Guidance

Nicaragua: migrant health guide

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

Ascertain any risk factors for hepatitis B infection that may indicate the need for screening, because Nicaragua 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.

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

Be alert for possible cases of Chagas disease, and refer as appropriate, because there is a risk of chronic Chagas disease in migrants from Nicaragua.

Infectious diseases

Immunisation

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

Tuberculosis (TB)

There is a high incidence of TB in Nicaragua (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

Nicaragua 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

Nicaragua 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

Nicaragua 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 low risk of malaria in some areas of Nicaragua, due to P. falciparum and P. vivax, so:

Typhoid

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

  • ensure that travellers to Nicaragua 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 Nicaragua

Helminths

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

Chagas disease

There is a risk of chronic Chagas disease in migrants from Nicaragua, so:

  • be alert for possible cases
  • refer as appropriate

Women’s health

Reproductive health indicators

Reproductive health indicator UK Nicaragua
Children per woman¹ 2 3
Use of contraception² 82% 68.6%

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 low risk of anaemia in adults (estimated prevalence in non-pregnant women is 5 to 20%), and in pre-school children (estimated prevalence is 5 to 20%), in Nicaragua, 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 risk of vitamin A deficiency in Nicaragua.

Iodine

People from Nicaragua may be at risk of iodine induced hyperthyroidism due to excessive intake.

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

Language Population (%)
Spanish¹ 95.3
Miskito 2.2
Mestizo² 2
Other 0.5

¹official ²of the Caribbean coast

Source: The World Factbook.

Religions

Religion Population (%)¹
Roman Catholic 58.5
Protestant² 23.2
None 15.7
Other 1.6
Jehovah’s Witness 0.9

¹2005 est. ²Evangelical 21.6%, Moravian 1.6%

Source: The World Factbook.

Migration to the UK

There were over 300 people from Nicaragua 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 TB and malaria, based on current prevalence in Nicaragua.
  2. First published.