Guidance

Madagascar: migrant health guide

Advice and guidance on the health needs of migrant patients from Madagascar for healthcare practitioners.

From:
Public Health England
Published
31 July 2014
Last updated
20 September 2021 — See all updates

Main messages

If the patient is new to the UK:

Screen all new entrants, including children, for tuberculosis (TB).

Due to an intermediate prevalence, consider screening for hepatitis B, particularly among those who have recently arrived.

There is a high risk of malaria.

There is a risk of typhoid infection.

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 Madagascar (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

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

Madagascar 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

Hepatitis B

Madagascar 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 universal infant immunisation programme for hepatitis B and a selective immunisation programme for higher risk groups

Hepatitis C

The prevalence of hepatitis C is similar to or lower than the UK, so ascertain any risk factors for HCV infection that may indicate the need for screening.

Malaria

There is a high risk of malaria in Madagascar, mainly due to P. falciparum, so:

  • test any unwell patient who has travelled to and from affected areas of Madagascar in the last year
  • remember that malaria can be rapidly fatal

Typhoid

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

  • ensure that travellers to Madagascar 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 Madagascar

Helminths

There is a risk of soil transmitted helminth infections.

Travel plans and advice

Ask opportunistically about any travel plans the patient may have to visit friends and relatives in their country of origin. People who travel to visit friends and relatives (VFR travellers) should visit the Foreign and Commonwealth Office for overseas travel advice and National Travel Health Network and Centre (NaTHNaC) for country specific travel advice prior to leaving the UK.

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 a high risk in pre-school children (estimated prevalence is >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:

  • darker skin
  • those who are not often outdoors
  • those who cover up most of their skin when outdoors

Vitamin A

There is a risk of vitamin A deficiency.

Iodine

There may be a risk of risk of mild iodine deficiency due to inadequate intake.

Women’s health

Reproductive health indicators

Reproductive health indicator UK Madagascar
Number of children per woman¹ 1.7 4.0
Use of contraception² 71.7% 44.3%

¹lifetime average; ²by woman of reproductive age or partner

Country profile

Health indicators and health care

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

Culture, politics and history

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

Languages

Language Population (%)
Malagasy (official) 99.9
French (official) 23.6
English 8.2
Other 0.6

Source: The World Factbook

Religions

The main religions in Madagascar are:

  • Christian
  • Indigenous religions
  • Muslim

Source: The World Factbook

Migration to the UK

There were over 1,000 people from Madagascar living in England and Wales at the time of the 2011 Census.

Source: Office for National Statistics

Updates to this page

Published 31 July 2014
Last updated 20 September 2021 + show all updates

  1. Updated country guidance on prevalence of communicable diseases and other health topics.

  2. First published.

Sign up for emails or print this page

Contents

Related content