The practice of voluntarily subjecting self to checking one’s health status at appropriate intervals, plays a significant role in detecting health challenges early and initiating steps that ensure that the harmful effects of such challenges are reduced to the barest minimum, or completely prevented.
Intervals between these health checks depend on whether the individual has an existing illness that is being monitored, other known risk factors for some health conditions, and the age of the individual.
Other known risk factors outside age include; family history, occupation, lifestyle choices, and environment.
Objectives of Health Status Check
Broadly, the objectives of health status check are;
- Detection of pointers to the possibility of developing a particular disease, so that steps are taken to prevent it, and;
- Making early diagnosis of a disease, so that treatment can be commenced on time, and better prognosis for the disease enhanced.
Outside scheduled health checks targeted at specific health conditions for people who are at high risk of developing those diseases, such as some forms of cancers; general medical examination should be done yearly, or every two years for people who are aged 40 years and above. The recommended steps are;
- The well-person consults a medical doctor who takes history from the person, paying particular attention to family and social history. Occupation and past medical history are also very important.
- The doctor then performs physical examination on the person, to check for any obvious abnormality with any system in the human body. The vital signs such as temperature, blood pressure and respiratory rate are checked at this stage. Blood sugar level, using Glucose meter instrument is also commonly checked at this level
- Appropriate further investigations for the individual are recommended by the doctor, who also reviews the results of the investigations and directs on the next steps.
For both adult males and females, blood pressure check ought to be done at least once every three months. There are however, certain investigations that should be scheduled yearly or every two years, for the apparently healthy individuals. These investigations include;
- Blood glucose test to check for diabetes mellitus or pre-diabetic condition.
- Electrolyte, Urea and Creatinine test to assess the health of the kidneys
- Blood lipid profile to detect early derangement in the quantity of harmful lipids such as Cholesterol and Low-Density Lipoprotein (LDL).
- Occult blood-in-stool test to detect blood in stool. Blood in stool could be a pointer to Peptic Ulcer Disease, or tumour of the gastrointestinal tract. It could also be as a result of haemorrhoids or other benign surgical conditions of the lower gastrointestinal tract such as fissure-in-ano.
- Colonoscopy can be done every 2 – 5 years to detect any tumour in any part of the colon, especially malignant tumour. This is an examination with a camera thread that enables good visualization of inside of the colon.
- Hepatitis B and C screening is very important, especially for the health worker, since the infection is blood-born and could be acquired through routine hospital practice such as surgery or administering drugs through the parenteral route. Chronic infection with hepatitis B or C could ultimately lead to cancer of the liver or liver cirrhosis. For persons who are hepatitis B virus infection negative, there is a potent vaccine; but currently, there is no vaccine for prevention of hepatitis C. There are however drugs for managing hepatitis B and C virus infections, so that the complications are prevented.
Male Specific Investigations
Prostate Cancer Screening
Prostate cancer is the most common cancer in men. It is commoner in black men; hence it is recommended that black men commence active screening for prostate cancer from 40 years of age, the other races should commence as from 50 years of age.
This screening can be done generally through PSA screening test, which should be repeated every 2 years for persons with result that is below 2.5ng/mL, and every year for persons with result of 2.5ng/mL and above; but below 4.0ng/mL. Persons with results above 4.0ng/mL MUST see a Urologist, who will further assess him.
Male Genital Self-Examination
This could be done every six months in healthy males. Persons who had noticed some problems with their genitals or recently exposed to unprotected sex are advised to do this more frequently, ranging from daily to bi-monthly. It is recommended that the male stands naked in front of a mirror and starts by inspecting penis and scrotum for any abnormalities.
This is then followed by gentle palpation of the penis and scrotum, checking for lumps and tenderness. If Sexually Transmitted Infection is suspected, the penis is “milked” during palpation to determine if there are any abnormal urethral discharge. Any abnormal finding is promptly reported to a medical doctor for further evaluation. Genital cancers are rare, but could occur. Detecting them early commonly results in good prognosis.
Female Specific Investigations
Cervical Cancer Screening
Cervical cancer is one of the common cancers that afflict females. Screening for this cancer can be done through;
- Pap smear, which is done by taking a swab from the cervix, and checking for abnormal cells that could point to cancer.
- Human Papilloma Virus screening is done by examining samples taken from the cervix to see if Human Papilloma Virus is present. This virus if untreated, could lead to cancer of the cervix.
- Visual Inspection with Ascetic Acid (VIA): White vinegar is used for this test. It is diluted and applied on the cervix, and then visualized. Abnormal areas of the cervix turn white, indicating that further investigations should be carried out. This test is useful in resource-constrained settings, since it is simple and cheap.
It is recommended that cervical cancer screening commences between 21 to 25 years of age, and repeated every 3 years. Screening may be discontinued at 65 years of age, if the last two results were normal.
Breast Cancer Screening
Screening for breast cancer can be done through the following three ways;
- Breast Self-Examination: Every woman 20 years and above should examine her breasts monthly. The more she does this, the more familiar she gets with her breast contours, and able to detect abnormalities. A health care worker guidance at the initial stage is usually helpful. The four quadrants of the breast should always be examined in a systematic order.
- Clinical breast examination: Women aged 20 to 40 years should have their breasts examined once every three years by a properly trained health care worker. This is in addition to their monthly breast self-examination. Women who are older than 40 years should have their breasts properly examined by a trained health care worker every year.
- Routine mammography: Mammography is a special type of X-ray for the breast. It is recommended that every woman should get a baseline mammogram at the age of 35 years. Yearly mammography screening could be commenced from 40 to 54 years of age, yearly mammography screening should be conducted, while those that are 55 years and above could reduce the frequency to every two years. Further recommendations by the United States Preventive Services Task Force (USPSTF) states that women aged 50 to 74 years of age, and are at average risk of getting breast cancer, should go for a mammogramme every two years. There are other recommendations by some other organizations, on when to commence breast cancer mammography, and the frequency.
Female Genital Self-Examination: From the age of 21 years, females could self-examine their genitalia to detect any abnormality. Some of these abnormalities could, in some instances be signs of potential worrisome health problems such as cancer, syphilis, etc. These may initially present as ulcers, bumps or areas of discoloration on the genitalia.
It is recommended that the examination be done in between monthly menstrual cycle when the genitalia is free from blood, and it is also recommended that the individual would not have used any vaginal cream or douching for the past 24 hours. For the self-examination, you need a hand-held mirror, flashlight, pillows and towel.
Having a diagram of female genitalia will also be helpful so that the individual is able to identified any part that has any abnormality.1
It is also very important that the individual washes her hands very well, and ensures that the finger nails are trimmed before the self-examination, or she uses sterile hand gloves. The female removes her clothes from waist down, and sits on the bed with firm matrass or on a clean towel or mat, spread on the floor. The back is propped up against a wall, and preferably supported by pillows.
The legs are spread, with the knees bent and the heels of the feet brought close to the genitalia. The mirror is used to inspect the genitalia. The vagina introitus may be parted with the fingers, and some part of the inside visualized with the help of a flashlight. Next stage is gently inserting the finger into the vagina and feeling the wall inside.
The inside wall of the vagina usually has small ridges known as rugae. If the finger is inserted deeper, one could even feel the cervix, which is the beginning of the womb (uterus). The cervix feels like the tip of the nose. The more one does genital self-examination, the more she develops the skill to detect abnormal conditions of the genitalia.
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