Adolescent Health

Question 1

Why is the adolescent age group focused on?

Answer 1

They have particular risk factors

Question 2

What is an adolescent?

Answer 2

Ages 10-19 (WHO definition)
- Fastest pace of growth and change 2nd only to infancy

Question 3

Epidemiology of adolescents?

Answer 3

• 1/6 people in the world (> ~1 billion)
• 24% of Malawi population

Question 4

What are key developmental experiences in adolescents?

Answer 4

1. Biological: Onset of puberty to adulthood
2. Socioeconomic: Movement towards independence
3. Psychological: Development of identity and complex reasoning
   Note: May vary across time, culture, and socioeconomic situation

Question 5

Brain development in childhood?

Answer 5

• Concrete here and now thinking
• Things are right or wrong.

Question 6

Brain development in adults?

Answer 6

Complex reasoning, abstract thinking, accept ambiguity

Question 7

Neurological changes in an adolescent?

Answer 7

1. Increasing myelination means impulse messages move at higher speeds
2. Incomplete inhibitory systems
3. Increased sensitivity to rewards
4. Trouble inhibiting emotional responses
5. Prefrontal Cortex (decision making) fully developed in mid 20s ~ age 25

Question 8

What is driving risk taking behavior?

Answer 8

1. Social affiliations outside family become more important – susceptible to peer pressure.
2. Exploring boundaries, independence
3. Looking for social acceptance and have increased sensitivity to rewards
4. Prefrontal Cortex reconciles internal emotional states with external reality demands

Question 9

Barriers to care in adolescent health?

Answer 9

1. Thought of as healthy
2. Poor health facility attendance
3. Restrictive laws or policies
4. Feeling invincible

Question 10

High risk behavior initiated by adolescents?

Answer 10

1. sex
2. drugs
3. experimentation
4. peer pressure

Question 11

What results in poor outcomes in adolescents?

Answer 11

1. Choices set the stage for health later in life
2. Especially vulnerable:
   - Unhoused
   - Trafficked
   - Immigrants
   - Refugees

Question 12

Leading causes of morbidity/mortality in adolescents?

Answer 12

1. Leading cause of death = Road traffic Injuries
2. HIV
3. suicide
4. depression
5. violence

Question 13

Mental health in adolescents?

Answer 13

½ of all mental health disorders start by age 14, most remain undetected and untreated

Question 14

Describe pregnancy in adolescence?

Answer 14

1. Complications during pregnancy and childbirth are the 2nd cause of death for adolescent girls globally
2. Babies born to adolescents have higher mortality
3. Every year, 3 millions girls globally undergo unsafe abortions

Question 15

Why are adolescent pregnancies more dangerous?

Answer 15

1. higher risk of pre-eclampsia
2. preterm labor
3. multiple gestations
4. low birth weight
5. STI
6. post partum depression

Question 16

Describe teenage pregnancy in Malawi?

Answer 16

1. 29 out of 100 pregnancies are in ages 10 -19 in 2019
   - 35 out of 100 in 2020
2. Teenage fertility 31% in rural areas, 21% in urban areas
   - 3x more likely in poorest households

Question 17

Why the increase in teenage pregnancies in 2020?

Answer 17

• Decreased health care access / contraception
• Education disrupted by pandemic

Question 18

What are the benefits of contraception for an adolescent?

Answer 18

1. reduce the rates of unwanted pregnancy
2. reduces need for unsafe abortion
3. reduces HIV transmissions from mothers to newborns

Question 19

Types of contraception?

Answer 19

1. pills
2. patch
3. ring
4. IUD
5. implant
6. depoprovera
7. condom

Question 20

Pros and cons of contraception?

Answer 20

Pros
Easy to access, regulate periods with less pain
Cons
Daily, frequent prescription refills, short term

Question 21

Pros and cons of the patch?

Answer 21

Pros
Periods more regular, less painful
Cons
Visible, short term, change each week

Question 22

Pros and cons of the ring?

Answer 22

Pros
Periods more regular, less painful
Cons
Insertion, short term

Question 23

Pros and cons of an IUD?

Answer 23

Pros
Long term, privacy, improves period cramps and bleeding
Cons
Procedure, irregular bleeding sometimes

Question 24

Pros and cons of an implant?

Answer 24

Pros
Long term, privacy
Cons
Irregular bleeding

Question 25

Pros and cons of depoprovera?

Answer 25

Pros Long term, privacy, decrease periods Cons Irregular bleeding, no bleeding, return every 3 month, weight changes, mood change

Question 26

Pros and cons of condoms?

Answer 26

Pros Non-hormonal, STIs Cons Breaks, access, physicality

Question 27

Which is the best family planning method for adolescents?

Answer 27

condoms

Question 28

Physical and emotional violence in Malawi?

Answer 28

Two in five females and two in three males, aged 18 to 24 years, experienced physical violence prior to the age of 18 years ~ 1/4 to 1/5 experienced emotional violence

Question 29

Sexual violence in Malawi?

Answer 29

- One out of five females and one out of seven males aged 18 to 24 years experienced at least one incident of sexual abuse before turning 18 - The average age of the first incident of sexual abuse was 13.5 years (for women)

Question 30

What is resillience?

Answer 30

The process of overcoming/recovering quickly from difficulties, and avoiding negative trajectories

Question 31

Describe factors that lead to resilience in adolescents?

Answer 31

1. Good relationship with caring adult 2. Good-natured disposition, emotional self regulation 3. Cognitive skills, school performance 4. Talents 5. Confidence

Question 32

Pillars of te adolescent consultation?

Answer 32

1. Understanding cognitive developmental changes 2. Establish a Trusting Relationship 3. Confidentiality 4. ASK GUARDIAN TO STEP OUT. NORMALIZE THE PROCESS

Question 33

How can you ask the guardian to step out?

Answer 33

saying I do this for all of my encounters

Question 34

HEADSSS Exam?

Answer 34

H: Home E: Education, employment, A: Accidents, ambition, activities, abuse D: Drugs S(x3): Sexuality, Suicide, Safety

Question 35

Communication strategies in consultation?

Answer 35

1. Positively framed-open ended questions 2. Nonjudgmental (language and tone) 3. Affirm: It’s good that you decided to open up.. 4. Reflection: It sounds like you are… 5. Summarize what he/she has said 6. Have adolescent repeat plan back to make sure he/she comprehends

Question 36

How do we talk about delicate topics?

Answer 36

1. indirect questions 2. contextualize 3. direct questions

Question 37

Strategies for counseling?

Answer 37

1. Ask permission: “May I offer some thoughts on ___” 2. Normalize pressure to do high risk behavior: “It is normal at this stage in your life to experiment and try ___, but sometimes that can lead to ___” 3. Non judgmental and reaffirm your advocacy for patient’s health and overall well-being

Question 38

What to do if assault comes up in consultation?

Answer 38

1. Ensure privacy, safety and adequate time for the victim. 2. Avoid taking victims through the story more than once. 3. Avoid leading questions, have the victim describe the assault. 4. Encourage them to speak out without interruption. 5. Accept the victim‘s story in a non-judgemental way. Remember it is up to the police to investigate further the validity of information given. 6. Note the normal reactions to rape, such as shock, fear, arousal, anxiety, assure the victim that he or she is not to blame

Question 39

Addressing sexual assault and rape (gender based violence)?

Answer 39

1. Emergency contraception if within 5 days depending on type 2. PEP if within 72 hours 3. STI testing and treatment 4. Pregnancy test 5. Emotional counseling 6. Ensuring safety 7. Medication for the relief of pain, anxiety or insomnia 8. Follow-up testing and counselling

Question 40

HIV in adolescence in Malawi?

Answer 40

1. Almost 100% of people in Malawi know about HIV/AIDS, but only 19% of girls and 14% of boys have been tested in the past 12 months (Unicef) 2. Young people ages 15-24 have the highest risk of infection, higher prevalence in adolescent girls 3. Age of consent for HTC testing = 13 years old

Question 41

Relationship between HIV and depression?

Answer 41

1. Prevalence rates of depression among people living with HIV in Africa range from 12-60%. 2. Malawi estimate for depression in adolescents with HIV is 18.9% 3. Depression has been shown to lead to more rapid progression to AIDS and death