Adolescenthealth 131113041626 Phpapp02

Adolescent Health
Dr. Gopalrao Jogdand, M.D. Professor & Head, Department of Community Medicine
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.
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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 & 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
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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 genderexperimentation Intimate relationships
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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 )
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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
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Adolescent health problems

A. Biomedical illness Congenital malformation/defects - Precocious/ delayed puberty - Short stature - Asthma, congenital & rheumatic heart diseases - Tuberculosis, malaria
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Contd..
B. Consequences of Risk taking behavior - Unintended injuries : automobile & sports related accidents - Intended injuries : violence, homicide, suicide - STDs, HIV/AIDS - Substance abuse
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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
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STIs/ HIV/AIDS - 2.6 million(50%) HIV infection every year - of 35 million cases of STIs in young - 32 % of Adolescents aware of RTIs - 1 out of 20 adolescents STD - 59% - Condoms, 49% OCP
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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
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Contd..
C. Nutritional problems malnutrition/ under- nutrition Micronutrient deficiencies Obesity Eating disorders
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45% girls, 20% boys undernourished 66% girls, 45%boys anemic 75% < 50% of RDA of Vit A IDD in 6-12yrs 30 -50%
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Contd..
D. Reproductive health problems Teenage pregnancy Abortion related problems Menstrual problems Reproductive tract infections
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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
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Contd..
E. Mental health problems Substance abuse Violence Depression & suicide Learning disorders Other psychiatric problems
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Multifactorial Causation of Health Problems

High Risk Behavior
Underlying factors
Immediate Causes
Adolescent Health Problems
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Underlying factors
Gender based discrimination Poverty Unemployment Urbanisation Migration Social values & norms Wars & emergencies
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Immediate Causes
Inadequate education & skills Poor access to health information & services Unsafe & Unsupportive environment families, friends, services providers, policies & the media Exploitation & abuse
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High Risk Behavior

Psychosocial risk factors Physiological / Biological risk factors Behavioral risk factors Situation / Condition risk factors
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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.
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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
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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
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Prevention of Adolescent health Problems

Primary prevention : policies, information & education. Secondary prevention : identification & reduction of risk
Tertiary prevention : treatment & rehabilitation

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Primary prevention
Promoting healthy development & establishment of healthy lifestyles. Policies & Legislation concept of minor reproductive health Substance abuse Occupational health Accidents Public health
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Information one way communication : radio, television, newspaper, books, films Two way communication : in person, by telephone, etc
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Education provides information Intellectual, social & moral development Enable adolescents to manage their health destiny Guidance on hygiene, exercise, rest, eating, drinking, maturation, sexuality & relationship
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Vehicles for health education - school - family - others health workers, Youth organisation leaders.. Educator - knowledgeable & skilled at communication
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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.
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Counselling & guidance centres - sexual & reproductive health - substance abuse - mental health problems - violent behaviors
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Tertiary prevention
Curative services, along with education & information on causes. Rehabilitation develop physically, psychologically & socially. Cooperation between sectors.
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Sources of health care

Schools health services General health services Special health services Social marketing
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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.
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Why Adolescent Immunization is important?

To boost immunity that is decreasing Efforts to decrease disease To have specific Protection To provide recent vaccines available for immunization
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IAP adolescent immunization schedule

TT
Rubella MMR Hepatitis B Typhoid Varicella* Hepatitis A*
Booster at 10 and 16 years

As part of MMR vaccine or (Monovalent) 1 dose to girls at 12-13 years of age, if not given earlier 1 dose at 12-13 years of age. (if not given earlier) 3 Doses (0, 1 and 6 m) if not given earlier TA, Vi or Oral typhoid vaccine every 3 years 1 dose upto 12-13 years, and 2 doses after 13 years of age. (if not given earlier) 2 doses (0 and 6 months) if not given earlier
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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.
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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.
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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.
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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
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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
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What is Life Skills?

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

UNICEF
life-skills based education is
-behavior change or behavior development approach -designed to address a balance of three areas:
knowledge, attitude, and skills.

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Contd..

WHO
the abilities for adaptive and positive behavior that - enables individuals to deal effectively with the demands and challenges of everyday life
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What are the Life Skills ?

Decision Making & Problem Solving Creative & Critical Thinking Negotiation Skills
Communication & Interpersonal Relationship Self Awareness & Empathy Coping with stress & Emotions
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Effective
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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
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How Life Skills lead to primary prevention of health problems?

Knowledge Attitudes Values
Life
Behavior
Skills
reinforcement or change Health Behavior of Health Problems

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Positive
Prevention
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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.
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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
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Adolescent friendly procedures - Easy registration, retrieval & storage of records - Short waiting time - Consultation with or without appointments
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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
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Adolescent friendly health facilities - provide safe environment & convenient location - provide information &educational material - privacy & avoid stigma - have enough facilities
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Adolescent & community involvement Community based outreach & peer to peer services Appropriate & comprehensive services Effective health services Efficient services
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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)
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Nutrition services Growth & development monitoring Detection & treatment of anemia Guidance regarding substance abuse Counselling regarding life skill development Screening for various disorders
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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
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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
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Adolescent Girls Scheme - Scheme 1 : girl to girl approach - Scheme 2 : Balika Mandal Family Health Awareness Campaign
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National AIDS Control Programme

ICE activities AIDS Education in Schools University Talk AIDS Programme
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ICDS
OBJECTIVES - improve health & nutritional status - provide literacy & numeracy skills - awareness on health, hygiene, nutrition ,family welfare. - train & equip in vocational skills
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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
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Nutritional Program 2003

Adolescent girls < 35 kg BPL 6kg ration free of cost / month Nutrition & health education by anganwadi worker
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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
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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
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Contents for Routine Adolescent visit

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

Growth & Development

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Sequence of pubertal events In boys In girls

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Adolescent health problems

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Free template from www.brainybetty.com

Free template from www.brainybetty.com

Free template from www.brainybetty.com

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Multifactorial Causation of Health Problems

Adolescent Health Problems

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High Risk Behavior

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Why Adolescents are Important?

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Why Invest in Adolescent Health?

Prevention of Adolescent health Problems

Tertiary prevention : treatment & rehabilitation

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Free template from www.brainybetty.com

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Sources of health care

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Importance of adolescent immunization

Why Adolescent Immunization is important?

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IAP adolescent immunization schedule

Booster at 10 and 16 years

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MENSTRUAL HYGIENE contd

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Barriers to utilisation of health services

Guiding Principals for Adolescent Health Programming

Adolescent Friendly Initiative

What is Life Skills?

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What is Life Skills?

knowledge, attitude, and skills.

What is Life Skills?

What are the Life Skills ?

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Significance of learning Life Skills

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How Life Skills lead to primary prevention of health problems?

reinforcement or change Health Behavior of Health Problems

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Life Skills Education

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Services under AFHS

National programmes for Adolescents

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National AIDS Control Programme

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