Adolescent health issues and their managemnet

The presentation outlines adolescent health issues and describes the different categories of adolescent and their needs

1. ADOLESCENT HEALTH

2. SPECIFIC OBJECTIVES By the end of this presentation everyone should be able to : Describe adolescent health Describe changes that take place in adolescents Explain problems faced by adolescents

3. CONT… Describe reproductive health programs provided to manage adolescent health problems Describe strategies to improve accessibility of Sexual Reproductive Health services to the adolescent . Describe constraint in providing adolescents health programs

4. introduction Origin from Latin word “ adolescer ” to grow into maturity Phase of human development encompassing the transition from childhood WHO-age period between 10-19 years for both sexes, married and unmarried people

5. ADOLESCENT 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

6. STAGES OF ADOLESCENT Early Adolescence(10- 13 years): is characterised by a spurt of growth, and the beginning of sexual maturation . Young people start to think abstractly Middle Adolescence( 14-16 years): main physical changes get completed, while the individual develops a stronger sense of identity, and relates more strongly to his or her peer group. Thinking becomes more reflective

7. Cont.... Late Adolescence(17-19 years): the body takes its adult form, while the individual now has a distinct identity and more settled ideas and opinions.

8. WHY ADOLESCENT HEALTH Major physical, psychological and behavioural changes take place Sexual maturity and onset of sexual activity Development of adult mental process and adult identity Healthy , responsible parenthood Great human resource for the society Growth spurt and physical activity Menstruation pregnancy

9. ADOLESCENT WORLDWIDE Around 1 in 6 persons in the world is an adolescent , that is more than1.2 billion people aged 10-19 Most are healthy, but there is still significant death, illness and diseases among adolescents Promoting healthy practices during adolescence, and taking steps to better protect young people from health risks are critical for the prevention.

10. GLOBAL ADOLESCENT HEALTH An estimated 1.5 million adolescents died in 2021 aged 10-24 years, about 4500 every day, mostly from preventable or treatable causes. Road traffic injuries were the leading cause of death (In 2019,115000 died) Globally, there are 42 births per 1000 girls aged 15-19 per year(2021). Complication linked to pregnancy and childbirth are the second cause of death for 15-19 years girl globally.

11. cont. Some 11% of all births worldwide are to girls aged 15-19 years and the vast majority are in low and middle income countries. Half of all mental heath disorders in adulthood start by age 14, but most cases are undetected and untreated.

12. PHYSICAL GROWTH SKELETAL GROWTH Secondary growth spurt-25% of adult height BODY COMPOSITION Weight gain Increase in adipose tissue in girls Increase muscle mass in boys

13. PSYCHOLOGICAL GROWTH Less interest in parental activities Mood swings Intense relationship with same and opposite sex friends Increased cognition Increased need for privacy Increased intellectual ability Lack of impulse control

14. SEXUAL GROWTH GIRLS BOYS Breast bud 8-12 years( Thelarche ) Testicular enlargement by 9 years Development of pubic hair 11-14 years ( Pubarche ) Development of pubic hair 10-15 years Growth spurt begins by 10 Enlargement of larynx, pharynx-voice break Menarche by 9-16 years Weight gain and increased muscle mass by 11-16 Enlargement of ovaries, uterus, clitoris Growth of facial and body hair Under arm hair by 13-16 years

15. Adolescence and family life FAMILY LIFE EDUCATION Educate the growing children, especially the adolescent regarding various aspects of living in a society and interacting with others at different levels along with imparting age appropriate knowledge of biological and sexual development. TWO KINDS OF NEEDS Their current normative needs associated with changing physical, sexual, cognitive, social and emotional development. Future family related needs

16. CONT.. Adolescence and family life Future family related needs Human relationship Adolescent development Values, morals, ethics Family as a basic unit of society Decision making and problem solving Career goals and planning Diet and fitness

17. Adolescence and NUTRITION For apparent growth, nutrition is the most important factor The major growth during adolescence are Height: nearly one-fifth(20%) of the adult height is gained during adolescence Weight gain : about 25-50% of the final adult weight is gained during adolecence . Almost 50% of bone mass is accumulated by the end of 2 nd decade of life.

18. CONT.. Adolescence and NUTRITION Early adolescence is marked by rapid growth phase and pubertal changes during which time the nutrient requirement is different as compared to late adolescence when growth has stabilised and the micronutrients have an important role.

19. Adolescent counselling Adolescents are diverse in their age and developmental stage Despite all variations, adolescence is a period of exaggerated physical , emotional , social, intellectual and spiritual growth with their complexities often resulting in need for counselling Adolescents might require preventive and therapeutic counselling to address their mental health needs.

20. Cont.. Adolescent counselling Early Adolescence: (10- 13 years) concrete thinkers and are unable to clearly understand the cause and effect between their behaviours and their health Middle Adolescence: (14-16years) think more abstractly . typically they are capable of complex logical thinking . Late Adolescence: (17-19 years) have a longitudinal understanding of how their behaviours affect their health. Counselling focus on risky behaviour and coping skills.

21. Adolescent mental health Non communicable disease and mental health illness result in high levels of medical, social and economic burden. Most of the adult mental health disorders have their onset during their childhood or adolescence. In low and middle income countries, adolescents with mental health needs often remain outside the safety of any health care system. An effective way to address is by enhancing the primary-care in the recognition, treatment and referral of the adolescents to mental health specialists.

22. FACTORS THAT INFLUENCE MENTAL HEALTH Physiological factors Physiological factors may affect the brain and consequently an individual’s capacity to perform physical and cognitive functions. A young person with these conditions may be unable to act in a capable way or manage everyday situations. Examples are brain injury or trauma at birth or later, developmental disorders, and convulsions resulting from illnesses such as malaria.

23. Psychological factors Some young people will experience difficult life events that may leave them less resilient and psychologically defeated. For example, young people who have had difficult childhoods may have limited abilities to cope with stress. Painful events may lock them into negative thought patterns, contributing to poor mental health.

24. Social factors Social problems such as poverty, school failure, sexual and physical abuse, unemployment, violence, and substance abuse can negatively affect young people’s emotional well-being. These conditions are common; our ability to manage or not manage them is the biggest determinant in maintaining good mental health. A young person with low self-esteem is at higher risk than a peer with high self-esteem of developing mental illness, owing to his or her inability to cope with social challenges.

25. TYPES AND CONSEQUENCES OF POOR MENTAL HEALTH Anxiety and stress Anxiety is a general term that refers to a mental disorder that causes apprehension, fear, nervousness, and worry, ultimately affecting how one behaves. These disorders may also exhibit physical symptoms. Stress refers to a state of mental or emotional tension resulting from adverse or very demanding circumstances. Most young people experience stress due to such everyday challenges as coping with adolescent growth and routine social challenges. Signs of anxiety and stress are feeling sad and low; loss of appetite; difficulty in sleeping; and being fearful, tense, or panicky. Physical manifestations may be frequent urination, diarrhoea , headaches, elevated blood pressure, and sweating. Uncontrolled anxiety and stress may lead to more serious mental health disorders, such as schizophrenia.

26. Depression Depression refers to a mental disorder characterized by low mood and a decrease in activity. It is a common phenomenon among young people, usually emerging after a young person experiences loss. The depressed young person becomes negative about the world and himself or herself , feels rejected, and loses confidence. Depression can progress to clinical illness if five or more of the following symptoms are seen in a person for at least two weeks: • Low mood • Loss of interest or pleasure • Feeling sad or empty • Experiencing a marked decrease or increase in appetite • Difficulty in sleeping or oversleeping • Loss of energy; tiredness • Feelings of worthlessness or guilt • Difficulties in concentrating or thinking • Recurrent thoughts of death

27. Eating disorders Eating disorders can be loosely defined as eating less than required or eating too much. Eating disorders can follow a stressful event such as an HIV-positive result, failure in class, or being bullied by parents. The person tends to project anger on food, thus eating too much or too little. Extreme eating disorders common in adolescents are anorexia nervosa (where very little is consumed) and bulimia nervosa (where young people throw up after they eat). A consequence for girls is cessation of menstrual periods due to inadequate intake of protein. For either sex, these conditions ultimately can be fatal.

28. Obsessive compulsive disorders Obsessive compulsive disorders (OCD) result when a person has thoughts that keep emerging in his or her mind, prompting the person to take some action such as frequent hand washing or checking repeatedly that doors are locked. Usually a particular situation triggers such intrusive thoughts and behaviours . The condition requires a psychiatrist to establish the cause of the disorder and map ways to manage it.

29. Schizophrenia Schizophrenia is a mental disorder characterised by abnormal psychosocial behaviour and inability to recognize the environment/what is real. The causes of schizophrenia are not well-known, but genetics and psychological and social stressors are factors that contribute to its development. Schizophrenia can have the following symptoms: • Disorganised thoughts and speech •Hallucinations (having a sensation that is not real—a false perception; auditory hallucinations, in which one hears voices that are not present, are the most common) • Delusions (false beliefs about oneself ) • Impaired social cognition (not recognizing the environment, such as people, places, and

30. Deliberate self-harm Deliberate self-harm sets in among young people when they feel completely lost, abandoned, ashamed, and guilty, and see no meaning in life. It builds from failure to cope with such negative experiences as unexpected pregnancy, drug abuse, loss of loved ones, and stigma and discrimination. Most will contemplate self-harm in the form of abusing drugs and alcohol or committing suicide. Young people who attempt self-harm can get therapeutic support through counselling and guidance to help them positively challenge the negative social events they experience every day.

31. ADOLESCENT sexuality Sexuality encompass whole range of thoughts, feelings, fantasies, emotions, desires and language besides action, sexual behaviour is only a part of it. Sex education is important at all ages, but it is more important than it is imparted during childhood and adolescence

32. Sex education Sex education of self awareness, personal relationships, human sexual development, reproduction and sexual behaviour Human sexuality is a function of the total personality, attitudes toward being a man or woman, and relationships among members of the same sex and the opposite sex. Help adolescent to understand their sexuality, learn to respect others feelings and to make responsible decision. Sexual relationship involves respect, trust and caring of the partner, perceiving the needs of the partner and feeling free to communicate desires and feelings

33. cont.. Adolescent health problems REPRODUCTIVE PROBLEMS Teenage pregnancy(16-19% of total pregnancy) Genital tract infection Preterm labour Intrauterine growth restricted babies Abortion related problems Unsafe abortion Girls from problem family are 2 times at high risk Acne Reproductive tract infections Irregular menstrual cycles Vulvovaginities and urologic issues

34. Cont.. Adolescent health problems SEXUALLY TRANSMITTED DISEASES HIV/AIDS- young people between 10-25 make 50% of new HIV infection Syphilis Gonorrhoea A report on world contraception day 2011 shows 28% young people had sex and 32% of them did not use any contraception

35. Cont.. BEHAVIOUR PROBLEMS Drug experimentation Substance abuse Tobacco, alcohol , illicit drug Risk behaviour Having knife, rods , rash driving Violence bullying

36. THE CONCEPT OF YFHS AND WHAT MAKES SERVICES “YOUTH FRIENDLY Malawi’s MOH has established the following criteria for health services to be youth friendly: they must be effective, safe, affordable, and meet the individual needs of young people, who return when they need to and recommend the services to friends. Even if this ideal cannot be achieved immediately, improvements bring results in the health and well-being of clients. Making services youth friendly is not primarily about setting up separate dedicated services, although the style of some facilities may change. The greatest benefit comes from improving generic health services in local communities and the competencies of healthcare providers to deal effectively with adolescents

37. Technical competence Technically competent and empathetic staff needs a system of ongoing support. A youth-friendly approach requires repeated training sessions to refresh the skills of current staff and develop the skills of new staff. Monitoring systems should encourage adolescents to provide feedback on services. Seeing the person, not the problem Technical competence must be accompanied by respect and sensitivity to draw the young person out and discover underlying problems that may not be the immediate cause of a visit. Technical skills and an empathetic professional approach should be combined with a nonjudgmental attitude. Healthcare providers do not need to abandon their own belief systems or values, but they do need to understand a situation from a young person’s point of view and not allow their own views to dominate the interaction.

38. Cont..characteristics Making the service physically accessible Services need to be provided in places that young people can reach. This may involve holding special clinics in youth centres or other places where young people gather. Physical surroundings are important. Many health facilities have no special youth department but are welcoming in other ways. Attention should be paid to the paint, posters on the walls, cleanliness, and whether there are enough chairs where people wait. Confidentiality and privacy Young people need to be assured of privacy during a consultation and confidentiality afterwards. Young people should not have to undress or be examined where people can see them. Those waiting outside should not be able to hear a doctor giving a diagnosis.

39. Services that are acceptable to the local community Young people must feel that the services being offered are acceptable and freely usable by them. Community support for the services must also be sought. The community should have an opportunity to understand why health services are important for young people, and why the services should address SRH and involve confidential counselling. Involving young people Services that achieve high quality are those that closely involve youth in their planning and monitoring. Through the involvement of young people, service providers can be confident that they are providing services in the right place, at the right time, and in the right style.

40. Prevention of adolescent health problem Primary prevention: Policies, information and education Secondary prevention: Identification and reduction of risk Tertiary prevention: Treatment and rehabilitation

41. REPRODUCTIVE HEALTH PROGRAM PROVIDED TO MANAGE ADOLESCENT HEALTH PROBLEMS Education on Sexual Reproductive Health and Rights Education on sexuality Family planning and Contraceptive education HIV and AIDS education Pregnancy counseling STI test and counseling Sexual violence counseling Life skills education Post abortion care

42. CONT… Education on gender issues Voluntary Counseling Testing STI treatment Substance abuse counseling Pregnancy and child birth services Recreational activities

43. CONSTRAINTS IN PROVIDING ADOLESCENT HEALTH PROGRAMS Inadequate policies Negative attitude by both service providers and the adolescents Lack of skills among the service provider to handle the adolescent Lack of privacy and confidentiality Long distance to health facilities where adolescent health programs are provided

44. CONT… Lack of specific youth services Long waiting hours for adolescent to receive health care Lack of knowledge among youth on the availability of services

45. STRATEGIES TO IMPROVE ACCESSIBILITY OF SEXUAL REPRODUCTIVE HEALTH TO THE ADOLESCENT Setting a special day –To reduce long waiting hours Setting special times –To reduce long waiting hours Special room for young people –To provide privacy and confidentiality Outreach clinic –To reduce long distance to health facility Setting up a youth corner –To give adolescent education on different sexual reproductive health topics

46. CONCLUSION In conclusion, Adolescent Health Services in most of the communities of Malawi exist, however they are not effective. Therefore it is our duty to scale up the Nursing Care Services for adolescence so that these services should be reachable, accessible and effective for every adolescent to utilize them .

47. REFERENCES Government of Malawi (2016). Youth Friendly Health Services Manual: Participants Hand Book . Lilongwe: Printers Key Sexual Health Services . (2010). Retrieved from http//:www.cdc.gov.com. 03 th August, 2020. Knopf, D. Park,M.N . & Mulye , T.P. (2008). The mental health of adolescents: A national profile. retrieved from http://nahic.ucsf.edu/downloads/MentalHealthBrief.pdf

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