Advice and guidance on the health needs of migrant patients from Nepal for healthcare practitioners.
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).
Ascertain any risk factors for hepatitis B infection that may indicate the need for screening, because Nepal has a low 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 malaria in some areas of Nepal.
There is a high risk of typhoid infection in Nepal.
Consider nutritional and metabolic concerns.
There is a high incidence of TB in Nepal (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
Nepal 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
Nepal has a low 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 universal infant immunisation programme for hepatitis B and a selective immunisation programme for higher risk groups
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.
There is a risk of malaria in some areas of Nepal, mainly due to P. falciparum and P. vivax, so:
- test any unwell patient who has travelled to-and-from affected areas of Nepal in the last year
- remember that malaria can be rapidly fatal
There is a high risk of typhoid infection in Nepal, so:
- ensure that travellers to Nepal 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 Somalia
There is a risk of helminth infections in Nepal, including:
- soil transmitted helminthiasis
Reproductive health indicators
|Reproductive health indicator||UK||Nepal|
|Number of children per woman¹||2||3|
|Use of contraception²||82%||48%|
|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
Nutritional and metabolic concerns
There is a high risk of anaemia in adults (estimated prevalence in non-pregnant women is >40%) and 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
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)
There is a high risk of vitamin A deficiency in Nepal.
Health indicators and health care
WHO Global Health Observatory has a summary of health indicators and health care in Nepal.
Culture, politics and history
¹2011 est.123 languages reported as mother tongue in 2011 national census; many in government and business also speak English; ²official
Source: The World Factbook
Source: The World Factbook
Migration to the UK
There were almost 50,000 people from Nepal living in the UK at the time of the 2011 Census.