Treating adolescents in South Africa: Time for adolescent medicine units?

They constitute a large fraction of society, with specific characteristics and needs. Sexual maturation and physical growth to almost adult size are attained early in adolescence, while psychological maturation takes longer. These factors lead to characteristic behaviours that can conduce to various diseases, and even death, and which influence the sick adolescent’s response to the health care process. Adolescents are generally regarded as the healthiest segment of any population and the embodiment of strength, health and beauty. However, the truth behind this idyllic view, as revealed by statistics worldwide and in South Africa, is notably different. The youth and adolescent policy of the Department of Health, published in 2001, identifies many health problems that require intervention. Adolescents’ sexual health is threatened by early age at first intercourse (average age 15 years) and unprotected coitus, leading to high risk of HIV and other sexually transmitted diseases. 3 Teenage pregnancy, with a rate quoted as 15% for South Africa and as high as 43% in some areas in Eastern Cape, 4 increases the risk of maternal death, doubles 0 - 1-year mortality, and is associated with increased school dropout rates, poverty and child abuse. The national policy assumes that 15% of adolescents will be diagnosed with a psychiatric disorder during adolescence. About 4 million adolescents worldwide attempt suicide each year, of whom more than 90 000 succeed. 1 Other typical problems include abuse of alcohol, tobacco and drugs; violence (assault, rape); road accidents; birth defects and inherited disorders; poor nutrition resulting in varying degrees of obesity or anorexia; and poor oral health.