Advice and guidance on the health needs of migrant patients from Afghanistan for healthcare practitioners.
If the patient is new to the UK:
- explain to them how the NHS works and their entitlements healthcare
- discuss how this compares to the healthcare system they’ve been used to
- follow guidance on how to comprehensively assess new migrant patients
- ensure that they are up-to-date with the UK immunisation schedule
- ask about any travel plans the patient may have to visit friends and relatives in their country of origin
Screen all new migrants, including children, for tuberculosis (TB).
Consider screening for hepatitis B, particularly among those who have recently arrived. Afghanistan has an intermediate prevalence.
There is a risk of malaria in some areas of Afghanistan.
There is a high risk of typhoid infection in Afghanistan.
Consider nutritional and metabolic concerns.
The incidence of TB in Afghanistan is high (40 to 499 cases per 100,000), so:
- screen all new entrants (including children) for TB according to NICE guidelines
- refer to TB services promptly if screening is positive
- maintain long term vigilance for symptoms of TB even if initial screening is negative
- be aware that TB is a notifiable disease
Sexually transmitted infections and HIV
Take a sexual history, and:
- screen for STIs and HIV according to risk as specified in the UK national standards and guidelines
- test all sexually active patients under the age of 25 for chlamydia
Afghanistan has a low rate of HIV (≤1%), so offer and recommend an HIV test if the patient:
- falls into a high risk group
- is newly registering in a high prevalence area
Afghanistan has an intermediate prevalence of hepatitis B, so:
- consider screening for hepatitis B, particularly those who have recently arrived
- offer screening for hepatitis B to all pregnant women during each pregnancy
- immunise appropriately babies born to mothers who are hepatitis B positive, and follow-up accordingly
- be aware that the UK has a a universal infant immunisation programme for hepatitis B and a selective immunisation programme for higher risk groups
Polio is endemic in Afghanistan, so:
- be alert for signs and symptoms of polio in anyone arriving from Afghanistan, and investigate as appropriate
- ensure all new entrants are brought up to date with the UK immunisation schedule, including polio vaccine as required
- See NaTHNaC for advice about polio vaccine requirements if patients are planning to travel back to Afghanistan, as specific recommendations are in place for long-term visitors (over 4 weeks) to Afghanistan
There is a risk of malaria in some areas of Afghanistan, due to Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax), so:
- test any unwell patient who has travelled to and from affected areas of Afghanistan in the last year
- remember that malaria can be rapidly fatal
There is a high risk of typhoid infection in Afghanistan, so:
- ensure that travellers to Afghanistan are offered typhoid immunisation and advice on prevention of enteric fever
- remember enteric fever in the differential diagnosis of illness in patients with a recent history of travel to or from Afghanistan
There is a risk of helminth infections in Afghanistan, including soil transmitted helminthiasis.
Travel plans and advice
Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin. People who travel to visit friends and relatives (VFR travellers) should visit the Foreign and Commonwealth Office for overseas travel advice and National Travel Health Network and Centre (NaTHNaC) for country specific travel advice prior to leaving the UK.
Nutritional and metabolic concerns
There is a moderate risk of anaemia in adults (estimated prevalence in non-pregnant women is 20 to 40%) and a high risk in pre-school children (estimated prevalence is > 40%) in Afghanistan, so:
- consider the possibility of anaemia in recently arrived migrants, particularly women and pre-school children
- test as clinically indicated
Consider the possibility of vitamin D deficiency in people who may be at risk due to:
- darker skin
- those who are not often outdoors
- those who cover up most of their skin when outdoors
There is a high risk of vitamin A deficiency in Afghanistan.
Reproductive health indicators
|Reproductive health indicator||UK||Afghanistan|
|Children per woman¹||1.7||4.3|
|Use of contraception²||71.7%||18.2%|
¹lifetime average ²by woman of reproductive age or partner
No data are available on:
- mammography screening rates
- cervical cancer screening rates
Health indicators and health care
WHO Global Health Observatory has a summary of health indicators and health care in Afghanistan.
Culture, politics and history
|Afghan Persian or Dari²||78|
¹percentages do not sum to 100% as there is much bilingualism ²official; Dari functions as the lingua franca
Source: The World Factbook.
|Sunni Muslim||84.7 to 89.7|
|Shia Muslim||10 to 15|
Source: The World Factbook.
Migration to the UK
There were almost 63,000 people from Afghanistan living in England and Wales at the time of the 2011 Census.
Source: Office for National Statistics
Afghan relocation and resettlement schemes: advice for primary care
Public Health England has produced.
Guidance on individual health assessments for Afghan refugees is available. It has been produced by the Office for Health Improvement and Disparities, NHS England and Improvement London, working with London Councils, the London Association of Directors of Public Health and the UK Health Security Agency.