Reaching Adolescent Health And Development

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Reaching Adolescent Health And Development

  1. 2. REACHING ADOLESCENTS HEALTH AND DEVELOPMENT DR. ARAVIND KARINAGANNANAVAR POSTGRADUATE DEPT. OF COMMUNITY MEDICINE, VIMS, BELLARY
  2. 3. <ul><li>INTRODUCTION </li></ul><ul><li>GLOBAL SCENARIO </li></ul><ul><li>INDIAN SCENARIO </li></ul><ul><li>RATIONALE OF IMPORTANCE OF ADOLESCENT HEALTH </li></ul><ul><li>CHACTERISTICS </li></ul><ul><li>HEALTH PROBLEMS </li></ul><ul><li>STRATEGIES </li></ul><ul><li>NATIONAL PROGRAMMES </li></ul>
  3. 4. ADOLESCENTS(10-19YEARS) <ul><li>‘ Adolescere’ ; meaning “ to grow, to mature” </li></ul><ul><li>The time in a person’s life between childhood and mature adult </li></ul><ul><li>Early adolescence 10-13 Years </li></ul><ul><li>Mid adolescence 14-16 Years </li></ul><ul><li>Late adolescence 17-19 Years </li></ul><ul><li>Youth 15-24 Years </li></ul><ul><li>Young people 10-24 Years </li></ul>
  4. 5. EARLY ADOLESCENCE 10-13 YR <ul><li>RAPID GROWTH & DEVELOPMENT </li></ul><ul><li>SECONDARY SEXUAL CHARACTERS </li></ul>
  5. 7. MID ADOLESCENCE 14-17 YRS
  6. 8. STRIVING FOR INDEPENDENCE
  7. 9. RELATIONSHIP OPPOSITE SEX
  8. 10. EXPERIMENTATION
  9. 11. LATE ADOLESCENCE 17-19 YRS <ul><li>ALMOST AN ADULT </li></ul>
  10. 12. <ul><li>Early adolescence </li></ul><ul><li>Mid adolescence </li></ul><ul><li>Late adolescence </li></ul>
  11. 13. WHO DEFINITION <ul><li>A period of biologically accelerated physical and sexual maturation, psychologically of major growth in personality and development , and socially of new status within and outside the family. </li></ul>
  12. 14. GLOBAL DATA <ul><li>1.2 billion, adolescent one in every five people - in the world today </li></ul><ul><li>1.5 billion young people </li></ul><ul><li>85 % living in developing countries </li></ul><ul><li>Low morbidity & mortality compared to children & adults </li></ul>
  13. 15. GLOBAL DATA <ul><li>Girls morbidity- RT & pregnancy related causes </li></ul><ul><li>Boys morbidity- violence, accidents & suicide </li></ul><ul><li>1/3 of 333 million new STDs cases occur in young people less than 25 year old </li></ul><ul><li>1/2 of 7000 new HIV cases belong to 10-24 year old </li></ul>
  14. 16. INDIAN SCENARIO 17.0 Total morbidity form notifiable diseases 6.7 Total deaths contributed by this group 9 %TFR contributed by 15-19 yrs 38 %Females enrolled in Secondary School 59 %Males enrolled in Secondary School 30 10 - 24 years as % of Total Population 284.2 Population age: 10 - 24 (Millions)
  15. 17. WHY THEY ARE IMPORTANT <ul><li>Adolescents are full of energy, with new ideas. </li></ul><ul><li>They are a positive force for a Nation and are responsible for its future productivity </li></ul><ul><li>A great human resource for society </li></ul><ul><li>Since mortality in this age group is relatively low the adolescents are considered to be healthy. </li></ul>
  16. 18. 15-25 YEARS 50-60 YEARS
  17. 19. 15-25 YEARS 50-60 YEARS
  18. 20. SPECIAL CHARACTERS <ul><li>Rapid physical growth and development </li></ul><ul><li>Physical social and psychological maturity </li></ul><ul><li>Sexual maturity and onset of sexual activity </li></ul>
  19. 21. <ul><li>Experimentation </li></ul><ul><li>Transition from total socioeconomic dependence to relative independence </li></ul><ul><li>Under-served population group </li></ul>
  20. 22. EXPERIMENTATION
  21. 23. CHARACTERISTICS <ul><li>A - Aggressive </li></ul><ul><li>D - Dynamic, Developing </li></ul><ul><li>O - Overconfident </li></ul><ul><li>L - Loud but lonely </li></ul><ul><li>E - Enthusiastic, Explorative, and Experimenting </li></ul><ul><li>S - Social, Sexual and Spiritual </li></ul><ul><li>C - Courageous, Cheerful, and Concern </li></ul><ul><li>E - Emotional, Eager </li></ul><ul><li>N - Nervous, never say no to Peers </li></ul><ul><li>T - Temperamental </li></ul>
  22. 25. A DIVERSE GROUP <ul><li>DIFFERENT STAGE OF DEVELOPMENT </li></ul><ul><li>DIFFERENT CIRCUMSTANCES </li></ul><ul><li>DIFFERENT NEEDS </li></ul><ul><li>DIFFERENT PROBLEMS </li></ul>
  23. 27. WHAT DO ADOLESCENTS NEED & WHY <ul><li>Accurate information about their health needs (they are still developing) </li></ul><ul><li>Acceptable and affordable, preventive and curative health services </li></ul>
  24. 28. <ul><li>Life skills to avoid risk-taking behavior </li></ul><ul><li>Counseling (they need a safety net) </li></ul><ul><li>Safe and supportive environment (they live in an adult world) </li></ul>
  25. 29. THE NEED TO INVEST IN YOUNG PEOPLE <ul><li>The millennium Investing in health of development goals </li></ul><ul><li>young people protects human capital </li></ul><ul><li>Adolescent and young peoples health has inter generational impact </li></ul><ul><li>Young people at the centre of the HIV/Aids epidemic </li></ul>
  26. 30. MAJOR PROBLEMS OF ADOLESCENTS <ul><li>Knowledge and information </li></ul><ul><li>Anaemia and malnutrition </li></ul><ul><li>HIV/AIDS </li></ul><ul><li>Early marriages Teenage pregnancies </li></ul><ul><li>Unwanted pregnancies and illegal abortions </li></ul>
  27. 31. EARLY MARRIAGE
  28. 32. TEENAGE PREGNANCY
  29. 33. MAJOR PROBLEMS OF ADOLESCENTS <ul><li>School dropouts </li></ul><ul><li>Accidents and trauma </li></ul><ul><li>Drug abuse </li></ul><ul><li>STI’s and STD’s </li></ul><ul><li>Lack of support </li></ul>
  30. 34. DRUG ABUSE
  31. 35. HEALTH PROBLEMS <ul><li>Biomedical illness </li></ul><ul><li>Asthama, RHD </li></ul><ul><li>Consequences of risk taking behavior </li></ul><ul><li>RTA, STI’s </li></ul><ul><li>Nutritional problems </li></ul><ul><li>IDA, Obesity </li></ul><ul><li>Reproductive health problems </li></ul><ul><li>Teenage pregnancy, Abortion </li></ul><ul><li>Mental health problems </li></ul><ul><li>Violence, Depression </li></ul>
  32. 38. ADOLESCENTS HEALTH IN INDIA <ul><li>45% of adolescent girls & 20% of boys under nourished </li></ul><ul><li>Early marriage 26% < 15yrs – girls, 54% < 18yrs </li></ul><ul><li>20 – 30% adolescent boys &10% girls sexually active </li></ul><ul><li>59% adolescents know about condoms </li></ul>
  33. 39. DRUG ABUSE
  34. 40. ADOLESCENTS HEALTH IN INDIA <ul><li>49% adolescents know about contraceptives </li></ul><ul><li>4.5% drug abuse </li></ul><ul><li>50% of all HIV positive new infections are in the age group of 10 – 25yrs </li></ul><ul><li>Adolescent abortion 1 – 4.4millions </li></ul>
  35. 41. WHY ADOLOESCENTS ARE RELUCTANT SEEK HELP FROM HEALTH SYSTEM <ul><li>Fear & ask difficult questions & conduct unpleasant procedures </li></ul><ul><li>Uncomfortable with health workers of the opposite sex </li></ul><ul><li>Health services are of poor quality </li></ul><ul><li>Lack of privacy </li></ul>
  36. 42. <ul><li>Concerns about confidentiality </li></ul><ul><li>Long waiting time </li></ul><ul><li>Parental consent required </li></ul><ul><li>Operational barriers: hours, costs, location, timing, transport </li></ul><ul><li>Lack of information: about needs and risks, about available services </li></ul>
  37. 43. STRATEGIES FOR PROMOTION OF ADOLESCENT HEALTH <ul><li>A =Adoption of healthy life style </li></ul><ul><li>D =Develop appropriate I.E.C. Strategy </li></ul><ul><li>O =Organize adolescent/ youth friendly clinic </li></ul><ul><li>L =Life skill training, legal support, liaison with </li></ul><ul><li>peers & parents </li></ul><ul><li>E =Educate about sexuality, spirituality </li></ul><ul><li>S =Safe, secure and supportive environment </li></ul><ul><li>C =Counseling </li></ul><ul><li>E =Enable & empower for responsible citizenship </li></ul><ul><li>N =Networking for experience sharing </li></ul><ul><li>T =Training for income generation, teen clubs </li></ul>
  38. 44. Physician Multi-Disciplinary Service Delivery Team Clinical Psychologist Counsellor Psychiatrist (Referral) Social Worker Gynecologist (Referral) Nutritionist Child Development Expert
  39. 45. ROLE OF HEALTH SERVICES <ul><li>Treat conditions that give rise to ill health </li></ul><ul><li>Respond to young peoples problems </li></ul><ul><li>Support young peoples concerns </li></ul><ul><li>Interact with adolescents during crisis </li></ul><ul><li>Make links with other services </li></ul>
  40. 46. STRATEGIC FRAMEWORK FOR ADOLESCENT & YOUTH HEALTH & DEVELOPMENT PROGRAM Guiding Principles Involvement of the Youth Rights based approach Diversity of Adolescents’ needs and problems Gender and Health perspective <ul><li>Prevent/ control & manage health risks Promote Healthy development </li></ul><ul><li>HIV / AIDS - Promote healthy lifestyle </li></ul><ul><li>Premarital sex - Adopt lifestyle approach </li></ul><ul><li>Early childbearing - Create a safe & supportive </li></ul><ul><li>Substance use environment </li></ul><ul><li>Abortion - Promote positive values </li></ul><ul><li>caring relationship </li></ul><ul><li>Malnutrition </li></ul><ul><li>Mental health </li></ul><ul><li>Accidents and disabilities </li></ul>Major strategies Service Provision Education and Information Buildings Skills Safe & Supportive Environment Monitoring and Evaluation Resource Mobilization Intervention settings Home and Family Community School Workplace Health Facility Street Well-informed Empowered, Responsible, Healthy Adolescent and Youth
  41. 47. MAPM (Mapping Adolescent Programming and Measurement) <ul><li>Planners to focus on the most important interventions, determinants, and behaviors. </li></ul><ul><li>To design & implement more effective programmes and also to identify what to measure, to demonstrate implementation of a programme </li></ul>
  42. 48. <ul><li>It helps in designing, monitoring and evaluating adolescent health and development programmes. </li></ul><ul><li>WHO strategy of “Strategic information, Services and supplies, Supportive environment and Strengthening other sectors” (4S) for addressing the young people issues in RCH and HIV/AIDS programmes. </li></ul>
  43. 49. Programmes for Adolescents <ul><li>Kishori Shakti Yojana </li></ul><ul><li>Balika Samridhi Yojana </li></ul><ul><li>Nehru Yuva Kendra </li></ul><ul><li>School AIDS education </li></ul>
  44. 50. <ul><li>Mahila Samakhya Programme </li></ul><ul><li>University Talks AIDS </li></ul><ul><li>Training of Rural Youth for Self Employment </li></ul><ul><li>Reproductive and Child Health Programme </li></ul>
  45. 51. National programmes
  46. 52. Ministry of youth Affairs and sports (MOYAS ) <ul><li>Focus on reproductive and sexual health and life skills education </li></ul><ul><li>NSS & Rajiv Gandhi National Institute of Youth Development and NGO’s for implementing adolescent related programmes </li></ul>
  47. 53. <ul><li>Have undertaken training of teachers and distributed learning resource material in the form of 12 modules to various NSS units, NYKS, parents, community and students </li></ul><ul><li>Adolescent reproductive and sexual health (ARSH) strategy (2006-07) under RCH-II </li></ul><ul><li>Strengthening of Nehru Yuva Kendra Sangathan (NYKS) </li></ul>
  48. 54. CORE LIFE SKILLS <ul><li>Self-awareness Critical thinking </li></ul><ul><li>Decision making Coping with emotion </li></ul><ul><li>Coping with stress Creative thinking </li></ul><ul><li>Problem solving Effective communication </li></ul><ul><li>Interpersonal relationship </li></ul>
  49. 55. SCHOOL HEALTH PROGRAMME
  50. 56. SCHOOL HEALTH PROGRAMME <ul><li>>1/2 of adolescents are in schools and can be reached for health, nutrition and population education programmes </li></ul><ul><li>The major component is health check-up tetanus toxoid at age 10 and 16 </li></ul>
  51. 57. Health check-up and Nutrition Counselling
  52. 58. <ul><li>Adolescents girls now are being targeted for IFA under NACP </li></ul><ul><li>Information on reproduction, sexual behaviour & population education remain a poor programme </li></ul><ul><li>Teachers training critical to reach adolescents in the school </li></ul>
  53. 59. ADOLESCENT REPRODUCTIVE AND SEXUAL HEALTH (ARSH) <ul><li>Under RCH all medical officers, health supervisors and health workers have been trained </li></ul><ul><li>Students to students programme </li></ul>
  54. 60. <ul><li>Few themes such as </li></ul><ul><li>Prevention of anemia </li></ul><ul><li>Malnutrition </li></ul><ul><li>Reproductive, menstrual cycle & hygiene </li></ul><ul><li>Age of marriage and childbirth </li></ul>
  55. 61. <ul><li>Risk of teenage pregnancies </li></ul><ul><li>Prevention & control of RTI/STI & </li></ul><ul><li>HIV/AIDS </li></ul><ul><li>Contraception, unsafe sex and unsafe abortions </li></ul>
  56. 62. NATIONAL AIDS CONTROL PROGRAMME <ul><li>Special groups for IEC activities </li></ul><ul><li>“ AIDS education in schools” introduced in 17 states and UT’s in secondary school curriculum </li></ul><ul><li>Reached mainly to urban schools were rural schools not covered </li></ul><ul><li>Teachers shy away from talking sexuality and reproduction </li></ul>
  57. 63. <ul><li>UNIVERSITY TALK AIDS PROGRAMME </li></ul><ul><li>3.5 million students & 4044 institutions </li></ul><ul><li>The major sources of information are print media, TV, radio </li></ul><ul><li>Teachers not at all mentioned as source of knowledge </li></ul><ul><li>Phase II of NACP envisaged covering all schools & universities </li></ul>
  58. 64. REACHING OUT OF SCHOOL ADOLSCENT GIRLS <ul><li>In 1991-92 ICDS launched a programme for AG & it was renamed as Kishori Shakti Yojana (KSY) in 2000 </li></ul><ul><li>Objectives </li></ul><ul><li>To improve the nutritional & health status </li></ul><ul><li>To provide the required literacy & numeracy skills, to improve their decision making capabilities </li></ul>
  59. 65. <ul><li>To promote awareness of health, hygiene, nutrition, family welfare, child care & to motivate them to marry after 18 years </li></ul><ul><li>Better understanding of their social issues </li></ul><ul><li>To encourage adolescent girls to </li></ul><ul><li>initiate various activities to be </li></ul><ul><li>productive and useful members of the </li></ul><ul><li>society </li></ul>
  60. 66. AG SCHEME <ul><li>2 SCHEMES </li></ul><ul><li>1) Girl-Girl approach </li></ul><ul><li>2) Balika mandal </li></ul>
  61. 67. GIRL-GIRL APPROACH <ul><li>11-15 years </li></ul><ul><li>Rs 6400/year & school dropouts in urban & rural areas </li></ul><ul><li>3 girls selected per Anganwadi for 6 months for learning & training </li></ul>
  62. 68. <ul><li>Initial 3 days training programme followed by one day every month for 6 months </li></ul><ul><li>Personal hygiene , nutrition, preventive health </li></ul>
  63. 69. BALIKA MANDAL <ul><li>11-18 years irrespective of income </li></ul><ul><li>10% of total Anganwadi centres are selected & 20 girls are selected for 6 months </li></ul><ul><li>These girls are provided supplementary nutrition for 6 days in a week </li></ul>
  64. 70. <ul><li>Personal hygiene </li></ul><ul><li>Environmental sanitation </li></ul><ul><li>Nutrition, home nursing, first aid </li></ul><ul><li>Communicable diseases </li></ul><ul><li>Vaccine preventable diseases </li></ul><ul><li>Child care & development </li></ul><ul><li>Participate in creative activities and recreation learning through sharing of experiences </li></ul>
  65. 71. NSW Centre for the Advancement of Adolescent Health (NSW CAAH)
  66. 72. FAMILY HEALTH AWARENESS CAMPAIGN (FHAC) <ul><li>Age 15-49 yrs </li></ul><ul><li>For control of STI’s/RTI’s in rural areas </li></ul><ul><li>Adolescents had access to printed information (card) but no discussions </li></ul><ul><li>Universalization of education for girls </li></ul>
  67. 73. <ul><li>Ensure 100% school enrolment particularly for girls & retention in school till 14yrs </li></ul><ul><li>Providing nutritional services of supplementary nutrition, nutrition education </li></ul><ul><li>Teachers training programme. Male and female teachers to address the problems of boys and girls separately </li></ul>
  68. 74. <ul><li>INDIAN ASSOCIATION OF ADOLESCENT HEALTH </li></ul><ul><li>Adoption of schools by NGO’s in different areas more so in rural and urban slum </li></ul><ul><li>Strengthening of PHC & SC. It could be clinic for adolescents on fixed days and days fixed for school health and regular meetings </li></ul>
  69. 75. ATTRACTING ADOLESCENT CLIENTS
  70. 76. <ul><li>Child Marriage Restraint Act (1976) </li></ul><ul><li>Women development functionaries in rural areas like Gram Sevikas, Mukhya Sevikas should take the responsibility to organize adolescent groups along with Mahila Mandals to generate awareness among rural adolescents. </li></ul>
  71. 77. <ul><li>DIFFERENT SECTORS LIKE </li></ul><ul><li>Health and family welfare </li></ul><ul><li>Women and child development </li></ul><ul><li>Education </li></ul>
  72. 78. <ul><li>Social welfare </li></ul><ul><li>Human resource development </li></ul><ul><li>Youth affair and sports and </li></ul><ul><li>information </li></ul><ul><li>Broadcasting do address one or the </li></ul><ul><li>other component of adolescent </li></ul><ul><li>needs </li></ul>
  73. 79. <ul><li>“ THESE TEND TO WORK IN ISOLATION” </li></ul>
  74. 80. Physician Multi-Disciplinary Service Delivery Team Clinical Psychologist Counsellor Psychiatrist (Referral) Social Worker Gynecologist (Referral) Nutritionist Child Development Expert
  75. 81. Best way to integrate is through institutional mechanism of schools and non-formal system of education
  76. 82. BARRIERS TO GET THESE SERVICES <ul><li>AVAILABILITY </li></ul><ul><li>ACCESSIBILITY </li></ul><ul><li>ACCEPTABILITY </li></ul>
  77. 83. <ul><li>31st July Every year - Teenage day </li></ul><ul><li>25-31st July Every year-Teenage week </li></ul><ul><li>Applied and action research in the </li></ul><ul><li>field of adolescent health is another </li></ul><ul><li>area where lot remains to be done </li></ul>
  78. 84. Call us and we will listen to you, answer your questions, and direct you to helping resources <ul><li>  </li></ul><ul><li>  </li></ul><ul><li>410 - 341 – 4216 </li></ul><ul><li>Monday-Friday 9 am-5 pm ET </li></ul><ul><li>The Focus Adolescent Services </li></ul>
  79. 85. REFERENCES <ul><li>SUNDERLAL TEXTBOOK OF COMMUNITY MEDICINE </li></ul><ul><li>O P GHAI TEXTBOOK OF COMMUNITY MEDICINE </li></ul><ul><li>ADOLESCETS HEALTH BY WHO </li></ul><ul><li>WWW.WHO.INT </li></ul><ul><li>K PARK TEXTBOOK OF PREVENTIVE AND SOCIAL MEDICINE </li></ul>
  80. 86. THANK YOU!

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