104  Preventive Care and Screening

104.1 Introduction

Preventive health care during adolescence lays the foundation for lifelong wellness. It is during these years that many lifelong habits—both protective and harmful—are formed. In Ghana and across West Africa, adolescents face a complex blend of opportunities and vulnerabilities, including nutritional transitions, rising rates of non-communicable diseases, continued exposure to infectious diseases, and significant mental and reproductive health needs. Providing effective preventive care therefore requires an approach that is comprehensive, culturally sensitive, adolescent-friendly, and grounded in evidence.

Preventive care is more than the early detection of disease. It includes building rapport, identifying risks, counselling, empowering adolescents, and supporting families and communities. This chapter blends narrative explanation with clear, structured elements to guide clinicians in practical implementation.

104.2 Goals of Preventive Adolescent Care

Preventive care aims to:

• Promote healthy physical, mental, and social development.
• Detect risks and conditions early, including mental health problems, substance use, and chronic illnesses.
• Provide age-appropriate health education (nutrition, hygiene, sexual health).
• Strengthen protective factors such as resilience, school engagement, supportive family relationships.
• Create a trusting and confidential environment for adolescents within the health system.

These goals require a longitudinal approach: preventive care is not a one-time visit but an ongoing relationship.

104.3 Core Components of the Preventive Visit

104.3.1 1. Building Rapport and Ensuring Confidentiality

Adolescents are more likely to disclose sensitive information when they trust the clinician. This requires:

• Introducing confidentiality clearly (including its limits).
• Speaking directly to the adolescent, not only to the caregiver.
• Creating a non-judgmental environment.
• Allowing private time with the adolescent during the consultation.

In Ghanaian settings, caregivers may expect to remain throughout the consultation; clinicians must balance cultural expectations with adolescents’ rights.

104.3.2 2. Comprehensive History

A structured approach such as HEADSSS remains most effective:

• Home and family environment
  
• Education and school performance
  
• Activities and peer relationships
  
• Drugs (including alcohol and tobacco)
  
• Sexuality and relationships
  
• Safety exposures
  
• Suicide, mood, and mental health

Narrative exploration within these domains helps uncover risk factors not immediately apparent from physical symptoms.

104.3.3 3. Physical Examination

A full examination should be performed at least annually. Key elements include:

• Growth parameters (height, weight, BMI-for-age)
• Tanner staging
• Blood pressure
• Assessment for signs of anaemia, chronic disease, thyroid disease, scoliosis, or dermatological conditions
• Vision and hearing (as available)

The exam provides opportunities to discuss body image, self-care, and normal developmental variations.

104.4 Screening Priorities in Adolescents

104.4.1 Infectious Diseases

While the burden of infectious diseases is decreasing globally, infections remain a major issue in Ghanaian adolescents. Screening should be tailored to risk, but may include:

• HIV testing (opt-out recommended by WHO from age 15)
  
• Hepatitis B screening in high-risk adolescents
  
• Tuberculosis symptom screening, especially in overcrowded settings
  
• STI screening (gonorrhoea, chlamydia, syphilis) for sexually active adolescents

In many communities, stigma limits disclosure of sexual activity; clinicians must therefore maintain a supportive, confidential approach.

104.4.2 Non-Communicable Disease Screening

Changes in diet and lifestyle in urban areas have led to rising metabolic risk factors. Key screening areas include:

• Hypertension (blood pressure annually)
  
• Obesity and overweight (BMI-for-age percentiles)
  
• Dyslipidaemia in overweight adolescents or those with family history
  
• Type 2 diabetes risk in adolescents with obesity or acanthosis nigricans

These screenings are particularly important in school health programmes.

104.4.3 Mental Health

Mental health remains one of the most under-recognised aspects of adolescent preventive care in Ghana. Screening should include:

• Mood (depression and anxiety)
  
• Sleep patterns
  
• Stressors at home or school
  
• Experiences of bullying or violence
  
• Substance use
  
• Body image concerns

Simple validated tools like PHQ-9A or GAD-7 can be applied where available, but narrative exploration remains valuable in low-resource settings.

104.4.4 Reproductive Health Screening

Includes:

• Menstrual health (cycle, pain, flow, anaemia risk)
• Contraceptive needs and counselling
• Screening for sexual violence or coercion
• Discussion of fertility myths and misconceptions
• Testicular health and self-examination in boys

In many communities, adolescents lack accurate reproductive health information; preventive visits offer an opportunity for education.

104.4.5 Nutritional Assessment

Given the double burden of malnutrition (stunting and obesity), assessment should consider:

• Dietary diversity
• Iron intake and anaemia risk
• Calcium and vitamin D adequacy
• Eating habits and body dissatisfaction

Nutrition counselling must be culturally aware, especially regarding high-carbohydrate staple diets.

104.4.6 Safety and Injury Prevention

Screening involves discussions on:

• Road traffic safety (helmet and seatbelt use)
• Alcohol-related risks
• Cyberbullying and online safety
• Domestic violence
• Occupational hazards (e.g., apprenticeships with electrical/mechanical exposure)

104.5 Immunisation in Adolescents

Adolescents require catch-up immunisation, as many may have missed doses during early childhood. Key vaccines include:

• HPV vaccine (now recommended for adolescents aged 9–14 in Ghana)
• Td or Tdap booster
• Hepatitis B if not completed earlier
• COVID-19 vaccination where applicable
• MMR and Varicella for those without documented immunity

School-based HPV vaccination programmes remain crucial in low-resource settings.

104.6 Lifestyle Counselling

Preventive care includes ongoing counselling about:

• Healthy eating and avoidance of ultra-processed foods
• Regular physical activity
• Adequate sleep hygiene
• Responsible media and digital use
• Avoidance of alcohol, tobacco, and substances
• Managing academic pressures

Counselling should be practical, context-aware, and respectful of family food availability and socioeconomic realities.

104.7 The Adolescent Preventive Visit: A Practical Flow

A typical adolescent preventive visit in a Ghanaian clinic may follow this pattern:

1. Greeting and rapport building
   
2. Confidentiality explanation
   
3. History using HEADSSS
   
4. Growth and vital signs assessment
   
5. Physical examination
   
6. Screening tests (HIV, STI, BP, mental health, etc.)
   
7. Counselling and health education
   
8. Immunisation updates
   
9. Caregiver discussion (when appropriate)
   
10. Plan and follow-up

This flow balances the adolescent’s privacy with the involvement of caregivers.

104.8 Challenges to Preventive Care in Ghana

• Limited privacy in many health facilities
  
• Sociocultural barriers to discussing sexuality
  
• Stigma surrounding mental health
  
• Shortage of adolescent-trained health workers
  
• Out-of-pocket costs for screening tests
  
• High patient load limiting time for counselling
  
• Incomplete school health programmes

Addressing these barriers requires system-wide collaboration between the Ghana Health Service, schools, communities, and policymakers.

104.9 Key Points

• Preventive care in adolescence is essential for identifying risks early and promoting healthy development.
  
• The HEADSSS framework supports comprehensive psychosocial assessment.
  
• Screening should include infectious diseases, NCD risks, mental health, reproductive health, and safety concerns.
  
• Immunisation and lifestyle counselling are central components of preventive adolescent care.
  
• Confidentiality, cultural sensitivity, and adolescent-friendly services are crucial for effective engagement.

104.10 Further Reading

1. World Health Organization. Global Standards for Quality Health-Care Services for Adolescents.
   
2. Klein DA, Goldenring JM, Adelman WP. HEADSSS 3.0: The psychosocial interview for adolescents.
   
3. Ministry of Health & Ghana Health Service. National Adolescent Health Strategy.
   
4. Clinical guidelines on adolescent preventive care from the American Academy of Pediatrics.
   
5. Sawyer SM et al. The health of adolescents: a global perspective. Lancet.