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Health problems of the adolescents and their prevention and control strategies

Health problems of the adolescents and their prevention and control strategies

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  • 1. Adolescent Health Dr. Gopalrao Jogdand, M.D. Professor & Head, Department of Community Medicine
  • 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 11/13/13 Free template from www.brainybetty.com 2
  • 3. 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 11/13/13 Free template from www.brainybetty.com 3
  • 4. 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). 11/13/13 Free template from www.brainybetty.com 4
  • 5. 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. 11/13/13 Free template from www.brainybetty.com 5
  • 6. 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 11/13/13 Free template from www.brainybetty.com 6
  • 7. Growth & Development A. Physical growth  Skeletal growth - Secondary growth spurt – 25% of adult height  Body composition - Weight gain - Increase in adipose tissue in girls - Increase muscle mass 11/13/13 Free template from www.brainybetty.com 7
  • 8.  Maturation of reproductive system  Hormonal changes - FSH, LH, Estradiol, Testosterone, adrenal androgens. Secondary sexual characters - Breast development - Pubic hairs - Development of genitilia. 11/13/13 Free template from www.brainybetty.com 8
  • 9. 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 11/13/13 Free template from www.brainybetty.com 9
  • 10. Sexual changes • Sexual desire increases • Sexual activities begin. Eg :masturbation/first sexual intercourse • Curious to know about their own as well opposite genderexperimentation • Intimate relationships 11/13/13 Free template from www.brainybetty.com 10
  • 11. Sequence of pubertal events In boys In girls Testes increase in size Genital hair ie pubarcheAxillary hair facial and body hair growth Penis increases in size Height velocity peaks Larynx enlarges, voice deepens Ejaculation occurs at night ie Nocturnal emissions (wet dreams ) 11/13/13 • 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 Free template from www.brainybetty.com 11
  • 12. Adolescent health problems A. Biomedical illness Congenital malformation/defects - Precocious/ delayed puberty - Short stature - Asthma, congenital & rheumatic heart diseases - Tuberculosis, malaria 11/13/13 Free template from www.brainybetty.com 12
  • 13. Contd.. B. Consequences of Risk taking behavior - Unintended injuries : automobile & sports related accidents - Intended injuries : violence, homicide, suicide - STDs, HIV/AIDS - Substance abuse 11/13/13 Free template from www.brainybetty.com 13
  • 14. • 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 11/13/13 Free template from www.brainybetty.com 14
  • 15. • 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 11/13/13 Free template from www.brainybetty.com 15
  • 16. • 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 11/13/13 Free template from www.brainybetty.com 16
  • 17. Contd.. C. - 11/13/13 Nutritional problems malnutrition/ under- nutrition Micronutrient deficiencies Obesity Eating disorders Free template from www.brainybetty.com 17
  • 18. • 45% girls, 20% boys undernourished • 66% girls, 45%boys anemic • 75% < 50% of RDA of Vit A • IDD in 6-12yrs – 30 -50% 11/13/13 Free template from www.brainybetty.com 18
  • 19. Contd.. D. - 11/13/13 Reproductive health problems Teenage pregnancy Abortion related problems Menstrual problems Reproductive tract infections Free template from www.brainybetty.com 19
  • 20. • 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 11/13/13 Free template from www.brainybetty.com 20
  • 21. Contd.. E. - 11/13/13 Mental health problems Substance abuse Violence Depression & suicide Learning disorders Other psychiatric problems Free template from www.brainybetty.com 21
  • 22. Multifactorial Causation of Health Problems Underlying factors Immediate Causes High – Risk Behavior Adolescent Health Problems 11/13/13 Free template from www.brainybetty.com 22
  • 23. Underlying factors • • • • • • • Gender – based discrimination Poverty Unemployment Urbanisation Migration Social values & norms Wars & emergencies 11/13/13 Free template from www.brainybetty.com 23
  • 24. Immediate Causes • Inadequate education & skills • Poor access to health information & services • Unsafe & Unsupportive environment – families, friends, services providers, policies & the media • Exploitation & abuse 11/13/13 Free template from www.brainybetty.com 24
  • 25. High – Risk Behavior • • • • Psychosocial risk factors Physiological / Biological risk factors Behavioral risk factors Situation / Condition risk factors 11/13/13 Free template from www.brainybetty.com 25
  • 26. 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. 11/13/13 Free template from www.brainybetty.com 26
  • 27. 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 11/13/13 Free template from www.brainybetty.com 27
  • 28. 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 11/13/13 Free template from www.brainybetty.com 28
  • 29. Prevention of Adolescent health Problems • Primary prevention : policies, information & education. • Secondary prevention : identification & reduction of risk • Tertiary prevention : treatment & rehabilitation 11/13/13 Free template from www.brainybetty.com 29
  • 30. Primary prevention • Promoting healthy development & establishment of healthy lifestyles. • Policies & Legislation  concept of minor  reproductive health Substance abuse Occupational health Accidents Public health 11/13/13 Free template from www.brainybetty.com 30
  • 31. • Information  one – way communication : radio, television, newspaper, books, films Two – way communication : in person, by telephone, etc 11/13/13 Free template from www.brainybetty.com 31
  • 32. • Education  provides information Intellectual, social & moral development Enable adolescents to manage their health destiny Guidance on hygiene, exercise, rest, eating, drinking, maturation, sexuality & relationship 11/13/13 Free template from www.brainybetty.com 32
  • 33. Vehicles for health education - school - family - others – health workers, Youth organisation leaders.. Educator - knowledgeable & skilled at communication 11/13/13 Free template from www.brainybetty.com 33
  • 34. 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. 11/13/13 Free template from www.brainybetty.com 34
  • 35. • Counselling & guidance centres - sexual & reproductive health - substance abuse - mental health problems - violent behaviors 11/13/13 Free template from www.brainybetty.com 35
  • 36. Tertiary prevention • Curative services, along with education & information on causes. • Rehabilitation – develop physically, psychologically & socially. • Cooperation between sectors. 11/13/13 Free template from www.brainybetty.com 36
  • 37. Sources of health care • Schools health services • General health services • Special health services • Social marketing 11/13/13 Free template from www.brainybetty.com 37
  • 38. 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. 11/13/13 Free template from www.brainybetty.com 38
  • 39. Why Adolescent Immunization is important? – – – – 11/13/13 To boost immunity that is decreasing Efforts to decrease disease To have specific Protection To provide recent vaccines available for immunization Free template from www.brainybetty.com 39
  • 40. 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 11/13/13 Free template from www.brainybetty.com 40
  • 41. 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. 11/13/13 Free template from www.brainybetty.com 41
  • 42. 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. • 11/13/13 Free template from www.brainybetty.com 42
  • 43. 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. 11/13/13 Free template from www.brainybetty.com 43
  • 44. 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 11/13/13 Free template from www.brainybetty.com 44
  • 45. Adolescent Friendly Initiative • Two component - Adolescent friendly health services - Adolescent friendly counselling services • 75 districts RCH II ( 200308). • Adolescent health clinics - Clinical services - Counselling services 11/13/13 Free template from www.brainybetty.com 45
  • 46. What is ‘Life Skills’? …abilities that help promote mental well being and competence in young people as they face the realities of life. 11/13/13 Free template from www.brainybetty.com 46
  • 47. Contd.. What is ‘Life Skills’? UNICEF “life-skills based education is -behavior change or behavior development approach -designed to address a balance of three areas:  knowledge, attitude, and skills. 11/13/13 Free template from www.brainybetty.com 47
  • 48. 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” 11/13/13 Free template from www.brainybetty.com 48
  • 49. What are the “Life Skills” ? • Decision Making & Problem Solving • Creative & Critical Thinking • Negotiation Skills 11/13/13 • Effective Communication & Interpersonal Relationship • Self Awareness & Empathy • Coping with stress & Emotions Free template from www.brainybetty.com 49
  • 50. 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 11/13/13 Free template from www.brainybetty.com 50
  • 51. How ‘Life Skills’ lead to primary prevention of health problems? Knowledge Attitudes Values Life Skills Behavior reinforcement or change Positive Health Behavior Prevention of Health Problems 11/13/13 Free template from www.brainybetty.com 51
  • 52. 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. 11/13/13 Free template from www.brainybetty.com 52
  • 53. 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 11/13/13 Free template from www.brainybetty.com 53
  • 54. Adolescent friendly procedures - Easy registration, retrieval & storage of records - Short waiting time - Consultation with or without appointments 11/13/13 Free template from www.brainybetty.com 54
  • 55. 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 11/13/13 Free template from www.brainybetty.com 55
  • 56. • Adolescent friendly health facilities - provide safe environment & convenient location - provide information &educational material - privacy & avoid stigma - have enough facilities 11/13/13 Free template from www.brainybetty.com 56
  • 57. • Adolescent & community involvement • Community based outreach & peer to peer services • Appropriate & comprehensive services • Effective health services • Efficient services 11/13/13 Free template from www.brainybetty.com 57
  • 58. 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) 11/13/13 Free template from www.brainybetty.com 58
  • 59. • Nutrition services • Growth & development monitoring • Detection & treatment of anemia • Guidance regarding substance abuse • Counselling regarding life skill development • Screening for various disorders 11/13/13 Free template from www.brainybetty.com 59
  • 60. National programmes for Adolescents • National Youth Policy 2003 - comprehensive view of youth issues - adolescents divided into A) rural & tribal youth B) out of school youth C) female adolescents 11/13/13 Free template from www.brainybetty.com 60
  • 61. • 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 11/13/13 Free template from www.brainybetty.com 61
  • 62. • Adolescent Girls Scheme - Scheme 1 : girl to girl approach - Scheme 2 : Balika Mandal • Family Health Awareness Campaign 11/13/13 Free template from www.brainybetty.com 62
  • 63. National AIDS Control Programme • ICE activities • AIDS Education in Schools • University Talk AIDS Programme 11/13/13 Free template from www.brainybetty.com 63
  • 64. ICDS • OBJECTIVES - improve health & nutritional status - provide literacy & numeracy skills - awareness on health, hygiene, nutrition ,family welfare…. - train & equip in vocational skills 11/13/13 Free template from www.brainybetty.com 64
  • 65. 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 11/13/13 Free template from www.brainybetty.com 65
  • 66. Nutritional Program 2003 • Adolescent girls < 35 kg • BPL • 6kg ration free of cost / month • Nutrition & health education by anganwadi worker 11/13/13 Free template from www.brainybetty.com 66
  • 67. 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 11/13/13 Free template from www.brainybetty.com 67
  • 68. • • • - 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 11/13/13 Free template from www.brainybetty.com 68
  • 69. Contents for Routine Adolescent visit • Medical history • Family history • Psychosocial history (HEADSS) • - Home - Drugs • - Education - Sexuality • - Activities - Suicide/ Depression • Physical examination • Laboratory test 11/13/13 Free template from www.brainybetty.com 69
  • 70. Thank You 11/13/13 Free template from www.brainybetty.com 70