Promoting men’s health

Men’s health is in many ways linked to women’s health. While the life expectancy gap between men and women has decreased, it's no secret that men still need to pay more attention to their bodies. Several things work against men. They tend to smoke and drink more, and they don't seek medical help as often as women.

Men are more likely to make unhealthy or risky choices, and put off regular check-ups. And some men define themselves by their careers, which can add to stress-related diseases.

Men are uniquely predisposed to some health conditions, mainly related to circulating testosterone levels. These include prostate cancer and some heart conditions. Many of the major health risks that men face can be prevented and treated with early diagnosis. It’s never too late for men to start taking better care of their health. Make eating healthy and being active a part of your daily routine. A healthy diet and regular physical activity can help lower your blood pressure, blood sugar, cholesterol levels and body mass index (BMI).By keeping these numbers down, you can lower your risk of serious health problems like diabetes and heart disease.

And men too, like women, should be aware of commonly available screening tests. Screenings tests identify potential diseases before any symptoms appear. If a disease is found early, appropriate measures can be instituted. Some diseases are curable if detected very early.Discuss with your doctor about screening tests that are right for you. Personalized tests should be based on prevailing health, personal characteristics and family history. Screening tests are available for blood pressure, cholesterol levels, diabetes, sexual health and certain cancers.

Can women help out? Yes, by encouraging their male partners to seek out healthy behaviour. Point out the connection between good health and family life, all coupled with performance at work and other activities. Create an exercise routine that involves and is enjoyable for both of you.Recruit male friends or relatives with good health habits to help reinforce lifestyle messages. Remind him that his children will be influenced by the example he sets when forming lifelong health habits. And if disease symptoms are apparent, encourage the males in your life to get medical attention promptly.

But men must take action themselves. Drink alcohol only in moderation, and quit smoking. Feel free to talk about concerns on your health with family members. Make small changes every day, they will all add up to better health. Walk instead of smoking, order salads in place of fries, ask for water in place of carbonated or alcoholic drinks.Finally, ask your doctor about preventive medicines like daily aspirin or appropriate vaccines.

When delivery needs to be assisted

Towards the end of pregnancy, new anxieties arise about the baby’s delivery. For the majority, the onset of labor usually leads to spontaneous delivery. Some women will however require help in delivering the baby, commonly referred to as ‘Assisted Vaginal Delivery’.

Labor and delivery is a predictable event, but many variables come into play. Obstetricians and Midwives are trained to recognise and intervene when the progress of labor veers from the expected pattern. The final point when the baby is about to be born is referred to as second stage of labor. It is usually a short period, lasting no longer than one to two hours, but Obstetricians may allow a longer interval depending on circumstances.

There are occasions when spontaneous expulsion of the baby will not happen, and a decision must be made on how best to help. It may be that the second stage has lasted too long, the baby may get distressed, or simply that the baby’s position may not be optimal for spontaneous delivery. In other cases, the mother may just be too exhausted to effectively push the baby out.

In such situations, assisting delivery with an instrument comes in. The Obstetrician or Midwife must make a reasoned judgement on the safest way to deliver the baby. In most cases, the head is too low in the pelvis, making instrumental delivery safer than a Ceserean. The choice is between two instruments: Vacuum delivery or Forceps. Each of the instruments is designed to be applied to specific and safe points on the baby’s head. The mother’s pushing efforts are then aided with measured pulls, thereby easing the baby out.

Assisting delivery with an instrument raises a lot of anxieties in the prospective parents. There are genuine concerns on the safety of the procedure. Thus the most important considerations must always be directed towards the safety of the mother and her baby. The Obstetrician or Midwife carrying out the procedure must be fully trained, skilled and certified to use the chosen instrument. And the equipment must be in good working condition. An objective judgement must also be made that an assisted delivery is warranted. Any doubts must trigger consideration of an alternative mode of delivery, or a second opinion from a more experienced Obstetrician or Midwife.

The safety of assisted vaginal delivery is not in question. It contributes to saving lives of newborn babies, and also helps prevent maternal complications that may arise due to prolonged labor. The WHO identifies assisted vaginal delivery as a key component of basic emergency Obstetric care in developing countries. Increased uptake of assisted vaginal deliveries improves maternal and newborn health, parts of millennium development goals. Obstetric and midwifery training on skilled assisted vaginal delivery, coupled with patient education are the key to negating misguided concerns on assisted deliveries.

Pre-marital health screening

Almost all couples in advanced stages of tying the knot attend several sessions of pre-marital counselling. There are even pre-nuptial legal agreements tied to material possessions pre-dating the marriage for some.But how many engage in pre-marital health screening? This should be considered of equal importance to all other pre-marital rituals, and should never be missed.

Many people are usually unaware of their state of health as many conditions have no significant symptoms. Pre-marital health screening should have some bare minimum health checks, but may also be stretched to a detailed comprehensive health check, albeit at great expense. At a minimum, the intending couples should be screenedfor sexually transmitted infections (STIs), hereditary conditions and potential fertility related issues. Other general health screening tests should be incorporated in the already existing and recommended screening intervals.

Ideally, the intending couple should attend for the health screening visits together. They should already have agreed on matters related to confidentiality of their results, especially if either party turned positive. Screening for STIs should include chlamydia, gonorrhoea, syphilis and HIV. Hepatitis B and C should also be tested for. If either party is found to be infected, treatment options and other precautions are available to negate transmission of the infections to the uninfected partner. And if a pregnancy is planned, several precautions can be put in place to reduce risks of disease transmission to the unborn baby as well.

If bearing children is on the cards, as in most marriages, having an idea about fertility potential is beneficial. This may simply take the form of a detailed medical history from either party, combined with pre-pregnancy advice. Specific fertility tests may be hard to justify, unless a problem is obviously apparent.

Hereditary conditions are uncommon, but if present have the potential of being transmitted to offspring. Screening for hereditary conditions should be guided by a detailed family history, and known predisposition of certain communities to some genetic conditions.An example in Kenya is Sickle Cell Disease, a genetically inherited condition affecting the blood cells. If the intending couple both carry the Sickle Cell gene, they would have a significant chance of bearing a child with the disease, and potential for lifelong ill health. If such information is known beforehand, certain medical interventions may be applicable prior to or during pregnancy, in attempts to maximize better outcomes.

Couples can chose to visit a General Practitioner for their pre-marital health check, or even a Gynecologist. Be wary of taking it too far, not every potential condition can be screened for, or predicted. You must draw a line on the barest minimum and practical screening tests. And be vigilant after getting the all clear, it’s easy to get STIs with extra-marital flings after the honeymoon is over!

Pregnancy symptoms you should never ignore

Pregnancy is a natural phenomenon. About 80% of pregnancies are usually uncomplicated, while the other 20% may encounter serious problems requiring special attention. But there are so many aches and pains that arise during pregnancy, sometimes making it difficult for couples to decide when it is necessary to see their Obstetrician or midwife.

The first thing is to be as informed as much as possible about your pregnancy. Your carers are rich sources of information, and you should always take advantage of this. More information is readily available on print media and on the web.

In the first third of the pregnancy (first trimester), general symptoms like nausea and vomiting are pretty common. Remedies are easily available to avoid excessive dehydration and poor nutrition. However if unable to tolerate any fluids or feeds, risks tend to rise and a hospital visit is usually warranted. Mild pelvic discomfort, and even some blood spotting are common symptoms which tend to resolve spontaneously. However any bleeding that mimics a period, or pain of severe intensity always warrant a review. These portend the likelihood of a miscarriage or ectopic pregnancy, necessitating specific measures.

Once a miscarriage has been diagnosed, you can be left alone to allow for a spontaneous resolution. Other alternatives are the use of some tablets to enhance the process, or being taken to theatre for what is called a uterine evacuation. All the three options are pretty safe, with neither resulting to any long term health risks. Infections after a miscarriage are very rare. But gynecologists tend to be very cautious, and you may sometimes be given antibiotics if there was even the slightest suspicion of an infection.

The next third (second trimester), tends to be more relaxed. Risks of late miscarriage are significantly reduced and, the nausea and vomiting tend to resolve. However pain and bleeding still remain as serious symptoms warranting assessment. Some women may experience leakage of fluid through the vagina. This is also the earliest time that other complications may start to show up, for example a rise in blood pressure or poor glucose control. Being aware of the signs to watch out for is important. If unsure about the significance of any symptoms, it’s always best to check with your carers. Phone advice is often good enough,unplanned clinic visits can often be avoided.

The last third of the pregnancy (third trimester) has specific problems that may arise. Any bleeding must always be assessed as it may signify serious complications that may be life threatening. Unexpected uterine contractions or leakage of fluid prematurely may be signs of premature labor, warranting thorough assessment especially if remote from the due date. Headaches are fairly common in pregnancy, but are usually not severe and tend to resolve with simple painkillers. But if the headaches are severe, and if accompanied by visual disturbance and sudden swelling of the face and hands, this may indicate a condition called pre-eclampsia. The blood pressure usually rises, with grave maternal and fetal complications if left unattended. The baby should remain active throughout,any reduction in fetal movements should be evaluated promptly.

The above symptoms cannot be exhaustive. Sometimes you just don’t feel right. If this the case, please phone for advice and get reassured, rather than predispose yourself to preventable situations.

Why maternal blood group matters in pregnancy

Blood group typing in pregnancy is important for various reasons. Standard blood groups are A, B, AB or O. Each group is additionally labelled either positive (+) or negative (-), which denotes what is called Rhesus factor. The Rhesus factor is a marker on the red blood cells, and majority of people have this factor and are labelled Rhesus positive. However, about one in every ten people are Rhesus negative.

Rhesus negativity in the mother, with a positive father can cause potential problems in pregnancy. The unborn baby inherits blood group and Rhesus factor from either parent, or in combination. If the mother is Rhesus negative and the father positive, the possibility of the baby being Rhesus positive arises, and precautions must be taken to negate potential complications. For practical purposes, the father is usually deemed Rhesus positive once the mother is proven to be Rhesus negative.

If the unborn baby inherits the father’s Rhesus factor and becomes positive, the potential for problems arises. Any cross-over of the unborn baby’s blood into the mother provokes formation of antibodies against the baby’s red blood cells. Such antibodies then cross back through the placenta into the baby, and destroy the unborn baby’s red blood cells. The baby develops anemia whilst still inside the uterus, and in severe cases this leads to serious problems including heart failure. This is called Rhesus disease, and was often fatal in the older days.

So what happens if an expectant mother is Rhesus negative? A blood test is usually done in the second half of the pregnancy to confirm that the mother does not already have antibodies to the Rhesus factor. Then an injection called Anti-D is given to reduce the risks of the mother forming antibodies. Anti-D is 99% effective, and over the years has considerably reduced the number of babies affected by Rhesus disease. Alternatively, novel techniques of confirming the unborn baby’s blood group can be instituted thus avoiding Anti-D if the baby is confirmed to be Rhesus negative. And if both partners are Rhesus negative, nothing further needs to be done.

Rhesus disease is uncommon in first pregnancies as it takes time for the mother to form antibodies. However the risk increases in subsequent pregnancies, and if there is bleeding in pregnancy or the mother undergoes some invasive procedures. Abortions and ectopic pregnancies increase the chance of antibodies being formed, and Anti-D is advised in such situations. Following delivery, the mother usually needs an extra dose of Anti-D if the baby’s blood group turns to be Rhesus positive.

If the expectant mother has already formed antibodies, Anti-D is not useful. The pregnancy must be closely monitored usually by blood tests and ultrasound scans. Severely affected babies may need blood transfusions whilst still in the uterus, and are usually delivered early.