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Main messages

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
• refer to TB services promptly if screening is positive
• seek advice, if you are a local TB service, from the 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 (鈮�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 .

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 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 , or the Health Protection Scotland websites ( and ), for travel advice.

Malaria

There is a risk of malaria in some areas of Pakistan, mainly due to P. falciparum and P. vivax, so:

• who has travelled to-and-from 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鈥檚 health

Reproductive health indicators

Reproductive health indicator	UK	Pakistan
Number of children per woman鹿	2	4
Use of contraception虏	82%	27.6%
Breast examination or mammography鲁	75%	1%
Cervical cancer screening鈦�	70%	3%

鹿lifetime average; 虏by woman of reproductive age or partner; 鲁women aged 50 to 69 years; 鈦磜omen aged 20 to 69 years

Find out more about women鈥檚 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

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

Culture, politics and history

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

Languages*

Language	Population (%)
Punjabi	48
Sindhi	12
厂补谤补颈办颈鹿	10
笔补蝉迟辞虏	8
鲍谤诲耻鲁	8
English鈦�, Burushaski and other	8
Balochi	3
Hindko	2
Brahui	1

鹿a Punjabi variant; 虏or Pashtu; 鲁official; 鈦磑fficial lingua franca of Pakistan elite and most government ministries

*Source:

Find out about language interpretation.

Religions*

Religion	Population (%)鹿
惭耻蝉濒颈尘虏	96.4
翱迟丑别谤鲁	3.6

鹿2010 est.虏Sunni 85 to 90%; Shia 10 to 15%; 鲁includes: Christian and Hindu

*Source:

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: