Adolescent Health

Dr. G. Murali Mohan Reddy

Assistant Professor
Department of Community
Medicine

What is adolescence?

Neonatal period <28 days

Infants <1 year
Child <5 years
School age children
Adolescents 10-19 years
Youth 10-24 years
Adults >20 years

DEFINITION OF
ADOLESCENCE
Adolescence is a transitional stage
of physical and mental
development that occurs between
childhood and adulthood.
WHO : period of life between 10
and 19 years.

PUBERTY
Puberty is the stage of the lifespan in
which a child develops secondary sex
characteristics.
The average age for girls:- 10-12
The average age for boys 12-14.

SIZE
1 in 5 people
85% live in developing countries
1/3 of the population in
developing countries

Not that simple?

A range of social and economic

factors have created a distinct group
in most societies, who are no longer
children and not yet adults
Age only one of the factors defining
the period between childhood and
adulthood, but a good proxy

10

Who are we talking about?

In reality it is a biologic and
developmental phase
Transition

11

Changing
Needs
Phase of rapid physical,
psychological, emotional
development
A time of new opportunities,
new capacities, new
experiences and new
challenges
Changing roles,
responsibilities, influences
and expectations: moving
towards family formation,
economic security,
citizenship

Diverse population
Different needs
Gender
Soc-economic conditions
Culture
Education

Adolescent Development Characteristics

Influencing Health and Health Seeking Behavior

No longer childrenyet not adults

Physical and psychosocial maturity
develop separately
Develop at different rates
Physically able to reproduce
Sense of independenceyet rely on adults
Risk taking
Invincible
14

Adolescent health
Common causes of mortality and
morbidity
Factors that impact future adult health
Barriers to health service delivery and
strategies for improving delivery
Adolescent friendly health services

How healthy are

adolescents?
2.6 million deaths per year
Reductions in adolescent mortality
rates have been ~half that compared
to reductions in child mortality rates

16

Causes of Death, 10-24 year olds,

2004

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

17

Causes of Death, 10-24 year olds,

females, 2004

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

18

Our country
15% of deaths among 15-24 y
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.

19

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

20

ADOLESCENT NUTRITION
Nutritional health during adolescence
- important for supporting the growing
body
- for preventing future health problems
- Dual burden of under nutrition and

PROBLEMSADOLESCENT NUTRITION
Changing lifestyle
Skipping breakfast
Dining outside often
FOOD more than
satisfying the hunger

REPRODUCTIVE & SEXUAL

HEALTH problems
STI
Emotinal distress: sexual abuse or
exploitation.
Unwanted Pregnancy failure or non
use of contraceptives
Criminal abortions
Menstrual disorders

MENTAL DISORDERS
Conduct and
behavioral
disorders
Learning disorders
Anxiety disorders
Teen depression
Juvenile
delinquency
Adjustment
problems

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

25

Impact on Adult Health ctd

15-24 year olds account for an
estimated 45% of new HIV infections
worldwide.

26

Impact on Adult Health

Risk factors in adolescence impact
future risk of chronic disease
Hypertension
Diabetes
Cardiovascular Disease
Cancer
27

Impact on Neonatal Health

11% of all births (16 million)
worldwide are among
adolescents
Stillbirths -- 50% increased risk
among under 20 years
Neonatal deaths -- 50100% more
frequent if the mother is an
adolescent versus older, and the
younger the mother, the higher the
risk.
28

FALSE SENSE

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

30

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
31

Youth response to health

services
Irrelevant to their needs
Distrustful
Avoid or use only when desperate

32

IN SUMMARY
Adolescent represents a great 'demographic dividend' and
offers a dependable potential to drive and sustain economic
growth of India.
Adolescents are generally considered healthy by themselves,
their families, even health care providers and society at large.
They suffer significant morbidity caused by risk taking
behavior and inadequate access to health care.
They require information and skills, health services and
counseling as well as a safe and supportive environment for
development

INDIAN RESPONSE

Missing Link- Continuum of care

35
Kerber K. Continuum of care for maternal, newborn, and child health: from slogan to service delivery. Lancet. 2007.

Aim of Adolescent health

Services
To reduce death and disease in
adolescents
To reduce the burden of disease in
later life
To protect human capital

Adolescent Health
Programs
1. Kishori Shakti Yojana : To improve the
health and nutritional status of girls
2. Balika Samridhi Yojana: To Delay the
age of marriage
3. Reproductive and Child Health
Programme
4. Adolescent Friendly Health Services:
5. National AIDS Control Programme
6. Family Life Education

Kishori Shakti Yojana

Key component of ICDS scheme which aims at
empowerment of adolescent girls.
Adolescent girls who are unmarried and belong to
families below the poverty line and school drop-outs
are attached to the local Anganwadi Centres for sixmonthly of learning and training activities
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 (Balika Mandal)

Age group 11-18 years
irrespective of income levels of
the family
Younger girls 11-15 years and
belonging to poor families

Balika Samridhi Yojana

Objectives:
To change negative family and community
attitudes towards the girl child at birth and
towards her mother.
To improve enrollment and retention of girl
children in schools ,to increase the age of
marriage of girls and to assist the girl to
undertake income generation activities.
.
Target group
Girl children belonging to families below the
poverty line

Benefits: A post birth grant amount of Rs. 500/Class

Amount of Annual
Scholarship
I-III
Rs. 300/- per annum for each class
IV
Rs. 500/- per annum
V
Rs. 600/- per annum
VI-VII
Rs. 700/- per annum for each class
VIII
Rs. 800/- per annum
IX-X
Rs. 1000/- per annum for each class
Procedure for obtaining the benefit
ICDS infrastructure in rural areas and Health
Department in urban areas.
The application forms are available with Anganwadi
Workers in the villages and with Health functionaries
in urban.

Payment at maturity
Attaining 18 years of age
Certificate of GP/Municipality
The
implementing
agency
authorizes the bank or post office
to withdraw

Withdrawl of benefit
Girl getting married<18yrs she
will not be given the benefit
In case of death all money will
be withdrawn

Funds
Prior to 1999-2000, funds were being released to the Additional Deputy
Commissioners by the Government of India. However, there after the
funds were being released to the State Govt.

Adolescent Reproductive and Sexual

Health(ARSH):
Package of services
1. Promotive services:

Focused care during antenatal period

Counselling & provision of emergency contraceptives
Counselling & provision of reversible contraceptives
Information/advice on SRH services

2. 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

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

Level
of
care

Servic
e
provid
er

Target
group

Subcentr
e

HW(F)

Unmarrie
d male&
female
Married
male&
female

Flow of
service
deliver
y
activiti
es

Services

During Enrolement of
newly married
routine couples
subcen
tre
Provision of spacing methods
clinic
Routine ANC care & institutional
deliveries
Referral
abortion
Education
RTI/STIs

for
on

early

&

prevention

safe
of

counselling
on
Nutritional
anemia prevention & menstrual
hygeine

Level of Service Target

care
provid group
er

Flow of service Services

delivery
activities

PHC/CH
C/DH

Once a wk teen
clinic at PHC for
2hrs

HA(F)LH Unmarried
V or
male&
MO
female

Contraceptive
condom programming
Management
of
menstrual disorders
Education
on
prevention of RTI/STIs
and
their
management
Counselling
services
pregnancy
termination

&
for

Nutritional
counselling
&
counselling for sexual
problems

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
Monitoring of 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

 The RCH-II has a strategy

for adoloscent health
facilities & at primary
during routine hours and
& times

to provide services
at public health
health care level
on dedicated days

Haryana is the first state in the country to

launch a distinct Adolescent Reproductive &
Sexual Health (ARSH) program providing
AFHS at government health facilities.

The Adolescence Education Programme

(AEP)
Co-curricular adolescence education in classes
IX-XI
Curricular adolescence education in classes IXXI and life skills education in classes I- VIII
Inclusion of HIV prevention education in preservice and in-service teacher training and
teacher education programmes.

Red Ribbon Club (RRC)

The club is established in every school and
college to provide youth with access to
information on HIV/AIDS and voluntary blood
donation.
The club also works towards promotion of life
skills to bring about behavioural change among
the youth.
YUVA - Youth Unite for Victory on AIDS

IN SUMMARY
Adolescent represents a great 'demographic dividend
Adolescents

are

generally

considered

healthy-

MISCONCEPTION
They suffer significant morbidity caused by risk taking
behavior and inadequate access to health care.
They require information and skills, health services
and counseling as well as a safe and supportive
environment for development

Thank you