Adolescent health. PRESENTED BY-Dr. l.karthiyayini MODERATOR-DR. DAMBHARE. What is adolescence?. Adolescence . The World Health Organization defines adolescence in terms of age between 10 to 19 years. Adolescence is a phase of life during which individuals reach sexual maturity
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PRESENTED BY-Dr. l.karthiyayini
Young people :
Its defined as generally people aged 10–24 years. Its divided into three categories:
GLOBALLY- The 1.2 billion people aged 10 to 19 make up about 20% of the global population.
SEAR- There are about 350 million adolescents comprising about 22% of the population in the countries of the South-East Asia Region (SEAR).
INDIA-About 22% of India's population is in the adolescent age group of 10-19 years. It is estimated that there are almost 225 million adolescents in India. 12 % belong to the 10-14 years age group and nearly 10 %are in the 15-19 years age group. Females comprise almost 47 %and males 53 % of the total adolescent population.
MAHARASHTRA-about 11 crores of adolescent population are there.
WARDA- 1.25lakh population are adolescents.
Pubertal changes begin at an average age of 10-11yrs in girls & 12-13yrs in boys.
Sexual maturation should be used to assess the extent of biological growth & development & the individual nutritional needs of adolescence in chronological age.
Sexual maturity rating (SMR), also know as tanner staging , is based upon a scale of secondary sexual characteristics that permits health professionals to gauge the degree of pubertal maturation that has occurred among adolescents, regardless of chronological age.
Boys: Genital Development
Girls: Breast Development
Both sexes: pubic hair
Pre pubertal hyperandrogenism
The recognition of body image issues need high index of suspicion clearing their myths about normal changes in the body, about media projected image, and Counselling these adolescents and about various steps they might have adopted to correct their perceived poor body image may be sufficient treatment in majority of adolescents.
Multimodal therapeutic approach include normalization of weight & eating behaviour , nursing & pedagogical measures , individual, group and family therapy, body therapy, art & music therapy .
Missing one or more meals.
Inappropriate choice of snack foods.
Overriding fear of obesity among girls. No supervision of selection of meals eaten away from home.
In some areas women eat after men have eaten & have access to lesser & inferior quality of food.
Nutrition related issues:
Binge eating disorder
Adolescentreproductive & sexual healthreferstothephysical, mental, and emotionalwellbeing of adolescents, and includesfreedomfrom:
Age-specific fertility rate in the age group of 15-19years contributes to 19 % of the total fertility rate.
Amongst currently married women, the unmet need of contraception is the highest in the age group of 15-19 years.
Nearly 27 % of married female adolescents have reported unmet need for contraception .
Most sexually active adolescents are in their late adolescence.
Over 35 % of all reported HIV infections in India occur among young people in the age group of 15-24 years, indicating that young people are highly vulnerable. The majority of them are infected through unprotected sex.
Protectivefactorswork in 3 ways,
Consequences of inappropriate sexual behaviour leads to,
About 16 million women 15–19 years old give birth each year, about 11% of all births worldwide.
In low- and middle-income countries, almost 10% of girls become mothers by age 16 years, with the highest rates in sub-Saharan Africa and south-central and south-eastern Asia.
Births to unmarried adolescent mothers are far more likely to be unintended and are more likely to end in induced abortion.
Coerced sex, reported by 10% of girls who first had sex before age 15 years, contributes to unwanted adolescent pregnancies
Although adolescents aged 10-19 years account for 11% of all births worldwide, they account for 23% of the overall burden of disease (disability- adjusted life years) due to pregnancy and childbirth.
Many health problems are particularly associated with negative outcomes of pregnancy during adolescence. These include anaemia, malaria, HIV and other sexually transmitted infections, postpartum haemorrhage and mental disorders, such as depression.
Educational levels for girls have risen in most countries, and job opportunities have expanded. Low education levels are closely associated with early childbearing.
Adolescents are at risk of acquiring STD.
Many adolescents particularly runaway, the homeless & gay males are exposed to HIV infection by risky sexual behaviors & drug abuse.
Although most teenagers are likely to know that the disease is transmitted by sexual intercourse & reused needles, they are continuing misconceptions and ignorance.
The prevalence of unprotected sex or unsafe sex is high & knowledge about safer sex practices is to be limited.
Extensive health education & preventive programs are required to reduce STDs, using mass media, school & communication based strategies with sensitive consideration of developmental needs of different age groups.
Depression and associated suicide. The combination of depression with substance abuse puts children and adolescents at greater risk for suicide.
Psychosis. Psychoses can result in a host of maladaptive behaviors. The early treatment of psychotic disorders such as schizophrenia not only brings relief to patients, families and society, but improves the prognosis.
Anxiety disorders. A heterogeneous category of disorders with variable diagnosis in even the most sophisticated settings. At the extreme phobias and panic disorder can lead to significant social isolation and lack of occupational attainment.
Conduct disorder/anti-social personality-. It should not be made prematurely because once made it is often seen as having such a negative prognosis that it may establish a self-fulfilling prophecy.
Substance abuse. While it is often impossible to diagnose children as meeting the criteria for substance dependence, whether it be alcohol or other drugs, the serious manifestations of the abuse of substances is evident.
Eating disorders. These disorders are now seen in developing as well as developed countries and may even manifest themselves in the face of apparent starvation.
Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.
Alcohol is a medication that blocks painful or intolerable reality. Alcohol abuse occurs when there are ongoing negative consequences from drinking. Alcohol dependence, or alcoholism, is more severe and occurs when people have problems stopping drinking. About 20% of men and 8% of women are alcohol dependent.40 percent of people who begin to drink before age 15 will become alcohol dependent at some point in their lives. They are four times more likely to become alcohol dependent than those who delay drinking until age 21.
Forty lakh tobacco related deaths occur annually all over the world of which India accounts for 20%. One person dies in every seven second due to Tobacco related diseases. Tobacco & pan chewing is definitely linked to oral cancer. The incidence is highest in India. Smoking is linked to 80 – 90% cases of lung cancer. Within seconds after tobacco smoke is inhaled some 4000 toxic byproducts are absorbed into blood stream and transported to every cell.Forms of tobacco use,
2 Chewing along with other substances
4 Application in the mouth as powder or paste
Worldwide some 250 000 homicides occur among youth 10-29 years of age each year – 41% of the annual total number of homicides globally. For each young person killed, 20-40 more sustain injuries requiring hospital treatment. Youth violence has a serious, often lifelong, impact on a person's psychological and social functioning.
Gender-based violence is another area of concern, especially for female adolescents. As per NFHS 3, nearly one out of every three (31%) ever-married female adolescents, in 15–19 age group, reported having experienced physical, sexual or emotional violence perpetrated by their spouse.
Demographic & social changes
Each year, almost 400,000 young people under 25 years old are killed in a road traffic crash - about 1049 youngsters every day. Most of these tragic deaths occur in low- and middle-income countries, particularly among pedestrians, cyclists, motorcyclists and those using public transport
Young road users are at risk for road traffic injuries for a number of reasons:
1. Reproductive and Child Health Programme
Adolescent Friendly Health Services:
2. National AIDS Control Programme
3. Millineum developmental goals.
a)REPRODUCTIVE & CHILD HEALTH PHASE II
In the National Rural Health Mission (NRHM), a national strategy for Adolescent Reproductive and Sexual Health (ARSH) has been approved as a part of the Reproductive and Child Health Phase II .
Adolescent Reproductive and Sexual Health(ARSH):
Services provided to all adolescent married and unmarried girls and boys
Package of services
4. Referral services:
5. Outreach services:
Two of the MDGs are particularly relevant to young people's health.
The main objective of the programme is to reduce the prevalence and severity of anaemia in school-going adolescent girls using schools as the delivery channel and in out-of-school adolescent girls using the community anganwadi centre of India’s Integrated Child Development Services (ICDS) programme as the delivery platform.
The programme strategy for the initial phase was built around three essential interventions:
1) weekly iron and folic acid supplementation (WIFS) comprising 100 mg of elemental iron and 500 µg of folic acid.
2) bi-annuaLdeworming prophylaxis (400 µg of albendazole) six months apart for the prevention of helminth infestations.
3) information, counselling and support to adolescent girls on how to improve their diets and how to prevent anaemia
To improve the health and nutritional status of girls. Key component of ICDS scheme which aims at empowerment of adolescent girls.
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 (BalikaMandal) Age group 11-18 years irrespective of income levels of the family .Younger girls 11-15 years and belonging to poor families .
Out reach services
Weekly iron & folic acid supplementation program
Community based activity
Screening for anemia, sickle cell, blood grouping and general medical health check ups.
Menstrual hygiene workshops are held for adolescent girls.