Guidance

Rwanda: migrant health guide

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

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

Consider screening for hepatitis C, because Rwanda 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 Rwanda.

There is a risk of typhoid infection in Rwanda.

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 Rwanda (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 Rwanda (>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 Rwanda 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

Rwanda 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

Rwanda 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 Rwanda, mainly due to P. falciparum, so:

Typhoid

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

  • ensure that travellers to Rwanda 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 Rwanda

Helminths

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

  • schistosomiasis
  • soil transmitted helminthiasis

Women’s health

Reproductive health indicators

Reproductive health indicator UK Rwanda
Number of children per woman¹ 2 6
Use of contraception² 82% 17.4%

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 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

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 Rwanda.

Iodine

People from Rwanda 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 Rwanda.

Culture, politics and history

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

Languages

Language Population (%)
Kinyarwanda only¹ 93.2
Kinyarwanda and other language(s) 6.2
French (official) and other language(s) 0.1
English (official) and other language(s) 0.1
Swahili² 0.02
Other 0.03
Unspecified 0.3

¹official, universal Bantu vernacular; ²or Kiswahili, used in commercial centres

Source: The World Factbook.

Religions

Religion Population (%)
Roman Catholic 49.5
Protestant¹ 39.4
Other Christian 4.5
Muslim 1.8
Animist 0.1
Other 0.6
None 3.6
Unspecified 0.5

¹includes Adventist 12.2% and other Protestant 27.2%

Source: The World Factbook.

Migration to the UK

There were over 4,000 people from Rwanda living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics.

Published 31 July 2014