Advice and guidance on the health needs of migrant patients from Paraguay 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 Paraguay 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 typhoid infection in Paraguay.
Be alert for possible cases of Chagas disease, and refer as appropriate, because there is a risk of chronic Chagas disease in migrants from Paraguay.
Consider nutritional and metabolic concerns.
There is a high incidence of TB in Paraguay (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
Paraguay 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
Paraguay 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
Paraguay has the same or lower prevalence of hepatitis C than the UK, so ascertain any risk factors for HCV infection that may indicate the need for screening
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 very low risk of malaria in Paraguay, so:
- test any unwell patient who has travelled to-and-from affected areas of Paraguay in the last year
- remember that malaria can be rapidly fatal
There is a risk of typhoid infection in Paraguay, so:
- ensure that travellers to Paraguay 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 Paraguay
There is a risk of helminth infections in Paraguay, including soil transmitted helminthiasis.
There is a risk of chronic Chagas disease in migrants from Paraguay, so:
- be alert for possible cases
- refer as appropriate
Reproductive health indicators
|Reproductive health indicator||UK||Paraguay|
|Number of children per woman¹||2||3|
|Use of contraception²||82%||72.8%|
|Breast examination or mammography³||75%||13%|
|Cervical cancer screening⁴||70%||53%|
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 low risk of anaemia in adults (estimated prevalence is 5 to 20%) and a moderate risk in pre-school children (estimated prevalence is 20 to 40%), so:
- be alert to this possibility in recently arrived migrants, particularly for 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 risk of vitamin A deficiency in Paraguay.
People from Paraguay may be at risk of iodine induced hyperthyroidism due to excessive intake.
Health indicators and health care
WHO Global Health Observatory has a summary of health indicators and health care in Paraguay.
Culture, politics and history
¹mixed Spanish and Amerindian
Source: The World Factbook.
|Other or unspecified||1.9|
Source: The World Factbook.
Migration to the UK
There were over 700 people from Paraguay living in England and Wales at the time of the 2011 Census.
Source: Office for National Statistics.