Importance of adolescent health Stages in adolescence Adolescence- worldwide & India Growth- physical, psychological & sexual growth Adolescent health issues Prevention Adolescent health programmes

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Adolescent Health

3. OVERVIEW
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⚫Importance of adolescent health
⚫Stages in adolescence
⚫Adolescence- worldwide & India
⚫Growth- physical, psychological & sexual growth
⚫Adolescent health issues
⚫Prevention
⚫Adolescent health programmes

4. ADOLESCENCE
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⚫Origin from Latin word – adolescere– to grow
into
maturity.
⚫Phase of human development encompassing the
transition from childhood to adulthood.
⚫WHO – age period between 10 – 19 years for
(both sexes)

5. ADOLESCENT
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⚫Adolescence
⚫Early Adolescence
⚫Middle adolescence :
⚫Late adolescence
⚫Youth
⚫Young people
: 10 – 19 years
: 10 – 13 years
14 – 16 years
: 17 – 19 years
: 15 – 24 years
: 10 - 24 years

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⚫ Early adolescence (10-13): is characterized by a spurt of
growth, and the beginning of sexual maturation. Young
peoplestart to think abstractly.
⚫ Mid-adolescence (14-15): main physical changesget
completed, while the individual developsa strongersenseof
identity, and relates more strongly to his or her peer group.
Thinking becomes more reflective.

7. ⚫Later adolescence (16-19): the body takes its adult form,
while the individual now has a distinct identity and more
settled ideasand opinions.
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8. IMP. Milestone OF LIFE
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⚫Majorphysical, psychological and behavioural changes
takeplace.
⚫Sexual maturity & onset of sexual activity.
⚫Development of adult mental process & adult identity.
⚫Great human resource forthesociety.
⚫Growth spurtand physical activity.
⚫Menstruation.
⚫Marriage/Pregnancy.

9. GLOBAL ADOLESCENT HEALTH
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⚫1-2 million adolescents die every year mostly
from preventableor treatablecauses.
⚫Road traffic injurieswere the leading causeof death
according to WHO, inadolescent age.
⚫Globally, thereare about 50 births per 1000 girlsaged 15 to
19 per year.
⚫Half of all mental health disorders in adulthood start by
age 14, but mostcases are undetected and untreated.

10. GLOBAL ADOLESCENT HEALTH
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⚫Complications linked to pregnancyand childbirthare the
second causeof death for 15-19-year-old girls globally.
⚫Some 11% of all births worldwide are to girls aged 15 to 19
years, and thevast majorityare in low- and middle-income
countries.

11. ADOLESCENT IN INDIA
⚫Nearly 20% of population in Indiaare Adolescent.
⚫Half of which is sexuallyactive before marriage.
⚫As fertility rate is high in adolescent
unsafe motherhood
MMR & IMR
⚫Low knowledge about familyplanning & healthysexuality
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12. ADOLESCENT IN INDIA
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⚫This age group is in a transient phase of life thus
requires proper nutrition, education, guidance to
ensure their devp. Into healthy adults.
⚫GOI recognized the potential as it is key determinant of
India’s overall health so launched Adolescent
reproductive and sexual health programme (ARSH) and
Adolescent friendly health clinics (AFHC) at all levels
of care.

13. PHYSICAL GROWTH
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SKELETAL GROWTH
-Secondarygrowth spurt – 25% of adult height
BODY COMPOSITION
-Weightgain
-Increase in adipose tissue in girls
-Increase muscle mass in case of boys

14. PHYSICAL GROWTH
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⚫The majorgrowth during adolescence are
1. Height: nearlyone-fifth (20%) of theadult height is
gained during adolescence.
2. Weight gain: About 25–50% of the final adult weight is
gained during adolescence.
3. Almost 50% of bone mass is accumulated by theend
of 2nd decade of life.

15. ⚫Less interest in listening advice from parents.
⚫Mood swings.
⚫Intense relationshipwith friends. (same & opposite
sex Increased cognition)
⚫Increased need forprivacy.
⚫Lack of impulsecontrol.
⚫Increased intellectual ability.
⚫Risk- taking behaviour.
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Psychological changes

16. SEXUAL DEVP.
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GIRLS BOYS
Breast devp. 8-12 years (Thelarche) Testicular enlargement by 9 years
Development of public hairs-14
years ( Pubarche )
Development of pubic hair 10-15
years
Growth spurt begins by 10 Enlargement of larynx, pharynx-
voice break
Menarche by 9-16 years Weight gain and increased muscle
mass by 11-16
Enlargement of
ovaries,utreus,clitoris
Growth of facial and body hair

17. ADOLESCENT COUNSELLING
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⚫Early adolescence (10–13 yrs) -concrete thinkers and are
unable toclearly understand thecauseand effects.
⚫ Mid-adolescence (14–17 yrs) - think more abstractly.
typically, theyarecapable of complex logical thinking.
⚫Late adolescence (18–19 yrs)- have understanding of how
their behaviours affect their health.
⚫Counselling focus on risky behaviourand coping skills.

18. ADOLESCENT MENTAL HEALTH
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⚫ This results in high levelsof medical, social and economic
burden.
⚫ Mostof theadult mental health disorders have theironset
during theirchildhood oradolescence.
⚫ In low- and middle-income countries, including India,
adolescentswith mental health problems needsattention.
⚫ An effective way to address is by enhancing the primary-care
paediatrician (PCP) in the recognition, treatment and referral
of theadolescentsto mental health specialists.

19. ADOLESCENT SEXUAL HEALTH
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⚫Sex education is important at all ages, but it is more
important than it is imparted during childhood and
adolescence.
⚫It is necessary till 45 yrs of age.
⚫This includes contraception, safe abortion,
diagnosis and management of STI’s including HIV.

20. SEX EDUCATION
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⚫ It consist of knowledge regarding reproduction and safe
sexual practices.
⚫Assessing risky behavior
⚫Contraception
⚫Counselling & education related to STI’s
⚫Also to avoid any deviation from natural sexual practices.

21. ADOLESCENT HEALTH PROBLEMS
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22. TOP KILLERS OF ADOLESCENTS IN INDIA
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SPECIFIC CAUSE 15-19 YEARS
Suicide 23.5%
Drowning 28.6%
RTA(accidents) 22.5%
Anaemia 13.9%
TB 7.0%
Burns 13.2%
cancer 6.1

23. ADOLESCENT NUTRITION
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⚫ UNDERNUTRITION
-leads to impaired growth, anemia, iodine deficiency.
⚫ IRON DEFICIENCYANEMIA
-prevalence in adolescentgirls range from 22-91%
- NFHS : prevalence in 15-49 women 56%
prevalence in 15-49 men 24%
-

24. reason for iron deficiency in adolescence-
1. increased requirement for growth
2. loss during menstruation
3. dislike of iron rich food
4. frequent dieting

25. NUTRITIONAL PROBLEMS
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⚫OBESITY
- prevalence of obesityand overweight is 11.1% and14.2%
respectively.
- prevalence is higher in boys.
⚫EATING DISORDER LIKE-
- Anorexia nervosa
- Binge-eating

26. REPRODUCTIVE PROBLEMS
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⚫ Teenagepregnancy (16-19% of total pregnancies)
-preterm labour
- intrauterinegrowth retardation.
⚫ genital tract infection
⚫ Abortion related problems
-unsafeabortions
⚫ Irregular menstrual cycles
⚫ Vulvovaginitisand Urologic issues

27. SEXUALLY TRANSMITTED DISEASES
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• HIV/AIDS – young people between 10-25 make 50% of new
HIV infection.
• 1 out of 20 adolescents in India contracts– STDs
-syphilis
-gonorrhea

28. MENTAL HEALTH PROBLEMS
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⚫Depression& suicide
⚫Psychosis
⚫Mania
⚫Anxietydisorder

29. BEHAVIOUR PROBLEMS
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⚫Drug experimentation
⚫Substance abuse
- tobacco, alcohol, illicitdrug
⚫Criminal behaviour
- keeping knife, rods , rash
driving
⚫Violence

30. SOCIAL FACTORS IN ADOLESCENT HEALTH
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⚫Parents perceptions, awareness aboutadolescent plays
majorrole in adolescent health.
⚫School dropouts.
⚫Female literacy.
⚫Economically weaker society
.
⚫Health seeking behavior

31. PROGRAMMES IN INDIA that are helpful in
addressing problems of ADOLESCENT HEALTH
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⚫Kishori Shatki Yojana: to improve the health
and nutritional status of women.
⚫Balika Samridhi Yojana: To Delay theage of
marriage.
⚫Reproductiveand Child Health Programme
⚫Adolescent Friendly Health Services
⚫National AIDS ControlProgramme

32. “Reproductive, Maternal, Newborn, Child and
Adolescent Health”(RMNCH+A) STRATERGY
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Priority intervention areaon adolescent health
1. Adolescent nutrition & IFA supplementation.
2. Facility based adolescent reproductiveand sexual health
services.
3. Information & counseling on adolescent sexual
& reproductive health.
4. Menstrual hygiene.
5. Preventive healthcheckups.

33. ADOLESCENT NUTRITION & IFA SUPPLEMENT
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⚫ Nutrition education sessions through kishori diwas, ICDS,
school curriculum and also linkage with Sakshar Bharat
Abhiyan.
CHILD HEALTH SCREENING & EARLY INTERVENTION
SERVICES
⚫ Screening of adolescent for low body mass indexand
counseling atadolescent health clinics.

34. IFA TABLET
⚫National Iron+ initiative programme
- for management of anemia.
-adolescents (10-19 yrs ) within school weekly iron and
folic acid supplementation (WIFS).
- outof school will be reached through AWCs.
IFA for Adolescent BLUE
COLOUR TABLET
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36. Weekly Iron Folic acid Supplementation
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⚫ WIFS scheme is community-based intervention address
nutritional anemiaamong adolescents.
⚫ Covers mid&lateadolescent.
⚫ Key features
1.weeklysupervised administrationof IFA iron-100 mg FA 500
microgm.
2. biannual deworming.
3.information & counseling for improved dietary intakeand
prevention of worm infestation.

37. ADOLESCENT FRIENDLY HEALTH SERVICES
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LEVEL OF CARE SERVICE
PROVIDER
TARGET ACTIVITY
Sub center Health worker/
ANM
Married
Unmarried
During routine
sub center clinics
PHC & CHC Medical officer Adolescent
unmarried boys &
girls
Once a week teen
clinic organized
for 2 hours.

38. SERVICES IN ADOLESCENT CLINIC
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⚫ CLINICAL SERVICES
- general examination
- nutritionadvise
- detect & treatanemia
- easy & confidential accessto MTP
- antenatal careand adviseregarding childbirth
- RTIs/ STIsdetectionand treatment
- treatmentof psychosomaticproblems

39. COUNSELLING SERVICES
⚫Voluntary counselling & testing center (VCTC) is the
process by which an individual undergoes confidential
HIV counseling to explore his /her risk of HIV infection
and exercises an informed choice regarding HIV testing

40. SCHEME FOR MENSTURAL HYGINE
⚫Scheme promote better
hygiene and ensure
adequate
knowledge and
information about useof
sanitary napkins.
⚫Sanitary napkins are
provided by NHM in the
name ‘free days’
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41. PREVENTIVE HEALTH CHECKUPS
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⚫New approach in the implementationof school health
programme
⚫Mobile School health camps by a team consisting of two
medical officers( MBBS/ dental/ AYUSH) and two
paramedics ( one ANM anyoneof following : pharmacist/
ophthalmicassistant/ dental assistant)

43. Schemes

44. SABLA
⚫Rajiv Gandhi Scheme forempowerment of AG
⚫200 selected districts
⚫OBJECTIVES
- Enable self development & empowerment of AG.
- Improve the nutrition & health status.
- Awareness about health hygieneand ARSH & familychild
care.
- Upgrade home based skill and vocational skill.
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45. KISHORI SHAKTI YOJANA
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⚫ Redesignof thealreadyexisting Adolescent Girls Scheme
being implemented as a component under the centrally
sponsored ICDS Scheme.
⚫ Aims atempowermentof adolescentgirls, soas toenable
them to takechargeof their lives.
⚫ Adolescent girls who are unmarried and belong to families
below the poverty lineand school drop-outsare selected and
attached to the local Anganwadi Centers for learning and
training activities.

46. KISHORI SHAKTI YOJANA
Scheme- I (Girl to Girl
Approach)
•Age group of 11-15 years
•Belonging to families whose
income level is below Rs.
6400/- per annum
Scheme-II (Balika Mandal)
•Age group 11-18 years
irrespective of income levels
of the family
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•Y
ounger girls
and belonging
11-15 years
to poor
families

47. KISHORI SHAKTI YOJANA
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⚫IFA supplementation along with deworming
⚫Education forschool dropouts and functional literacy
among illiterateadolescent girls
⚫Non-formal education toadolescent girls. Emphasison life
education aspects including physical, developmental and
sex education is given.

48. NATIONAL AIDS CONTROL
PROGRAMME
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• Under NACO Adolescent Education Programme developed
which focuses primarilyon prevention through awareness.
• The Adolescent Education Programme is one of the key
policy initiativesof NACP II.
• Relevant messages on safesex, sexualityand relationships
are developed and disseminated for youth via posters,
booklets, panels and printed material.

49. THE ADOLESCENT EDUCATION
PROGRAMME(AEP)
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• Co-curricularadolescenceeducation in classes IX-XI.
• Lifeskillseducation in classes I- VIII
• Inclusion of HIV prevention education in pre-service and in-
service teacher training and teachereducation programmes.
• Inclusion of HIV prevention education in the programmes for
out-of-school adolescentsand young persons.
• Incorporating measures to prevent stigma and discrimination
against learners/students and educators and life skills
education intoeducation policy for HIV prevention.

50. YUVA
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⚫ YUVA (Youth Unite forVictoryon AIDS)
-Yuvacomprising sevenyouth organisations.
-AIDS prepared Campus, AIDS prepared Communityand
AIDS prepared Country.
-Prevention, educationand lifeskills forpromoting healthy
and safe behaviour and practices amongst them young
people.
⚫ Red Ribbon Club (RRC)
-This club is established in every school and college to provide
youth with access to information on HIV/AIDS and voluntary
blood donation.

52. INFORMATION & COUNSELLING ON
ADOLESCENT SEXUAL HEALTH
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⚫LIFE SKILLS
“ theabilities foradaptiveand positive behaviourthat
enable individuals to deal effectivelywith thedemands and
challenges of everyday life” – WHO
“ a behaviour change or behaviour development approach
designed to address a balance of three areas: knowledge,
attitudeand skills” - UNICEF

53. LIFE SKILL EDUCATION
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⚫Teaching through participatory learning methods like
games, role plays , groupdiscussion and practicing skills
through experimental learning in a non threatening
setting.
⚫It provides individual with widealternative and creating
way of solving problems pertaining to drug use, sexual
abuse, teenage pregnancy, early sexual experimentation,
bullying.
⚫It’s a promotional program which improve positive health
& self esteem.

54. LIFE SKILLS
⚫To be taughtat school level
- critical thinking & creative thinking
- decision making & problem solving
- communication skills & interpersonal relation
- coping with emotion and stress
- self awareness & empathy
⚫Lifeskills and education are incorporated through schools,
ICDS and community outreach session.
⚫Teachers, AWW,ANM are to be trained in counseling.
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