Guidance

Djibouti: migrant health guide

Advice and guidance on the health needs of migrant patients from Djibouti 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).

Offer and recommend an HIV test to all adults from Djibouti, 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. Djibouti has a high 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 Djibouti.

Female genital mutilation (FGM) has been estimated to affect more than 80% of women and girls in Djibouti.

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 very high incidence of TB in Djibouti (>500 cases/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

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

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 Djibouti 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

Djibouti has a high 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

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 Djibouti, mainly due to P. falciparum., so:

Typhoid

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

  • ensure that travellers to Djibouti 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 Djibouti

Helminths

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

Women’s health

Reproductive health indicators

Reproductive health indicator UK Djibouti
Number of children per woman¹ 2 4
Use of contraception² 82% 17.8%

¹lifetime average; ²by woman of reproductive age or partner

No data are available on:

  • mammography screening rates
  • cervical cancer screening rates

Female genital mutilation

Female genital mutilation (FGM) has been estimated to affect more than 80% of women and girls in Djibouti, so be advised that:

  • children born in the UK may be at risk of FGM during visits to friends and relatives in Djibouti
  • it is illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM, whether or not it is lawful in Djibouti

If you are concerned that a British citizen may be taken overseas for the purpose of FGM, please call the Foreign and Commonwealth Office on 020 7008 1500, or email fgm@fco.gov.uk.

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 Djibouti.

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

The main languages used in Djibouti are:

  • French (official)
  • Arabic (official)
  • Somali
  • Afar

Source: The World Factbook.

Religions

Religion Population (%)
Muslim 94
Christian 6

Source: The World Factbook.

Migration to the UK

There were over 400 people from Djibouti living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics.

Published 31 July 2014