Saturday Fare

Adolescent Healthcare: Concerns and Strategies

Sentinel Digital Desk

The World Health Organisation defines adolescence both in terms of age (spanning the ages between 10 and 19 years) and in terms of a phase of life marked by special attributes such as rapid physical growth and development; physical, social and psychological maturity but not all at the same time; sexual maturity and the sexual activity; experimentation; development of adult mental processes and adult identity and transition from total socio-economic dependence to relative independence. During the adolescent period one attends the puberty. Puberty, which usually begins between the age of 10 and 16 years, is the gradual process of changing from a child to an adult characterized by changes in the body, behavior and lifestyle. The body parts like hands, arms, feet, legs, hip and chest become larger. The body produces hormones which are special chemical messengers that tell the body how to grow and change. The sexual organs of the body start growing bigger and begin producing hormones. The skin may become oilier and hair appears in arm pits, legs, arms and pubic region. In India 22.5% of the total population are adolescents. Even though mortality is less in this age group, but they suffer of various health and nutritional problems which may lead to morbidity and nutritional deficiencies. Many health problems like mental health problems, substance use, violence,unintentional injuries, nutritional problems and sexual and reproductive health problems may arise during adolescent period.

Mental health problems such as conduct disorders, anxiety, depression, eating disorders and other risk behaviors including those that relate to sexual behavior, substance use and violent behavior may emerge in late childhood and early adolescence. Enhancing social skills, problem-solving skills and self confidence can help to prevent these mental health problems. Health workers need to have the competencies to relate to young people, to detect mental health problems early, and to provide treatments which include counseling, cognitive-behavioral therapy and where appropriate psychotropic medication. In addition to laws that limit the availability of illicit substances, tobacco and alcohol interventions to reduce demand for these substances improve the conditions for healthy development. Increasing their awareness of the dangers of substance use, building their competence to resist peer pressure and to manage stress in a healthy manner is effective in reducing adolescents' motivation for substance use.

Life skills and social development programmes for children and adolescents are important for reducing violent behavior. Supporting teachers and parents to build skills in problem solving and non-violent disciplining is also effective in reducing violence. If violence occurs, actions to make health systems more responsive and to build the empathy and competence of health workers can ensure that adolescents get effective and sensitive care and treatment. Ongoing psychological and social support can help adolescents deal with the long term psychological effects of violence, and to reduce the likelihood of their becoming perpetuators of violence. Approaches for reducing road accidents and the occurrence of serious injuries are important for safeguarding adolescent health. Enforcing speed limits, combining education with laws to promote seat belt and helmet use, preventing driving under the influence of alcohol or other psychoactive substances, providing alternatives to driving by increasing the availability of safe and inexpensive public transport, taking actions to make the environment safer and educating children and adolescents on how to avoid drowning, burns and falls can help to reduce the likelihood of their occurrence. When someone is injured, prompt access to effective trauma care can be life saving

Chronic malnutrition in early years is responsible for widespread stunting and adverse health and social consequences throughout the life span. This is best prevented in childhood but actions to improve access to food could benefit adolescents as well. Anemia is one of the key nutritional problems in adolescent girls. Preventing too-early pregnancy and improving the nutritional status of girls before they enter pregnancy could reduce maternal and infant mortality, and contribute to breaking the cycle of inter-generational malnutrition. This will involve improving access to nutritious food, to micro-nutrient supplementation and in many places to prevent infections as well. Adolescence is a timely period to shape healthy eating and exercise habits which can contribute to physical and psychological benefits during the adolescent period and reduces the likelihood of nutrition-related chronic diseases in adulthood. Promoting healthy lifestyles is also crucial to halt the rapidly progressing obesity epidemic. Adequate nutrition and healthy eating and physical exercise habits at this age are foundations for good health in adulthood.

Programmes that aim to educate adolescents about sexual and reproductive health need to be combined with efforts to make it easier for adolescents to obtain any preventive or curative health services they might need from competent and empathetic health workers. Sexual coercion in adolescence needs to be fought at different levels. Laws requiring severe punishment for this crime should be passed and energetically enforced, and public opinion should be mobilized to become fiercely intolerant of it. Girls and women should be protected from sexual harassment and coercion in educational institutions, work places and in other community settings. Preventing too early pregnancy may require the enactment and enforcement of laws that specify a minimum age for marriage, as well as actions to mobilize families and communities to give their daughters the additional time they need to grow and develop from girlhood into womanhood before becoming wives and mothers.

Young people's risk of HIV infection is closely correlated with age of sexual debut. Abstinence from sexual intercourse and delayed initiation of sexual behavior are among the central aims of HIV prevention efforts for young people. Decreasing the number of sexual partners and increasing access to, and utilization of comprehensive prevention services, including prevention education and provision of condoms, are essential for young people who are sexually active. Programmes should also focus on prevention and early intervention in other health risk behaviors, such as substance use. Young people need HIV testing services that are accessible and appropriate. Young people living with HIV need treatment, care, support and positive prevention services. All HIV services for young people should involve young people living with HIV in their planning and provision.