ADOLESCENT HEALTH CLINIC KOLKATA. HISTORY, PRESENT FUTURE
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Dept of Pediatrics, Medical College, Kolkata - 700073 *
Background
  • 22% of Indian population are in adolescent age. Significant physical and mental health transformation to become an adult hence deviation from normal, leading to disease, during this period is most likely. Mental health issues are more common. Proper guidance for all and counseling in selected cases will not only help those adolescents to become resourceful adult but also prevents them to become diseased or antisocial personality. Very few organized health facility available for adolescents. Adolescents need a separate health care delivery point since they are very shy and choosy to tell about their problems. They need privacy, confidentiality and friendly atmosphere at health care delivery points. The conventional criteria of Adolescents Friendly Services (AFS) set by adults in the society may not be considered AFS always by the adolescents. This is the experience all over the world observed by WHO including in our clinic hence attendance in AFS points are not increasing as it happens in health clinics for physical illness for general population.
  • Realizing the need for "Adolescent care" in India WHO came forward in collaboration with Govt. of India and Govt. of West Bengal for constituting a Task Force for Adolescents Care. Clinic based along with out reach activities were initiated.

Need Assessment Study
  • The Dept. of Pediatrics, Medical College Kolkata is operating an Adolescent Health Clinic with the support of WHO, Govt. of India and State Govt.
  • A need assessment and health awareness study was carried out among 2506 school going adolescents in Kolkata by using a questionnaire based format. Three boys and three girls schools participated in the study.

Followings are some major findings of the need assessment study :
  • A total no. of 2506 students (1283 boys & 1223 girls) participated in the study. Amongst them 48% was early adolescents (11-13 years), 46% mid adolescents (14-16 years) & 6% was late (17-19 years) adolescents. Due to impending board examination, no. of participants from class 12 was low. Most of the students considered their parents as good natured, good friends, helpful, loving and caring through some described their fathers as indifferent and strict. More than 70% adolescents expressed their relationship with siblings as healthy and positive. Adolescents have positive attitude towards school and education. More than 80% enjoys schooling and considered doing well is important for them. About 16% were school drop out, 35% found deterioration of their scholastic performances. Most of the students are involved in regular / irregular extra curricular activities. About 64% students (both boys & girls) considered themselves healthy where as 10% did not think so and 25.8% were not sure about it. Around 45% adolescents suffered from occasional cough and cold, 43% get tired easily and 30% suffered from headache mainly due to tension. Pain abdomen, visual problems, skin problems, earaches etc are common health problem of them. About 11.3% adolescents suffered from anxiety, tension and sleeplessness which needs intervention. Atleast 35% children heard about methods of birth control of which 16% mentioned condom, 10% mentioned oral pill, 6% operations (vasectomy / tubectomy) and 3% as safe period. About 52% boys and 1.7% girls adolescents smokes cigarettes occasionally, 23% boys and 1% girls drinks alcohol once a week and 5.2% boys and 0.8% girls tried drugs atleast once in life. They are not habituated though health risk factors persists.
  • Nearly 66% adolescents ready to use adolescent friendly (AFS) for their problems where as 8% are not ready to use it and 26% are not sure about it. Students of higher classes are more willing to utilize the .

Adolescent Friendly Centre
  • The first Adolescent Health Clinic in West Bengal was inaugurated at Medical College Kolkata, in Dept. of Pediatrics on 28th June 2002 by Dr. Suryakanta Mishra, Honb'le Minister in charge, Dept. of Health and Family Welfare, Govt. of West Bengal as a pilot project supported by WHO and GOI.
  • Special multidisciplinary adolescent friendly clinic, once a week, 2-4 p.m. on Friday in the Dept. of Pediatrics having separate registration and counseling room with counseling spread over the week.

Clinic based services -
  • Growth development monitoring and nutritional advices. Early detection and management of medical problems. Regular counseling to encourage and reinforce behaviors that promote healthy life style.
  • Advices to the parents of adolescents in specific health care issues.

School based services -
  • Assessment of knowledge and health needs of adolescents using a questionnaire based format. Teacher orientation programs on adolescent issues. Session for awareness and attitude of parents regarding adolescent issues. FLE (Family life education) sessions in schools and clinic.
  • Organization of group discussion, interschool debate and essay competition.

Package of Reproductive and Sexual Health to adolescent.
  • Workshop on Family Life Education among school children at our clinic. Assessment of knowledge and attitude of adolescents on reproductive and sexual health among school children using questionnaire based format. Group and individual counseling of adolescents having sexual health problems. Treatment of adolescents having RTI/STI. Assessment of nutritional status of school children by using a questionnaire based format.
  • Nutritional counseling of adolescents attending O.P.D.
Service Providers at the Center
At Clinic
  • Pediatrician as key personnel - Prof Sukanta Chatterjee MD, trained at International training program on adolescent health organized by IAP, Advanced International Training on Adol sexual & Reproductive Health organized by SIDA & MAMTA, International Member of Society for Adolescent Health (USA). Faculties of Dept. of Pediatric Medicine - 6 (MD).
  • M.O. Adolescent Health Clinic (1 Female) MBBS, DMCW.
    Trained in Adolescent Health.

Awareness training programs
  • Other specialties gynecologist, endocrinologist, psychiatrist, dermatologist and others.
  • Psychologist - 1 (Female) MSc, PhD (CU).
    Trained in Adolescent Health Awareness training programs.
    Trained in Counseling & Psychotherapy, Specialty in substance abusers.
  • Technical staff and supporting staff - 2 (Male).
  • Nurses & Gr.D staff from general pool of the hospital.

At school -
  • Teachers - Teacher's orientation program on adolescent health. No. of orientation program held - 10. No. of teachers oriented - 283.

At Home -
  • Parents - Session for awareness & attitude of parents regarding adolescent issues.
    No. of orientation program held at our clinic = 5.
    No. of parents participated = 311.

Description of beneficiaries
  • Number of adolescents at clinic 536. No. of school students = 2732, girls - 1193, boys - 1539. Age distribution shown in Table I.
  • Sex Ratio
      At School Male : Female 1539:1193

      At Clinic Male : Female 302:235
  • Socioeconomic Status shown in Table III. Out of School : Only four adolescents are out of school
  • Marital Status : No married adolescent in clinic till then.

Kinds of problems seen in adolescents -
  • Psychological / behavioral problem - Lack of concentration - 81%. Poor memory - 60%
    Deterioration of academic performance - 62% Restlessness - 28% Disobedient - 52% Depression - 69% Anxiety - 73% Habit - 58% Adjustment - 47% Medical problem - 18.8%Reproductive and Sexual Health problem - 8.2% Body Image - 15%
  • Growth and development 9.8%.

Lessons learnt from experience:
  • Adolescent care is an insufficiently addressed problem in our country due to lack of awareness in adolescents, parents and the authorities. It can lead to wide spread and far reaching consequences. Health guidance especially on sexual and reproductive health issues are not readily available to adolescents at any level - family, school or society. They have a lot of unmet needs especially regarding personal and sensitive issues like sexuality, birth control, boy / girl friend problems, emotional problems, interpersonal relationship etc. They want to receive information/services related to those issues but hesitate to discuss. Problems related to Health risk behaviors like substance abuse, unprotected sex, injuries etc need special attention. Trust between adolescent and their parents' needs to be established. Growing up issues, career guidance and matter related to life skills are priority issues with adolescents. Consent for physical exam refused by 9 boys (no girl) in the clinic since they had no perceived problem but parents brought them. SMR exam consent was not universal (16/72 boys, 3/97 girls refused consent), may it affect friendliness of the clinic? Self exam of SMR is more reliable (both boys and girls) for public hairs than for genital organ or breast. Self exam and clinical exam were found almost equally reliable.
  • 'SMR age' was more related with physical and behavioral changes than chronological age.

Table I. Age distribution in school students.s

10 yrs 11 yrs 12 yrs 13 yrs 14 yrs 15 yrs 16 yrs 17 yrs 18 yrs 19 yrs
136 250 268 312 380 378 376 290 290 52


Table II. Age distribution in clinic adolescents

10 yrs 11 yrs 12 yrs 13 yrs 14 yrs 15 yrs 16 yrs 17 yrs 18 yrs 19 yrs
10 22 35 32 78 92 97 105 42 23


Table III. Socio-economic status.

Economic status Lower middle class Middle class Affluent Total
At School 815 1497 420 2732
At Clinic 87 422 36 536


Table IV. Educational level of clinic adolescents

Classes V VI VII VIII IX X XI XII
At Clinic
(Total No. = 536)
10 18 36 82 174 154 32 30
At School 136 340 468 612 471 330 313 52


Marital status : No married adolescent in the clinic till date.
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