Adolescent health
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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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Adolescent health

Adolescent health

PRESENTED BY-Dr. l.karthiyayini

MODERATOR-DR. DAMBHARE


What is adolescence

What is adolescence?


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

  • It is the period of transition from puberty to maturity

    Young people :

    Its defined as generally people aged 10–24 years. Its divided into three categories:

  • 10–14 years (early adolescence);

  • 15–19 years (late adolescence)

  • 20–24 years (young adulthood)


Adolescent population

Adolescent population

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.


Changes during adolescent period

Changes during adolescent period

  • Rapid physical growth and development.

  • Physical, social and psychological maturity

    • Sexual maturity and the onset of sexual activity

    • Experimentation

    • Development of adult mental processes and adult identity

    • Transition from total socio-economic dependence to relative independence.

    • Stage of life in which individuals establish their own identities and prepare to become adults.


Changes during adolescent period contd

Changes during adolescent period….contd.

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.


Tanner staging

Tanner staging

Boys: Genital Development

  • Stage 1: Preadolescent. Testes, scrotum and penis are about the same size and proportion as in early childhood.

  • Stage 2: Enlargement of scrotum and testes. Skin of scrotum reddens and changes in texture. Little or no enlargement of penis.

  • Stage 3: Enlargement of penis, at first mainly in length. Further growth of testes and scrotum.

  • Stage 4: Increased size of penis, with growth in breadth and development of glans. Testes and scrotum larger. Scrotal skin darkened.

  • Stage 5: Genitalia are adult in size and shape.


Tanner staging1

Tanner staging

Girls: Breast Development

  • Stage 1: Preadolescent. Elevation of papilla only.

  • Stage 2: Breast bud stage. Elevation of breast and papilla as small mound. Enlargement of diameter of areola.

  • Stage 3: Further enlargement and elevation of the breast and areola, with no separation of their contours.

  • Stage 4: Projection of areola and papilla to form a secondary mound above the level of the breast.

  • Stage 5: Mature stage. Projection of papilla only, owing to recession of the areola to the general contour of the breast.


Tanner staging2

Tanner staging

Both sexes: pubic hair

  • Stage 1: Preadolescent. Vellus over pubis is not developed further than that over abdominal wall (i.e., no pubic hair).

  • Stage 2: Sparse growth of long, slightly pigmented downy hair, straight or slightly curled, chiefly at base of penis and along labia.

  • Stage 3: Hair is considerably darker, coarser and more curled. It spreads sparsely over the junction of pubis.

  • Stage 4: Hair is adult in type, but area covered is still considerably smaller than in adult. No spread to medial surface of thighs.

  • Stage 5: Hair is adult in quantity and type, with distribution of horizontal (or classic “feminine” in females) pattern. Spread to medial surface of thighs but not up linea alba or elsewhere above base of inverse triangle (spread up linea alba occurs late and is rated Stage 6).


Pubertal disorders

Pubertal disorders

Short stature

Delayed puberty

Gynecomastia

Pre pubertal hyperandrogenism

hirsutism


Psychosocial changes

Psychosocial changes


Adolescent body image

Adolescent body image

  • Body image is defined as “the way of perception of one’s body and its competences”.

  • Determinants of body image: 

    • General self-esteem- one’s overall perception of self- worth

    • Social self-esteem- one’s perception of interpersonal peer relationships

    • Parent-related self-esteem –one’s perception of her/his status at home, including how his/her parents view her/him.

    • Academic self-esteem- one’s perception of his/her ability to succeed academically

    • Physical self-esteem-one’s perception of physical ability & physical appearance


Clinical presentation of poor body image

Clinical presentation of poor body image

  • Low weight for age, height & SMR stage

  • Anemia

  • Menstrual irregularities

  • Eating disorders

  • Excessive shyness

  • Sleep problems

  • Withdrawal & depression

  • postural problems.


Management and treatment of poor body image

Management and treatment of poor body image:

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 .


Adolescent nutrition

Adolescent nutrition

  • Increased nutritional needs at this juncture relate to the fact that adolescents gain up to 50% of their adult weight, more than 20% of their adult height, and 50% of their adult skeletal mass during this period.

  • Caloric and protein requirements are maximal. Increased physical activity, combined with poor eating habits and other considerations, e.g. menstruation and pregnancy, contribute to accentuating the potential risk for adolescents of poor nutrition.  


Recommended dietary allowance

Recommended dietary allowance


Eating behaviour of adolescents

Eating behaviour of adolescents

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:

Anemia

Obesity

Malnutrition

Anorexia

Bulimia nervosa

Binge eating disorder


Adolescent reproductive sexual health arsh

Adolescent reproductive & sexual health(ARSH)

Adolescentreproductive & sexual healthreferstothephysical, mental, and emotionalwellbeing of adolescents, and includesfreedomfrom:

  • unwantedpregnancy

  • unsafeabortion

  • sexuallytransmittedinfections (STIs), including HIV/AIDS

  • allforms of sexual violence and coerción.


Contd

Contd….

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.


Contd1

Contd…

  • Factors influencing sexual health of adolescents:

    Protectivefactorswork in 3 ways,

  • Encourage & sustain positive behaviour.

  • Reduce therisk of negativehealthbehaviour & outcomes.

  • Diminishtheeffect of & supportrecoveryfromnegativehealthoutcomes.

Risk factors

Risk behaviours

Negative outcomes

Protective factors


Contd2

Contd….

Protectivefactors are,

  • Caring and meaningfulrelationships.

  • Positive schoolenvironment.

  • Sructure and boundariesforbehaviour

  • Having spiritual beliefs

  • Encouragement of self-expression

  • Oppurtunitiesforparticipation & contribution.

    Consequences of inappropriate sexual behaviour leads to,

  • Adolescentpregnancy

  • Unsafeabortion

  • Sexuallytransmitteddiseases

  • Social & economicimpact.


Menstrual problems in adolescent girls

Menstrual problems in adolescent girls

  • Premenstual syndrome-

  • Before the onset of the menstual cycle, females face many uncomfortable symptoms which last for a short period, stretching from few hours to few days called as premenstrual syndrome.

  • Dysmenorrhea- Dysmenorrhea is feeling intense menstrual pain and cramps..

  • Amenorrhea - it is the condition in which the female skips her menses for more than three consecutive menstrual cycles. There are many causes of amenorrhea such as ovulation abnormality, eating disorders, birth defects, anatomical abnormalities, malnourishment, pregnancy, thyroid disorder, obesity and other medical conditions.

  • Dysfunctional uterine bleeding


Adolescent pregnancy

Adolescent pregnancy


Adolescent pregnancy1

Adolescent pregnancy

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


Contd3

Contd…

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.


Sexually transmitted diseases

Sexually transmitted diseases

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.


Mental health

Mental health

among adolescents

  • World-wide up to 20% of children and adolescents suffer from a disabling mental illness

  • World-wide suicide is the 3rd leading cause of death


Mental disorders

MENTAL DISORDERS

  • Conduct and behavioural disorders

  • Learning disorders

  • Anxiety disorders

  • Teen depression

  • Juvenile delinquency

  • Adjustment problems


Contd4

Contd..

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.


Contd5

Contd…

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.


Prevention of mental illness

Prevention of mental illness

  • Enhancing social skills, problem-solving skills and self confidence can help prevent mental health problems such as conduct disorders, anxiety, depression and eating disorders as well as other risk behaviours including those that relate to sexual behaviour, substance abuse, and violent behaviour.

  • Also there should be competencies to relate to young people, to detect mental health problems early, and to provide treatments which include counselling, cognitive-behavioural therapy and, where appropriate, psychotropic medication.


Other special issues

Other special issues

  • Substance abuse

  • Violence and gender bias

  • Road safety


Substance abuse

Substance abuse

Substance abuse refers to the harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs.


Drug abuse

Drug abuse

  • Psychoactive substance use can lead to dependence syndrome - a cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include a strong desire to take the drug, difficulties in controlling its use, persisting in its use despite harmful consequences, a higher priority given to drug use than to other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.

  • The projected number of drug abusers in India is about 3 million and most drug abusers are in the age group of 16-35 years


Alcohol

Alcohol

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.


Tobacco

Tobacco

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,

1 Smoking

2 Chewing along with other substances

3 Snuffing

4 Application in the mouth as powder or paste


Violence by against adolescents

Violence by & against adolescents

  • The World Health Organization defines violence as: The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.

  • Homicide and non-fatal assaults involving young people contribute greatly to the global burden of premature death, injury and disability forms of violence in society. Participating in physical fights, bullying and carrying of weapons are important risk behaviours for youth violence.


Contd6

Contd…

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 biased violence

Gender biased violence

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.


Risk factors of violence

Risk factors of violence

Individual factors

Family influences

Relationship factor

Peer influences

Community factors

Demographic & social changes

Income inequality

Political structures

Cultural influences


Road safety among adolescents

Road safety among adolescents


Contd7

Contd..

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


Contd8

Contd..

Young road users are at risk for road traffic injuries for a number of reasons:

  • insufficient consideration of their specific needs when roads are being planned;

  • physical and developmental characteristics that increase their risk, for example, the small stature of young children;

  • risk taking behavior and peer pressure particularly among adolescents; and

  • other risk factors such as speeding, drink-driving, not using helmets or not wearing seat-belts.


Adolescent health programs programs

Adolescent Health Programs:PROGRAMS

1. Reproductive and Child Health Programme

Adolescent Friendly Health Services:

2. National AIDS Control Programme

3. Millineum developmental goals.

4. ICDS


Reproductive and child health ii

Reproductive and Child Health-II

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


Adolescent health

ARSH

Package of services

  • Promotive services:

    • Focused care during antenatal period

    • Counselling & provision of emergency contraceptives

    • Counselling & provision of reversible contraceptives

    • Information/advice on SRH services

  • Preventive services:

    • Services for TT and prophylaxsis against nutritional anemia

    • Nutritional counselling

    • Services for early and safe termination of pregnancy and management of post abortion complications


Adolescent health

3.Curative services:

  • Treatment for common RTI/STIs

  • Treatment & counselling of menstrual disorders sexual concerns of males and female adolescents

    4. Referral services:

  • Integrated Counselling and Testing Centre

  • Prevention of Parent to Child Transmission

    5. Outreach services:

  • Periodic health checkups and community camps

  • Periodic health education activities

  • Co-curricular activities


Adolescent friendly health services

Adolescent Friendly Health Services:

  • AFHS provides a broad range of preventive, promotive & curative services

  • AFHS in India is first taken by Safdarjang Hospital in New Delhi

  • Package of health services at AFHS:

  • Monitoring of growth & development&behaviour problems

  • Offer information & counselling on developmental changes, personal care & ways of seeking help

  • Reproductive health including contraceptives, STI treatment, pregnancy care & post abortion management

  • Integrated counselling & testing for HIV

  • Management of sexual violence

  • Mental health services including management of substance abuse


B national aids control programme

b)National AIDS Control Programme

  • Under NACO Adolescent Education Programme developed which focuses primarily on prevention through awareness building

  • The Adolescent Education Programme is one of the key policy initiatives of NACP II.

  • Relevant messages on safe sex, sexuality and relationships are developed and disseminated for youth via posters, booklets, panels and printed material.


C the millennium development goals mdgs

c)The Millennium Development Goals (MDGs).

Two of the MDGs are particularly relevant to young people's health.

  • MDG 5 aims to achieve universal access to reproductive health, for which one of the indicators is the pregnancy rate among 15 to 19 year old girls.

  • MDG 6 to halt the spread of HIV/AIDS has indicators like a 25% reduction among young people, and also measures the proportion of 15 to 24 year olds with comprehensive and correct knowledge of HIV/AIDS


Adolescent health

ICDS

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


Kishori shakti yojana ksy

KishoriShaktiYojana (KSY)

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 .


At district level in wardha under arsh the following activities are carried out

At district level in wardha under ARSH, the following activities are carried out,

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.

Health education


References

REFERENCES:

  • Adolescents in India, A Profile, UNFPA for UN systems in India, 2003; 21-22.

  • Adolescence : a foundation for future. Lancet 2012; 379: 1630–40

  • National Rural Health Mission. Implementation Guide On RCH-II Adolescent Reproductive Sexual Health Strategy. For State and District Health Managers May 2006. [Online]. Available from: http://www.mohfw.nic.in/NRHM/Documents/ARSH/Implementation_guide_on_RCH %20II .pdf[cited 2009 Sept 30].

  • Ministry of Health and Family Welfare. Government of India. Reproductive And Sexual Health People in India July 2009. [Online]. Available from: http://www.mohfw.nic.in/NRHM/Documents/ARSH/Orientation_Programme_Facilitators_Guide .pdf[cited 2009 Sept 30].

  • World health report 2000.


Adolescent health

  • National AIDS Control Organization[Online]. 2009 Oct 5 [cited 2009 Oct 15]; Available from: URL:http://www.nacoonline.org/Quick_Links/Youth/School_Age_Education_Program_SAEP

  • World health organization. Adolescent health. http://www.who.int/maternal_child_adolescent/topics/maternal/adolescent_pregnancy/en/index.html

  • Anaemia Control Programme- Breaking the Inter-Generational Cycle of Undernutrition in India with a focus on Adolescent Girls. UNICEF organization.

  • Adolescent health,Oxford book of public health.


Adolescent health

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