Guidance

Bolivia: migrant health guide

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

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.

Screen all new entrants, including children, for tuberculosis (TB).

Ascertain any risk factors for hepatitis B infection that may indicate the need for screening, because Bolivia has a low prevalence.

Consider screening for hepatitis C, because Bolivia has a considerably higher prevalence than the UK.

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 high risk of malaria in some areas of Bolivia.

There is a high risk of typhoid infection in Bolivia.

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

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 high incidence of TB in Bolivia (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

Bolivia 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
  • be advised that national guidelines do not recommend routine consideration of HIV testing of infants and children who have recently arrived in the UK

Hepatitis B

Bolivia has a low prevalence of hepatitis B, so:

  • 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

Bolivia has a considerably higher prevalence of hepatitis C than the UK, so consider screening for hepatitis C.

Travel plans and advice

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.

Malaria

There is a high risk of malaria in some areas of Bolivia, due to P. falciparum and P. vivax], so:

Typhoid

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

  • ensure that travellers to Bolivia 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 Bolivia

Helminths

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

Chagas

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

  • be alert for possible cases
  • refer as appropriate

Women’s health

Reproductive health indicators

Reproductive health indicator UK Bolivia
Number of children per woman¹ 2 4
Use of contraception² 82% 58.4%

¹lifetime average; ²by woman of reproductive age or partner; ³women aged 50 to 69 years; ⁴women aged 20 to 69 years

No data are available on:

  • 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 high risk of vitamin A deficiency in Bolivia.

Iodine

People from Bolivia may be at risk of iodine induced hyperthyroidism due to excessive intake.

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

Language Population (%)
Spanish (official) 60.7
Quechua (official) 21.2
Aymara (official) 14.6
Foreign Languages 2.4
Guarani (official) 0.6
Other native languages 0.4
None 0.1

Source: The World Factbook.

Religions

Religion Population (%)
Roman Catholic 95
Protestant (Evangelical Methodist) 5

Source: The World Factbook.

Migration to the UK

There were almost 4,000 people from Bolivia living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics.

Published 31 July 2014