of biomass combustion (particularly indoor cooking fires) and other air pollutants that contribute to acute respiratory infections. Complete and timely immunizations, e.g., Pneumococcal and pentavalent vaccinations. Seek early treatment of respiratory infections for the children	Recognition of LRTI signs and symptoms	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility
Primary Care
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Avoidance of smoking and secondary exposure to smoke Avoidance of air pollutants Full immunizations, e.g. Pneumococcal and pentavalent vaccinations Healthy nutrition including breastfeeding including exclusive breastfeeding for the first 6 months of life and for up to two years Good hygiene practices including hand washing and feeding utensils Avoidance of smoking within the household and secondary exposure to smoke to the under 5s Avoidance of biomass combustion (particularly indoor cooking fires) and other air pollutants that contribute to acute respiratory infections. Complete and timely immunizations, e.g., Pneumococcal and pentavalent vaccinations. Seek early treatment of respiratory infections for the children	History Physical examination Pulse Oximetry	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility Assess and classify for Cough or Difficult breathing using the IMNCI guideline Treat and refer according to the classification as per the guidelines Monitor progress and follow-up and refer giving urgent Referral treatment with oxygen, antibiotics, correction of hypoglycaemia, etc.) Advise mother when to return immediately Advise mother when to return if not improving
Referral Facility: General
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Full immunizations, e.g. Pneumococcal and pentavalent vaccinations	History Physical examination Pulse Oximetry Full blood count Chest radiography	Parenteral antibiotics Oxygen supplementation IV fluids
Referral Facility: Specialist
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Full immunizations, e.g. Pneumococcal and pentavalent vaccinations	History Physical examination Pulse Oximetry Full blood count Chest radiography	Parenteral antibiotics Oxygen supplementation IV fluids Intensive care for severe disease Physical and clinical examination Hospitalization based by severity ((low oxygen saturation, poor feeding, dehydration, apnea, respiratory distress) Oxygen therapy -Maintenance of oxygen saturation levels Management of dehydration through Intravenous fluids administration Monitoring using blood tests, culture, chest x-ray, GeneXpert Check for any underlying condition for those with persistent symptoms of lower respiratory tract infections Follow-up/regular review until all symptoms and signs resolve ICU services for those with severe disease

Age Cohort: 5 - 11 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on respiratory tract infections including prevention measures (hand feeding, bottle feeding) Distribution of IEC materials on lower respiratory tract infections Advocacy for proper sanitation and good housing Community mobilisation for routine immunisation especially for the pneumococcal vaccine	Good hygiene practices including hand washing Avoidance of smoking within the household Avoidance of secondary exposure to smoke Avoidance of biomass combustion (particularly indoor cooking fires) and Avoidance of air pollutants Observation of good hygiene practices in food preparation for the children Encourage utilization of safe portable water in homes and communities Counselling on WASH services (use of safe water supply, sanitation and hygiene) Early recognition of danger signs by the family members Preventive zinc supplements Vaccination: rotavirus	Recognition of LRTI signs and symptoms	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility Syndromic diagnosis of lower respiratory tract infection (LRTI) and management with oral antimicrobials Oral antipyretics Oral hydration * Clinical assessment for early recognition of need for referral
Primary Care
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Immunizations Vaccination: pneumococcal conjugate Vaccination: haemophilus influenzae type b (Hib) Vaccination: seasonal influenza Vaccination: COVID-19 Vaccination: diphtheria-tetanus-pertussis-containing vaccines (DTPCV)	History Physical examination Pulse Oximetry	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility History and physical examination for lower respiratory infections Clinical assessment for early recognition of need for referral Pulse oximetry Point of care testing Inhaled bronchodilators for lower respiratory infections Oral antimicrobials for acute lower respiratory tract infections Oral antipyretics for acute lower respiratory tract infections Intramuscular antimicrobials for lower respiratory tract infections Education for home-based monitoring for danger signs History and physical examination for lower respiratory infections Basic laboratory tests Point of care testing Supplemental oxygen Inhaled bronchodilators for lower respiratory infections
Referral Facility: General
Health education on LRTI prevention measures and early treatment	Immunizations	History Physical examination Pulse Oximetry Full blood count, Chest radiography	Parenteral antibiotics Oxygen therapy IV fluids		Post-pneumonia pulmonary rehabilitation
Referral Facility: Specialist
Health education on LRTI prevention measures and early treatment	Immunizations	History Physical examination Pulse Oximetry Full blood count, Chest radiography	Parenteral antibiotics Oxygen therapy IV fluids Intensive care for severe disease		Post-pneumonia pulmonary rehabilitation

Age Cohort: 12 - 24 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on respiratory tract infections including prevention measures (hand feeding, bottle feeding)	Good hygiene practices including hand washing Avoidance of smoking within the household Avoidance of secondary exposure to smoke Avoidance of biomass combustion (particularly indoor cooking fires) and Avoidance of air pollutants	Recognition of LRTI signs and symptoms	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility
Primary Care
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Immunizations, e.g., Pneumococcal, influenza, COVID	History Physical examination Pulse Oximetry Chest radiography	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility
Referral Facility: General
Health education on LRTI prevention measures and early treatment	Immunizations, e.g., Pneumococcal, influenza, COVID	History Physical examination Pulse Oximetry Full blood count, Chest radiography	IV/IM antibiotics Oxygen supplementation IV fluids Oxygen therapy IV fluids
Referral Facility: Specialist
Health education on LRTI prevention measures and early treatment	Immunizations, e.g. Pneumococcal, influenza, COVID	History Physical examination Pulse Oximetry Full blood count, Chest radiography	IV/IM antibiotics Oxygen supplementation IV fluids Intensive care for severe disease

Age Cohort: 25 - 59 years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on respiratory tract infections including prevention measures Distribution of IEC materials on lower respiratory tract infections Advocacy for proper sanitation and good housing	Good hygiene practices including hand washing Avoidance of smoking within the household Avoidance of secondary exposure to smoke Avoidance of biomass combustion (particularly indoor cooking fires) and Avoidance of air pollutants	Recognition of LRTI signs and symptoms	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility
Primary Care
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Immunizations, e.g., Pneumococcal, influenza, COVID	History Physical examination Pulse Oximetry	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility
Referral Facility: General
Health education on LRTI prevention measures and early treatment	Immunizations, e.g; Pneumococcal, influenza, COVID	History Physical examination Pulse Oximetry Full blood count, Chest radiography	IV/IM antibiotics Oxygen supplementation IV fluids		Post-pneumonia pulmonary rehabilitation
Referral Facility: Specialist
Health education on LRTI prevention measures and early treatment	Immunizations, e.g., Pneumococcal, influenza, COVID	History Physical examination Pulse Oximetry Full blood count, Chest radiography	IV/IM antibiotics Oxygen supplementation IV fluids Intensive care for severe disease		Post-pneumonia pulmonary rehabilitation

Age Cohort: 60+ years

Health Promotion	Disease Prevention	Diagnostic	Curative	Rehabilitative	Palliative
Community Level
Create awareness on respiratory tract infections including prevention measures (hand feeding, bottle feeding) Distribution of IEC materials on lower respiratory tract infections Advocacy for proper sanitation and good housing	Good hygiene practices including hand washing Avoidance of smoking within the household Avoidance of secondary exposure to smoke Avoidance of biomass combustion (particularly indoor cooking fires) and Avoidance of air pollutants Use of cleaner liquid fuels Use of solid fuel stoves WASH activities including clean drinking water, sanitation and hygiene Counselling about household indoor air pollution Counselling on seeking early treatment for respiratory infections Vaccination: seasonal influenza Vaccination: COVID-19	Recognition of lower respiratory tract infections signs and symptoms	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility Syndromic diagnosis of lower respiratory tract infection (LRTI) and management with oral antimicrobials Oral antipyretics Oral hydration * Clinical assessment for early recognition of need for referral
Primary Care
Health education on LRTI prevention measures and early treatment	Good hygiene practices including hand washing Counselling and guidance on avoidance of smoking within the household and secondary exposure to smoke Immunizations, e.g., Pneumococcal, influenza, COVID Secondary level Vaccination: seasonal influenza Vaccination: COVID-19	History Physical examination Pulse Oximetry Complete blood count	First-line antibiotic treatment Immediate transfer of unresponsive or sever cases to a higher-level health care facility Facility based case management Standard of care (hospitalization+ low-flow oxygen and antibiotics)
Referral Facility: General
Health education on LRTI prevention measures and early treatment	Vaccination: seasonal influenza Vaccination: COVID-19	History Physical examination Pulse Oximetry Full blood count, Chest radiography	Antibiotics Oxygen supplementation IV fluids History and physical examination for lower respiratory infections Clinical assessment for early recognition of need for referral Basic laboratory tests Advanced laboratory tests Basic imaging (Ultrasound, X-ray) Treatment for acute lower respiratory tract infections Intravenous fluids Supplemental oxygen Mechanical ventilation		Post-pneumonia pulmonary rehabilitation
Referral Facility: Specialist
Health education on LRTI prevention measures and early treatment	Immunizations, e.g., Pneumococcal, influenza, COVID	History Physical examination Pulse Oximetry Full blood count, Chest radiography	Antibiotics Oxygen supplementation IV fluids Management of complications		Post-pneumonia pulmonary rehabilitation