Guidance

Tunisia: migrant health guide

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

Consider screening for hepatitis B, particularly among those who have recently arrived, because Tunisia 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 National Travel Health Network and Centre (NaTHNaC), or the Health Protection Scotland websites (TRAVAX and fitfortravel), for travel advice.

Be advised that there is a risk of typhoid infection in Tunisia.

Infectious diseases

Immunisation

Ensure that all patients, especially children, are up-to-date with the UK immunisation schedule.

Tuberculosis (TB)

There is a low incidence of TB in Tunisia (<40 cases per 100,000), so:

  • routine screening is not required
  • consider testing in patients (including children) who show signs and symptoms
  • 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

Tunisia 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

Hepatitis B

Tunisia 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

Tunisia 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.

Typhoid

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

  • ensure that travellers to Tunisia 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 Tunisia

Women’s health

Reproductive health indicators

Reproductive health indicator UK Tunisia
Children per woman¹ 2 2
Use of contraception² 82% 62.6%
Breast examination or mammography³ 75% 7%
Cervical cancer screening⁴ 70% 10%

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 moderate risk of anaemia in adults (estimated prevalence in non-pregnant women is 20 to 40%), and in pre-school children (estimated prevalence is 20 to 40%), in Tunisia, 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 Tunisia.

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

Languages used in Tunisia include:

  • Arabic: official, one of the languages of commerce
  • French: commerce
  • Berber (Tamazight)

Source: The World Factbook.

Religions

Religion Population (%)
Muslim¹ 99
Other² 1

¹official: Sunni ²includes Christian, Jewish, Shia Muslim and Baha’i

Source: The World Factbook.

Migration to the UK

There were almost 6,000 people from Tunisia living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics © Crown Copyright 2014.

Published 31 July 2014