Guidance

Malawi: migrant health guide

Advice and guidance on the health needs of migrant patients from Malawi 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 Malawi, 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. Malawi has a high prevalence.

Consider screening for hepatitis C, because Malawi 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 Malawi.

There is a risk of typhoid infection in Malawi.

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 Malawi (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

There is a high rate of HIV in Malawi (>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 Malawi 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

Malawi 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

Hepatitis C

Malawi 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 Malawi, so:

Typhoid

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

  • ensure that travellers to Malawi 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 Malawi

Helminths

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

  • schistosomiasis
  • lymphatic filariasis
  • soil transmitted helminthiasis

Women’s health

Reproductive health indicators

Reproductive health indicator UK Malawi
Number of children per woman¹ 2 6
Use of contraception² 82% 41.7%
Breast examination or mammography³ 75% 0%
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

Nutritional and metabolic concerns

Anaemia

There is a low risk of anaemia in adults (estimated prevalence is 5 to 20%) and a high risk in pre-school children (estimated prevalence is >40%), so:

  • be alert to this possibility in recently arrived migrants, particularly for 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 Malawi.

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

The main languages used in Malawi are:

  • English (official)
  • Chichewa (common)
  • Chinyanja
  • Chiyao
  • Chitumbuka
  • Chilomwe
  • Chinkhonde
  • Chingoni
  • Chisena
  • Chitonga
  • Chinyakyusa
  • Chilambya

Source: The World Factbook.

Religions

Religion Population (%)
Christian 82.6
Muslim 13
Other 1.9
None 2.5

Source: The World Factbook.

Migration to the UK

There were almost 16,000 people from Malawi living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics

Published 31 July 2014