Sierra Leone: migrant health guide
Advice and guidance on the health needs of migrant patients from Sierra Leone 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.
Be aware that there has been an outbreak of Ebola in Sierra Leone.
Screen all new entrants, including children, for tuberculosis (TB).
Offer and recommend an HIV test to all adults from Sierra Leone, and consider offering an HIV test to infants and children who have recently arrived in the UK.
Offer to all sexually active individuals:
- a full sexual health screen
- safer sex health promotion advice
Consider screening for hepatitis B, particularly among those who have recently arrived, because Sierra Leone has a high prevalence.
Consider screening for hepatitis C, because Sierra Leone 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 the National Travel Health Network and Centre (NaTHNaC) for travel advice.
Be advised that there is a high risk of malaria in Sierra Leone.
Be advised that there is a risk of typhoid infection in Sierra Leone.
Be aware that female genital mutilation (FGM) has been estimated to affect more than 80% of women and girls in Sierra Leone.
Consider nutritional and metabolic concerns.
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 the immunisation collection with complete schedules.
Tuberculosis
There is a high incidence of TB in Sierra Leone (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 Sierra Leone (>1%), so:
- offer and recommend an HIV test according to UK national testing guidelines
- consider offering an HIV test to infants and children who have recently arrived in the UK according to UK national testing guidelines
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 Sierra Leone 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
Sierra Leone has a high 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
Hepatitis C
Sierra Leone 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 NaTHNaC for travel advice.
Malaria
There is a high risk of malaria in Sierra Leone, mainly due to P. falciparum, so:
- test any unwell patient who has travelled to-and-from affected areas of Sierra Leone in the last year
- remember that malaria can be rapidly fatal
Typhoid
There is a risk of typhoid infection in Sierra Leone, so:
- ensure that travellers to Sierra Leone 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 Sierra Leone
Helminths
There is a risk of helminth infections in Sierra Leone, including:
- schistosomiasis
- lymphatic filariasis
- soil transmitted helminthiasis
Women’s health
Reproductive health indicators
| Reproductive health indicator | UK | Sierra Leone |
|---|---|---|
| Children per woman¹ | 2 | 7 |
| Use of contraception² | 82% | 5.3% |
¹lifetime average ²by woman of reproductive age or partner
No data are available on:
- mammography screening rates
- cervical cancer screening rates
Female genital mutilation
Female genital mutilation (FGM) has been estimated to affect more than 80% of women and girls in Sierra Leone, so be advised that:
- children born in the UK may be at risk of FGM during visits to friends and relatives in Sierra Leone
- it is illegal to take girls who are British nationals or permanent residents of the UK abroad for FGM, whether or not it is lawful in Sierra Leone
If you are concerned that a British citizen may be taken overseas for the purpose of FGM, call the Foreign and Commonwealth Office on 020 7008 1500, or email fgm@fco.gov.uk.
Find out more about women’s health.
Nutritional and metabolic concerns
Anaemia
There is a high risk of anaemia in adults (estimated prevalence in non-pregnant women is >40%), and in pre-school children (estimated prevalence is >40%), in Sierra Leone, 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 high risk of vitamin A deficiency in Sierra Leone.
Country profile
Health indicators and health care
WHO Global Health Observatory has a summary of health indicators and health care in Sierra Leone.
Culture, politics and history
BBC News and The World Factbook provide background information on the culture, politics and history of Sierra Leone.
Languages
The main languages used in Sierra Leone are:
- English (official, regular use limited to literate minority)
- Mende (principal vernacular in the south)
- Temne (principal vernacular in the north)
- Krio (English-based Creole, spoken by the descendants of freed Jamaican slaves who were settled in the Freetown area, a lingua franca and a first language for 10% of the population, but understood by 95%)
Source: The World Factbook.
Find out about language interpretation.
Religions
| Religion | Population (%) |
|---|---|
| Muslim | 60 |
| Indigenous beliefs | 30 |
| Christian | 10 |
Source: The World Factbook.
Migration to the UK
There were over 23,000 people from Sierra Leone living in England and Wales at the time of the 2011 Census.
Source: Office for National Statistics © Crown Copyright 2014.
Last updated 18 April 2016 + show all updates
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Updated advice about screening for TB based on current prevalence in Sierra Leone.
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First published.