Guidance

India: migrant health guide

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

Be advised that there is a high burden of multi drug resistant tuberculosis (MDR-TB) in India.

Determine any risk factors for hepatitis B infection that may indicate the need for screening. India has a low prevalence of hepatitis B.

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.

Be advised that there is a high risk of malaria in some areas of India.

Be advised that there is a high risk of typhoid infection in India.

Find out more about children’s health.

Infectious diseases

Immunisation

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

Tuberculosis (TB)

The incidence of TB in India is high (40 to 499 cases per 100,000), and there is also a high burden of MDR-TB, so:

  • screen all new entrants (including children) for TB according to NICE guidelines
  • refer to TB services promptly if screening is positive
  • seek advice, if you are a local TB service, from the MDR-TB Clinical Advice Service before treating patients from India for TB
  • 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

India 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

India 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

India has a 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 India, mainly due to P. falciparum and P. vivax., so:

Typhoid

There is a high risk of typhoid infection in India, so:

  • ensure that travellers to India 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 India

Helminths

There is a risk of helminth infections in India, including:

  • lymphatic filariasis
  • soil transmitted helminthiasis

Women’s health

Reproductive health indicators

Reproductive health indicator UK India
Children per woman¹ 2 3
Use of contraception² 82% 56.3%
Breast examination or mammography³ 75% 2%
Cervical cancer screening⁴ 70% 3%

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

Female genital mutilation

Female genital mutilation (FGM) has occasionally been documented in India.


Find out more about women’s health.

Nutritional and metabolic concerns

Anaemia

There is a high risk of anaemia in adults (estimated prevalence in non-pregnant women is >40%), and in pre-school children (estimated prevalence is >40%), in India, 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 India.

Country profile

Health indicators and health care

WHO Global Health Observatory has a summary of health indicators and healthcare in India.

Culture, politics and history

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

Languages

Language Population (%)
Hindi 41
Bengali 8.1
Telugu 7.2
Marathi 7
Tamil 5.9
Other 5.9
Urdu 5
Gujarati 4.5
Kannada 3.7
Malayalam 3.2
Oriya 3.2
Punjabi 2.8
Assamese 1.3
Maithili 1.2

Source: The World Factbook.


Find out about language interpretation.

Religions

Religion Population (%)¹
Hindu 80.5
Muslim 13.4
Christian 2.3
Sikh 1.9
Other 1.8
Unspecified 0.1

¹2001 census

Source: The World Factbook.

Migration to the UK

There were almost 694,000 people from India living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics © Crown Copyright 2014.

Published 31 July 2014
Last updated 8 April 2016 + show all updates
  1. Updated advice on testing for hep B and awareness of FGM, based on current prevalence in India.
  2. First published.