Guidance

Belize: migrant health guide

Advice and guidance on the health needs of migrant patients from Belize for healthcare practitioners.

Published 31 July 2014

From:: Public Health England

Main messages

If the patient is new to the UK:

explain to them how the NHS works
discuss how this compares to the healthcare system they’ve been used to

Ensure that all patients are up-to-date with the UK immunisation schedule.

Offer and recommend an HIV test to all adults from Belize, and consider offering an HIV test to infants and children who have recently arrived in the UK.

Offer to all sexually active individuals:

a full sexual health screen
safer sex health promotion advice

Consider screening for hepatitis B, particularly among those who have recently arrived. Belize has an intermediate prevalence.

Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin, and see National Travel Health Network and Centre (NaTHNaC), or the Health Protection Scotland websites (TRAVAX and fitfortravel), for travel advice.

There is a risk of typhoid infection in Belize.

Be alert for possible cases of Chagas disease, and refer as appropriate, because there is a risk of chronic Chagas disease in migrants from Belize.

Consider nutritional and metabolic concerns.

Infectious diseases

Immunisation

Ensure that all patients, especially children, are up-to-date with the UK immunisation schedule. See Immunisation collection with complete schedules.

Tuberculosis

There is a low incidence of TB in Belize (<40 cases/100,000), so:

routine screening for TB is not required
consider testing in patients (including children) who show signs and symptoms
be aware that TB is a notifiable disease

Sexually transmitted infections and HIV

There is a high rate of HIV in Belize (>1%), so:

offer and recommend an HIV test to all adults according to UK national testing guidelines
consider offering an HIV test to infants and children who have recently arrived in the UK according to UK national testing guidelines

Although recent global data on STIs are not available, countries with high HIV rates tend to have higher rates of STIs, and the range of STIs encountered in Belize may vary from those in the UK, so offer to sexually active individuals:

a full sexual health screen
safer sex health promotion advice by referral to local genito-urinary medicine services

Hepatitis B

Belize 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 selective immunisation programme for hepatitis B

Hepatitis C

Belize has the same or lower prevalence of hepatitis C than the UK, so ascertain any risk factors for HCV infection that may indicate the need for screening.

Travel plans and advice

Malaria

There is a very low risk of malaria in Belize, mainly due to P. vivax, so:

test any unwell patient who has travelled to-and-from affected areas of Belize in the last year
remember that malaria can be rapidly fatal

Typhoid

There is a risk of typhoid infection in Belize, so:

ensure that travellers to Belize 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 Belize

Helminths

There is a risk of helminth infections in Belize, including soil transmitted helminthiasis

Chagas

There is a risk of chronic Chagas disease in migrants from Belize, so:

be alert for possible cases
refer as appropriate

Women’s health

Reproductive health indicators

Reproductive health indicator	UK	Belize
Number of children per woman¹	2	3

¹lifetime average

No data are available on:

contraceptive use
mammography screening rates
cervical cancer screening rates

Nutritional and metabolic concerns

Anaemia

There is a moderate risk of anaemia in adults (estimated prevalence in non-pregnant women is 20 to 40%) and pre-school children (estimated prevalence is 20 to 40%), so:

be alert to the possibility of anaemia in recently arrived migrants, particularly women and pre-school children
test as clinically indicated

Vitamin D

Consider the possibility of vitamin D deficiency in people who may be at risk due to:

covering their body for cultural or religious reasons (lack of sunlight)
skin colour
diet (vegan or vegetarian)

Vitamin A

There is a risk of vitamin A deficiency in Belize.

Country profile

Health indicators and health care

WHO Global Health Observatory has a summary of health indicators and health care in Belize.

Culture, politics and history

BBC News and The World Factbook provide background information on the culture, politics and history of Belize.

Languages

Language	Population (%)
Spanish	46
Creole	32.9
Mayan dialects	8.9
English (official)	3.9
Garifuna (Carib)	3.4
German	3.3
Other	1.4
Unknown	0.2

Source: The World Factbook

Religions

Religion	Population (%)
Roman Catholic	39.3
Pentecostal	8.3
Seventh Day Adventist	5.3
Anglican	4.5
Mennonite	3.7
Baptist	3.5
Methodist	2.8
Nazarene	2.8
Jehovah’s Witness	1.6
Other¹	9.9
Unknown	3.1
None	15.2

¹includes Baha’i Faith, Buddhism, Hinduism, Islam, and Mormon