Adolescent health

Adolescent HealthDr. Gopalrao Jogdand, M.D.

Professor & Head,Department of Community Medicine

04/12/23 Free template from www.brainybetty.com 2

Introduction

• Adolescence – stage of human development encompassing the transition from childhood to adulthood.

• Latin word – adolescere – to grow into maturity.

• Puberty – biologic changes & sexual maturation during this transition.Textbook of PSM – Piyush & Ghai


Definition

• WHO – age period between 10 – 19 years for both sexes, married & unmarried people.

• Youth – 15- 24 years• Young people – 10- 24 years• Most healthiest period of life & the

most problematic.

Textbook of CM – Sunder Lal


Demography

• 1/5th of total world population• 1 in every 5 human on this planet

is Adolescent.• 85% of them live in Developing

Countries.• 22.8% of Indian population• 230 million adolescents in

India(2001).


Special characters- Rapid physical growth &development.- Physical, social & psychological

development. - Sexual maturity & onset of sexual activity- Experimentation- Transition from total socioeconomic

dependence to relative independence.- Onset of reproductive cycle- Development of adult mental process &

adult identity.


Stages

• Early adolescence – 10 -13 years - growth spurt & secondary sexual

characters.• Mid adolescence – 14-16 years - independence & identity,

experimentation & relationship with peers and opposite sex.

• Late adolescence – 17 -19 years


Growth & DevelopmentA. Physical growth Skeletal growth- Secondary growth spurt – 25% of adult

height Body composition- Weight gain- Increase in adipose tissue in girls- Increase muscle mass


Maturation of reproductive system Hormonal changes- FSH, LH, Estradiol, Testosterone,

adrenal androgens.Secondary sexual characters- Breast development- Pubic hairs- Development of genitilia.


Psychosocial development

• Less interest in parental activities- Mood swings- Intense relationship with same &

opposite sex friends- Increased cognition- Increased need for privacy- Lack of impulse control. - Increased intellectual ability- Risk- taking behavior


Sexual changes

• Sexual desire increases• Sexual activities begin. Eg :masturbation/first sexual

intercourse• Curious to know about their own

as well opposite gender- experimentation

• Intimate relationships


Sequence of pubertal events In boys In girls

• Breast development i.e. Thelarche-

• Genital hair ie Pubarche-

• Axillary hair• Height velocity peaks• Menstruation begins ie

Menarche• Final development to

adult status of pubic hair, breasts, height etc

Testes increase in size Genital hair ie pubarche-Axillary hairfacial and body hair growthPenis increases in size Height velocity peaks Larynx enlarges, voice deepensEjaculation occurs at night ie Nocturnal emissions (wet dreams )


Adolescent health problems

A. Biomedical illness Congenital malformation/defects- Precocious/ delayed puberty- Short stature- Asthma, congenital & rheumatic

heart diseases- Tuberculosis, malaria


Contd..

B. Consequences of Risk taking behavior

- Unintended injuries : automobile & sports related accidents

- Intended injuries : violence, homicide, suicide

- STDs, HIV/AIDS- Substance abuse


• Untended injuries – premature death - 15-44years 50% - Motor vehicle accidents- 80% - 40% of death in 10- 19 yrs in US• Intended injuries – 1,00000 suicide in adolescents - Girls victims


• STIs/ HIV/AIDS- 2.6 million(50%) HIV infection

every year- ½ of 35 million cases of STIs in

young- 32 % of Adolescents aware of RTIs- 1 out of 20 adolescents – STD- 59% - Condoms, 49% – OCP


• SUBSTANCE ABUSE - tobacco, alcohol, illicit drug use

begins in adolescence. -150- 300 million smokers - India – 4.54% 0f 12-17yr - 13.86% of 18-23yrs


Contd..

C. Nutritional problems- malnutrition/ under- nutrition- Micronutrient deficiencies- Obesity- Eating disorders


• 45% girls, 20% boys undernourished

• 66% girls, 45%boys anemic• 75% < 50% of RDA of Vit A• IDD in 6-12yrs – 30 -50%


Contd..

D. Reproductive health problems

- Teenage pregnancy- Abortion related problems- Menstrual problems- Reproductive tract infections


• 50% of females under18yrs – married

• 11% (16million) birth – adolescent girls 15- 19yrs

• Adolescent abortion – 1- 4.4million/ year

• 20-30% boys, 10% girls sexual active before marriage


Contd..

E. Mental health problems- Substance abuse - Violence- Depression & suicide- Learning disorders- Other psychiatric problems


Multifactorial Causation of Health Problems

Underlying factors Immediate CausesHigh – Risk

Behavior

Adolescent Health Problems


• Gender – based discrimination

• Poverty

• Unemployment

• Urbanisation

• Migration

• Social values & norms

• Wars & emergencies

Underlying factors


• Inadequate education & skills

• Poor access to health information & services

• Unsafe & Unsupportive environment – families, friends, services providers, policies & the media

• Exploitation & abuse

Immediate Causes


• Psychosocial risk factors

• Physiological / Biological risk factors

• Behavioral risk factors

• Situation / Condition risk factors

High – RiskBehavior


Why Adolescents are Important?

• They are a demographic force.• They are an economic force.• They are the future health.• They have a right to participate.


Needs of Adolescents

• Correct information , on health, reproduction, nutrition, growth & development, sexuality& HIV/AIDS, STDs/ STI.

• Adequate diet• Healthy lifestyles• Education & health• Safe &Supportive environment• Counselling


Why Invest in Adolescent Health?

• Health Benefits – Current & Future Health– Intergenerational Effects

• Economic Benefits – Improved Productivity– Return On Investments– Alleviate Future Health Cost

• As a Human Right


Prevention of Adolescent health Problems

• Primary prevention : policies, information & education.

• Secondary prevention : identification & reduction of risk

• Tertiary prevention : treatment & rehabilitation


Primary prevention

• Promoting healthy development & establishment of healthy lifestyles.

• Policies & Legislation concept of minor reproductive healthSubstance abuseOccupational healthAccidentsPublic health


• Information one – way communication : radio,

television, newspaper, books, films

Two – way communication : in person, by telephone, etc


• Education provides informationIntellectual, social & moral

development Enable adolescents to manage

their health destinyGuidance on hygiene, exercise,

rest, eating, drinking, maturation, sexuality & relationship


Vehicles for health education - school - family - others – health workers, Youth

organisation leaders.. Educator - knowledgeable &

skilled at communication


Secondary prevention• Screening programme for visual

& oral health problems & learning disorders, illness & risk behaviors

• Through schools, work places, youth organisation.

• Services – more accessible to young.

• Health care providers – like, listen, respect adolescents.


• Counselling & guidance centres - sexual & reproductive health - substance abuse - mental health problems - violent behaviors


Tertiary prevention

• Curative services, along with education & information on causes.

• Rehabilitation – develop physically, psychologically & socially.

• Cooperation between sectors.


Sources of health care

• Schools health services• General health services• Special health services• Social marketing


Importance of adolescent immunization

Prevention and control of disease is important for their healthy growth.

Routine immunization also provides a chance of a health visit

Gives further chance for preventive services and health counseling.


– To boost immunity that is decreasing

– Efforts to decrease disease – To have specific Protection– To provide recent vaccines

available for immunization

Why Adolescent Immunization is important?


IAP adolescent immunization schedule

TT Booster at 10 and 16 years

Rubella As part of MMR vaccine or (Monovalent) 1 dose to girls at 12-13 years of age, if not given earlier

MMR 1 dose at 12-13 years of age. (if not given earlier)

Hepatitis B 3 Doses (0, 1 and 6 m) if not given earlier

Typhoid TA, Vi or Oral typhoid vaccine every 3 years

Varicella* 1 dose upto 12-13 years, and 2 doses after 13 years of age. (if not given earlier)

Hepatitis A* 2 doses (0 and 6 months) if not given earlier


MENSTRUAL HYGIENE• “good personal hygiene” will keep

you confident during these days .• Menstrual hygiene is very important

to prevent infection, local itching & bad odor.

• Take bath daily,• Use cotton under garments.• Wash with soap & water after toilet.


MENSTRUAL HYGIENE contd…

• Cloth/sanitary napkin is personal choice, but they should be clean and changed frequently as needed.

• If cloth is used ,it should be washed well before reuse, and not used for more than three months.

• Cloth should be very soft .Rough or thick cloth can cause irritation & itching.

•


Barriers to utilisation of health services

• Fear that health worker may ask difficult questions, conduct unpleasant procedures

• Uncomfortable with health workers• Concerns about confidentiality• Long waiting hours• Parental consent required• Lack of information: about needs & risks,

available services• Operational barriers: cost, location,

timing.


Guiding Principals for Adolescent Health

Programming(UNFPA, UNICEF & WHO)

• Adolescence is a time for opportunity and risk

• Not all adolescents are equally vulnerable• Adolescent Development underlies

prevention of Health Problems• Problems have common roots and are

interrelated• Social environment influences adolescent

behavior• Gender considerations are fundamental


Adolescent Friendly Initiative

• Two component- Adolescent friendly health

services- Adolescent friendly

counselling services• 75 districts RCH II

( 2003-08).• Adolescent health clinics- Clinical services- Counselling services


What is ‘Life Skills’?

…abilities that help promote mental well being and competence in young people as they face the realities of life.


UNICEF“life-skills based education is

-behavior change or behavior development approach

-designed to address a balance of three areas:

knowledge, attitude, and skills.

What is ‘Life Skills’?Contd..


What is ‘Life Skills’?

•WHO–“the abilities for adaptive and positive behavior that

- enables individuals to deal effectively with the demands and challenges of everyday life”

Contd..


What are the “Life Skills” ?

• Decision Making & Problem Solving

• Creative & Critical Thinking

• Negotiation Skills

• Effective Communication & Interpersonal Relationship• Self Awareness & Empathy• Coping with stress & Emotions


Significance of learning Life Skills

• To be able to explore alternatives

• Weigh pros and cons

• Make rational decisions

• Communicate effectively

• To say “No”

• Be assertive


How ‘Life Skills’ lead to primary prevention of health problems?

KnowledgeAttitudesValues

Life Skills

Behavior reinforcement or change

Positive Health Behavior

Prevention of Health Problems


Life Skills Education

• Dynamic teaching & Dynamic learning• Working in small groups & pairs• Brainstorming• Role-plays• Experiential learning• Games & debates• Home assignments, to further discuss and

practice skills with family & friends.


Characters of AFHS

Adolescent friendly policies - fulfils the rights of adolescents - account for special groups,

including vulnerable & underserved groups

- attention to gender factor - privacy & confidentiality - free & affordable


Adolescent friendly procedures- Easy registration, retrieval &

storage of records- Short waiting time- Consultation with or without

appointments


Adolescent friendly health care providers

- technically competent - good interpersonal communication

skills - non – judgmental & considerate - devote adequate time - treat all clients with equal care &

respect - provide information & support


• Adolescent friendly health facilities

- provide safe environment & convenient location

- provide information &educational material

- privacy & avoid stigma - have enough facilities


• Adolescent & community involvement

• Community based outreach & peer to peer services

• Appropriate & comprehensive services

• Effective health services• Efficient services


Services under AFHS

• General examination • Reproductive Health services with

sexual & reproductive health education• Contraception• Pregnancy testing & options of MTP• STIs/ HIV screening , counselling&

treatment• Prenatal & postpartum care• Well baby care ( adolescent mothers)


• Nutrition services• Growth & development monitoring• Detection & treatment of anemia• Guidance regarding substance

abuse• Counselling regarding life skill

development• Screening for various disorders


National programmes for Adolescents

• National Youth Policy 2003 - comprehensive view of youth

issues - adolescents divided intoA) rural & tribal youthB) out of school youthC) female adolescents


• Adolescent reproductive health• School health programme• National HIV/AIDS Control

Programme• ICDS - Reaching out of school Adolescent

Girls / Kishori Shakti Yojana - nutritional program for

Adolescent girls 2003


• Adolescent Girls Scheme- Scheme 1 : girl to girl approach- Scheme 2 : Balika Mandal• Family Health Awareness

Campaign


National AIDS Control Programme

• ICE activities

• AIDS Education in Schools

• University Talk AIDS Programme


ICDS

• OBJECTIVES- improve health & nutritional status- provide literacy & numeracy skills- awareness on health, hygiene,

nutrition ,family welfare….- train & equip in vocational skills


Kishori Shakti Yojana

• Adolescent girls 11- 18yrs• 2000 projects, 12.8 lakh girls• Services - watch over menarche- immunisation - deworming- general health checkup( 6 months)- treatment & referral- prophylactic measures against anemia


Nutritional Program 2003

• Adolescent girls < 35 kg• BPL• 6kg ration free of cost / month• Nutrition & health education by

anganwadi worker


Adolescent Girls(AG) Scheme

• Girl to girl approach- AG 11-15yrs, school dropouts- family income < Rs.6400/year- urban & rural - 3 AG/ anganwadi• Balika Mandal- AG 11-18yrs- 20 AG/ Anganwadi for 6 month


• 6 month learning & training• Supplementary nutrition • 10 themes for training- Env. Sanitation - child development- Nutrition - legal rights of

women- Home nursing – home economics- First Aid - positive attitudes- Family life education - motivation


Contents for Routine Adolescent visit

• Medical history• Family history• Psychosocial history (HEADSS)• - Home - Drugs• - Education - Sexuality• - Activities - Suicide/ Depression• Physical examination• Laboratory test


Thank You

Adolescent health

Health & Medicine

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