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TRANSITIONS TO ADULTHOOD
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Adolescence is regarded by the medical community as a period of relatively few health problems. However, this assumption ignores the possibility that accumulated health "deficits" from earlier childhood may adversely affect health status as young people undergo the changes of puberty. Further health risks are encountered in the social environment if, for example, an adolescent is exposed to unhygienic conditions at work or premature childbearing. In the ASCE survey both social context variables and clinical indicators were measured, as well as parents' and adolescents' reports on health service utilization patterns.
KEY FINDINGS:
Female circumcision: This traditional practice in Egypt typically takes place before or just as a girl reaches puberty The ASCE survey provides the first estimate of circumcision rates among a nationally-representative sample of unmarried adolescents. Survey findings indicate that the level of circumcision among single girls aged 13-19 is 86 percent (by age 13, nearly all circumcisions have been performed). While high, this rate is more than 10 percentage points lower than the almost universal prevalence found in the 1995 Egyptian Demographic and Health Survey (EDHS) of ever-married women ages 15-49. (The prevalence found among married adolescents is virtually identical to the EDHS, 98 percent.) Moreover, girls who have at least one parent with secondary education have a significantly lower prevalence of circumcision (48%). Nearly half of circumcised girls report that the procedure was done by a physician. Comparison with older cohorts in the EDHS suggests an upward trend in the medicalization of the procedure, confirming the trend first detected by the EDHS. There is some evidence of reduction in female circumcision following the 1994 International Conference on Population and Development held in Cairo. With the expansion of anti-circumcision campaigns and education in Egypt, we may expect further declines in female circumcision in the future.
| The overall prevalence of anemia was 47 percent, with little variation by socioeconomic level or gender. However, by age 19, boys' levels of anemia are declining while girls' levels are rising. |
Anemia: The survey found that nearly half (47%) of Egyptian adolescents suffer from anemia, though most is of a mild degree. The prevalence of anemia did not vary significantly among adolescents by socioeconomic status.
Moreover, contrary to expectations, anemia prevalence among boys was found to be slightly higher than among girls, in spite of girls' blood loss during menstruation. As girls approach age 20, anemia rates rise, whereas anemia for boys declines as they approach full adult growth. While other developing countries have reported similar patterns between adolescent boys and girls, there is an incomplete understanding of the phenomenon. More research is needed on dietary and hygiene behaviors and environmental factors that affect adolescent anemia. Parasitic infections: More than half of all adolescents (56%) were found to be infected with intestinal parasites. Not surprisingly, this varied considerably by whether their homes have access to public sewerage and water facilities and a separate room for cooking. Infection also varied markedly by region, with infection rates almost 20 percentage points higher in Lower and Upper Egypt than in the urban governorates.
Sexual maturation and growth: Assessments of physical growth and sexual maturation reveal that Egyptian adolescents, particularly boys, are stunted at significant levels and are generally delayed in their sexual maturation (18% boys, 14% girls). These conditions are the result of poor nutrition, high levels of anemia and parasitic infections, and accumulated health problems from childhood.
Management of menstruation: More than half of adolescent girls (61%) reported feeling shock, fear, or weepy with the onset of their menses. Among those in school, only 14 percent use the bathrooms in school to change during their menses. For the significant group that report experiencing severe menstrual pain, only 4 percent have ever sought care from a doctor.
Health services utilization: The School Health Insurance System is now available to nearly all in-school adolescents. However, the private sector was found to be the main provider of health care to adolescents during illness. Satisfaction among users of the School Health Insurance System is quite high, but more than half of students eligible for coverage are not using these services.
Smoking. A notable proportion of adolescent boys report that they smoke (11%), and nearly half of them report that their peers smoke (suggesting that the reported level of smoking is an underestimate). Peer pressure, considered to be a critical factor in the initiation and maintenance of smoking, is common as well among boys. Girls report lower levels of smoking and exposure to peer pressure to smoke. The reported use of drugs is negligible, though almost certainly underreported.
