ADOLESCE

NT HEALTH
Dr. FIDA
Adolescents
World Health Organization (WHO) defines Adolescents as young people
aged 10-19 years.
Road traffic injuries are the leading cause of death among adolescents..

About 15% of global maternal death occurs among adolescent girls

There is an increasing trend in adolescent obesity due to a great shift in

diet and activity pattern.
Top 10 causes of death of an adolescents
Road injury

HIV/AIDS

Self harm

Lower respiratory infections

Interpersonal violence

Diarrhoeal disease

Drowning

Meningitis
Adolescent
It is a vital stage of growth and development

It is a period of transition from childhood to adulthood it is characterised

by

Rapid physical

Psychological

Cognitive

Behavioural changes and development

Adolescence is classified into three groups
Early adolescence

Mid adolescence

Late adolescence
Early adolescence group
Age group - 10 years till 13 years

Behaviour changes - demand for privacy

Teens are impulsive and has limited ability to perceive future complications
of their current behaviour

Prefer same sex peers

Excessive consciousness of other people’s concerns about their appearance

Priorities change - may start engaging in risky behaviours, such as

experimenting with smoking, drugs.
Mid adolescence
Age group - 14 years till 16 years

Follows puberty by 1 to 1 and half years

Emotional autonomy

Detached from family

Youth thinks beyond self and there is beginning of abstract reasoning

Period of irritability, wide mood swings and rapidly changing feelings

Parental obedience is replaced by conformity to peer group standards and loyalties

Contact with adults outside the family

Sexual experiments
LATE ADOLESCENCE

Age group - 17 till 19 years

Period of transition - individual gains grip of his or her future

Moral values and self identity establishment

Realise that their parents can be their best friends

Increase bonding between parents and adolescent, especially if both

shows mutual respect for each other

More selective and discriminating in relationships

Concerned about the future

Attitude towards health
Adolescents are considered to be at peak of their health; yet they
coincide with onset of many health disorders
Girls are often unprepared for their first periods.

A significant proportion are sexually active.

Why pay attention to health of Adolescents
To reduce burden of disease in later life

Malnutrition - lifelong health problems

High incidence of STD - risk-taking behaviour

Disease of late middle age

Healthy and unhealthy practices adopted today may last a lifetime
Adolescence is a period of curiosity, when young people are receptive to
information about themselves and their bodies, and when they begin to
take an active part in decision making
Major adolescent problems
Risk-taking behaviour

Substance abuse

Eating habits - anorexia nervosa/obesity

Lack of connectedness with parents

Early pregnancy

STDs

Nutritional deficiencies

Mental health problems

Health problems
Nutrition and eating disorders

In this period of rapid growth, micronutrients are as important as protein and

energy

53% at adolescent girls are anaemic

Low mineral density of bone is more pronounced in underprivileged girls due

to low intake of protein in addition to calcium and vitamin D.

Vitamin A deficiency

Malnutrition due to eating disorders in upper socio-economic class while girls

from poor families face gender discrimination
Mental health problems
Adjustment and anxiety disorders, depression, suicide, delinquent
behaviour, poor, body, image and low self-esteem are major concerns
Adolescents are at higher risk of committing suicide because of
cognitive immaturity and impulsivity.

Psychological disorders, nine depression, substance, abuse, parent,

child, conflict, physical or sexual abuse and family, history of suicide
make them prome for such attempts
Sleep disturbances
Due to physiologic delay in melatonin secretion, adolescents have delay
in sleep onset and awakening by almost 1 hour
Poor sleep habits reflects in school performance, and course day time,
drowsiness, aggressive behaviour, conduct disorders, anxiety, restless,
leg syndrome, and depression.
Infections
With increased outdoor activity, teens are exposed to TB, HIV, skin and
parasitic infections, and STDs
Early sexual activity is common
Problems specific to females
It’s common to have anovulatory and irregular menstrual cycles during
first two years after menarche

PCOS occurs in 9% adolescent girls

Adolescent girls miss school during menstruation because of lack of

access to safe sanitary products or lack of privacy

Poor menstrual hygiene contribute to reproductive infections

With the introduction of government and private run ‘ menstrual hygiene

schemes’ many young women now use hygienic methods during menses
Genital infections and STDs
Simple vaginal discharge may indicate physiological leucorrhoea of
puberty
Gonorrhoea can cause vulvovaginitis, urethritis or proctitis

Chlamydia causes inter-menstrual or post coital bleeding

Candidal infections are common

PID is often present in sexually active adolescent girls

Lifestyle diseases
Obesity is the other end spectrum of malnutrition and is epidemic in
urban settings
Prevalence of obesity is higher in males than females

Obesity has strong association with asthma, sleeping disorders, reflux,

disease, Blount, disease, gallstones, metabolic syndrome, and PCOS
Substance abuse
Tobacco and alcohol use start during adolescence

14% school youth uses tobacco (NFHS 2014)

Addicts are prone to accidents, injuries, HIV, Hepatitis C and STDs

Vulnerability
Many women in India suffer from domestic and sexual violence
Motor vehicle accidents and industrial accidents are common in boys,
while burns are more common in girls

Many adolescent migrate for labour or educational opportunities

Trafficking of youth is a serious problem in India

Environmental and social challenges
Pollution - increasing asthma, electromagnetic exposure from
communication devices in disorders like childhood leukaemia, brain
tumours, and immune dysregulation

Media - glamorous, portrait of tobacco and alcohol consumption,

unrealistic expectations, and destructive behaviour. Spending more
time indoors results in deprivation of sunlight and physical activity

Peer pressure - risk-taking behaviour and initiation of substance abuse

Poverty - inadequate diet, depression, antisocial behavior

Academic and emotional stress
Examinations cause significant physiological and psychological stress

Academic burden, pay rental expectation and changing social

environment cause stress among youth

Switching from vernacular to English, medium schools, long hours of

school and tuitions are additional stress factors
History taking in adolescent
“HEADSS”

Home - who lives with them? Do they have their own room relationships at home? New people in
home?

Education and employment- school performance? Any dramatic change favourite subject in the
class failed dropping out ? future education plans?

Activities - on own, with peers? With family? Sports? Church attendance? Hobbies? TV? Favourite
music?

Drugs - used by peers? Used by himself? Used by family members? Amount/frequency/patterns of

use? Source-How paid for?

Sexuality - orientation? Degree and type of sexual experience? Number of partners?

Masturbation? STDs? Pregnancy/abortion? Knowledge of contraception? Comfort with sexual
activities? History of physical abuse?
Suicide/depression - Sleep disorders? Appetite/eating behaviour
changes.
Bore them? Emotional outburst/highly impulsive behaviour? History of
withdrawal/isolation? Hopeless feelings? History of past suicide
attempts in family or peers? Suicidal ideation? avoidance of eye
contact.?
Roles of healthcare provider
Checklist for adolescent clinic visit

History from parents and adolescent

History of presenting problems

Parental concerns on growth and development

Academic success, alcohol absenteeism, diet history

Menstrual history, sleep problems

History on separate questioning of adolescent
Emotional problems

Relationship with family and peers

Outlook towards physical and sexual changes

Involvement in relationship/sexual activity

Awareness about contraception

Tobacco or substance use

History on separate questioning of parent
Relationship with family

Level of communication on sensitive matters

Physical examination
Anthropometry

BP

Markers of obesity, acanthosis

SMR

Signs of malnutrition, anaemia, and vitamin deficiencies

Signs of skin and genital infections

Level of general hygiene

Signs of trauma or abuse

Counselling
Nutritional intervention

Hygienic practices

Building rapport with parents and adolescent

Information and sources on sex education

Investigations
HB

Blood sugar, lipid profile

Genital swab

Ultrasound of ovaries
Referral
Counsellor
Dietician

Psychiatrist

Gynaecologist

Voluntary and confidential HIV testing

Social services, child protection, agencies to account

Referral to social services psychological evaluation
It is mandatory for a healthcare provider to report all cases of child
abuse (even suspected)
Doctors are punishable if they fail
Adolescent health programmes
1. RMNCH + A
2. ARSH
3. RASHTRIYA KISHOR SWASTHYA KARYAKRAM(RKSK)
4. Kishori Shakti Yojana - to improve health and nutritional status of
girls
5. Nutrition program for adolescent girls (NPAG)
6. Balika Samriddhi Yojana
7. WIFS
8. National AIDS control programme
9. Adolescent friendly health clinics (AFHCs)
RMNCH + A
Addresses major causes of mortality among women and children

RMNCH + A 2013

TO ENSURE EQUAL FOCUS ON VARIOUS LIFE STAGES

IFA, supplementation for pregnant, lactating, women, children 6th-60

months and adolescent

Provides a weekly dose of 100 mg elemental iron and 500 mcg Folic
acid with biannual de worming under WIFS
RKSK
MoHFW

Launched on 7th Jan 2014

To strengthen adolescent component of RMNCH +A

OBJECTIVES :

Improve nutrition, sexual and reproductive health

Enhance mental health, prevent injuries and violence

Prevent substance misuse

Prevent noncommunicable disease

Services provided
WIFS

Clinics and counselling

Peer educator and adolescent health Day

Menstrual hygiene scheme

WIFS
The program covers 11.2 crore beneficiaries

To reduce prevalence and severity of anaemia in adolescent population

Target group- school, going adolescent girls and boys 6th to 12th class
enrolled in government or manciple schools

Out of school student

Urban and rural area

Intervention

Supervised weekly iron and folic acid supplement

Screening of target group for moderate/severe anaemia and appropriate

refferals

Biannual de worming
Kishori Shakti Yojana
Launched-year 2000
Key component of ICDS

Aim - breaking down intergenerational life-cycle of nutritional and gender

disadvantage and providing supportive environment for self development

Objectives- to improve nutritional and health status of adolescent girls

To provide required literacy and numerous skills through

non-formal stream of education

Upgrade, home-based and vocational skills