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The road to adolescent health

16th Dec, 2019 | Dr Harrison Samuel | ||

Adolescence is transitional phase of growth and development between childhood and adulthood. Its a critical period of human development with rapid physical, psychosocial, cognitive and emotional development, and sexual and reproductive maturation.

While biology impacts adolescent health and development, social contexts including families, media, schools, and neighbourhoods where adolescents live, learn, and grow also have a great impact on their health and well-being. Social and cultural norms, particularly regarding gender, as well as ethnicity, sexual orientation, or disability, determine social patterns of behaviour and can both limit and enable everyday choices, needs and expectations.

The World Health Organization (WHO) defines an adolescent as any person between ages 10 and 19. This age range falls within WHO's definition of young people, which refers to individuals between ages 10 and 24. Youth refers to person aged between 15 to 24 years.
There are three stages of adolescence:
1) Early Adolescence (Ages 10 to 13)
2) Middle Adolescence (Ages 14 to 16)
3) Late Adolescents (Ages 17-19)

What are the physical changes of adolescence?
There are three main physical changes that come with adolescence:
1) The growth spurt (an early sign of maturation);
2) Primary sex characteristics (changes in the organs directly related to reproduction);
3)) Secondary sex characteristics (bodily signs of sexual maturity that do not directly involve reproductive organs)

What are the intellectual changes of adolescence?
Adolescent thinking is on a higher level than that of children. Children are only able to think logically about the concrete, the here and now. Adolescents move beyond these limits and can think in terms of what might be true, rather than just what they see is true. They are able to deal with abstractions, test hypotheses and see infinite possibilities. Yet adolescents still often display egocentric behaviors and attitudes.

What are the social and emotional changes of adolescence?
Adolescents are also developing socially and emotionally during this time. The most important task of adolescence is the search for identity. (This is often a lifelong voyage, launched in adolescence.) Along with the search for identity comes the struggle for independence. There are nearly 1.2 billion adolescents (10-19 years old) worldwide. In some countries, adolescents make up as much as a quarter of the population and the number of adolescents is expected to rise through 2050, particularly in low- and middle-income countries (LMICs) where close to 90% of 10- to 19-year-olds live.

Nigeria is the most populous country in the sub sahara Africa (about 200million)and has a very young population. The majority of the population is below the age of 25 years. With 39 million representing 22% of the country's population between the ages of 10 to 19 years An estimated 1.2 million adolescents die each year, largely from preventable causes. Adolescents benefited less from the improved health outcomes seen over recent decades among younger children, including because of inadequate levels of resourcing. While the health of younger children remains a priority in many countries, deaths in older adolescents are now greater than for 1 to 4 year old in a growing number of countries.

Adolescence is a period of life with specific health and developmental needs and rights. It is also a time to develop knowledge and skills, learn to manage emotions and relationships, and acquire attributes and abilities that will be important for enjoying the adolescent years and assuming adult roles. Adolescents are not "older children" or "younger adults". Marked by physiological maturation of all body systems and other life-changing transformations, including from childhood dependence on parents and caregivers to adult independence, this period of life requires tailored health and education services, protection and health promotion designed to be aligned with their developmental stage and to meet their needs.

Therefore we cannot just assume that what is effective in health care provision for older or younger age groups also works for adolescents. It doesn't. Adolescents face specific barriers in accessing health care and information:
* They often find public health care services unacceptable because of perceived lack of respect, privacy and confidentiality, fear of stigma, discrimination, and imposition of the moral values of health-care providers.
* The impact of out-of-pocket costs including service fees, pharmaceuticals and transportation for adolescents is made worse by their limited capacity to access services independent of their parents and their limited access to cash, either their own or their family's. If they are covered by health insurance, insurance is generally brokered by family. In addition, most adolescents leave in countries with low levels of public spending on health as a percentage of total health spending. At low levels of spending, variations in financial protection performance at are greater and depend more on deliberate policy decisions than on the level of public spending on health per se. Adolescents do not have their lobby groups and they are the most exposed to be overlooked in these decisions, especially older adolescents of 19 years old that are no longer included in insurance schemes tied to family.
* Furthermore, support or permission of parents and partners is often required to use health services, including for sensitive issues such as sexual and reproductive health. Lack of parental support and parental or partner control stemming from socio-cultural and gender norms, and often reinforced by laws and regulations on consent, can further restrict care-seeking.
* As with other age groups, barriers including low health literacy, poverty and marginalization also negatively affect adolescents' access, but likely with stronger impact
The World Health Organisation describes the leading health-related problems in the age group 10 – 19 years to include: *Early pregnancy and childbirth
* HIV
* Other infectious diseases
*Mental health problems including depression and suicide
* Violence
* Alcohol and other drugs
* Injuries both unintentional and self-injury
* Extreme activity sports and games
* Sexual health / Infectious diseases
* Malnutrition and obesity
* Exercise and Nutrition
* Tobacco use
* Rights of adolescents
* Conflicts with Parents and constituted authority
* Peer Pressure

Worrying signs to Note in an adolescent:
* Change in behaviour for no apparent reason—such as acting withdrawn, frequently tired or depressed or hostile
* Change in peer group
* Carelessness with grooming
* Decline in academic performance
* Missing classes or skipping school
* Loss of interest in favorite activities
* Changes in eating or sleeping habits
* Deteriorating relationships with family members and friends

Young people often lack awareness of the harm associated with risk behaviours, and the skills to protect themselves as well as the lack knowledge about how and where to seek help for their health concerns. By intervening at this early life stage, many chronic conditions later in life can be prevented. Children and their parents often struggle with changing dynamics of family relationships during adolescence. But parents are still a critical support throughout this time.

Principles Of Prevention Of Adolescents Risk Factors
* Focus on known risk factors
* Interventions should be based on what is known to work
* Focus on enhancing protective factors
* Intervene early before risk behavior commences or stabilizes
* Address multiple problems together
* Ensure youth involvement
* Mobilize the community and involve stakeholders

Roles of Parents/ Guardians

While adolescence can be a trying period for both youth and their parents, the home does not have to become a battleground if both parents and young people make special efforts to understand one another. The following guidelines may help parents:

* Help your child anticipate changes in his or her body. Learn about puberty and explain what's ahead. Reassure them that physical changes and emerging sexuality is part of normal, healthy development. Leave room for questions and allow children to ask them at their own pace. Talk to your pediatrician when needed and allow for independent health care visits during late adolescence phase.
* Give your children your undivided attention when they want to talk. Don't read, watch television or busy yourself with other tasks.
* Listen calmly and concentrate on hearing and understanding your children's point of view.
* Speak to your children as courteously and pleasantly as you would to a stranger. Your tone of voice can set the tone of a conversation.
* Understand your children's feelings, even if you don't always approve of their behavior. Try not to make judgments. Keep the door open on any subject. Be an "open/approachable" parent.
* Avoid humiliating your children and laughing at what may seem to you to be naive or foolish questions and statements.
* Encourage your children to "test" new ideas in conversation by not judging their ideas and opinions, but instead by listening and then offering your own views as plainly and honestly as possible. Love and mutual respect can coexist with differing points of view.
* Help your children build self-confidence by encouraging their participation in activities of their choice (not yours).
* Make an effort to commend your children frequently and appropriately. Too often, we take the good things for granted and focus on the bad, but everyone needs to be appreciated.
* Encourage your children to participate in family decision-making and to work out family concerns together with you. Understand that your children need to challenge your opinions and your ways of doing things to achieve the separation from you that's essential for their own adult identity.

Roles of Government /Society
To make progress toward universal health coverage, government will need to transform how health systems respond to the health needs of adolescents. A transition is needed from "adolescent-friendly" projects to adolescent-responsive health systems and Adolescent Health in All Policies approach. Governments should ensure that the specific needs of adolescents are recognized through international political processes and their related outcome documents.

Government should train health care workers on adolescents health and to establish adolescent friendly health services in hospitals with community involvement. The infrastructure should support and encourage adolescent participation. Investing in school health programmes is a priority for intersectoral action on adolescent health, and every school should become a health-promoting school. There should be linkage between NGOs and government run health facilities

What can adolescents do during this time?
* Avoid looking at your parents as the enemy. Chances are that they love you and have your best interests in mind, even if you don't necessarily agree with their way of showing that.
* Try to understand that your parents are human beings, with their own insecurities, needs and feelings.
* Listen to your parents with an open mind, and try to see situations from their point of view.
* Share your feelings with your parents so that they can understand you better.
* Live up to your responsibilities at home and in school so that your parents will be more inclined to grant you the kind of independence you want and need
. * Bolster your criticisms of family, school and government with suggestions for practical improvements.
* Be as courteous and considerate to your own parents as you would be to the parents of your friends.

Investment in adolescent health protects the present, future, and next generation adolescents through: * Promotion of positive behaviours
* Prevention, early detection and treatment of problems e.g. substance abuse, STIs etc.)
* Promotion of emotional well being and healthy practices
* Prevention of risk factors and burdens that can help protect health of offspring e.g. female genital mutilation, interpersonal violence and early pregnancy. The adolescent years can feel like riding a roller coaster. By maintaining positive and respectful parent-child relationships and keying into government policies during this period, your family can (try to) enjoy the ride!

News Update

According to the Minister, Sir Ohaa never shied away from difficult situations, a trait which he added he (Minister) found very useful in the running of the affairs of FCTA, adding that the job of Permanent Secretary of the nation's capital's bureaucracy was not an easy one.

Director of Public Health, Federal Capital Territory Administration (FCTA), Dr. Josephine Okechukwu, has counseled residents of the Territory to distance themselves from persons who fail to put on face masks.

Inspector-General of Police, IGP Mohammed Abubarka Adamu, received three operational vehicles donated by Innoson Vehicle Manufacturing Company Limited to the Nigeria Police Force in support of ongoing efforts at repositioning the Force for optimal performance.

Universal Basic Education Commission (UBEC) has commended Federal Capital Territory Administration (FCTA) for its efforts in development of basic education in the Territory.


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