Guidance

Lesotho: migrant health guide

Advice and guidance on the health needs of migrant patients from Lesotho 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 Lesotho, 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. Lesotho has an intermediate prevalence.

Consider screening for hepatitis C, because Lesotho 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 risk of typhoid infection in Lesotho.

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 Lesotho (>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 Lesotho (>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 Lesotho 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

Lesotho 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

Lesotho 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.

Typhoid

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

  • ensure that travellers to Lesotho 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 Lesotho

Helminths

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

Women’s health

Reproductive health indicators

Reproductive health indicator UK Lesotho
Number of children per woman¹ 2 4
Use of contraception² 82% 37.3%

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

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 a high risk in pre-school children (estimated prevalence is >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 Lesotho.

Iodine

People from [country] may be at risk of moderate iodine deficiency due to inadequate intake.

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

The main languages used in Lesotho are:

  • Sesotho (official) (southern Sotho)
  • English (official)
  • Zulu
  • Xhosa

Source: The World Factbook.

Religions

Religion Population (%)
Christian 80
Indigenous beliefs 20

Source: The World Factbook.

Migration to the UK

There were over 700 people from Lesotho living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics.

Published 31 July 2014