Pakistan: migrant health guide
Advice and guidance on the health needs of migrant patients from Pakistan 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 Pakistan.
Consider screening for hepatitis B, particularly among those who have recently arrived, because Pakistan has an intermediate prevalence.
Consider screening for hepatitis C, because Pakistan has a considerably higher prevalence than the UK.
Be alert for signs and symptoms of polio, and ensure vaccination as required, because polio is endemic in Pakistan.
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 malaria in some areas of Pakistan.
Be advised that there is a high risk of typhoid infection in Pakistan.
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 Immunisation collection with complete schedules.
Tuberculosis (TB)
The incidence of TB in Pakistan is high (40 to 499 cases per 100,000), and there is also a high burden of MDR-TB, so:
- screen all new entrants, including children, 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 Pakistan 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
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
Pakistan 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
Pakistan 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
Pakistan has a considerably higher prevalence of hepatitis C than the UK, so consider screening for hepatitis C.
Polio
Polio is endemic in Pakistan, so:
- be alert for signs and symptoms of polio in anyone arriving from Pakistan, and investigate as appropriate
- ensure all new entrants are brought up to date with the UK immunisation schedule, including polio vaccine as required
- See NaTHNaC for advice about polio vaccine requirements if patients are planning to travel back to Pakistan, as specific recommendations are in place for long-term visitors (over 4 weeks) to Pakistan
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 some areas of Pakistan, mainly due to P. falciparum and P. vivax, so:
- test any unwell patient who has travelled to-and-from affected areas of Pakistan in the last year
- remember that malaria can be rapidly fatal
Typhoid
There is a high risk of typhoid infection in Pakistan, so:
- ensure that travellers to Pakistan 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 Pakistan
Helminths
There is a risk of helminth infections in Pakistan, including:
- lymphatic filariasis
- soil transmitted helminthiasis
Women’s health
Reproductive health indicators
| Reproductive health indicator | UK | Pakistan |
|---|---|---|
| Number of children per woman¹ | 2 | 4 |
| Use of contraception² | 82% | 27.6% |
| Breast examination or mammography³ | 75% | 1% |
| Cervical cancer screening⁴ | 70% | 3% |
¹lifetime average; ²by woman of reproductive age or partner; ³women aged 50 to 69 years; ⁴women 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 people from Pakistan (estimated prevalence in non-pregnant women 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 risk of vitamin A deficiency in Pakistan.
Iodine
People from Pakistan may be at risk of severe iodine deficiency due to inadequate intake.
Country profile
Health indicators and health care
WHO Global Health Observatory has a summary of health indicators and health care in Pakistan.
Culture, politics and history
BBC News and The World Factbook provide background information on the culture, politics and history of Pakistan.
Languages*
| Language | Population (%) |
|---|---|
| Punjabi | 48 |
| Sindhi | 12 |
| Saraiki¹ | 10 |
| Pasto² | 8 |
| Urdu³ | 8 |
| English⁴, Burushaski and other | 8 |
| Balochi | 3 |
| Hindko | 2 |
| Brahui | 1 |
¹a Punjabi variant; ²or Pashtu; ³official; ⁴official lingua franca of Pakistan elite and most government ministries
*Source: The World Factbook
Find out about language interpretation.
Religions*
| Religion | Population (%)¹ |
|---|---|
| Muslim² | 96.4 |
| Other³ | 3.6 |
¹2010 est.²Sunni 85 to 90%; Shia 10 to 15%; ³includes: Christian and Hindu
*Source: The World Factbook
Migration to the UK
At the time of the 2011 census there were over 482,000 people from Pakistan living in England and Wales.
Source: Office for National Statistics
Updates to this page
Last updated 29 June 2017 + show all updates
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Updated and made editorial changes to meet GOV.UK style.
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First published.