Professional Documents
Culture Documents
Children Adolescent
Pregnant &
lactating Reproductive • NEW COMPONENT
• As part of the women Age group • IFA to be distributed by
antenatal care ASHA during doorstep
package, at all delivery of contraceptives;
levels of health IFA tablets to be given for
52 weeks each year
facilities , sub
centre and
outreach
RMNCH+A: AFHS
◦ Adolescent Friendly Health Services include
Reproductive health services
Sexual & reproductive health education
Contraception
Pregnancy testing andoptions
MTP
STD/HIV Screening, counselling, treatment
Prenatal and Post natal care
Well baby care
Nutritional Services
Growth and Development monitoring
Anticipatory guidance regarding substance abuse
Counseling on life skill development
Screening for various disorders
RMNCH+A: AFHS
Services at sub centre: ANM
Adolescent Information and Counseling
Centre will be made functional by MO and
ANM at PHC on weekly basis.
At CHC, DH/SDH/ and Medical College:
Adolescent Health Clinics(daily basis)
Special focus will be given to establishing
linkages with Integrated Counseling and
Testing Centres (ICTCs) and making
appropriate referrals for HIV testing and
RTI/STI management
RMNCH+A: Scheme for
promotion of menstrual hygiene
among adolescent girls in rural
India
This scheme promotes better health and
hygiene among adolescent girls
Sanitary napkins are provided under
NRHM’s brand ‘Free days’.
These napkins are being sold to
adolescent girls by ASHAs
RMNCH+A: Preventive health
checkups and screening for diseases,
deficiency and disability
Components of School Health Programme
include screening, basic health services and
referral
Bi-annual health screening is undertaken for
students (6–18 years age group)
Implementation of School Health Programme
Team consist of:
- 2 Medical Officers
(MBBS / Dental / AYUSH qualified)
- 2 paramedics
(one ANM and any one of the following
Pharmacist/ Ophthalmic Assistant/Dental assistant)
SOCIAL CHALLENGES
MEDIA
PEER PPRESSURE
POVERTY
ILLITERACY
EARLY MARRIAGE
ACADEMIC AND EMOTIONAL STRESS
DISCRIMINATION
LACK OF SEX EDUCATION
ROLE OF HEALTH CARE
PROVIDER
Identifying risk
Establishing rapport
Confidentiality
Consent(<12, 12-18, >18)
Nutritional intervention
Providing health information
Contraception
ROLE OF HEALTH CARE
PROVIDER
Referral to social services, psychological
evaluation and support
◦ National Commission for Protection of Child
Rights Act 2005 consider a person below 18
yr as a child.
◦ It is mandatory for a health care provider to
report all cases of child abuse (even
suspected) to the chairperson of the
commission (online/writing).
◦ Doctors are protected in case of erroneous
reporting but punishable if they fail to report.
ROLE OF HEALTH CARE PROVIDER
Adolescent immunisation
CHECKLIST FOR ADOLESCENT
HEALTH VISIT
History from parents and adolescents
◦ History of presenting problem
◦ Parental concern on growth and development
◦ Academic success; school absenteeism
◦ Diet intake including calcium, protein and iron
intake; junk food
◦ Menstrual history; sleep problems
CHECKLIST FOR ADOLESCENT
HEALTH VISIT
History on questioning of adolescents
◦ Emotional problems; relationship with family
and peers
◦ Outlook toward physical and sexual changes
◦ Involvement in relationship or sexual activity
◦ Awareness about safe sex and contraception
◦ Specific problems related to sex organs
◦ Tobacco or other substance use
◦ Counsel and clear doubts on sensitive topics
CHECKLIST FOR ADOLESCENT
HEALTH VISIT
History on separate questioning of parents
◦ Relationship with family
◦ Level of communication on sensitive matters
Physical examination
◦ Anthropometry
◦ Blood pressure, obesity, acanthosis
◦ Sexual maturity rating
◦ Signs of malnutrition, anemia and vitamin
deficiency
◦ Signs of skin and genital infection
CHECKLIST FOR ADOLESCENT
HEALTH VISIT
◦ Level of general hygiene
◦ Signs of trauma; abuse
◦ Signs of drug abuse and tobacco abuse
Counseling
◦ Nutritional intervention
◦ Hygiene practices
◦ Building rapport between parents and
adolescents
◦ Providing information and sources on sex
education
CHECKLIST FOR ADOLESCENT
HEALTH VISIT
Investigations
◦ Hemoglobin level
◦ Blood sugar, lipid profile
◦ Genital swab
◦ Ultrasound of ovaries
Referral
◦ Counselor
◦ Dietitian
◦ Psychiatrist
◦ Gynecologist
◦ Voluntary and confidential HIV testing
◦ Social services, child protection agencies, support groups.
References
OP Ghai- Essential Pediatrics
Nelsons Textbook of Pediatrics
UNICEF Global Data – 2013
Integrated Child Development Services
Scheme. Kishori Sakati Yojana. Available from:
http://wcd.nic.in/KSY/ksyguidelines.htm.
A Strategic Approach to Reproductive, Maternal,
Newborn, Child and Adolescent
Health(RMNCH+A) in India. Ministry of
Health & Family Welfare Government of
India February 2013
Thank You.