Lesson 1Latest international and national guidelines for ARI assessment (WHO, AAP, local health ministry)This section reviews key international and national guidelines for assessing paediatric acute respiratory infections, including WHO, AAP, and local ministry protocols, highlighting similarities, differences, and practical ways to adapt them to various clinic environments in Nigeria.
Core principles of WHO ARI and IMCI guidanceAAP recommendations for bronchiolitis and pneumoniaLocal health ministry algorithms and care pathwaysReconciling conflicting guideline recommendationsAdapting guidelines to resource-limited settingsKeeping protocols updated and staff trainedLesson 2Quality improvement measures: clinic triage, pathways, and audit of ARI management outcomesThis section introduces quality improvement methods for ARI care, covering triage systems, standard clinical pathways, auditing outcomes with feedback, and using data to minimise variations, boost safety, and increase efficiency in busy Nigerian clinics.
Designing and refining ARI triage processesImplementing standardised ARI care pathwaysCollecting and analysing ARI outcome indicatorsAudit and feedback to change clinician behaviourReducing delays in oxygen and critical treatmentsEngaging teams and leadership in QI projectsLesson 3Severity classification frameworks and decision rules for home care vs hospital referral (red flags, validated scores)This section explains severity classification systems for paediatric ARIs, including red flag signs and validated scores, and demonstrates how to use them to choose between home care, observation, hospital referral, or close monitoring in resource-constrained areas.
Key red flag signs requiring urgent interventionUse of WHO pneumonia and bronchiolitis categoriesValidated paediatric early warning and triage scoresDeciding on home care versus hospital referralObservation, short-stay, and step-down optionsDocumenting and communicating risk stratificationLesson 4Rational use of diagnostics: pulse oximetry, chest X-ray, CRP/POC tests, viral testing – indications and interpretationThis section guides the sensible use of diagnostics in paediatric ARIs, such as pulse oximetry, chest X-rays, CRP and point-of-care tests, and viral tests, stressing when to use them, how to interpret results, and avoiding needless tests in Nigerian health facilities.
Routine use and pitfalls of pulse oximetry in childrenWhen chest X-ray is indicated and how to interpretRole and limits of CRP and other POC biomarkersIndications for viral testing and result implicationsAvoiding unnecessary tests and radiation exposureCommunicating diagnostic decisions to caregiversLesson 5Caregiver guidance: home care instructions, warning signs, return precautions, infection control and preventionThis section prepares clinicians to advise caregivers on safe home care for respiratory infections, covering symptom relief, hydration, infection control, warning signs, and tailored return instructions based on local resources and family situations in Nigeria.
Explaining illness course and expected symptom durationHome comfort measures, fluids, and fever managementRecognising red flag symptoms and danger signsClear return precautions and when to seek urgent careHousehold infection control and isolation strategiesAdapting advice to literacy, culture, and resourcesLesson 6Oxygen therapy, nebulization vs MDI with spacer, indications for hospitalization and escalationThis section reviews indications and methods for paediatric oxygen therapy, compares nebulisation with MDI plus spacer, and outlines criteria for hospital admission, escalating care, and safe transfers in settings with varying resources across Nigeria.
Indications and targets for paediatric oxygen therapySafe oxygen delivery devices and monitoringNebuliser versus MDI with spacer: pros and consCorrect MDI with spacer technique and coachingCriteria for hospital admission and higher level careStabilisation and safe transfer of hypoxemic childrenLesson 7Focused respiratory physical exam: work of breathing, auscultation findings, oxygenation assessment, hydration, and danger signsThis section details a focused paediatric respiratory exam, stressing assessment of breathing effort, auscultation results, oxygenation, hydration, and neurological state to spot danger signs and direct prompt management in primary care.
Inspection of respiratory rate and chest movementsIdentifying retractions, grunting, and nasal flaringAuscultation: wheeze, crackles, and diminished air entryAssessing oxygenation, colour, and mental statusEvaluating hydration and perfusion in sick childrenIntegrating exam findings into severity assessmentLesson 8Evidence-based symptomatic treatments and medications: bronchodilators, inhaled steroids, antipyretics, antibiotics (when indicated)This section reviews evidence-based treatments and drugs for paediatric ARIs, including bronchodilators, inhaled steroids, antipyretics, and antibiotics, focusing on when to use them, dosing, safety, and preventing antimicrobial resistance in Nigeria.
Nonpharmacologic comfort and nasal clearanceWhen bronchodilators are indicated and effectiveUse of inhaled steroids in wheezing illnessesSafe antipyretic use and caregiver instructionsAntibiotic indications, choices, and durationsAntimicrobial stewardship and resistance preventionLesson 9Epidemiology and etiology of ARIs in children under 5 (viral vs bacterial causes)This section summarises global and local epidemiology of acute respiratory infections in under-fives, differentiating viral from bacterial causes, seasonal trends, and how age, comorbidities, and environment affect causes and outcomes in Nigerian contexts.
Global and local burden of ARIs in under-fivesCommon viral pathogens and typical clinical patternsBacterial causes and associated risk profilesSeasonality and outbreak patterns in young childrenImpact of malnutrition, HIV, and chronic diseaseAntimicrobial resistance trends and implicationsLesson 10Documentation, follow-up planning, and safety-netting communication strategies with caregiversThis section covers proper documentation of ARI visits, creating personalised follow-up plans, and safety-netting talks that help caregivers grasp next steps and know when to seek more help in community health settings.
Essential elements of ARI visit documentationWriting clear, actionable follow-up plansExplaining expected course and variability of illnessSafety-netting language that caregivers understandUsing teach-back to confirm caregiver understandingCoordinating with primary care and community workersLesson 11Structured history taking: key symptoms, duration, risk factors, immunization, feeding, home environmentThis section outlines a structured, efficient respiratory history for young children, including main symptoms, start and length, risk factors, immunisation, feeding and hydration, and home exposures that impact disease severity in Nigeria.
Characterising cough, breathing difficulty, and feverOnset, duration, and progression of respiratory symptomsPrematurity, comorbidities, and other risk factorsImmunisation status, including pneumococcal and influenzaFeeding, hydration, and urine output assessmentHome crowding, smoke, and biomass exposure history
