Guidance

South Africa: migrant health guide

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

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

Offer and recommend an HIV test to all adults from South Africa, 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 South Africa has an intermediate prevalence.

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.

There is a risk of malaria in some areas of South Africa.

There is a risk of typhoid infection in South Africa.

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 South Africa is high (40 to 499 cases/100,000) and there is also a high burden of Multi Drug Resistant (MDR) TB, so:

  • screen all new entrants (including children) from (country) 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 South Africa 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

There is a high rate of HIV in South Africa (>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 South Africa 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

South Africa 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

South Africa has a higher prevalence of hepatitis C than the UK, so consider screening for hepatitis C if other risk factors apply.

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 South Africa, mainly due to P. falciparum, so:

Typhoid

There is a risk of typhoid infection in South Africa, so:

  • ensure that travellers to South Africa 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 Somalia

Helminths

There is a risk of helminth infections in South Africa, including:

  • schistosomiasis
  • soil transmitted helminthiasis

Women’s health

Reproductive health indicators

Reproductive health indicator UK South Africa
Number of children per woman¹ 2 3
Use of contraception² 82% 60.3%
Breast examination or mammography³ 75% 6%
Cervical cancer screening⁴ 70% 17%

¹lifetime average; ²by woman of reproductive age or partner; ³women aged 50 to 69 years; ⁴ women 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 adults (estimated prevalence in non-pregnant women is 20 to 40%) and pre-school children (estimated prevalence 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 high risk of vitamin A deficiency in South Africa.

Country profile

Health indicators and health care

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

Culture, politics and history

BBC News and The World Factbook have background information on the culture, politics and history of South Africa.

Languages*

Language Population (%)¹
IsiZulu² 22.7
IsiXhosa² 16
Afrikaans² 13.5
English² 9.6
Sepedi² 9.1
Setswana² 8
Sesotho² 7.6
Xitsonga² 4.5
siSwati² 2.5
Tshivenda² 2.4
isiNdebele² 2.1
Other 1.6
Sign language 0.5

¹2011 est. ²official

*Source: The World Factbook


Find out about language interpretation.

Religions*

Religion Population (%)¹
Protestant² 36.6
Other Christian 36
None 15.1
Catholic 7.1
Other 2.3
Muslim 1.5
Unspecified 1.4

¹2001 census; ²includes: Zionist Christian 11.1%, Pentecostal / Charismatic 8.2%, Methodist 6.8%, Dutch Reformed 6.7%, Anglican 3.8%

*Source: The World Factbook

Migration to the UK

At the time of the 2011 census, there were over 191,000 people from South Africa 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.