Adolescent Health Flashcards
Why is the adolescent age group focused on?
They have particular risk factors
What is an adolescent?
Ages 10-19 (WHO definition)
- Fastest pace of growth and change 2nd only to infancy
Epidemiology of adolescents?
- 1/6 people in the world (> ~1 billion)
- 24% of Malawi population
What are key developmental experiences in adolescents?
- Biological: Onset of puberty to adulthood
- Socioeconomic: Movement towards independence
- Psychological: Development of identity and complex reasoning
Note: May vary across time, culture, and socioeconomic situation
Brain development in childhood?
- Concrete here and now thinking
- Things are right or wrong.
Brain development in adults?
Complex reasoning, abstract thinking, accept ambiguity
Neurological changes in an adolescent?
- Increasing myelination means impulse messages move at higher speeds
- Incomplete inhibitory systems
- Increased sensitivity to rewards
- Trouble inhibiting emotional responses
- Prefrontal Cortex (decision making) fully developed in mid 20s ~ age 25
What is driving risk taking behavior?
- Social affiliations outside family become more important – susceptible to peer pressure.
- Exploring boundaries, independence
- Looking for social acceptance and have increased sensitivity to rewards
- Prefrontal Cortex reconciles internal emotional states with external reality demands
Barriers to care in adolescent health?
- Thought of as healthy
- Poor health facility attendance
- Restrictive laws or policies
- Feeling invincible
High risk behavior initiated by adolescents?
- sex
- drugs
- experimentation
- peer pressure
What results in poor outcomes in adolescents?
- Choices set the stage for health later in life
- Especially vulnerable:
- Unhoused
- Trafficked
- Immigrants
- Refugees
Leading causes of morbidity/mortality in adolescents?
- Leading cause of death = Road traffic Injuries
- HIV
- suicide
- depression
- violence
Mental health in adolescents?
½ of all mental health disorders start by age 14, most remain undetected and untreated
Describe pregnancy in adolescence?
- Complications during pregnancy and childbirth are the 2nd cause of death for adolescent girls globally
- Babies born to adolescents have higher mortality
- Every year, 3 millions girls globally undergo unsafe abortions
Why are adolescent pregnancies more dangerous?
- higher risk of pre-eclampsia
- preterm labor
- multiple gestations
- low birth weight
- STI
- post partum depression
Describe teenage pregnancy in Malawi?
- 29 out of 100 pregnancies are in ages 10 -19 in 2019
- 35 out of 100 in 2020 - Teenage fertility 31% in rural areas, 21% in urban areas
- 3x more likely in poorest households
Why the increase in teenage pregnancies in 2020?
- Decreased health care access / contraception
- Education disrupted by pandemic
What are the benefits of contraception for an adolescent?
- reduce the rates of unwanted pregnancy
- reduces need for unsafe abortion
- reduces HIV transmissions from mothers to newborns
Types of contraception?
- pills
- patch
- ring
- IUD
- implant
- depoprovera
- condom
Pros and cons of contraception?
Pros
Easy to access, regulate periods with less pain
Cons
Daily, frequent prescription refills, short term
Pros and cons of the patch?
Pros
Periods more regular, less painful
Cons
Visible, short term, change each week
Pros and cons of the ring?
Pros
Periods more regular, less painful
Cons
Insertion, short term
Pros and cons of an IUD?
Pros
Long term, privacy, improves period cramps and bleeding
Cons
Procedure, irregular bleeding sometimes
Pros and cons of an implant?
Pros
Long term, privacy
Cons
Irregular bleeding
Pros and cons of depoprovera?
Pros
Long term, privacy, decrease periods
Cons
Irregular bleeding, no bleeding, return every 3 month, weight changes, mood change
Pros and cons of condoms?
Pros
Non-hormonal, STIs
Cons
Breaks, access, physicality
Which is the best family planning method for adolescents?
condoms
Physical and emotional violence in Malawi?
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
Sexual violence in Malawi?
- 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)
What is resillience?
The process of overcoming/recovering quickly from difficulties, and avoiding negative trajectories
Describe factors that lead to resilience in adolescents?
- Good relationship with caring adult
- Good-natured disposition, emotional self regulation
- Cognitive skills, school performance
- Talents
- Confidence
Pillars of te adolescent consultation?
- Understanding cognitive developmental changes
- Establish a Trusting Relationship
- Confidentiality
- ASK GUARDIAN TO STEP OUT. NORMALIZE THE PROCESS
How can you ask the guardian to step out?
saying I do this for all of my encounters
HEADSSS Exam?
H: Home
E: Education, employment,
A: Accidents, ambition, activities, abuse
D: Drugs
S(x3): Sexuality, Suicide, Safety
Communication strategies in consultation?
- Positively framed-open ended questions
- Nonjudgmental (language and tone)
- Affirm: It’s good that you decided to open up..
- Reflection: It sounds like you are…
- Summarize what he/she has said
- Have adolescent repeat plan back to make sure he/she comprehends
How do we talk about delicate topics?
- indirect questions
- contextualize
- direct questions
Strategies for counseling?
- Ask permission: “May I offer some thoughts on ___”
- 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 ___”
- Non judgmental and reaffirm your advocacy for patient’s health and overall well-being
What to do if assault comes up in consultation?
- Ensure privacy, safety and adequate time for the victim.
- Avoid taking victims through the story more than once.
- Avoid leading questions, have the victim describe the assault.
- Encourage them to speak out without interruption.
- 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.
- Note the normal reactions to rape, such as shock, fear, arousal, anxiety, assure the victim that he or she is not to blame
Addressing sexual assault and rape (gender based violence)?
- Emergency contraception if within 5 days depending on type
- PEP if within 72 hours
- STI testing and treatment
- Pregnancy test
- Emotional counseling
- Ensuring safety
- Medication for the relief of pain, anxiety or insomnia
- Follow-up testing and counselling
HIV in adolescence in Malawi?
- 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)
- Young people ages 15-24 have the highest risk of infection, higher prevalence in adolescent girls
- Age of consent for HTC testing = 13 years old
Relationship between HIV and depression?
- Prevalence rates of depression among people living with HIV in Africa range from 12-60%.
- Malawi estimate for depression in adolescents with HIV is 18.9%
- Depression has been shown to lead to more rapid progression to AIDS and death
