Guidance

Pakistan: migrant health guide

Advice and guidance on the health needs of migrant patients from Pakistan 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

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

Screen all new entrants (including children) for tuberculosis (TB).

There is a high burden of multi drug resistant tuberculosis (MDR-TB) in Pakistan.

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

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

Be alert for signs and symptoms of polio, and ensure vaccination as required, because polio is endemic in Pakistan.

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 malaria in some areas of Pakistan.

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

Find out more about children’s health.

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 (TB)

The incidence of TB in Pakistan is high (40 to 499 cases per 100,000), and there is also a high burden of MDR-TB, so:

  • screen all new entrants, including children, for TB according to NICE guidelines
  • refer to TB services promptly if screening is positive
  • seek advice, if you are a local TB service, from the MDR-TB Clinical Advice Service before treating patients from Pakistan for TB
  • 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 (STIs) 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

Pakistan 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

Pakistan 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

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

Polio

Polio is endemic in Pakistan, so:

  • be alert for signs and symptoms of polio in anyone arriving from Pakistan, 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 Pakistan, as specific recommendations are in place for long-term visitors (over 4 weeks) to Pakistan

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

Typhoid

There is a high risk of typhoid infection in Pakistan, so:

  • ensure that travellers to Pakistan 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 Pakistan

Helminths

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

  • lymphatic filariasis
  • soil transmitted helminthiasis

Women’s health

Reproductive health indicators

Reproductive health indicator UK Pakistan
Number of children per woman¹ 2 4
Use of contraception² 82% 27.6%
Breast examination or mammography³ 75% 1%
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


Find out more about women’s health.

Nutritional and metabolic concerns

Anaemia

There is a moderate risk of anaemia in people from Pakistan (estimated prevalence in non-pregnant women is 20 to 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 risk of vitamin A deficiency in Pakistan.

Iodine

People from Pakistan may be at risk of severe 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 Pakistan.

Culture, politics and history

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

Languages*

Language Population (%)
Punjabi 48
Sindhi 12
Saraiki¹ 10
Pasto² 8
Urdu³ 8
English⁴, Burushaski and other 8
Balochi 3
Hindko 2
Brahui 1

¹a Punjabi variant; ²or Pashtu; ³official; ⁴official lingua franca of Pakistan elite and most government ministries

*Source: The World Factbook


Find out about language interpretation.

Religions*

Religion Population (%)¹
Muslim² 96.4
Other³ 3.6

¹2010 est.²Sunni 85 to 90%; Shia 10 to 15%; ³includes: Christian and Hindu

*Source: The World Factbook

Migration to the UK

At the time of the 2011 census there were over 482,000 people from Pakistan living in England and Wales.

Source: Office for National Statistics

Published 31 July 2014
Last updated 29 June 2017 + show all updates
  1. Updated and made editorial changes to meet GOV.UK style.
  2. First published.