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Main messages

If the patient is new to the UK:

• explain to them how the NHS works and their entitlements to healthcare
• discuss how this compares to the healthcare system they鈥檝e been used to
• follow guidance on how to comprehensively assess new migrant patients
• ensure that they are up-to-date with the UK immunisation schedule
• ask about any travel plans the patient may have to visit friends and relatives in their country of origin

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

Offer and recommend an HIV test to all adults from Malawi, 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

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

The prevalence of HTLV is high.

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 Malawi (40 to 499 cases per 100,000), so:

• screen all new entrants (including children) for TB according to
• 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 Malawi (>1%), so:

• offer and recommend an HIV test to all adults according to .
• consider offering an HIV test to infants and children who have recently arrived in the UK according to

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 Malawi 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

HTLV

The prevalence of Human T-cell lymphotropic virus (HTLV) is high. Refer to further HTLV guidance about testing and treatment.

Hepatitis B

There is 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 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 higher than the UK, so if other risk factors apply.

Malaria

There is a high risk of malaria in Malawi, so:

• test any unwell patient who has travelled to or from in the last year
• remember that malaria can be rapidly fatal

Typhoid

There is a risk of typhoid infection, so:

• ensure that travellers 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 this country

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 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.

Women鈥檚 health

Reproductive health indicators

Reproductive health indicator	UK	Malawi
Number of children per woman鹿	1.7	4.1
Use of contraception虏	71.7%	59.2%

鹿lifetime average; 虏by woman of reproductive age or partner

Country profile

Health indicators and health care

has a summary of health indicators and health care in Malawi.

Culture, politics and history

and provide background information on the culture, politics and history of Malawi.

Languages

The main languages used in Malawi are:

• English (official)
• Chewa (common)鹿
• Lambya
• Lomwe
• Ngoni
• 狈办丑辞苍诲别虏
• 狈测补办测耻蝉补虏
• 狈测补苍箩补鹿
• Sena
• Tonga
• Tumbuka
• Yao

鹿Chewa and Nyanja are mutually intelligible dialects; 虏Nkhonde and Nyakyusa are mutually intelligible dialects

Source: .

Religions

Religion	Population (%)
笔谤辞迟别蝉迟补苍迟鹿	33.5%
Roman Catholic	17.2
Other Christian	26.6
Muslim	13.8
Traditionalist	1.1
Other	5.6
None	2.1

鹿includes Church of Central Africa Presbyterian 14.2%, Seventh Day Adventist/Baptist 9.4%, Pentecostal 7.6%, Anglican 2.3%

Source: .

Migration to the UK

There were almost 16,000 people from Malawi living in England and Wales at the time of the 2011 Census.

Source: