Knowledge, attitude and practice (KAP) survey regarding antibiotic use among pilgrims attending the 2015 Hajj mass gathering

Study on knowledge, attitudes and behavioral practices of antimicrobial usage and resistance in animals and humans in Bahir Dar City, Northwest Ethiopia

Antimicrobial resistance has emerged as one of the foremost global public health challenges. While not a new issue, AMR has gained increasing attention due to the rise of multi-resistant pathogenic organisms, leading to higher mortality rates and significant economic burdens. To assess the knowledge, attitudes, and practices of the Bahir Dar City community regarding human and animal antimicrobial use and AMR, a community-based cross-sectional study was conducted from February to June 2023. The study area was selected purposively, and a simple random sampling approach was used to select kebeles, households, and individual participants. A total of 400 participants were enrolled in the study, with 63.25% being male and 31.25% having graduated from secondary school. Additionally, 61.5% of respondents were married, and the majority (46.5%) owned two species of animals. The findings revealed that 48.5% of the participants had moderate knowledge, 57.5% had positive attitudes, and 52.75% demonstrated good practices regarding antimicrobial resistance and usage. Chi-square analysis revealed statistically significant associations (p < 0.05) between respondents' knowledge level and their educational level, marital status, and position in the house. Attitude level were significantly associated (p < 0.05) with educational level, marital status, occupation, house ownership, and position in the house. Practice level also showed significant association (p < 0.05) with position in the house and occupation. Furthermore, there were significant associations among knowledge, attitude, and practice: knowledge was significantly associated with attitude (χ2 = 209.91, p ≤ 0.001), knowledge with practice (χ2 = 160.43, p ≤ 0.001), and attitude with practice (χ2 = 136.95, p ≤ 0.001). In conclusion, the study found a moderate level of knowledge, positive attitude, and good practice regarding antimicrobial usage and resistance among participants. It is recommended to promote responsible antimicrobial use across all sectors and encourage interdisciplinary collaboration.

Risk factors for diarrheal diseases among pilgrims during Arba'een mass gathering: a case-control study

BACKGROUND

A significant portion of the Muslim community participates in the Arba'een pilgrimage, with participant numbers increasing each year. There have been relatively few studies on the health of Arba'een Mass gathering (MG). Researching the prevalence and distribution of diseases among Arba'een pilgrims is essential to recognize any outbreaks and take timely responses to contain them. The current study aimed to identify exposures and risk factors for diarrheal disease in pilgrims who referred to the clinics located in Iraq among the Arba'een MG in 2023.

METHODS

This case-control study randomly selected 200 outpatients (100 cases and 100 controls) who were referred to Iraq clinics. Cases were patients with gastrointestinal symptoms (diarrhea), while controls were randomly selected from unaffected pilgrims at the same time for the cases. The study groups matched for age, and sex. Face-to-face interviews using a reliable field based checklist of the Center for Disease Control and Prevention of Iran's Ministry of Health to collect potential exposures and risk factors for diarrheal disease. Multiple logistic regression was used to estimate the crude and adjusted odds ratio (AOR) for the risk of diarrhea with a 95% confidence interval (CI).

RESULTS

The average age of the participants was 38.6 years. Diarrhea in 100% and fever in 81% were the most common clinical symptoms in patients. Having underlying diseases was not associated with an increased risk of diarrhea disease (P > 0.05). Regarding risk factors for diarrheal, the final analysis after adjusting for potential confounders indicated that consumption of insanitary (unpackaged) drinking water (AOR = 1.95; 95% CI: 1.05-3.6; P = 0.024), inappropriate hand washing (AOR = 3.82; 95% CI: 1.7-8.6; P = 0.001), ritual foods (AOR = 2.56; 95% CI: 1.3-5.2; P = 0.004), and public toilets (AOR = 1.46; 95% CI: 1.04-4.3; P = 0.038) were significantly increased the likelihood of diarrheal disease.

CONCLUSIONS

Contamination of water sources, food, inadequate and poor hand washing were the most common sources of diarrheal diseases among Arba'een pilgrims. The results indicate that the potential occurrence of outbreaks, especially water- and foodborne diseases, threatens participants in the Arba'een MG. It is recommended to provide risk assessment, improve pilgrims' awareness, pre-and post-screening, vaccination, compliance with personal hygiene, improvement of the environment, provision of sanitary water and food sources and hygienic disposal of sewage, laboratory diagnosis to identify the common types of pathogens in Arba'een MG.

The impacts of knowledge and attitude on behavior of antibiotic use for the common cold among the public and identifying the critical behavioral stage: based on an expanding KAP model

BACKGROUND

This study aims to explore the impacts of knowledge and attitude on the behavior of antibiotic use during the treatment of the common cold based on the expanding KAP model, and then identify the critical behavioral stage.

METHODS

A cross-sectional study was conducted on 815 public from 21 community health centers (CHCs) in Chongqing, China. Based on the expanding KAP model, a self-administered questionnaire was designed to measure knowledge, attitude, multi-stage behavior, and perceived threat, in which multi-stage behavior was divided into pre-use antibiotic behavior, during-use antibiotic behavior, and post-use antibiotic behavior. A structural equation model was used to examine the model fit and the direct, indirect, mediating effects, and moderating effect of the variables.

RESULTS

The expanding KAP showed good model fit indices with χ²/df = 0.537, RMSEA = 0.033, CFI = 0.973, GFI = 0.971, NFI = 0.934, TLI = 0.979. Knowledge had a positive effect on attitude (β = 0.503, p < 0.05), pre-use antibiotic behavior (β = 0.348, p < 0.05), during-use antibiotic behavior (β = 0.461, p < 0.001), and post-use antibiotic behavior (β = 0.547, p < 0.001). Attitude had a positive effect on during-use antibiotic behavior (β = 0.296, p < 0.001), and post-use antibiotic behavior (β = 0.747, p < 0.001). The mediating effect of attitude was positive among knowledge, during-use antibiotic behavior (β = 0.149, p < 0.05), and post-use antibiotic behavior (β = 0.376, p < 0.001). Perceived threat also had a positive moderating effect between knowledge and post-use antibiotic behavior (β = 0.021, p < 0.001).

CONCLUSIONS

Knowledge, attitude and perceived threat had different effects on different stages of antibiotic behavior. The critical behavioral stage prioritized the post-use antibiotic behavior and during-use antibiotic behavior over pre-use antibiotic behavior.

Knowledge, Attitude, and Practice of using Antibiotics among the Community in Eastern Province, Saudi Arabia

Objectives

The purpose of this study is to explore and evaluate the knowledge, attitude, and practice of using antibiotics among the community in the Eastern Province, of Saudi Arabia.

Methods

A cross-sectional study was conducted, from February 2022 through March 2022, among people in Eastern Province, Saudi Arabia.

Results

The study population was 753 of the Saudi community. The questionnaire used open-ended and multiple-choice questions. Out of 753 participants, only 254 (55.6%) think that antibiotics can treat a bacterial infection, whereas 163 (35.7%) and 82 (17.9%) think it treats viral and fungal infections respectively. 26 (5.7%) of the respondents think that they should be stopped when the antibiotics are finished, while 72 (15.8%) think that they should be stopped when the symptoms disappear. The most common side effect in the respondent's opinion was diarrhea 183 (40%), followed by 168 (36.76%) antibiotics resistance. The major reason for taking antibiotics without a prescription was found to be mild symptoms 28 (50.90%), adequate information 21 (38.18%), difficulty in taking appointments 17 (30.90%), long waiting hours during the hospital visits 15 (27.27%). 169 (36.9%) kept the leftover antibiotics for reuse. The most common antibiotics used for self-medication were found to be Amoxicillin and clavulanic acid 23 (41.8%), followed by Amoxicillin 9 (16.36%). Knowledge of antibiotic resistance was highest in the age group 20-30 (62.7%) (P < 0.05).

Conclusion

People in Saudi Arabia show a high awareness of antibiotics' proper usage, and this returns to the great awareness campaign held by The Ministry of Health (MoH).

Knowledge, Attitude and Practice Regarding Antibacterial and Their Resistance in Medellín-Colombia: A Cross-Sectional Study

OBJECTIVE

To describe the knowledge, attitudes, and practices (KAPs) profile on bacterial resistance and antibiotic in the general population of Medellín.

MATERIAL AND METHODS

A cross-sectional study was conducted from September to December 2022, with 902 participants selected through stratified sampling with proportional allocation of different sectors of the city. The KAP scale was developed through a literature review, elimination of duplicate items, validity assessment, and reliability evaluation using Cronbach's alpha. Each item was presented with absolute and relative frequencies on a Likert scale, with a total score ranging from 0 to 100, where a higher score indicates better knowledge, attitudes, and practices. Comparisons were made using Mann-Whitney U, Kruskal-Wallis H, and linear regression.

RESULTS

The knowledge score median was 73.3 (IQR 63.3-93.3), with 36.9% reporting that antibiotics can be stopped once symptoms improve and 26.1% considering them as analgesics or antipyretics. The attitudes score was 83.3 (IQR 73.3-93.3), with 95.3% expressing concern about the impact on their health or that of their family and over 90% agreeing that more information is needed on antibiotic resistance. The practice score was the lowest at 63.9 (IQR 50-75), with 48% having been prescribed antibiotics at the pharmacy and 42.6% taking them to treat flu symptoms. Economic status (β 2.645), education in health-related areas (β 6.224), gender (β 2.892), and education level (β 3.257) determined knowledge. Knowledge (β 0.387), gender (β 2.807), and education level (β 0.686) influenced attitudes, but practices were only determined by Knowledge (β 0.084) attitudes (β 0.552) and age group (β 2.858).

CONCLUSIONS

Knowledge about antibiotics and bacterial resistance does not significantly influence the practices of the population. Therefore, interventions aimed at improving knowledge need to be reconsidered as they may not contribute to the appropriate use of antibiotics and prevention of resistance to these drugs.

Risk factors for heat-related illnesses during the Hajj mass gathering: an expert review

Human exposure to a hot environment may result in various heat-related illnesses (HRIs), which range in severity from mild and moderate forms to life-threatening heatstroke. The Hajj is one of the largest annual mass gatherings globally and has historically been associated with HRIs. Hajj attracts over two million Muslim pilgrims from more than 180 countries to the holy city of Makkah, Kingdom of Saudi Arabia. Several modifiable and non-modifiable factors render Hajj pilgrims at increased risk of developing HRIs during Hajj. These include characteristics of the Hajj, its location, population, and rituals, as well as pilgrims' knowledge of HRIs and their attitude and behavior. Makkah is characterized by a hot desert climate and fluctuating levels of relative humidity. Pilgrims are very diverse ethnically and geographically, with different adaptations to heat. Significant proportions of the Hajj population are elderly, obese, and with low levels of fitness. In addition, many have underlying health conditions and are on multiple medications that can interfere with thermoregulation. Other factors are inherent in the Hajj and its activities, including crowding, physically demanding outdoor rituals, and a high frequency of infection and febrile illness. Pilgrims generally lack awareness of HRIs, and their uptake of preventive measures is variable. In addition, many engage in hazardous behaviors that increase their risk of HRIs. These include performing rituals during the peak sunshine hours with no sun protection and with suboptimal sleep, nutrition, and hydration, while neglecting treatment for their chronic conditions. HRIs preventive plans for Hajj should incorporate measures to address the aforementioned factors to reduce the burden of these illnesses in future Hajj seasons. Lessons from the Hajj can be used to inform policy making and HRIs preventive measures in the general population worldwide.

Knowledge, Attitudes, and Practices (KAP) About Antibiotic Use in Hemodialysis Patients with Chronic Kidney Disease and Their Household Contacts, Medellín-Colombia

Purpose

The lack of knowledge and the excessive and inappropriate use of antibiotics are some of the causes of bacterial resistance. Hemodialysis patients have a high consumption of antibiotics and are constantly cared by their household contacts. This population circulates between hospital and community and are a model to study knowledge regarding bacterial resistance and antibiotic use in these settings. This study describes the knowledge, attitudes and practices (KAP) about antibiotic use and bacterial resistance in hemodialysis patients and their household contacts in Medellín-Colombia.

Patients and Methods

A cross-sectional descriptive study was conducted on hemodialysis patients from a renal unit associated with a hospital in Medellín-Colombia, and their household contacts between May 2019 and March 2020. A KAP instrument was applied to participants during home visits. The KAP regarding antibiotic use were characterized, and a content analysis of open questions was made.

Results

A total of 35 hemodialysis patients and 95 of their household contacts were included. Of participants, 83.1% (108/130) did not correctly identify the situations in which antibiotics should be used. Likewise, a gap in knowledge about antibacterial resistance was evidenced thanks to the emerging categories in content analysis. Regarding attitudes, 36.9% (48/130) of the participants discontinued antibiotic treatment when they felt better. Additionally, 43.8% (57/130) agree to keep antibiotics in their home. Finally, it was found that it is usual for pharmacists and family members to recommend or sell antibiotics without prescription; likewise, pharmacies were the most popular place to acquire these medications.

Conclusion

This study identified gaps in KAP regarding the use of antibiotics and bacterial resistance in hemodialysis patients and their household contacts. This allows focusing education strategies in this regard, in order to increase awareness about the correct use of antibiotics and the consequences of bacterial resistance and to improve prevention actions in this vulnerable population.

Respiratory pathogens among ill pilgrims and the potential benefit of using point-of-care rapid molecular diagnostic tools during the Hajj

We investigated respiratory pathogens among ill Hajj pilgrims from Marseille. We also discuss the potential role of point-of-care (POC) rapid molecular diagnostic tools for this purpose. Clinical data were collected using a standardised questionnaire. Influenza A and B viruses, human rhinovirus and human coronaviruses, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae were investigated using real-time PCR in respiratory samples obtained during travel, at the onset of symptoms. 207 participants were included. A cough, expectoration, rhinitis and a sore throat were the most frequent respiratory symptoms, followed by loss of voice and dyspnoea. 38.7% and 25.1% of pilgrims reported a fever and influenza-like symptoms, respectively. 59.4% pilgrims received antibiotics. Rhinovirus (40.6%) was the most frequent pathogen, followed by S. aureus (35.8%) and H. influenzae (30.4%). Virus and bacteria co-infections were identified in 28.5% of participants. 25.1% pilgrims who were positive for respiratory bacteria did not receive antibiotic treatment. In the context of the Hajj pilgrimage, it is important to detect infections that can be easily managed with appropriate treatment, and those that can affect prognosis, requiring hospitalisation. POC rapid molecular diagnostic tools could be used for patient management at small Hajj medical missions and to rationalise antibiotic consumption among Hajj pilgrims.

A Cross-Sectional Study of the Knowledge, Attitude, and Practice of Self-Medication Among the General Population in the Western Region of Saudi Arabia

Introduction Self-medication (SM) is defined as consuming pharmaceutical drugs without the advice of a physician for either diagnosis or treatment. Reliance on self-medication has become a more common worldwide issue and now plays a major role in self-care. However, the practice is linked to many risks for patients and the whole community. This study assesses knowledge, attitudes, and practices associated with self-medication in the western region of Saudi Arabia. Methods This is an observational questionnaire-based cross-sectional study conducted over two months, between January and March 2022. The survey comprised 29 questions adapted from similar studies and was translated into Arabic to fit the study population. All residents of the three major cities, Makkah, Jeddah, and Taif, were included; the population under 18 years of age and health workers were excluded. We used OpenEpi version 3.0 (www.OpenEpi.com) for sample size calculation and Statistical Package for Social Sciences (IBM Corp, Armonk, USA) was used for data analysis. Results Most of the participants (67.7%) declared that they practiced self-medication: (28.6%) men and (39.1%) women. Self-medicating for different indications showed differences between men and women but without statistical significance. Major indications for self-medicating were headache (45.3%), cough, cold/flu (42.7%), and fever (34.0%). The primary reasons participants gave for choosing to self-medicate were easy availability of the medicines (41.4%) and that they were treating a minor illness (40.8%). Many types of medicines were used, most commonly analgesics (44.0%) and antipyretics (43.6%). Conclusion The practice of self-medication is high among the population in Makkah, Jeddah, and Taif. Educating the public on the consequences and adverse effects is necessary.

An Exploration of the Public’s Attitude toward Antibiotic Use and Prescription in Light of the Recent Ministry of Health Regulations: A Cross-Sectional Study in the Kingdom of Saudi Arabia

Background: Restricting antibiotic (AB) use with prescriptions and ensuring proper knowledge and attitudes toward AB use is important to reduce antibiotic resistance (ABR). To prevent resistanse problem, several countries have applied prescribing restrictions. Thus, the aim of this work was to re-evaluate the public knowledge and attitudes related to AB use in light of the recent Ministry of Health (MOH) restrictions on AB prescriptions. Methods: A cross-sectional, population-based survey was distributed through various social media platforms. The survey was distributed via email and personal social media. Data were collected and analyzed using appropriate statistical tests. Result: A total of 1333 participants completed the survey. Most participants were female (i.e., 70%), aged 18–24 years old (i.e., 40%), and were aware of the AB restrictions implemented by the MOH. In addition, 77% of participants were aware of the MOH Emergency Call Center (i.e., the 937 Service), but most did not know that it could be used to obtain an AB prescription. Conclusion: Although the knowledge and attitude of the general Saudi population appear better than before, it remains clear that some elements of the population’s knowledge, attitude, and practice need to be strengthened. This could be achieved by utilizing effective channels such as the MOH 937 Service and increased advertising.

Associations between socio-spatially different urban areas and knowledge, attitudes, practices and antibiotic use: A cross-sectional study in the Ruhr Metropolis, Germany

Inappropriate and excessive antibiotic use fuels the development of antibiotic resistance. Determinants of antibiotic use, including knowledge and attitudes, are manifold and vary on different spatial scales. The objective of this study was to examine the associations between socio-spatially diverse urban areas and knowledge, attitudes, practices and antibiotic use within a metropolitan city. A cross-sectional survey was conducted in the general population in socio-spatially different areas in Dortmund, Germany, in February and March 2020. Three urban areas were chosen to represent diverse socio-spatial contexts (socio-spatially disadvantaged: A, intermediate: B, socio-spatially disadvantaged: C). Participants were selected via simple random sampling. The questionnaire comprised knowledge and attitude statements and questions around antibiotic use and handling practices. Differences between the areas were examined by estimating odds ratios (OR) and corresponding 95% confidence intervals by multiple logistic regression. Overall, 158 participants were included. Participants of Area C showed the lowest proportions of correct knowledge statements, indicated more often attitudes contrary to common recommendations, lower risk awareness and reported more often antibiotic use (C: 40.8%; A: 32.7%; B: 26.5%) and potential mishandling practices (C: 30.4%; A: 9.6%; B: 17.3%). The multiple logistic regression confirmed these differences. Around 42.3% (C), 33.3% (A) and 20.0% (B) of the diseases mentioned for which an antibiotic was used are mainly caused by viral pathogens. A common misconception across all areas was the perception of antibiotic resistance as an individual rather than a universal issue. This study reveals distinct differences between socio-spatially diverse urban areas within a metropolitan city, regarding knowledge, attitudes and practices around antibiotics and ABR. Our findings confirm that enhanced efforts are required to better inform the population about the adequate use and handling of antibiotics. This study emphasizes the need for future interventions to be tailored to the specific local socio-economic context.

Knowledge, Attitude, and Perceived Risks Towards COVID-19 Pandemic and the Impact of Risk Communication Messages on Healthcare Workers in Saudi Arabia

Purpose

To investigate knowledge, attitude, and perceived risks towards COVID-19 pandemic among healthcare workers (HCWs) in Saudi Arabia. Besides, the impact of risk communication strategy on the attitude and practice of HCWs was investigated.

Patients and Methods

We conducted a cross-sectional study that targeted HCWs from various Saudi health facilities. We utilized a self-administrated, online-based questionnaire designed to assess basic knowledge of COVID-19, attitude and disease perception, and the impact of risk communication messages among HCWs.

Results

A total of 1691 responses were received in the study. The HCWs exhibited good levels of knowledge (total maximum score is 1) of COVID-19 concerning the modes of transportation of COVID-19 (0.82±0.16), sample collection method for COVID-19 diagnosis (0.98±0.08), transmission of infection from asymptomatic individuals (0.99±0.11), and that antibiotics are not effective against the new COVID-19 (0.83±0.38). Nearly one-third of the participants considered a high/very high possibility of acquiring COVID-19 infection. HCWs had good attitude scores concerning their willingness to deal with new COVID-19 patients (0.87±0.33) and their beliefs in being educated on COVID-19 (0.99±0.11). Almost all participants strongly agree/agree that it is important to take action to prevent the spread of COVID-19 within healthcare facilities and received health information messages. Notably, 93.4% of the participants stated that the received messages changed their attitude towards COVID-19 and its preventive measures. Good knowledge scores were significantly associated with age > 49 years old, higher educational level, and physician occupation. Similarly, good attitude scores were higher among males, HCWs aged 40–49 years old, non-Saudi nationals, and physician and nurse occupations.

Conclusion

HCWs have fair knowledge and attitude towards the COVID-19 pandemic. The risk communication is an effective strategy to improve the attitude and practice of HCWs towards COVID-19 in Saudi Arabia.

Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey

Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6-4.4)], versus secondary education (8-10 grade) [AOR = 1.8 (95% Cl = 1.0-3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.

Medication Handling and Storage among Pilgrims during the Hajj Mass Gathering

We aimed to investigate the knowledge and practices of Hajj pilgrims regarding medication storage and handling during the Hajj mass gathering. In this cross-sectional study, adult pilgrims from 30 countries were interviewed using a structured questionnaire during the 2019 Hajj. The study enrolled 1221 participants with a mean age of 50.8 years (SD = 12.5, range = 18-98) and male:female ratio of 1.7:1. Most pilgrims were literate, 50.4% had a university or higher education, and 38% reported at least one underlying health condition. Most pilgrims reported receiving education regarding the proper way to store their medication during Hajj, mainly from physicians (73.7%) and pharmacists (39.4%). Although 68.2% of pilgrims had good knowledge regarding medication storage and the potential effect of inappropriate storage conditions on medications and health, inadequate knowledge and poor practice were identified among some. Level of education, having an underlying health condition and receiving health education on mediation storage were independently associated with good knowledge. Most pilgrims took their medications with them during Hajj, although storage and handling of their medication also varied depending on the stages of their Hajj pilgrimage journey. Improving Hajj pilgrims' awareness and knowledge about appropriate storage and handling of their medications are beneficial in reducing the risk of associated adverse health outcomes, both during Hajj and beyond the mass gathering.

Meningococcal carriage among Hajj pilgrims, risk factors for carriage and records of vaccination: a study of pilgrims to Mecca

Objective

The Saudi government requires that all pilgrims receive a quadrivalent meningococcal vaccine at least 10 days before the Hajj. We conducted a study to determine the uptake of meningococcal vaccine and antibiotic use. We also investigated risk factors of meningococcal carriage and carriage of Neisseria meningitidis pathogenic serogroups A, C, W and Y.

Methods

A cross‐sectional oropharyngeal carriage survey was conducted in 2973 Hajj pilgrims in September 2017. A real‐time polymerase chain reaction (rt‐PCR) assay was used to identify N. meningitidis from the oropharyngeal swabs. A questionnaire investigated potential risk factors for carriage of N. meningitidis.

Results

Two thousand two hundred forty nine oropharyngeal swabs were obtained. The overall prevalence of carriage of N. meningitidis was 4.6% (95% CI: 3.4%–6%). Carriage of pathogenic serogroups was not associated significantly with any of the meningococcal risk factors evaluated. 77% of pilgrims were vaccinated but 22.58 % said they were carrying unofficial vaccination cards.

Conclusion

Carriage of serogroups A, C, W and Y was not significantly associated with any of the risk factors investigated. Almost a quarter of pilgrims were unlikely to have been vaccinated, highlighting a need to strengthen compliance with the current policy of vaccination to prevent meningococcal disease outbreaks during and after the Hajj.

Medication utilization pattern among outpatients during the Hajj mass gathering

Background

The Kingdom of Saudi Arabia (KSA) provides free healthcare, including medications, for the over 2 million Muslim pilgrims who attend Hajj every year. Information on drug utilization patterns at the Hajj is important to strengthen the supply chain for medicines, avert stock-outs, identify inappropriate use, and support public health planning for the event.

Method

We investigated drug utilization pattern among outpatients in eight seasonal Holy sites hospitals in Makkah, KSA, during the 2018 Hajj. Data on medication prescribed and dispensed were retrieved from the hospitals' electronic records. Data were also used to calculate six of the WHO indicators for drug use at these facilities.

Results

A total of 99,117 medications were prescribed for 37,367 outpatients during 37,933 encounters. Outpatients were mainly older males and originated from 134 countries. Twenty medications accounted for 72.8% of the 323 different medications prescribed. These were mainly nonsteroidal anti-inflammatory drugs, analgesics and antipyretics, and antibacterial medicines for systemic use. Outpatients were prescribed an average of 2.6 (SD = 1.2) drugs per consultation and polypharmacy (≥5 medications) was observed in 4.8% of the encounters. Antibiotics and an injection were prescribed in 46.9% and 6.5% of encounters, respectively. Nearly 90% of the prescribed drugs were actually dispensed. On average, medications were dispensed 16.4 (SD = 119.8) minutes from the time they were prescribed for the patient. All hospitals had a copy of the essential drugs list available and all of the prescribed drugs appeared on that list.

Conclusion

Nonsteroidal anti-inflammatory drugs, analgesics and antibiotics are the most common medications prescribed to outpatient during Hajj. Our results, including the calculated WHO drug use indicators, can form a basis for further investigations into appropriate drug use at the Hajj and for planning purposes. These results could also guide the development of reference values for medications prescribing and use indicators at mass gatherings.

Meningococcal disease surveillance in the Asia-Pacific region (2020): The global meningococcal initiative

The degree of surveillance data and control strategies for invasive meningococcal disease (IMD) varies across the Asia-Pacific region. IMD cases are often reported throughout the region, but the disease is not notifiable in some countries, including Myanmar, Bangladesh and Malaysia. Although there remains a paucity of data from many countries, specific nations have introduced additional surveillance measures. The incidence of IMD is low and similar across the represented countries (<0.2 cases per 100,000 persons per year), with the predominant serogroups of Neisseria meningitidis being B, W and Y, although serogroups A and X are present in some areas. Resistance to ciprofloxacin is also of concern, with the close monitoring of antibiotic-resistant clonal complexes (e.g., cc4821) being a priority. Meningococcal vaccination is only included in a few National Immunization Programs, but is recommended for high-risk groups, including travellers (such as pilgrims) and people with complement deficiencies or human immunodeficiency virus (HIV). Both polysaccharide and conjugate vaccines form part of recommendations. However, cost and misconceptions remain limiting factors in vaccine uptake, despite conjugate vaccines preventing the acquisition of carriage.

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.