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If the patient is new to the UK:

• explain to them how the NHS works and their entitlements healthcare
• discuss how this compares to the healthcare system theyve 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 migrants, including children, for tuberculosis (TB).

Consider screening for hepatitis B, particularly among those who have recently arrived. Afghanistan has an intermediate prevalence.

Be alert for signs and symptoms of polio, and ensure vaccination as required, because polio is endemic in Afghanistan.

There is a risk of malaria in some areas of Afghanistan.

There is a high risk of typhoid infection in Afghanistan.

Consider nutritional and metabolic concerns.

Infectious diseases

Immunisation

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

Tuberculosis (TB)

The incidence of TB in Afghanistan is high (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

Afghanistan 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

Afghanistan 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 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 consider screening for hepatitis C if other risk factors apply.

Polio

Polio is endemic in Afghanistan, so:

• be alert for signs and symptoms of polio in anyone arriving from Afghanistan, 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 Afghanistan, as specific recommendations are in place for long-term visitors (over 4 weeks) to Afghanistan

Malaria

There is a risk of malaria in some areas of Afghanistan, due to Plasmodium falciparum (P. falciparum) and Plasmodium vivax (P. vivax), so:

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

Typhoid

There is a high risk of typhoid infection in Afghanistan, so:

• ensure that travellers to Afghanistan 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 Afghanistan

Helminths

There is a risk of helminth infections in Afghanistan, including soil transmitted helminthiasis.

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%) in Afghanistan, so:

• consider 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 high risk of vitamin A deficiency in Afghanistan.

Womens health

Reproductive health indicators

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