ANNALS OF IBADAN POSTGRADUATE MEDICINE
O. Adeleke1 and F.M. Balogun1,2
Introduction: Adolescence was previously assumed to be a diseases free stage of life. It is however now known that adolescents are not only involved in risky health behaviours but they also have their own share of health problems that other age groups face. The adolescent-friendly model helps to create adolescent-responsive health systems, Nigeria currently has no country-specific report on the adolescent-friendly characteristics of the health services rendered to her adolescents. This study identified various health problems for which in-school adolescents in Ibadan NorthEast Local Government Area sought healthcare and determined their perception of received healthcare services with regards to its “adolescent-friendliness”.
Methods: This was a school-based cross-sectional study that utilized quantitative method of data collection. A multi-stage systematic random sampling technique was employed to select 500 students for school survey. Self-administered, semistructured questionnaire was used to collect data. Descriptive statistics and Chisquare test at =0.05 were used for data analysis.
Results: Perceived malaria (52.4%), acne (36.2%), menstrual pain (17.0%) and depression (3.0%) were the common health problems adolescents sought health care for. Majority of the adolescents perceived the health services received as being adolescent-friendly. These health services were perceived to be accessible by (87%), acceptable by (93.2%), appropriate by (81.4%), effective by (91.4%), and equitable by (82.2%) of the respondents. Adolescents who sought mental care perceived least adolescent-friendliness of received healthcare services.
Conclusion: Adolescents in Ibadan currently view received health services as adolescent-friendly. However, the management of mental health problems in adolescents should incorporate adolescent friendly elements entrenched at every level of the health system.
Keywords: In-school adolescents, Adolescent health problems, Adolescent-friendly health services, Health seeking behaviour, Nigeria.
Dr. F.M. Balogun
Institute of Child Health,
College of Medicine,
University of Ibadan,
Ibadan, Oyo State,
Adolescence is a stage that many expect to be free of health problems1 but there have been very little improvement in mortality rates of adolescents over the decades2 . Adolescent health problems stem from two main sources. First, adolescence is a key period for the initiation and adoption of risky health behaviours that often leads to health problems 3 . Secondly, adolescents have their own share of health problems faced by other age groups, for example, adolescents in Sub-Saharan Africa are currently faced with a double burden of both communicable and noncommunicable diseases just like the other age groups in the region2,4,5 .
Globally, about 1.5 million young people died from preventable or treatable causes in 2012 which were mainly depression, road traffic injuries, anaemia, HIV/AIDS and self-harm2 . The main cause of death among the youths in Africa in 2010 were HIV and AIDS (53.0%), maternal conditions (16.7%), tuberculosis (4.5%), sexually transmitted diseases excluding HIV/ AIDS (17%), and malaria (1.5%)6 . The appropriate response to avert death from these diseases among African young people is the provision of adolescentfriendly healthcare to adolescents amidst other intervention package.
The nature of health services required by adolescents as documented by international health organizations6,7,8 are:
• Pubertal issues (Adolescent Growth and Development, Pubertal delay or precocity, Weight and height issues).
• Sexual and reproductive health (Gynaecological and menstrual problems, contraception, pregnancy testing and option, STD/HIV screening counselling and treatment, sexual & reproductive health education).
• Psycho-social issues (relationship development, adjustment problems, growing-up issues).
• Nutrition issues (healthy eating during adolescence, anaemia prevention and management, undernutrition and obesity, eating disorders (Anorexia nervosa, bulimia nervosa, binge Disorder).
• Safety and injury prevention.
• Chronic conditions like (asthma, diabetes, hypertension, renal disorders), eye care, ENT care, dental care.
• Preventive health check-ups, like, annual check-up, pre-college health check-up, pre-marital counselling etc.
• Adolescent Mental Health such as psychiatric disorders (depression, anxiety, bipolar, personality disorder), and Substance abuse including tobacco and alcohol.
The WHO designed the adolescent-friendly health services model to modify the pattern of healthcare delivery to adolescents in order to increase utilisation of health services and ultimately reduce mortality among adolescents8 . The characteristics of adolescent-friendly health services are “accessibility, equitability, acceptability, appropriateness, comprehensiveness, effectiveness and efficiency of healthcare services to all adolescents and at all times”8 . The health facilities are also expected to be adolescent-friendly and possess attributes such as allocated time slot, allocated area, dedicated attention and longer interaction time, privacy and confidentiality, service packages, orientation and training of the providers (caring, non-judgemental, interpersonal skill, supportive attitude towards the adolescent).2,6,8
Adolescent-friendly health services concept is drawn from the perspective that adolescents and young people deserve health services of high standards9,10 . Over the past decade, international health bodies have emphasised that applying the adolescent-friendly framework in healthcare delivery will immensely improve the quality of healthcare services rendered to adolescents11. Hence, the adolescent-friendly model is being increasingly employed to deliver healthcare services to adolescents in high-income countries12,13 .
Sadly, most adolescents in the developing countries still do not have access to adolescent-friendly health services14. Lack of adolescent-friendliness at various service delivery points of healthcare in developing countries has been linked to the increasing prevalence of adolescents’ health problems as adolescents tend to avoid health facilities with unfriendly health providers and seek healthcare from alternative informal sources15,16 .
Incorporating the adolescent-friendly model fully into healthcare system is an effective approach to create adolescent responsive health systems17. It will also help to actualise the SDG 3 spearheaded by the United Nations by the year 203014. Currently, Nigeria has no country-specific report on the state of health services delivered to adolescents in relation to its adolescent-friendly characteristics. There is a need for an assessment of Nigerian adolescents’ perception about the “adolescent-friendliness” of health services that they receive as this will provide insight into how they see the health services currently available to them. This study described the health problems that adolescents in Ibadan North East Local Government area of Nigeria sought health care for in the past and also determined the perception of in-school adolescents on the “adolescent-friendliness” of the healthcare services they received in Ibadan, Nigeria.