Emerging issues in adolescent healthcare--an urgent call for action.

Adolescent health is now emerging as one of the areas for major healthcare concern. Adolescence is considered as a transitional stage of physical and mental human development between childhood and adulthood. This stage in life is regarded important because it brings about pubertal, social and psychological changes. The World Health Organization has defined adolescent as an individual between 10-19 years of age.1 Around 3 billion, nearly half of the world’s population is estimated to be less than 25 years of age. An estimated 1.3 billion adolescents live in developing countries and with 500 million adolescent girls.2 Adolescents constitute about 32.6% of Pakistan’s population; 65% among them live in rural areas.3 It is unfortunate that there is no reliable objective data from either rural non urban areas of Pakistan concerning adolescent issues. Health is affected by socioeconomic issues and a need exists to study them in the context of adolescent population. Issues such as undernourishment, infections, illiteracy and child birth should be studied in the context of adolescent population. This period of growth and development is extremely important because youth during this time undergo rapid physical, psychological and social changes. These changes make them vulnerable for health threatening behaviours as compared to other age groups. There are health care related specific issues important for consideration in this age group. Increasing prevalence of obesity and its associated issues are an upcoming challenge, becoming more prevalent in both developed and developing countries worldwide and particularly affecting adolescent age group.4 Around 10% of the youth between the ages 5-17 years were reported to be overweight worldwide by the International Obesity Task Force in the year 2000.5,6 It is expected that the proportion of obesity in school-age children will almost double by 2010.4 There are several factors responsible for worsening obesity problem among youth including increase consumption of fast food, soft drinks (67%) and increase in prevalence of sedentary life style.7 The increase prevalence of obesity among youth is a reflection of a western society influence affecting school children and leading to an increase incidence of diabetes, dyslipidemia, hypertension, heart disease, stroke and cancers in later life.8 Mental health issues are also increasing among the youths. Increase prevalence of obesity and overweight leads to low self esteem and psychological issues. Changing trends of the society towards more materialism and artificial standards have increased anxiety in life. Anxiety and depression in younger age groups is increased due to increased expectations from elders, extra burden from teachers and unnecessary competitions in studies by the peers. Overambitious and unrealistic plans of teenagers are also contributory in this context.9 Reproductive health and its related issues are of special concern for the youths. They lack access to reliable and correct information sources related to reproductive and sexual health. It is reported that our youth is less aware about reproductive and sexual health issues as compared to their counterparts in the western world.10 A majority of adolescents lack knowledge about simple matters such as physical changes in boys and menstruation in girls, before attaining puberty.10 A more serious issue is their inability to protect themselves from sexual abuse and their being ill-equipped to handle the reproductive health burden. Recent explosion in electronic media and unchecked easy accessibility of internet facilities have played a profound negative impact on these youngsters. It is a matter of grave concern that preventive and curative services regarding sexual health and diseases are deficient in most of the developing countries. The incidence of sexually transmitted infections including HIV/AIDS is on the rise among the youth that further adds to the dilemma.11 Providing adolescents with access to appropriate information, education and services appears to be the main challenge for health care planners and policy makers.