在印度青少年健康战略(IAHS)的背景下,需要对青少年的健康需求进行细致入微的了解,以便为改善印度青少年健康和福祉的政策干预提供信息。
■使用来自全球疾病负担的数据,受伤,和2019年风险因素研究,我们确定了导致寿命损失(YLL)的十大原因,残疾生活年(YLDs),和残疾调整寿命年(DALYs),按性别和年龄组(10-14岁和15-19岁)分列,2019年印度及其各州。向IAHS通报改善印度青少年健康所需的改进或扩展重点,我们回顾了在IAHS中解决疾病负担的十大原因的程度,以及在青少年友好健康诊所监测信息系统(AFHCMIS)和健康管理信息系统(HMIS)中捕获的青少年服务利用数据中的年龄和性别分类。我们还审查了IAHS操作框架中确定的数据来源中IAHS结果指标在人口一级的数据捕获中的可用性以及年龄和性别分类。
■10-14岁和15-19岁年龄组的女性有675万和925万DALY,分别,其中39.1%和44.2%为YLL;男性的相应DALYs分别为671万和965万(42.3%和41.1%YLL),分别。在IAHS的6个主题领域中,确定的大多数战略和指标都是针对性健康和生殖健康,其次是营养,在青少年中,这些疾病广泛地占YLD而不是YLL。与致命疾病和病症的疾病负担相比,IAHS存在显着差距,传染病,和非传染性疾病。在15-19岁的男性和女性中,损伤占YLL的65.9%和45.3%,10-14岁男性占40.8%。具体来说,道路伤害(15.3%,95%UI11.0-18.0)和自我伤害(11.3%,95%UI8.7-14.2)占15-19年伤害死亡的大部分,而溺水(7.7%95%UI5.8-9.6)和道路伤害(6.9%,95%UI4.7-8.6)是10-14岁男性中受伤死亡最多的人。然而,只有自我伤害和基于性别的暴力在IAHS中被特别处理,对其他伤害采取非特异性干预措施.腹泻,下呼吸道感染,疟疾,脑炎,结核病,伤寒,肝硬化,和肝炎是导致青少年YLL和DALYs的其他疾病,但IAHS和AFHCMIS下的服务提供中均未解决这些问题。在HMIS中捕获的死亡原因数据中没有年龄或性别分类,以了解青少年的死亡率。对于人口水平的IAHS结果指标,在人口调查中,不分性别的10-14年的数据采集在很大程度上缺失,没有一项调查采集15-19岁女性或男性的身体活动不足和心理健康指标数据.
■与印度青少年致命和非致命疾病负担的主要原因相比,IAHS主题重点存在相当大的差异,以及在监测IAHS结果指标的人口水平数据的可用性方面,可能会对改善印度的青少年健康构成重大限制。决策者可以利用本文中的发现来完善旨在改善青少年健康和福祉的行动。
■比尔和梅琳达·盖茨基金会。
UNASSIGNED: A nuanced understanding of the health needs of adolescents in the context of the India Adolescent Health Strategy (IAHS) is needed to inform policy interventions for improving the health and well-being of adolescents in India.
UNASSIGNED: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we identified the top ten causes of years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) disaggregated by sex and age group (10-14 and 15-19 years) for India and its states in 2019. To inform the IAHS of refinement or expansion in focus needed to improve adolescent health in India, we reviewed the extent to which the top 10 causes of disease burden are addressed in the IAHS, and the availability of and age- and sex-disaggregation in the service utilisation data for adolescents captured in the Adolescent Friendly Health Clinic monitoring information system (AFHC MIS) and Health Management Information System (HMIS). We also reviewed the availability of and age-and sex-disaggregation in the data capture at the population level for the IAHS outcome indicators in the data sources identified in the IAHS operational framework.
UNASSIGNED: Females in the 10-14 and 15-19 years age groups suffered 6.75 million and 9.25 million DALYs, respectively, 39.1% and 44.2% of which were YLLs; the corresponding DALYs for males were 6.71 million and 9.65 million (42.3% and 41.1% YLLs), respectively. Within the 6 thematic areas of the IAHS, most strategies and indicators identified are for sexual and reproductive health followed by nutrition, and broadly these conditions accounted for YLDs and not YLLs in adolescents. Significant gaps in the IAHS in comparison to the disease burden for fatal diseases and conditions were seen across injuries, communicable diseases, and non-communicable diseases. Injuries accounted for 65.9% and 45.3% of YLLs in males and females aged 15-19 years, and 40.8% in males aged 10-14 years. Specifically, road injuries (15.3%, 95% UI 11.0-18.0) and self-harm (11.3%, 95% UI 8.7-14.2) accounted for most of the injury deaths in 15-19 years whereas drowning (7.7% 95% UI 5.8-9.6) and road injuries (6.9%, 95% UI 4.7-8.6) accounted for the most injury deaths in 10-14 years males. However, only self-harm and gender-based violence are specifically addressed in the IAHS with non-specific interventions for other injuries. Diarrhoea, lower respiratory infections, malaria, encephalitis, tuberculosis, typhoid, cirrhosis, and hepatitis are the other disease conditions accounting for YLLs and DALYs in adolescents but these are neither addressed in the IAHS nor in service provision under the AFHC MIS. There is no age- or sex-disaggregation in the cause of death data captured in the HMIS to allow an understanding of mortality in adolescents. For the IAHS outcome indicators at the population level, data capture for the 10-14 years irrespective of sex was largely missing from the population surveys and none of the surveys captured data for either females or males aged 15-19 years for physical inactivity and mental health indicators.
UNASSIGNED: The considerable differences seen in the IAHS thematic focus as compared with the leading causes of fatal and non-fatal disease burden in adolescents in India, and in the availability of population-level data to monitor the outcome indicators of the IAHS can pose substantial limitations for improving adolescent health in India. The findings in this paper can be utilized by decision makers to refine action aimed at improving adolescent health and well-being.
UNASSIGNED: Bill & Melinda Gates Foundation.