The annual Hajj pilgrimage-minimizing the risk of ill health in pilgrims from Europe and opportunity for driving the best prevention and health promotion guidelines

Protection enhancement strategies of potential outbreaks during Hajj

OBJECTIVE

This study aimed to assist governments and organizers of mass gathering events in reviewing existing preventive measures for disease outbreaks to inform the adoption of enhanced strategies for risk reduction and impacts on public health.

DESIGN

A cross-sectional, quantitative, descriptive study.

SETTING

This study was conducted in a mass gathering of Hajj, an annual religious event in Mecca, Saudi Arabia.

PARTICIPANTS

A convenience sample of 70 personnel working in government ministries of Saudi Arabia (Ministry of Health, Ministry of Hajj, and Ministry of Interior) and the Saudi Red Crescent Authority involved in health management in Hajj, including policy formulation and implementation.

MAIN OUTCOME MEASURES

Perception and knowledge of health risks and outbreaks associated with Hajj.

RESULTS

The majority of the respondents (60 percent) expressed concern about the potential for infection transmission during Hajj. The respondents also reported having or knowing a colleague, a friend, or a family member with a history of infection during or after Hajj. However, the respondents' knowledge of the possible modes of infection of various diseases was limited.

CONCLUSIONS

Hajj is associated with various risks of outbreaks, and thus, better protection-enhancing measures are required. Training personnel involved in health management, including planners, coordinators, and healthcare providers, can help reduce the risks and prevent potential outbreaks.

Understanding the pattern of musculoskeletal pain and its contributing factors among Hajj pilgrims

BACKGROUND

Hajj is a series of rituals that are done in specific areas and periods in Mecca. Performing Hajj requires a great amount of physical demand which may result in musculoskeletal pain (MSP) in different age groups.

OBJECTIVE

To estimate the prevalence of MSP and understand its pattern via exploring the factors that could be associated with muscular pain among pilgrims in the 2022 Hajj.

METHODS

A web-based survey was distributed during the annual Hajj mass gathering. Pilgrims were recruited from Hajj ritual sites. The collected data included demographics, musculoskeletal pain at ten anatomical body sites, and physical activity (PA) level. Descriptive and inferential statistics were used to analyze the data at a 0.05 significance level.

RESULTS

A total of 248 pilgrims participated in the study. The mean age of the sample was 43.49±12.70 years. Of all pilgrims, 78.6% had reported MSP in at least one anatomical body site during performing Hajj. Results revealed that Pilgrims were more likely to have MSP in the lower limb while performing Hajj rituals where the most prevalent reported pain was in the legs (46% ), followed by the lower back (45% ), knees (37% ), and ankles/feet (30% ). Age, sex, and PA were not significantly associated with MSP except the BMI was found to be a significant factor related to MSP among pilgrims (p <0.05).

CONCLUSION

Many pilgrims exhibited pain in at least one body part. Although physical fitness recommendations are published in the Saudi Ministry of Health, MSP preventative measures need to be disseminated by organizations and interested parties worldwide.

Between Sacredness and Public Health: Global Religious Sacred Places and the Fight Against COVID-19

This paper aims to explore the diverse impacts of religious sacred places on specific spheres of contemporary international relations, particularly in the context of public health governance as well as the fight against COVID-19. The spread of disease or germs and viruses within the context of pilgrimage, the healing purposes associated with such practices, as well as historical conquests of sacred places have attracted the attention of ancient physicians and modern scientists. In the nineteenth century, many Abrahamic religions sought to strengthen their influence in the Holy Land, particularly in the sacred city of Jerusalem. As part of their efforts, they focused on constructing modern hospitals, which became a means of religious competition over the region. From the perspective of the specific relationship between the sacred places and the public health governance system in the modern age, sacred places continue to succeed in animal management (native animals and sacrifice animals), water source management (sacred water and holy rivers), and management of sanitary quarantine (the extension of homeland health security defense), which have present positive effects. Based on the literature review, case analysis and interdisciplinary research methods, several findings have emerged regarding the global fight against COVID-19 since early 2020. Mecca-Medina, Jerusalem-Bethlehem, Rome-Vatican, Santiago de Compostela, Qom, and other religious sacred cities have faced huge pandemic pressures. These cities have played unique roles in protecting the health of pilgrims and have implemented measures to reduce the number and scale of pilgrimages in response to the global mobility challenges posed by the pandemic.

Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic

Hajj pilgrimage is a large mass gathering global event that may facilitate the spread and emergence of various infectious diseases as well as antimicrobial resistance (AMR) in a local and global scenario. Planning and preparing for these public health issues is a challenging and complex process for the Kingdom of Saudi Arabia (KSA) health authorities. Despite multiple efforts for the prevention and treatment of infectious diseases through longtime funding in education and medical care, the prevalence of infectious disease is still high among Hajj pilgrims. The commonly observed infectious diseases during Hajj include respiratory tract infections (influenza and pneumonia), urinary tract infections and skin infections that may necessitate the use of antimicrobials. Beta-lactams are used as a first-line treatment for hospital acquired infections as well as community acquired infections due to their broad-spectrum activity. However, most of the bacterial isolates such as Staphylococcus spp., Pseudomonas spp. and E. coli are resistant to beta-lactams. Irrational use of antimicrobials, lack of infection prevention practices and suboptimal healthcare access further exacerbate the risk of spreading AMR among Hajj pilgrims. Enhanced collaboration between countries, sharing of best practices and international cooperation are crucial in addressing AMR threats among pilgrims. Consequently, robust surveillance systems for early detection and monitoring of AMR, collaboration with national as well as international healthcare agencies, effective infection prevention and control measures, public awareness and rational use of antimicrobials via antimicrobial stewardship programs are required to mitigate the risk of AMR and ensure the health and well-being of pilgrims during Hajj.

The Extent of Medication Errors During Hajj in the Kingdom of Saudi Arabia

Background Medication errors are frequently identified in healthcare institutions and pose a risk to patients. The mass gathering during Hajj may expose the pilgrims to numerous health risks. No study has reported the extent of medication errors during Hajj in Saudi Arabia. We investigated the rate, nature, reporting, severity, and causes of medication errors in Hajj pilgrims. Methodology A retrospective analysis of medication errors reported by healthcare professionals was conducted from July 5, 2022, to July 15, 2022, at Mina Al Wadi Hospital, Saudi Arabia. This study included all medication error report forms collected during the Hajj season. The National Coordinating Council for Medication Error Reporting and Prevention Index was used to classify the severity of medication errors. Results There were reports of 43 medication errors in 3,210 prescriptions. The medication error incidence rate was 1.5% (43/3,210). The highest proportion of medication errors (83.72%, 95% confidence interval (CI) = 72.69-94.75) occurred during the prescribing phase, and 97% (95% CI = 93.16-100.0) of medication errors were classified as near misses. Wrong drugs (23.25%) and frequency (18.60%) were responsible for nearly half of the medication errors. Lack of drug information was the leading cause of reported medication errors (58.14%), followed by environmental, personnel, and workload issues (23.25%), and look-alike/sound-alike medication issues (18.60%). Conclusions This study found that the incidence of medication errors was consistent with the global standard, and many of them did not reach pilgrims and were preventable. This highlights the importance of targeted interventions. Incorrect medication was the common type of medication error, highlighting a crucial area for intervention and improvement. Lack of drug information was the primary underlying factor in the occurrence of medication errors. Pharmacists were more likely than other healthcare professionals to report medication errors, highlighting the importance of their involvement in improving medication safety among pilgrims. Future research needs to focus on examining the effectiveness of interventions (e.g., provision of education regarding medicines and medication review) in reducing medicine-related events during Hajj.

Public Health Challenges in Saudi Arabia during the COVID-19 Pandemic: A Literature Review

Similar to most countries, Saudi Arabia faced several challenges during the novel coronavirus disease 2019 (COVID-19) pandemic, some of which were related to the religious position of the country. The main challenges included deficits in knowledge, attitudes, and practices toward COVID-19, the negative psychological impacts of the pandemic on the general population and healthcare workers, vaccine hesitancy, the management of religious mass gatherings (e.g., Hajj and Umrah), and the imposition of travel regulations. In this article, we discuss these challenges based on evidence from studies involving Saudi Arabian populations. We outline the measures through which the Saudi authorities managed to minimize the negative impacts of these challenges in the context of international health regulations and recommendations.

Risk factors analysis of non-compliance of Tuberculosis (TB) patients taking medicine in Puskesmas Polonia, Medan, 2021

OBJECTIVE

This study aims to analyze the risk factors (knowledge, role of health workers, drug Consumption Supervisors activity, side effects of drugs, duration of taking medication, and feeling healthy) for non-adherence to TB patients taking medication at the Puskesmas.

METHOD

The research design used in this study was a case control where the population was all patients who visited the working region of the Polonia Public Health Center. The research subjects were 138 samples consisting of 68 cases and 68 controls. The data were analyzed using a tabulation and statistical system using the SPSS program with the Odds ratio test and logistic regression.

RESULT

It was found that there was an influence on the role of health workers OR=8,933 (95% CI: 1,085-73.525), side effects of drugs with OR=6,873 (95% CI; 2,435-19,398), felt healthy OR=4,643 (95% CI; 1,247-17,287), and knowledge OR=2,700 (95% CI; 1,083-6,731) It is recommended to be healthy and monitor the occurrence of drug side effects in patients during treatment.

Heat-related illnesses in a mass gathering event and the necessity for newer diagnostic criteria: a field study

Heat-related illnesses (HRIs), mainly heat exhaustion (HE) and heat stroke (HS), are characterized by an elevation of core body temperature. In this study, we aimed to explore the HRIs' types and patient characteristics among a sample taken from various representative in-field points in the Hajj season. A cross-sectional study was conducted in 2018 at 80 data collection points distributed in the field. Data related to demographics, features and risk factors were collected and analyzed from all encountered cases with suspected HRIs. Moreover, we developed a diagnostic tree for HRIs by using the XGBoost model. Out of the 1200 persons encountered during the study period, 231 fulfilled the criteria of HRIs spectrum and were included in this study. Around 6% had HS and 20% had HE. All HS cases (100%) were from outside of Saudi Arabia as compared with 72.5% diagnosed with HE (27.5% were from Saudi Arabia). In addition, 16% were considered as heat-induced muscle spasms, and 7% had limb heat edema. Additionally, most of HRIs cases were reported between 11 am and 1 pm. The HRIs diagnostic tree model gave a diagnostic accuracy of 93.6%. This study highlights the magnitude of HRIs among pilgrims in Hajj and provides a diagnostic tree that can aid in the risk stratification and diagnosis of these patients. We advise the implementation of more educational campaigns to pilgrims regarding preventable measures especially for the vulnerable groups (e.g. from outside Saudi Arabia, those with comorbidities and light-skinned people).

Pattern of Respiratory Viruses among Pilgrims during 2019 Hajj Season Who Sought Healthcare Due to Severe Respiratory Symptoms

The aim of our study was to define the spectrum of viral infections in pilgrims with acute respiratory tract illnesses presenting to healthcare facilities around the holy places in Makkah, Saudi Arabia during the 2019 Hajj pilgrimage. During the five days of Hajj, a total of 185 pilgrims were enrolled in the study. Nasopharyngeal swabs (NPSs) of 126/185 patients (68.11%) tested positive for one or more respiratory viruses by PCR. Among the 126 pilgrims whose NPS were PCR positive: (a) there were 93/126 (74%) with a single virus infection, (b) 33/126 (26%) with coinfection with more than one virus (up to four viruses): of these, 25/33 cases had coinfection with two viruses; 6/33 were infected with three viruses, while the remaining 2/33 patients had infection with four viruses. Human rhinovirus (HRV) was the most common detected viruses with 53 cases (42.06%), followed by 27 (21.43%) cases of influenza A (H1N1), and 23 (18.25%) cases of influenza A other than H1N1. Twenty-five cases of CoV-229E (19.84%) were detected more than other coronavirus members (5 CoV-OC43 (3.97%), 4 CoV-HKU1 (3.17%), and 1 CoV-NL63 (0.79%)). PIV-3 was detected in 8 cases (6.35%). A single case (0.79%) of PIV-1 and PIV-4 were found. HMPV represented 5 (3.97%), RSV and influenza B 4 (3.17%) for each, and Parechovirus 1 (0.79%). Enterovirus, Bocavirus, and M. pneumoniae were not detected. Whether identification of viral nucleic acid represents nasopharyngeal carriage or specific causal etiology of RTI remains to be defined. Large controlled cohort studies (pre-Hajj, during Hajj, and post-Hajj) are required to define the carriage rates and the specific etiology and causal roles of specific individual viruses or combination of viruses in the pathogenesis of respiratory tract infections in pilgrims participating in the annual Hajj. Studies of the specific microbial etiology of respiratory track infections (RTIs) at mass gathering religious events remain a priority, especially in light of the novel SARS-CoV-2 pandemic.

The Prevalence and Factors Associated with Musculoskeletal Pain Among Pilgrims During the Hajj

Background

Musculoskeletal pain is a primary burden on individuals as well as social and health care systems. Annually, 2-3 million pilgrims perform the Hajj in Mecca, Saudi Arabia. The Hajj is highly physically demanding because pilgrims generally move by foot for long distances among a series of religious sites, an effort that may exceed their typical levels of physical activity. To understand the impact of musculoskeletal pain on the completion of the Hajj, it is first necessary to evaluate the extent of the problem. Accordingly, this study aimed to estimate the prevalence of musculoskeletal pain and associated factors among pilgrims during the Hajj.

Methods

A cross-sectional survey was conducted during the period of the Hajj. The participants were adult pilgrims ≥ 18 years of age. Data regarding demographics, the prevalence of falls and the point prevalence of musculoskeletal pain by anatomical site were recorded. Participants were allowed to report more than one site of pain. Prevalence, crude and adjusted risk ratios were calculated.

Results

A total of 1715 pilgrims were included in the analysis. The prevalence of falls was 13.76%. The prevalence of overall musculoskeletal pain (pain at any site) was 80.46%. Musculoskeletal pain was most commonly reported in the ankle/foot (38.34%), leg (29.89%), lower back (28.47%) and knee (21.84%). In general, musculoskeletal pain at multiple sites was more common in females and in older and obese individuals. However, there were variations in the importance of sex, age and body mass index as associated factors across different pain sites.

Conclusion

Musculoskeletal pain is common among pilgrims. Unlike most populations examined in other studies, ankle/foot pain was the most common in pilgrims. These data provide guidance for potential preventative programs and the allocation of resources to optimize pilgrims' experiences and ability to complete the Hajj.

Prevalence of Diabetes and Hypertension among Hajj Pilgrims: A Systematic Review

The Hajj mass gathering is attended by over two million Muslims each year, many of whom are elderly and have underlying health conditions. Data on the number of pilgrims with health conditions would assist public health planning and improve health services delivery at the event. We carried out a systematic review of literature based on structured search in the MEDLINE/PubMed, SCOPUS and CINAHL databases, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, to estimate the prevalence of diabetes and hypertension among Hajj pilgrims. Twenty-six studies conducted between 1993 and 2018 with a total of 285,467 participants were included in the review. The weighted pooled prevalence rates of hypertension and diabetes among Hajj pilgrims in all included studies were 12.2% (95% CI: 12.0-12.3) and 5.0% (95% CI: 4.9-5.1), respectively. The reported prevalence of other underlying health conditions such as chronic respiratory, kidney or liver disease, cardiovascular disease, cancer and immune deficiency were generally low. Potentially a large number of pilgrims each Hajj have diabetes and/or hypertension and other underlying health conditions. Hajj could be a great opportunity to reduce the burden of these diseases within the over 180 countries participating in the event by identifying undiagnosed cases and optimizing patients' knowledge and management of their conditions. Prospero registration number: CRD42020171082.

Assessment of Preventative Measures Practice among Umrah Pilgrims in Saudi Arabia, 1440H-2019

:Background: Annually, approximately 10 million pilgrims travel to the Kingdom of Saudi Arabia (KSA) for Umrah from more than 180 countries. This event presents major challenges for the Kingdom's public health sector, which strives to decrease the burden of infectious diseases and to adequately control their spread both in KSA and pilgrims home nations. The aims of the study were to assess preventative measures practice, including vaccination history and health education, among Umrah pilgrims in Saudi Arabia. Methods: A cross sectional survey was administered to pilgrims from February to April 2019 at the departure lounge at King Abdul Aziz International airport, Jeddah city. The questionnaire comprised questions on sociodemographic information (age, gender, marital status, level of education, history of vaccinations and chronic illnesses), whether the pilgrim had received any health education and orientation prior to coming to Saudi Arabia or on their arrival, and their experiences with preventative practices. Results: Pilgrims (n = 1012) of 41 nationalities completed the survey. Chronic diseases were reported among pilgrims (n = 387, 38.2%) with cardiovascular diseases being the most reported morbidity (n = 164, 42.3%). The majority of pilgrims had been immunized prior to travel to Saudi Arabia (n = 770, 76%). The most commonly reported immunizations were influenza (n = 514, 51%), meningitis (n = 418, 41%), and Hepatitis B virus vaccinations (n = 310, 31%). However, 242 (24%) had not received any vaccinations prior to travel, including meningitis vaccine and poliomyelitis vaccine, which are mandatory by Saudi Arabian health authorities for pilgrims coming from polio active countries. Nearly a third of pilgrims (n = 305; 30.1%) never wore a face mask in crowded areas during Umrah in 2019. In contrast, similar numbers said they always wore a face mask (n = 351, 34.6%) in crowded areas, while 63.2% reported lack of availability of face masks during Umrah. The majority of participants had received some form of health education on preventative measures, including hygiene aspects (n = 799, 78.9%), mostly in their home countries (n = 450, 44.4%). A positive association was found between receiving health education and practicing of preventative measures, such as wearing face masks in crowded areas (p = 0.04), and other health practice scores (p = 0.02). Conclusion: Although the experiences of the preventative measures among pilgrims in terms of health education, vaccinations, and hygienic practices were at times positive, this study identified several issues. These included the following preventative measures: immunizations, particularly meningitis and poliomyelitis vaccine, and using face masks in crowded areas. The recent COVID-19 pandemic highlights the need for further studies that focus on development of accessible health education in a form that engages pilgrims to promote comprehensive preventative measures during Umrah and Hajj and other religious pilgrimages.

COVID-19 and the scaled-down 2020 Hajj Pilgrimage - Decisive, logical and prudent decision making by Saudi authorities overcomes pre-Hajj public health concerns

The Publisher regrets that this article is an accidental duplication of an article that has already been published, DOI of original article: https://doi.org/10.1016/j.ijid.2020.08.006 . The duplicate article has therefore been withdrawn.

The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy .

Doing biocultural anthropology: Continuity and change

Biocultural anthropology has long represented an important approach in the study of human biology. However, despite demonstrated utility, its somewhat amorphous identity leaves some scholars questioning just what it means to be biocultural. In this article, rather than providing proscriptive doctrine, we contribute to these conversations about the nature of biocultural anthropology by considering what biocultural research does. We begin with a consideration of some of the foundational themes of biocultural work including recognition of the dialectical nature of sociocultural and biological forces, interest in inequality, and incorporation of both evolutionary and political economic perspectives. To emphasize the consistency of biocultural work over time, we also trace these themes from originating work to their appearance in current research. We then identify some of the key actions of the biocultural approach, noting that biocultural work can execute any number though rarely all of these actions simultaneously. We then offer brief introductions to the articles that make up this special issue, highlighting the ways in which each piece undertakes key biocultural actions. Following these introductions, we provide a discussion of some of the types of biocultural work that are not present in this special issue, recognizing the breadth of biocultural research across multiple subfields of anthropology. Finally, we point to some potentially fruitful directions for future biocultural research. In the end, we conclude that while biocultural anthropology may not have a cohesive or set agenda, it does have a clear and recognizable form of content and methodology illuminated by its actions.

Arbaeen public health concerns: A pilot cross-sectional survey

BACKGROUND

Arbaeen is an annual religious procession in Iraq with an estimated 17-20 million participants. Public health risks associated with such a mass gathering can be serious at both local and global levels. This is the first quantitative examination of risk factors for, and symptoms of, infectious disease among Arbaeen participants.

METHODS

A cross-sectional survey was conducted of a convenience sample of 191 Arbaeen participants in 2017. Interviewers administered a structured questionnaire. Questions included food sources, preventive measures used and symptoms of infectious diseases during the procession.

RESULTS

Data were collected for 191 participants (143 males, 58 females). The most prevalent symptoms were respiratory (runny nose: 22.6%, cough: 22.5%). Diarrhoea was reported by 12.6% of participants, with a strong association with high-income country origin and eating (commercial) street food (odds ratios 6.1 and 4.1, respectively, p < 0.05). All symptoms investigated, except breathlessness, were more prevalent in high-income country participants (p < 0.05).

CONCLUSION

Street food and high-income country origin were independent risk factors for respiratory or gastrointestinal infection symptoms in this sample of Arbaeen participants. However, these results cannot be generalised due to possible selection bias. Further studies are required to inform policy development and health system preparedness to reduce Arbaeen-associated health risks.

Risks threatening the health of people participating in mass gatherings: A systematic review

CONTEXT

Mass gatherings (MGs) are established for different religious, social, political, cultural, and sport motivations. Many risks threaten the participants' health in MGs for different reasons. One duty of health-care system is to identify the risks and manage them to reduce the participants' injuries in MGs. This study aimed to identify and classify the risks threatening the health of participants in MGs and review related articles systematically.

SUBJECTS AND METHODS

In this study, we investigated electronic databases including Science Direct, PubMed, Ovid, ProQuest, Web of Science, Scopus, and Google Scholar. This systematic review investigated those health articles which studied MGs published after 2000. Keywords that were searched included (Mass gathering OR Crowd) AND (Assessment OR Evaluation) AND (Disaster OR Emergencies) AND (Injuries OR Stamped). The final full text articles were assessed qualitatively by STROBE article assessment checklist, and then the data extracted from the results of the articles were analyzed and reported.

RESULTS

Initially, a total of 1874 articles were found, qualitative exclusion and inclusion criteria were applied, and finally 29 full-text articles were selected for the analysis. More than forty health-related risks were recognized. In order to better understand the risks and use of the results more efficiently, the risks were classified and reported into the following five domains: environmental risks, individual risks, psychological risks, public health risks, and management risks.

CONCLUSION

Many risks threaten the health of participants in MGs. Recognizing and managing the risks are considered the primary and basic essentials of health sector for the better management of MGs.

A cross-sectional study on factors associated with hypertension and genetic polymorphisms of renin-angiotensin-aldosterone system in Chinese hui pilgrims to hajj

Background

Hypertension is the leading risk factor for cardiovascular disease (CVD), however, the studies on lifestyle and genetic risks in Chinese pilgrims to Hajj was limited. The aim of this study is to examine the prevalence and associated lifestyle and genetic risks for hypertension among Hui Hajj pilgrims in China.

Methods

We performed a cross-sectional analysis of data in 1,465 participants aged 30–70 years who participated in a medical examination for Hui Hajj pilgrims from Gansu province, China in 2017. Multiple logistic regression was used to evaluate the association of potential risk factors with hypertension. Deoxyribonucleic acid (DNA) polymorphism was examined at sites in the renin-angiotensin-aldosterone system (RAAS).

Results

The prevalence of hypertension was 47% among this population. Lifestyle factors such as fried food preference (like vs. dislike: odds ratio [OR]: =1.53, 95% confidence interval [CI]: 1.13–2.09) and barbecued food preference (like vs. dislike: OR = 1.45, 95% CI: 1.06–1.97) were associated with elevated risk of hypertension among Hui pilgrims. Comparing with Angiotensin converting enzyme (ACE) rs4425 AA genotype, TT genotype was associated with hypertension risk (OR = 2.16, 95% CI: 1.17–4.00). Similar results were also observed for ACE rs4437 CC genotype (OR = 1.95, 95% CI: 1.07–3.55), Angiotensin II receptor (ATR) rs129876 AA genotype (OR = 4.10, 95% CI: 2.30–7.32) and Aldosterone synthase (CYP11B2) rs1912 TT genotype (OR = 2.82, 95% CI: 1.57–5.06) genotypes.

Conclusions

Unhealthy lifestyle and genetic factors were associated with the prevalence of hypertension in Chinese Hui pilgrims and their interactions were also observed.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7357-1) contains supplementary material, which is available to authorized users.

Travel health-related activities and services provided by community pharmacies in Selangor, Malaysia: A cross-sectional analysis

BACKGROUND

Millions of tourists visit Malaysia annually while a large number of Malaysians travel overseas. Taking care of travellers' healthcare needs is important aspect of the healthcare system. Community pharmacies are ideally positioned to provide travel health-related services. However, studies are lacking in this area. Therefore, this study aims to explore the nature and type of travel health-related services provided by Malaysian community pharmacies.

METHODS

A survey was carried out at 135 community pharmacies in nine districts of Selangor, Malaysia, from November 2017 to February 2018, using a self-administered standardized questionnaire.

RESULTS

The majority (n = 95, 85%) of community pharmacies reported to have provided services to both international travellers and outbound Malaysian travellers. The common healthcare services provided to international travellers were monitoring of chronic diseases including hypertension and diabetes, and advice on minor ailments, supplements and medical devices. The key health services provided to outbound Malaysian travellers were advice on vaccination requirements, better management of chronic diseases and necessary medications to manage illness during travel. Most of the respondents supported the provision of travel health-related services through the community pharmacies.

CONCLUSION

The study findings showed that Malaysian community pharmacies provided several travel health-related services to both international and Malaysian outbound travellers. Pharmacists in Malaysia are ideally positioned to have an increased role in travel medicine. They have the training to advise on complex medication issues especially with regard to interactions and polypharmacy. However, further training and courses should be provided that are tailored specifically for the needs of this professional group.

Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events

Mass gathering events are associated with major public health challenges. The 2014 Lancet Series on the new discipline of mass gatherings medicine was launched at the World Health Assembly of Ministers of Health in Geneva in May, 2014. The Series covered the planning and surveillance systems used to monitor public health risks, public health threats, and experiences of health-care providers from mass gathering events in 2012 and 2013. This follow-up Review focuses on the main public health issues arising from planned mass gathering events held between 2013 and 2018. We highlight public health and research data on transmission of infectious diseases and antibiotic-resistant bacteria, mass casualty incidents, and non-communicable diseases, including thermal disorders. In the events discussed in this Review, the combination of a large influx of people, many from countries with outbreak-prone infectious diseases, with a high degree of crowd interactions imposed substantial burdens on host countries' health systems. The detection and transmission of antibiotic-resistant bacteria in pilgrims attending the Kumbh Mela and the Hajj raise concern of possible globalisation from mass-gathering religious events. Priorities for further investments and opportunities for research into prevention, surveillance, and management of these public health issues are discussed.

Characteristics of Heat Illness during Hajj: A Cross-Sectional Study

Introduction

Data regarding the characteristics and outcomes of heat illness are lacking in the literature. The present study aimed to identify the clinical characteristics, morbidity, management, and mortality associated with heat illness among Hajj participants.

Methods

A cross-sectional study was conducted during the Hajj in 2016 on patients who presented to emergency departments and were diagnosed with heat exhaustion or heatstroke. Data were collected using a structured collection sheet developed based on the literature.

Results

A total of 267 patients were recruited. Of these, 80 (29%) and 187 (67.75%) were diagnosed with heatstroke and heat exhaustion, with 6.3% and 0.0% mortality, respectively. The mean age of the patients was 54.0 ± 16 years. Diabetes mellitus was the most common comorbidity among both heatstroke and heat exhaustion patients. The majority of patients had hyperthermia and electrolyte imbalance. Most of the heat illness cases were treated per heat illness guidelines.

Conclusions

Although authorities are working on research and forming interdisciplinary teams to prevent health problems during the Hajj, the mortality rate from heatstroke is high and the majority of the patients had hyperthermia, varied signs and symptoms, elevated creatinine levels, and electrolyte imbalances.

Global Health and Visa Policy Reform to Address Dangers of Hajj during Summer Seasons

Every year on the 12th month of the Islamic calendar, 2–3 million Muslims from over 160 countries migrate to Holy sites in Saudi Arabia to perform the Hajj, representing one of the largest mass gathering events worldwide. Yet, the Hajj poses several challenges to global health and public safety, including the unique health risks posed by seasonal variability when Hajj occurs during summer months. Specifically, pilgrims taking the journey to Mecca are at higher risk for heat illnesses, heat-related injuries and exhaustion, and stampedes, when summer temperatures can reach up to 48.7°C. In response, we propose that the Saudi government, in coordination with the Organization of Islamic Cooperation and the World Health Organization, explore the establishment of an expert committee, create and use a predictive risk modeling tool, and establish a dynamic quota on Hajj visas to limit potential heat exposure for high-risk populations when the Hajj falls on seasons associated with extreme weather exposure. As climate change is projected to lead to future increases in temperatures in the region, this form of dynamic and evidence-based policymaking is needed to ensure human health and safety for generations of Hajj pilgrims to come.