Adolescent Health and Medicine

Home

Search Doctor

Name

Specialty

Dr. Kumar Gaurav Gupta MD (Pediatrics) Resident	Dr. V N Tripathi HOD (Pediatrics) GSVM Medical College Kanpur	Article Submitted by
		E-mail -	gauravgsvm@yahoo.co.in
		Post Method -	via E-mail
		Post Date -	10^th, October, 06
		Submission Category -	Doctor's Article

Medical problems:

The major health problems of adolescents are asthma, respiratory infections, goiter bed wetting, dandruff, skin infection, dysmenorrhea, pimples, dental caries, weight problems, etc. an Indian study shown that dental caries is most common followed by intestinal worms, night blindness, refractive error, ear discharge, pyoderma, scabies and goiter.

Fertility, sexual behavior and contraception, STD’s and HIV / AIDS:

Adolescent’s knowledge regarding sexual and reproductive health is limited, and they are at the risk of STD’s and RTIs, especially in rural areas. A very low proportion of adolescent girls link menarche with sex, pregnancy and reproduction. Unhygienic practices during menstruation endanger reproductive health and expose them to RTIs, PIDs and their complications. The national average of HIV infection rate among pregnant women in Asia is still relatively low but is increasing rapidly in many areas. While the rates are below 1% in most countries, these are relatively high in some areas. For example it varies from 8% in Chiang Mai (Thailand) to 3-7% in parts of Myanmar and up to 5% in parts of Maharashtra , India. Adolescents are disproportionately affected by the risks associated with early and unprotected sex. Many young people become sexually active without planning the sexual relationship or thinking about the consequences. In many cases early sexual experience is unwanted but is the result of coercion or pressure.

Adolescents live in increasingly sexualized societies, exposed to mass media that challenge cultural values. The rapid growth of cities and the breakdown of traditional family structures erode a protective cultural layer. There is a trend towards sexual maturation at an earlier age and, in many societies, a social change towards marriage at a much later age. As a result many young people live for more than 10 years as a sexually mature person before they get married and plan a family. This trend is beneficial if it means that girls do not start having children at too young an age. However, it means that adolescents need to be able to deal with conflicting pressures and expectations without putting themselves or sexual partners at risk. Girls who become pregnant under the age of 18 are between two and five times more likely to die in childbirth than older women. Sexually transmitted infections affect one in 20 young people every year, and although most are curable, many infections are left untreated. HIV/AIDS is a worldwide pandemic, which affects young people disproportionately. Across the world every day around 7,000 young people are infected with HIV, a significant threat to this generation and to the economic prospects of affected countries..

Mental health problems:

Mental health problems may first become apparent during adolescence. A young person experiencing depression or another mental health problem has no frame of reference for his or her condition and may not recognize this as an illness or seek treatment. Depression is seen in 2-8% adolescents. Leslie showed a total prevalence of 21% in boys and 14% of girls with various psychiatric illnesses. Indian study of adolescent girls shows low self-esteem in 7.73% and 88.4% have medium self-esteem. Potential risk factor cited for suicide attempts include female gender, psychopathology especially a major depressive disorder, previous suicide attempts, hopelessness, recent stressful life events, and suicide attempts by family members or friends. Sudhir kumar et al in a study of 74 adolescents ( who attempted suicide) showed that 48(64.86%) of them had psychiatric morbidity, the most common diagnosis being depression (37.7%).

Substance abuse and addiction:

Drugs and substance use is common among today’s adolescents. The most common reason for use is for friendship and togetherness, enjoyment, to remove boredom and out of curiosity. Tobacco is most commonly used followed by alcohol in urban slum and university colleges in north India. Other substances used are cannabis, medicinal drugs like diazepam, amphetamines, barbiturates, etc. the use of one substance increases the probability of use of another.

In one study in India found the prevalence of abuse of psychoactive substances in adolescent as 25% in slum and 18% in college students. Tobacco abuse being most frequent(50.3% in slum, 72.5% in college) followed by alcohol (11.7% & 16.2%). worldwide mortality from smoking related diseases is expected to rise to 10 million deaths a year by 2030, more than the total of deaths from malaria, maternal and major childhood conditions and tuberculosis combined. Over 70% of these deaths will be in the developing world.

Accidents, injury and violence:

Deaths and injuries from accidents are more likely at this age than any other. Unintentional injury is the leading cause of death amongst young peoples in many countries, with road traffic accidents a constant threat in urban areas. Boys are particularly vulnerable to injury from accidents throughout adolescence.

The factors, which increase the chance of accidents, are consumption of alcohol, infrequent use of seat belt and presence of another teenage passenger. Nonfatal injuries are also most common cause of head and spinal injuries among adolescents.

Violent deaths and injuries have significant impact on adolescents. The first source of violence is usually domestic violence. Occasional wife battering is estimated to exist in 16% of families and 3.4% of wives are beaten regularly by their husbands. Another source of violence exposure is community violence where adolescents are expose to death and murder in community. Television violence is ubiquitous exposure and real life violence leading to death of school students, friends or a known-to affects the adolescent outlook profoundly.

What health services do the adolescents need:

Adolescents have in many surveys expressed their views about what they want from health services. They want a welcoming facility, where they can ‘drop in’ and be attended to quickly. They insist on privacy and confidentiality, and do not want to have to seek parental permission to attend. They want a service in a convenient place at a convenient time that is free or at least affordable. They want staff to treat them with respect, not judge them. They want a range of services, and not to be asked to come back or referred elsewhere. Of course, those who plan and provide services cannot only think about the wishes of adolescents — services must be appropriate and effective, and they must be affordable and acceptable for the community too..

Characteristics of adolescent friendly health services:

Adolescent friendly health services need to be accessible, equitable, acceptable, appropriate, comprehensive, effective and efficient. These characteristics are based on the WHO Global Consultation in 2001 and discussions at a WHO expert advisory group in Geneva in 2002. They require:

(1) Adolescent friendly policies that

fulfill the rights of adolescents as outlined in the UN Convention on the Rights of the Child and other instruments and declarations,
take into account the special needs of different sectors of the population, including vulnerable and under-served groups,
do not restrict the provision of health services on grounds of gender, disability, ethnic origin, religion or (unless strictly appropriate) age,
pay special attention to gender factors,
guarantee privacy and confidentiality and promote autonomy so that adolescents can consent to their own treatment and care,
ensure that services are either free or affordable by adolescents.

(2) Adolescent friendly procedures to facilitate

easy and confidential registration of patients, and retrieval and storage of records,
short waiting times and (where necessary) swift referral, consultation with or without an appointment