ADOLESCENTS: THE FUTURE ASSETS OF A NATION

Worldwide, adolescents and young persons are a major group driving transformative change in global health and development. Twenty five years down the line from the 1994 International Conference on Population and Development (ICPD), giant strides in advancing the health and wellbeing of this target group were recorded and they constitute a formidable force for National development. Designing the strength and prospects of Nigerian youthful population through investments in their health and development will bring about serious economic and social benefits as well as a safer and more prosperous nation, which is a necessary condition for the country to contribute to achieving the Sustainable Development Goals (SDGs 3&4).

Nigerian population stands at 217,079,601 as at August 25, 2022 (to” World meter, 2022) with youths accounting for 70% and 42% of these are under the age of 15 years – 7 Oct 2022.

�WHO IS AN ADOLESCENT?

The World Health Organization (WHO) defines adolescents as individuals within the age range of 10-19 years and youths as 15-24 years while young people covers the age range of 10-24 years. One in 4 people in Nigeria are adolescents.This is the transitional phase of growth and development between childhood and adulthood involving physical, cognitive and psychosocial changes due to hormonal variations.

WHY FOCUS ON ADOLESCENTS?

Choices made during adolescence can develop into repeated habits that continue into adulthood including both healthy and unhealthy behaviors. Globally, nearly two-thirds of premature deaths are associated with behaviors and conditions that began during adolescence period. We need to remember that adolescent is a pivotal and formative phase that can have lifelong consequences depending on the choices that are made. For instance 70% of early deaths in childhood (i.e. cancer, obesity, addiction and heart disease) are attributable to unhealthy behaviors that are experienced during adolescence (such as smoking, poor nutrition, and substance abuse). This fact emphasizes the need for programming across the life course and encourages people to begin investing in adolescent health early to produce healthier adults, one of the most significant reasons that we have are youth bulge is because there has been tremendous success in maternal and child health to keep babies and young children alive. However, global adolescent mortality rate have remain stagnant for more than 50 years. We cannot waste our investments made in MCH only to lose our young people in adolescent and young adulthood.

WHO and the global community recognize the need to focus on adolescent health, if we better understand the reasons why young people make these choices and if youths themselves know how to recognize and better understand the reasons behind their own decision making we can create more targeted interventions. By better understanding when and how to support youth, we can address young people’s developmental stages, needs and challenges at that period in their lives and design programmer for better results. In recognition of this dangerous and pivotal phase of life we know that we need to increase our programming efforts for this age group.

Adolescents are not big children nor small adults. They have their own needs, desires, risks, influences and life experiences, which makes their need for and access to health very difficult from their adult or child counterpart. This picture (Fig. 3) captures a bit of the stereotypes many of us have about the teenage brain. While there is good humor here there are still some pieces of truth about this period of life, the adolescent brain is still developing until roughly the mid-twenties.

HEALTH PROBLEMS OF ADOLESCENTS

Health issues of the adolescents include but are not limited to the following;

• Injuries, unintentional injuries, road traffic accident, drowning, violence, self-harm etc. – These are the leading causes of death and disability among the adolescents.
• Mental health – Mental health conditions account for 16% of global burden of disease and injury in people aged 10-19 years. Half of all mental health disorders in adulthood start by age 14 years but most cases are undetected therefore untreated. Depression is one of the leading causes of illness and disability among the adolescents, and suicide is the second in people aged 15-19 years. Building socio-emotional skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programmes to help strengthen the ties between adolescents and their families and improve quality of home environments are also important. If problems arise, they should be detected and managed timely by competent and caring health workers.
• Tobacco, alcohol, and other substance use – Early onset of substance use is associated with high risks of developing dependence and other problems during adult life. People of younger age are disproportionally affected by substance use compared with people of older ages. Alcohol and drug use in children and adolescents is associated with neurocognitive alterations which can lead to behavioral, emotional, social and academic problems in later life.
• Eating disorders – Examples of eating disorders are anorexia nervosa and bulimia nervosa, which commonly emerge during adolescence and young adulthood. These disorders involve abnormal eating behavior and preoccupation with food, accompanied in most instances by concerns about body weight and shape. Anorexia nervosa can lead to premature death, often due to medical complications or suicide, and has higher mortality than any other mental disorder.

5) HIV/AIDS – Many risk-taking behaviors for health such as sexual risk-taking start during adolescence. Adolescents living with HIV have worse access to antiretroviral treatment, poor adherence to treatment, retention in care and viral suppression. A key factor contributing to these is limited provision of adolescent-friendly services including psychosocial interventions and support. Adolescents and young people need to know how to protect themselves from HIV infection and must also have the means to do so. This includes being able to obtain information on and access to HIV prevention and intervention services including  voluntary medical male circumcision, condoms, pre-exposure prophylaxis, better access to HIV  testing and counselling, and stronger links to HIV treatment services for those who test positive

• Early pregnancy and childbirth – Approximately 12 million girls aged 15-19 years and at least 777,000 girls under 15 years give birth each year in developing regions. Complications from pregnancy and childbirth are among the leading causes of death for girls aged 15-19 years globally. The UN Population Division puts the global adolescent birth rate in 2020 at 41 births per 1000 girls in this age-group while country rates range from 1 to over 200 births per 1000 girls. This decrease is reflected in a similar decline in maternal mortality rates among girls aged 15-19 years.

One of the specific health targets of the Sustainable Development Goals (SDG3) is that by 2030 , the world should ensure universal access to sexual and reproductive health care services, including child spacing , information and education and the integration of reproductive health into national strategies and programmes.

• Other infections – Infectious diseases like with human papilloma virus that normally occurs after the onset of sexual activity can lead to both short-term diseases (genital warts) during adolescence but more importantly also lead to cervical and other cancers several decades later. Early adolescences (9-14 years) is the optimal time for vaccination against HPV infection and it is estimated that if 90%of girls globally get the HPV Vaccine more than 40 million lives could be saved over the next century. However, it is estimated that in 2019 only 15% of girls globally received the vaccine.

RECOMMENDATIONS

• Supplementation of iron and folic acid are a solution that can promote health before adolescents become parents so as to prevent iron deficiency anemia, which is the second leading cause of years lost by the adolescents to death
• Regular deworming in areas where intestinal helminths such as hookworm infestation are common is recommended to prevent micronutrient deficiencies,
• Establish good and healthy eating habits during adolescence. These are foundations for good health in adulthood.
• Putting regulation in place to reduce the marketing of foods high in saturated fats, trans-fatty acids, free sugars or salt and providing access to healthy foods are important for all, but especially for children and adolescents.
• Places for healthy relaxation and physical activities should be provided by both government and the private sector for the use of adolescents and young people.
• Government should include adolescent health and adolescent-responsive and friendly health systems including the provision of high quality age-appropriate health services for the adolescents
• Raising awareness on health issues for young people among the general public and other interested stakeholders
• Advocating with government and working with youth-led and youth serving organizations to support establishment of national level structures and processes to institutionalize adolescent participation in dialogues about relevant areas of public policy, financing and program implementation that affects them.

 

References

• Clinton Health Access Initiative (CHAI)
• Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infections: recommendations for a public health approach-2^nd ed: World Health Organisation, 2016.
• eHealth Africa (eHA)
• Kaduna State Policy on Health and Development of Adolescent and young Persons(AYP) 2021-2030
• nited Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) Levels and Trends in Child Mortality: Report 2021Worldwide, adolescents and young persons are a major group driving transformative change in global health and development. Twenty five years down the line from the 1994 International Conference on Population and Development (ICPD), giant strides in advancing the health and wellbeing of this target group were recorded and they constitute a formidable force for National development. Designing the strength and prospects of Nigerian youthful population through investments in their health and development will bring about serious economic and social benefits as well as a safer and more prosperous nation, which is a necessary condition for the country to contribute to achieving the Sustainable Development Goals (SDGs 3&4).Nigerian population stands at 217,079,601 as at August 25, 2022 (to” World meter, 2022) with youths accounting for 70% and 42% of these are under the age of 15 years – 7 Oct 2022.

  �

  WHO IS AN ADOLESCENT?

  The World Health Organization (WHO) defines adolescents as individuals within the age range of 10-19 years and youths as 15-24 years while young people covers the age range of 10-24 years. One in 4 people in Nigeria are adolescents.This is the transitional phase of growth and development between childhood and adulthood involving physical, cognitive and psychosocial changes due to hormonal variations.

   

  WHY FOCUS ON ADOLESCENTS?

  Choices made during adolescence can develop into repeated habits that continue into adulthood including both healthy and unhealthy behaviors. Globally, nearly two-thirds of premature deaths are associated with behaviors and conditions that began during adolescence period. We need to remember that adolescent is a pivotal and formative phase that can have lifelong consequences depending on the choices that are made. For instance 70% of early deaths in childhood (i.e. cancer, obesity, addiction and heart disease) are attributable to unhealthy behaviors that are experienced during adolescence (such as smoking, poor nutrition, and substance abuse). This fact emphasizes the need for programming across the life course and encourages people to begin investing in adolescent health early to produce healthier adults, one of the most significant reasons that we have are youth bulge is because there has been tremendous success in maternal and child health to keep babies and young children alive. However, global adolescent mortality rate have remain stagnant for more than 50 years. We cannot waste our investments made in MCH only to lose our young people in adolescent and young adulthood.

   

  WHO and the global community recognize the need to focus on adolescent health, if we better understand the reasons why young people make these choices and if youths themselves know how to recognize and better understand the reasons behind their own decision making we can create more targeted interventions. By better understanding when and how to support youth, we can address young people’s developmental stages, needs and challenges at that period in their lives and design programmer for better results. In recognition of this dangerous and pivotal phase of life we know that we need to increase our programming efforts for this age group.

  Adolescents are not big children nor small adults. They have their own needs, desires, risks, influences and life experiences, which makes their need for and access to health very difficult from their adult or child counterpart. This picture (Fig. 3) captures a bit of the stereotypes many of us have about the teenage brain. While there is good humor here there are still some pieces of truth about this period of life, the adolescent brain is still developing until roughly the mid-twenties.

  HEALTH PROBLEMS OF ADOLESCENTS

  Health issues of the adolescents include but are not limited to the following;

  • Injuries, unintentional injuries, road traffic accident, drowning, violence, self-harm etc. – These are the leading causes of death and disability among the adolescents.
  • Mental health – Mental health conditions account for 16% of global burden of disease and injury in people aged 10-19 years. Half of all mental health disorders in adulthood start by age 14 years but most cases are undetected therefore untreated. Depression is one of the leading causes of illness and disability among the adolescents, and suicide is the second in people aged 15-19 years. Building socio-emotional skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programmes to help strengthen the ties between adolescents and their families and improve quality of home environments are also important. If problems arise, they should be detected and managed timely by competent and caring health workers.
  • Tobacco, alcohol, and other substance use – Early onset of substance use is associated with high risks of developing dependence and other problems during adult life. People of younger age are disproportionally affected by substance use compared with people of older ages. Alcohol and drug use in children and adolescents is associated with neurocognitive alterations which can lead to behavioral, emotional, social and academic problems in later life.
  • Eating disorders – Examples of eating disorders are anorexia nervosa and bulimia nervosa, which commonly emerge during adolescence and young adulthood. These disorders involve abnormal eating behavior and preoccupation with food, accompanied in most instances by concerns about body weight and shape. Anorexia nervosa can lead to premature death, often due to medical complications or suicide, and has higher mortality than any other mental disorder.

  5) HIV/AIDS – Many risk-taking behaviors for health such as sexual risk-taking start during adolescence. Adolescents living with HIV have worse access to antiretroviral treatment, poor adherence to treatment, retention in care and viral suppression. A key factor contributing to these is limited provision of adolescent-friendly services including psychosocial interventions and support. Adolescents and young people need to know how to protect themselves from HIV infection and must also have the means to do so. This includes being able to obtain information on and access to HIV prevention and intervention services including  voluntary medical male circumcision, condoms, pre-exposure prophylaxis, better access to HIV  testing and counselling, and stronger links to HIV treatment services for those who test positive

  • Early pregnancy and childbirth – Approximately 12 million girls aged 15-19 years and at least 777,000 girls under 15 years give birth each year in developing regions. Complications from pregnancy and childbirth are among the leading causes of death for girls aged 15-19 years globally. The UN Population Division puts the global adolescent birth rate in 2020 at 41 births per 1000 girls in this age-group while country rates range from 1 to over 200 births per 1000 girls. This decrease is reflected in a similar decline in maternal mortality rates among girls aged 15-19 years.

  One of the specific health targets of the Sustainable Development Goals (SDG3) is that by 2030 , the world should ensure universal access to sexual and reproductive health care services, including child spacing , information and education and the integration of reproductive health into national strategies and programmes.

   

  RECOMMENDATIONS

  • Supplementation of iron and folic acid are a solution that can promote health before adolescents become parents so as to prevent iron deficiency anemia, which is the second leading cause of years lost by the adolescents to death
  • Regular deworming in areas where intestinal helminths such as hookworm infestation are common is recommended to prevent micronutrient deficiencies,
  • Establish good and healthy eating habits during adolescence. These are foundations for good health in adulthood.
  • Putting regulation in place to reduce the marketing of foods high in saturated fats, trans-fatty acids, free sugars or salt and providing access to healthy foods are important for all, but especially for children and adolescents.
  • Places for healthy relaxation and physical activities should be provided by both government and the private sector for the use of adolescents and young people.
  • Government should include adolescent health and adolescent-responsive and friendly health systems including the provision of high quality age-appropriate health services for the adolescents
  • Raising awareness on health issues for young people among the general public and other interested stakeholders
  • Advocating with government and working with youth-led and youth serving organizations to support establishment of national level structures and processes to institutionalize adolescent participation in dialogues about relevant areas of public policy, financing and program implementation that affects them.References
    • Clinton Health Access Initiative (CHAI)
    • Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infections: recommendations for a public health approach-2^nd ed: World Health Organisation, 2016.
    • eHealth Africa (eHA)
    • Kaduna State Policy on Health and Development of Adolescent and young Persons(AYP) 2021-2030
    • United Nations Inter-Agency Group for Child Mortality Estimation (UN IGME) Levels and Trends in Child Mortality: Report 2021

   

  Other infections – Infectious diseases like with human papilloma virus that normally occurs after the onset of sexual activity can lead to both short-term diseases (genital warts) during adolescence but more importantly also lead to cervical and other cancers several decades later. Early adolescences (9-14 years) is the optimal time for vaccination against HPV infection and it is estimated that if 90%of girls globally get the HPV Vaccine more than 40 million lives could be saved over the next century. However, it is estimated that in 2019 only 15% of girls globally received the vaccine.