Guidelines for research on acute respiratory infections: memorandum from a WHO meeting.

The main objective of the WHO programme on acute respiratory infections (ARI) is the development, through epidemiological and operational research, of standard plans of patient management that can be applied at the primary health care level, and eventually of prototype programmes of ARI control. Research may be either hospital-based or population-based; each type has advantages and disadvantages. Studies in hospitalized patients should attempt to establish clinical descriptions of the different types of disease and the relative frequency of the various pathogens involved, to carry out controlled trials of therapeutic methods, and to monitor the locally prevalent pathogenic microorganisms. Population-based research, on the other hand, can provide information on the morbidity and mortality rates in the community, investigate the determinants of incidence and severity of illness, identify individuals and groups at special risk, and determine disease outcome in patients discharged from hospital; in addition controlled trials of preventive and therapeutic interventions can be carried out in a community setting. Research towards the standard plan of patient management should take into account the roles of the mother, the primary health care worker, and the hospital or health centre. The steps in the planning of these studies and in planning for the introduction of a programme of control, and of evaluating the results, are considered in detail. The design of questionnaires for this type of work and the role of the laboratory support are also discussed.