Eswatini (Swaziland): migrant health guide
Advice and guidance on the health needs of migrant patients from Eswatini (Swaziland) 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).
Offer and recommend an HIV test to all adults from Eswatini, 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. Eswatini has a high 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 high risk of malaria in Eswatini.
Consider nutritional and metabolic concerns.
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 Eswatini (40 to 499 cases/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 Eswatini (>1%), so:
- offer and recommend an HIV test to all adults 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 Swaziland 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
Swaziland 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
Swaziland 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 high risk of malaria in Eswatini, so:
- test any unwell patient who has travelled to-and-from affected areas of Eswatini in the last year
- remember that malaria can be rapidly fatal
Typhoid
There is a risk of typhoid infection in Eswatini, so:
- ensure that travellers to Eswatini 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 Swaziland
Helminths
There is a risk of helminth infections in Eswatini, including:
- schistosomiasis
- soil transmitted helminthiasis
Women’s health
Reproductive health indicators
| Reproductive health indicator | UK | Eswatini |
|---|---|---|
| Number of children per woman¹ | 2 | 4 |
| Use of contraception² | 82% | 46% |
| Breast examination or mammography³ | 75% | 5% |
| Cervical cancer screening⁴ | 70% | 4% |
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
Anaemia
There is a low risk of anaemia in adults (estimated prevalence is 5 to 20%) and a high risk in pre-school children (estimated prevalence is >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 high risk of vitamin A deficiency in Eswatini.
Country profile
Health indicators and health care
WHO Global Health Observatory has a summary of health indicators and health care in Eswatini.
Culture, politics and history
BBC News and The World Factbook provide background information on the culture, politics and history of Eswatini.
Languages
The main languages used in Eswatini are:
- English (official, used for government business)
- siSwati (official)
Source: The World Factbook
Religions
| Religion | Population (%) |
|---|---|
| Zionist¹ | 40 |
| Roman Catholic | 20 |
| Muslim | 10 |
| Other² | 30 |
¹a blend of Christianity and indigenous ancestral worship; ²includes Anglican, Baha’i, Methodist, Mormon, Jewish
Source: The World Factbook
Migration to the UK
There were over 1,000 people from Eswatini living in England and Wales at the time of the 2011 Census.
Source: Office for National Statistics
Last updated 30 May 2019 + show all updates
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Updated country name from Swaziland to Eswatini. Updated TB guidance based on the latest World Health Organization (WHO) data.
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First published.