Guidance

Madagascar: migrant health guide

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

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

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

Be alert for signs and symptoms of polio, and ensure vaccination as required, because polio (wild polio or cVDPV) has recently been reported in Madagascar.

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 Madagascar.

There is a risk of typhoid infection in Madagascar.

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 Madagascar (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

Madagascar 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

Madagascar 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

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

Polio

Polio (wild polio or cVDPV) has been reported in Madagascar, so:

  • be alert for signs and symptoms of polio in anyone arriving from Madagascar, and investigate as appropriate
  • ensure all new entrants are brought up to date with the UK immunisation schedule, including polio vaccine as required
  • see NaTHNaC for advice about polio vaccine requirements if patients are planning to travel back to Madagascar, as specific advice is in place for long-term visitors (over 4 weeks) to Madagascar

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 Madagascar, mainly due to P. falciparum, so:

Typhoid

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

  • ensure that travellers to Madagascar 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 Madagascar

Helminths

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

  • schistosomiasis
  • lymphatic filariasis
  • soil transmitted helminthiasis

Women’s health

Reproductive health indicators

Reproductive health indicator UK Madagascar
Number of children per woman¹ 2 5
Use of contraception² 82% 27.1%

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 Madagascar.

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

The main languages used in Madagascar are:

  • French (official)
  • Malagasy (official)
  • English

Source: The World Factbook

Religions

Religion Population (%)
Indigenous beliefs 52
Christian 41
Muslim 7

Source: The World Factbook

Migration to the UK

There were over 1,000 people from Madagascar living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics

Published 31 July 2014