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Adolescent Health. Donna M. Denno HServ/GH 544. Photos: http://www.fhi.org/en/Youth/YouthNet/index.htm, WHO website and references, and D Denno. Learning Objectives. Describe mortality rate trends by age group List common causes of mortality and morbidity among young adults

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adolescent health

Adolescent Health

Donna M. Denno

HServ/GH 544

Photos: http://www.fhi.org/en/Youth/YouthNet/index.htm, WHO website and references, and D Denno

learning objectives

Learning Objectives

Describe mortality rate trends by age group

List common causes of mortality and morbidity among young adults

Describe factors during adolescence that impact adult health

Describe barriers to health service delivery for youth and strategies for improving delivery

who are we talking about
Who are we talking about?
  • Neonatal period <28 days
  • Infants <1 year
  • Child <5 years
  • School age children
  • Adolescents 10-19 years
  • Youth 10-24 years
  • Adults >20 years
all cause mortality young people 2004
All cause mortality, young people, 2004

Patton GC et al. Global patterns of mortality in young people. Lancet. 2009.

causes of death 10 24 year olds 2004
Causes of Death, 10-24 year olds, 2004

Patton GC et al. Global patterns of mortality in young people. Lancet. 2009.

causes of death 10 24 year olds females 2004
Causes of Death, 10-24 year olds, females, 2004

Patton GC et al. Global patterns of mortality in young people. Lancet. 2009.

as always causes of mortality vary by region country
As always…causes of mortality vary by region, country
  • e.g. 15% of deaths among 15-24 yo females in India are due to burns.
    • Unintentional
    • Self inflicted (related to domestic violence)
    • Homicide

Shangavi et al. Fire-related deaths in India in 2001: a retrospective analysis of data. Lancet. 2009.

slide8
Should developing countries focus attention on adolescent health? What is the role of the health sector?
beyond mortality
Beyond Mortality

Major contributors to disease burden in youth

  • Sub-lethal injuries  life long disabilities
  • HIV burden
  • STI burden
  • Reproductive health related problems
  • TB burden
  • Malnutrition
  • Mental health problems
impact on adult health
Impact on Adult Health

~2/3 of premature deaths and 1/3 of the total disease burden in adults--associated with conditions or behaviors that begin in youth

  • Substance abuse including tobacco and alcohol
  • Unprotected intercourse
  • Sexual coercion and force
  • Exposure to violence
  • Eating and exercise patterns
impact on adult health ct d
Impact on Adult Health ct’d
  • 15-24 year olds account for an estimated 45% of new HIV infections worldwide.
impact on adult health ct d1
Impact on Adult Health ct’d
  • Risk factors in adolescence impact future risk of chronic disease
    • Hypertension
    • Diabetes
    • Cardiovascular Disease
    • Cancer
impact on neonatal health
Impact on Neonatal Health

11% of all births worldwide are among adolescents

  • Stillbirths -- 50% increased risk among under 20 years
  • Neonatal deaths -- 50–100% more frequent if the mother is an adolescent versus older, and the younger the mother, the higher the risk.
continuum of care
Continuum of Care

Kerber K. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007.

health sector response
Health Sector Response
  • Relatively healthy group
  • Do not need prioritization or special consideration
  • Provide minimum subset of adult (or child) health services
  • Laws and policies may prevent delivery of services to adolescents
health provider response
Health Provider Response
  • Uncomfortable serving youth who are sexually active or engaging in risk behaviors
  • Communication and compliance issues frustration
  • May not have training to address adolescent concerns/questions about their changing bodies, emotions
  • Bias
adolescent development characteristics influencing health and health seeking behavior
Adolescent Development Characteristics Influencing Health and Health Seeking Behavior
  • No longer children…yet not adults
  • Physical and psychosocial maturity develop separately
  • Develop at different rates
  • Physically able to reproduce
  • Sense of independence…yet rely on adults
  • Risk taking
  • Invincible
youth response to health services
Youth response to health services
  • Irrelevant to their needs
  • Distrustful
  • Avoid or use only when desperate
case anthony
Case: Anthony
  • 12 yo
  • Came to town from country side when crops failed
  • Domestic helper in a distant relative’s household, domestic violence
  • Concerned about pubertal changes--is this normal?

Case: Florence

  • 16 yo
  • Doing well at school, encouraged by family to continue with education
  • Coerced sex, pregnant, induced abortion, still bleeding a week later
  • Her mom’s friend works at the clinic
what are barriers to delivery of effective health services
Youth

Cost

Lack of services—hours, cost, permission

Lack of confidentiality

Lack of compassion

Distrust

Ill treatment

Health system

Lack of

Data

Training

Supplies

Funding

Restrictive laws/policies

Vertical programming

What are barriers to delivery of effective health services?
youth friendly health services
Youth Friendly Health Services

ACCESSIBLE

  • “I can’t go there…I don’t have the money…They won’t see me without registration papers…I cannot understand the forms…They won’t see me without parental permission…They ran out of ___…”

ACCEPTABLE

  • “I don’t want to go there…It’s dirty…I have to wait too long…The doctor doesn’t know what she’s doing…The nurse yells at me...They might tell my family…Someone will see me go there, I’ll get in trouble…”

EQUITABLE

  • “I get treated poorly because I use ___, I’m poor… a street kid…from a minority group…from the countryside…”
continuum of care1
Continuum of Care

Kerber K. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007.

intergenerational cycle of undernutrition
Intergenerational Cycle of Undernutrition

The cycle of poor nutrition perpetuates itself across generations

Childhood: Child growth failure, impaired mental development

Fetal and Infant stages: Low birthweight baby

Pregnancy

Compromised nutritional status

Adolescents: Low weight and height

Adult: Small adult woman, lowered productivity