Adolescent Health-An Overview

Rajive K. Dikshit ,MD,FCCM MO I/C DH & FW Uttarakhand

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Adolescent Health-An Overview

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THREE STORIES WITH SIMILAR ENDING NINA URBAN ADOLESCENT CHETAN ADOLESCENT BOY

RESHMA RURAL ADOLESCENT

DEVELOPING RAPIDLY

EXPERIMENTING SEXUALLY

APPARENTLY HEALTHY SON OF A DOCTOR

EARLY MARRIAGE

TEENAGE PREGNANCY

NEVER SCREENED

TEENAGE PREGNANCY

ABORTION R.M.P.

+HISTROY OF CHD

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DEATH

Adolescent Health-An Overview

ALL THESE EVENTS ARE THE EXAMPLES OF SYSTEM FAILURE

SYSTEM WHICH IS INSENSITIVE TO THE NEEDS OF ADOLESCENT

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DOUBLE DISADVANTAGE
CARRY THE BURDEN OF PRE EXISTING DISEASES OF CHILD HOOD DEVELOPING RAPIDLY AND HAVING EXTREME DEGREE OF PRESSURE FROM PEERS, PARENTS, SOCIETY AND SELF

LACK KNOWLEDGE AND SKILL TO COPE UP WITH PRESSURE

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Adolescent Health-An Overview

No longer Children, Not Yet Adults

Adolescence 10-19 years

Young people
10-24 Years

Youth
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15-24 Years

Adolescent Health-An Overview

Population Profile: Ages 10-24 Years in India

Population age-10-24 (Millions)
10-24 years as % of total population % Male enrolled in secondary school % Female enrolled in secondary school Average age at first marriage Total fertility rate % TFR contributed by 15-19 years % using contraceptives
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284.2
30 59 38 20 3.4 9 7
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Population Reference Bureau. Inc.

Adolescent Health-An Overview

India: Country of Diversity 5,000 year old civilization

325 languages spoken 1,652 dialects

18 official languages
29 states, 5 union territories

3.28 million sq. kilometers - Area

7,516 kilometers - Coastline

1,000,000,000 people in 2000

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207 Million Adolescents

Adolescent Health-An Overview

Adolescents: A Very diverse population segment

Different stages of development Different circumstances Different needs and Diverse problems

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Adolescent Health-An Overview

Adolescents have important subgroups with markedly different needs: Urban Rural Slum Street Children Those in specially difficult circumstances
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Adolescent Health-An Overview

Why Focus on Adolescents?

Large number >22% of the population (Approximately 207 Million of our population); Adolescence is a period of rapid physical growth, sexual and psycho-social changes; Habits and behavior picked up during adolescence (Risk taking behavior, substance abuse, eating habits, conflict resolution) have life long impact.
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Adolescent Health-An Overview

Why Focus on Adolescents?

Adolescence is the last chance to correct growth lag and malnutrition; Many adolescent boys and girls are sexually active but lack information and skills for self protection (Low level of information on FP, low contraception use); Have simple, but wide pervading and crucial RH needs menstrual hygiene, contraception; (including Emergency Contraception), safety from STI/HIV; Communication gap exists with parents and other adults (Lack of family 1/12/2014 12 Connectedness);

 70% of mortality in adulthood is linked to habits picked up during adolescence. (Risk taking behavior, substance abuse, eating habits, conflict resolution); Prevailing malnutrition, anemia, stunting and lack of immunization has adverse impact on MMR, IMR, morbidity and have inter- generational effects;
Adolescent sexuality: leads to adolescent pregnancy, unsafe abortions, RTI, STI/HIV and social problems; Adolescent pregnancy : Risk of ADVERSE outcome (IMR, MMR, LBW babies) is higher; Lack of connectedness with parents and other adults prevents transmission of health messages and crucial skills, leading to adoption of risky behavior- substance abuse, early sexual debut, 1/12/2014 13 STI/HIV etc.

Public Health Implications

Adolescent Health-An Overview

Characteristics

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A Aggressive Anaemic Abortion D Dynamic,Developing,Depressed O Overconfident,Overindulging,Obese L Loud but lonely,& Lack information E Enthusiastic,Explorative,& Experimenting S Social,Sexual, & Spiritual C Courageous,cheerful, &concern E Emotional,Eager,& Emulating N - Nervous,Never say no to peers T Temperamental,Teenage pregnancy
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Ill Health Recipe: Ye Dil Mange More Lifestyle of Adolescents

Tobacco/ Alcohol Excess dietary FAT Lack of vegetables & fruits

Sedentary habits
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Sexual behavior/ poor genital hygiene

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Adolescent Health-An Overview

Adolescent Health-An Overview

A Common Scenario
14 Year old school girls in a big City X: Out of 100 girls:
60 have never had sex; 15 have had sex, but are not currently sexually active; 25 are sexually active more or less regularly 8 have had health problems; 2 have been coerced into having sex;

All these girls have different needs for health information, services and social support
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Adolescent Health-An Overview

Evidence of Common Roots*

Risk & Protective factors for
adolescents

Early Sex Substance Depression Use

A positive relationship with parents Conflict in the family A positive school environment Friends who are negative role models A positive relationship with adults in the community Having spiritual beliefs Engaging in other risky behaviours 1/12/2014
*Broadening the Horizon Evidence from 52 countries

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Adolescent Health-An Overview

Priority Health Problems

Sexual and reproductive health problems Nutritional problems Mental health problems Substance abuse Accidental and intentional violence

Clustering of problems
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PREVALENCE OF ANAEMIA IN ADOLESCENT-MEERUT

70% 60% 50% 40% 30% 20% 10% 0% BOYS GIRLS-R NORMAL GIRLS(U) ANAEMIC
42 34 36

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Adolescent Health-An Overview

Health problems
Large number are malnourished, and anaemic (56% Baroda study, 95% SWACH study), or stunted (59% boys, 37% girls- NNMB 2000); Obesity is increasing,8-10% in public schools of Meerut and Delhi. Adolescent pregnancy common (50%of women in india had a child before reaching the age of 20IP-JAN 2004) Large number of adolescents are still unimmunized. (TT,RUBELLA );

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Adolescent Health-An Overview

HEALTH PROBLEMS
One out of 10 children in India is sexually abused at any given point of time (WHO) Sexual problems;25%of patients attending Government STI clinics are Younger than 18 Year old (Ramasubban-1995) Increasing vulnerability to HIV/AIDS,Over 50%of all new HIV cases in india are among 1024years (UNAIDS-2002) Substance abuse is quite common
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PROGRAMMES FOR ADOLESCENTS

KISHORI SHAKTI YOJANA To improve the health and nutritional status of girls BALIKA SAMRIDHI YOJANA To Delay the age of marriage NEHRU YUVA KENDRA ACT AS HEALTH AWARENESS UNIT-Through active participation of youth

MAHILA SAMAKHYA PROGRAMME- Equal access to education facilities for adolescent girls and young women
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Adolescent Health-An Overview

PROGRAMMES FOR ADOLESCENTS

SCHOOL AIDS EDUCATION, UNIVERSITY TALKS AIDS TRAINING OF RURAL YOUTH FOR SELF EMPLOYMENT

REPRODUCTIVE AND CHILD HEALTH PROGRAMME

? WHERE ARE THE BOYS NO COMPREHENSIVE PROGRAMME ADDRESSING ALL NEEDS OF ADOLESCENT 1/12/2014

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Adolescent Health-An Overview

Programming
To promote healthy development to meet needs and build competencies
Safety, Belonging, Self Esteem, Caring relationship

To prevent and respond to health problem from:

Early, unprotected, unwanted sex Use of tobacco and misuse of alcohol and other substances Accidents Violence Poor nutrition Endemic disease

Physical eg eating habits

Psychological eg communication

Moral eg personal responsibility

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Vocational eg entrepreneurial skills

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STRATEGIES FOR PROMOTION OF ADOLESCENT HEALTH

A =ADOPTION OF HEALTHY LIFE STYLE
D=DEVELOP APPROPRIATE I.E.C. STRATEGY DISCOURAGE EARLY MARRIAGE AND TEENAGE PREGNANCY O=ORGANIZE ADOLECENT/ YOUTH FRIENDLY CLINIC L=LIFE SKILL EDUCATION , LEGAL SUPPORT, LIASIAN WITH PEERS , PARENTS E=EDUCATE ABOUT SEXUALITY,SAFE SEX,SPIRITUALITY,RESPONSIBLE PARENTHOOD S=SAFE, SECURE AND SUPPORTIVE ENVIRONMENT TO BE PROVIDED C=COUNSELLING / CURRICULM IN SCHOOL INCUSIVE OF FAMILY LIFE EDUCATION E=ENABLE &EMPOWER FOR RESPONSIBLE CITIZENSHIP N=NETWORKING FOR EXPERIENCE SHARING
1/12/2014 T=TRAINING FOR INCOME GENERATION,TEEN CLUBS 25

Adolescent Health-An Overview

IAP HAS MADE AN ADOLESCENT CHAPTER

EXISTING HEALTH FACILITIES MUST BE MADE ADOLESCENT FRIENDLY IAPSM HAS GOT THE INSIGHT LET US JOIN TOGETHER AND TAKE APPROPRIATE ACTION LET US WORK WITH YOUTH NOT MERELY FOR YOUTH AND MAKE THEM CHANGE AGENTS

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Adolescent Health-An Overview

THE CHALLENGES ARE THERE BUT POTENTIAL IS FAR GREATER

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Thank You!

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