Adolescent health

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.
Textbook of PSM – Piyush & Ghai
11/13/13

Free template from www.brainybetty.com

2

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


3

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).
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4

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.
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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
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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.
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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
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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


11

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
- 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
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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.
-

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Nutritional problems
malnutrition/ under- nutrition
Micronutrient deficiencies
Obesity
Eating disorders


17

• 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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18

Contd..
D.
-

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Reproductive health problems
Teenage pregnancy
Abortion related problems
Menstrual problems
Reproductive tract infections


19

• 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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20

Contd..
E.
-

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Mental health problems
Substance abuse
Violence
Depression & suicide
Learning disorders
Other psychiatric problems


21

Multifactorial Causation of
Health Problems
Underlying factors

Immediate Causes

High – Risk
Behavior

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?
–
–
–
–

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


39

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

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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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45

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

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• Effective

Communication
& Interpersonal
Relationship
• Self Awareness
& Empathy
• Coping with stress
& Emotions


49

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 Skills
Behavior reinforcement or change
Positive Health Behavior
Prevention of Health Problems
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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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63

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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70

Adolescent health

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