1. Dr.I.Selvaraj,I.R.M.S B.SC.,M.B.B.S.,(M.D Community medicine).,D.P.H.,D.I.H.,P.G.C.H&FW(NIHFW,New Delhi) Sr.D.M.O (ON STUDY LEAVE) INDIAN RAILWAYS MEDICAL SERVICE ADOLESCENT HEALTH

2. The term adolescence is derived from the Latin word “adolescere” meaning to grow, to mature. It is considered as a period of transition from childhood to adulthood. They are no longer children yet not adults. It is characterized by rapid physical growth, significant physical,emotional, psychological and spiritual changes. Adolescents constitute 22.8% of population of India as on 1st march 2000. They are not only in large numbers but are the citizens and workers of tomorrow. The problems of adolescents are multi- dimensional in nature and require holistic approach. A large number of adolescents in India are out of school, malnourished, get married early, working in vulnerable situations, and are sexually active. They are exposed to tobacco or alcohol abuse.

3. Adolescence : 10 – 19 years Early Adolescence : 10 – 13 years Middle adolescence : 14 – 16 years Late adolescence : 17 – 19 years Youth : 15 – 24 years Young people :10 - 24 years

4. Challenges in adolescent development and health in INDIA: 1.45% of adolescent girls under nourished 2.20% of adolescent boys under nourished 3.Early marriage 26% < 15yrs – girls, 54% < 18yrs 4.20 – 30% adolescent boys sexually active 5.10% adolescent girls sexually active 6.59% adolescents know about condoms 7.49% adolescents know about contraceptives 8.4.5% drug abuse 9.50% of all HIV positive new infections are in the age group of 10 – 25yrs 10.Adolescent abortion 1 – 4.4millions

5. INDIAN ACADEMY OF PAEDIATRICS PROPOSAL: 1999 = Family Education for adolescents 2000 = Teenage care clinic in the hospitals 2001 – 2003 = Teenage care wards for girls and boys in the hospitals 31 st July Every year = Teenage day 25 – 31 st July Every year = Teenage week

6. Early adolescence(10 -13yrs): Spurt of growth of development of secondary sex.  Middle adolescence(14-16yrs): Separate identity from parents, new relationship to peer groups, with opposite sex and desire for experimentation. Late adolescence(17-19yrs): Distinct identity, well formed opinion and ideas

7. The following changes are taking place during adolescent period: a)Biological changes – onset of puberty b)Cognitive changes – emergence of more advanced cognitive abilities c)Emotional changes – self image, intimacy, relation with adults and peers group d)Social changes – transition into new roles in the society

8. SMR(Sexual Maturity Rating) Genitalia stage for boys(G1 to G5) Pubic hair stage(PH1 to PH5) Breast development for girls(B1 to B5)

9. Impact of adolescence: 1) Lack of formal or informal education 2) School dropout and childhood labour 3) Malnutrition and anemia 4) Early marriage, teenage pregnancies 5) Habits and behaviours picked up during adolescence period have lifelong impact 6) Lot of unmet needs regarding nutrition, reproductive health and mental health 7) They require safe and supportive environment 8) Desire for experimentation 9) Sexual maturity and onset of sexual activity 10) Transition from dependence to relative independence

10. Ignorance about sex and sexuality Lack of understanding Sub optimal support at family level Social frustration Inadequate school syllabus about adolescent health Misdirected peer pressure in absence of adequate knowledge Lack of recreational, creative, and working opportunity

11. ADOLESCENT HEALTH PROBLEMS 1.Anorexia nervosa 2.Obesity & overweight 3.Adolescent pregnancy 4.Micronutrient deficiency 5.Emotional problems 6.Behavioural problems 7.Substance abuse & injuries 8.Sexually transmitted infection 9.Thinking and studying problems 10.Identity problems

12. Reasons for adolescent reluctant to seek help FEAR UNCOMFORTABLE WITH OPPOSITE HEALTH WORKER POOR QUALITY PERCEPTION LACK OF PRIVACY CONFIDENTIALITY CUMBERSOME PROCEDURE LONG WAITING TIME PARENTAL CONSENT OPERATIONAL BARRIER LACK OF INFORMATION FEELING OF DISCOMFORT

13. HEALTH EDUCATION SKILL BASED HEALTH EDUCATION LIFE SKILL EDUCATION FAMILY LIFE DUCATION COUNSELLING FOE EMOTIONAL STRESS NUTRITIONAL COUNSELLING EARLY DIAGNOSIS & MANAGEMENT OF MEDICAL AND BEHAVIOURAL PROBLEM PREVENTION

14. Syllabus for adolescent health education Development of secondary sexual characters & menarche Problems associated with menstrual cycle & menstrual hygiene Body image Nutritional needs (micronutrients) Managing emotional stress Early marriage RTI/HIV/AIDS Safe sex Family life including pregnancy Child rearing & responsible parenthood Stress management Substance abuse

15. ADOLESCENT FRIENDLY HEALTH SERVICE

16. ADOLESCENT FRIENDLY HEALTH CENTER SERVICES Reproductive Health services Sexual & Reproductive health education Contraception Pregnancy testing and option MTP STD/HIV Screening counselling and treatment Prenatal & postpartum care Well baby care Nutritional services Growth & development monitoring Anticipatory guidance about substance abuse and other risk taking behaviour Counseling for life skill development Screening for various disorders

17. CRITERIA FOR ADOLESCENT FRIENDLY HEALTH WORKER Welcoming and friendly Nature Knowledgeable Presentable Have good communication skill Maintain confidentiality Punctuality Flexibility Understanding Good listener Non-judgemental

18. Criteria for Adolescent Friendly Health Center Good reception All facilities Accessibility Quality care service Well trained people Security Easy communication to the outside Privacy Conducive environment

19. Conclusion: This adolescent period is hazardous for adolescent health due to absence of proper guidance and counselling. Family has a crucial role in shaping the adolescents behaviour They have to ensure a safe, secure, and supportive environment for the adolescents. Family members in the community to be informed and educated about this problem. A positive and encouraging attitude has to be developed among the family members and parents. School teachers should be trained on adolescent health. Community leaders play a vital role on adolescent health care.

20. THANK YOU Reference: 1.ESSENTIAL PAEDIATRICS BY O.P.GHAI(6th edition Revised) 2.INDIAN PUBLIC HEALTH JOURNAL = SEP-2002, MARCH- 2001