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Moulaei K, Bastaminejad S, Haghdoost A. Health challenges and facilitators of arbaeen pilgrimage: a scoping review. BMC Public Health 2024; 24:132. [PMID: 38195530 PMCID: PMC10777642 DOI: 10.1186/s12889-024-17640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/01/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The Arbaeen Pilgrimage, a momentous religious journey drawing millions of participants annually, presents a profound spiritual experience. However, amidst its significance lie various health challenges that pilgrims encounter along the way. Addressing these challenges is vital to ensure the well-being of participants and the success of this extraordinary event. In light of this, the aim of this study is to examine the health challenges of the Arbaeen Pilgrimage, identify facilitators for solving these challenges, and propose effective solutions to enhance the overall pilgrimage experience for all involved. METHODS The scoping review was performed by searching databases such as Web of Science, PubMed, Scopus, and Google Scholar search engine with a focus on the keywords "Arbaeen", "Arbaeen walk" and "Arbaeen pilgrimage". The search was not constrained by a specific time limitation in the databases. Data from studies were extracted using a data extraction form consisting of 9 fields. The selection of articles and data extraction were carried out by two researchers, adhering to predefined inclusion and exclusion criteria. Any disagreements were resolved through consultation with a third researcher. The study was reported following the PRISMA checklist. RESULTS Out of 1619 retrieved articles, 9 were finally included in this study. All these studies were published since 2017 and conducted in Iraq and Iran. In total, 101 health challenges and facilitators were identified, comprising 61 challenges and 40 facilitators. The challenges with the highest frequency included "infectious disease outbreaks" (n = 7), "Poor management of Iraq's health system in waste collection and disposal" (n = 4), "Rising incidence of walking injuries among pilgrims (e.g., burns, fractures, lacerations, wounds, and blisters)" (n = 4), and "Insufficient knowledge about personal and public health"(n = 4). The most important facilitators to solving the challenges were: "Customized pilgrim training and addressing their issues, with a focus on vital practices" (n = 6), "Coordinating mass gathering stakeholders, including health ministries and organizations" (n = 4), and "Implementing an agile syndromic system for rapid surveillance and identification of contagious illnesses" (n = 4). CONCLUSION The article discusses health challenges faced during the Arbaeen Pilgrimage and proposes facilitative measures for participants' well-being. It emphasizes the significance of addressing health risks in large gatherings and suggests incorporating measures for a safer and enjoyable pilgrimage experience. Overall, understanding and managing these health factors can lead to a successful execution of the Arbaeen Pilgrimage, benefiting the physical and spiritual well-being of all involved.
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Affiliation(s)
- Khadijeh Moulaei
- Department of Health Information Technology, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - Saiyad Bastaminejad
- Department of Genetics, Faculty of Paramedical, Ilam University of Medical Sciences, Ilam, Iran
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
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Debie A, Nigusie A, Gedle D, Khatri RB, Assefa Y. Building a resilient health system for universal health coverage and health security: a systematic review. Glob Health Res Policy 2024; 9:2. [PMID: 38173020 PMCID: PMC10765832 DOI: 10.1186/s41256-023-00340-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Resilient health system (RHS) is crucial to achieving universal health coverage (UHC) and health security. However, little is known about strategies towards RHS to improve UHC and health security. This systematic review aims to synthesise the literature to understand approaches to build RHS toward UHC and health security. METHODS A systematic search was conducted including studies published from 01 January 2000 to 31 December 2021. Studies were searched in three databases (PubMed, Embase, and Scopus) using search terms under four domains: resilience, health system, universal health coverage, and health security. We critically appraised articles using Rees and colleagues' quality appraisal checklist to assess the quality of papers. A systematic narrative synthesis was conducted to analyse and synthesise the data using the World Health Organization's health systems building block framework. RESULTS A total of 57 articles were included in the final review. Context-based redistribution of health workers, task-shifting policy, and results-based health financing policy helped to build RHS. High political commitment, community-based response planning, and multi-sectorial collaboration were critical to realising UHC and health security. On the contrary, lack of access, non-responsive, inequitable healthcare services, poor surveillance, weak leadership, and income inequalities were the constraints to achieving UHC and health security. In addition, the lack of basic healthcare infrastructures, inadequately skilled health workforces, absence of clear government policy, lack of clarity of stakeholder roles, and uneven distribution of health facilities and health workers were the challenges to achieving UHC and health security. CONCLUSIONS Advanced healthcare infrastructures and adequate number of healthcare workers are essential to achieving UHC and health security. However, they are not alone adequate to protect the health system from potential failure. Context-specific redistribution of health workers, task-shifting, result-based health financing policies, and integrated and multi-sectoral approaches, based on the principles of primary health care, are necessary for building RHS toward UHC and health security.
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Affiliation(s)
- Ayal Debie
- Departement of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
- College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Adane Nigusie
- Departement of Health Education and Behavioral Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Dereje Gedle
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Taheri M, Eshrati B, Bahadorimonfared A, Sohrabi MR. The Association of Acute Watery Diarrhea in Iranian Pilgrims of Iraq with Cholera Cases in Iranians. Med J Islam Repub Iran 2023; 37:52. [PMID: 37426475 PMCID: PMC10329509 DOI: 10.47176/mjiri.37.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Indexed: 07/11/2023] Open
Abstract
Background Despite the advances in the control of infectious diseases like cholera, they can potentially cause epidemics, especially in mass gathering events. One of the most important countries on the walking way of the Arbaeen religious event is Iran, which requires health system preparedness. The aim of this study was to predict the cholera epidemic in Iran by using the syndromic surveillance system of Iranian pilgrims in Iraq. Methods The data of the Iranian pilgrims with acute watery diarrhea in Iraq during the Arbaeen religious event and the confirmed cholera cases of pilgrims after returning to Iran were analyzed. We used the Poisson regression model of the relationship between the numbers of cases to evaluate acute watery diarrhea and cholera. Spatial statistics and hot spot analysis were used to identify the provinces with the highest incidence. SPSS software Version 24 was used for statistical analysis. Results The frequency of acute watery diarrhea cases was 2232 and the frequency of cholera in pilgrims after returning to Iran was 641. The results of spatial analysis for acute watery diarrhea cases showed a high number of acute watery diarrhea cases in the Khuzestan and Isfahan provinces, located in hot spots. Using Poisson regression, the relationship between the number of acute watery diarrhea reported in the syndromic surveillance system and the number of cholera cases was confirmed. Conclusion The syndromic surveillance system is useful to predict the outbreak of infectious diseases in large religious mass gatherings.
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Affiliation(s)
- Mahbobeh Taheri
- Department of Community Medicine, School of Medicine, Shahid Beheshti University
of Medical Sciences, Tehran, Iran
| | - Babak Eshrati
- Preventive Medicine and Public Health Research Center, Iran University of
Medical Sciences, Tehran, Iran
| | - Ayad Bahadorimonfared
- Department of Community Medicine, School of Medicine, Shahid Beheshti University
of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Sohrabi
- Department of Community Medicine, School of Medicine, Shahid Beheshti University
of Medical Sciences, Tehran, Iran
- Social Determinants of Health Research Centre, Shahid Beheshti University of
Medical Science, Tehran, Iran
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Infectious diseases threats at the Arba'een - a neglected but one of the largest annually recurring mass gathering religious events. Int J Infect Dis 2022; 123:210-211. [PMID: 36108958 DOI: 10.1016/j.ijid.2022.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ahmadi C, Karampourian A, Samarghandi MR. Explain the challenges of evacuation in floods based on the views of citizens and executive managers. Heliyon 2022; 8:e10759. [PMID: 36193530 PMCID: PMC9525901 DOI: 10.1016/j.heliyon.2022.e10759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/20/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background Flood is one of the natural hazards that causes a lot of human and financial losses. Emergency evacuation in the response phase is necessary to reduce damage. The present study was conducted to explain the challenges related to evacuation in floods based on the views of citizens and executive managers. Materials and methods In this study, a qualitative research method with a contractual content analysis approach was used. 27 participants including 10 citizens and 17 executive managers were included in the study by purposive sampling. Semi-structured interviews were used to collect data. In order to have confidence the validity of the results, rigor was certified by using the guidelines suggested by Guba and Lincoln for making trustworthiness. The duration of the interview was between 45 min and 60 min. The interviews were handwritten by line-by-line content analysis and then analyzed. Results Data analysis led to the extraction of 6 main categories with 14 sub-categories including: lack of primary warning system (with 2 sub-categories, lack of national early warning system and lack of attention to early warning), insufficient resources (with 4 sub-categories, lack of equipment, lack of manpower Human resources, inadequate allocation of financial resources and lack of information resources), problems related to unpreparedness (having 2 sub-categories, lack of pre-determined program and lack of attention to public education), problems related to emergency housing (having 2 sub-categories, lack of housing program and lack of attention to indigenous culture in housing), lack of risk perception (has 2 sub-categories of people’s belief in floods and officials' belief in flood) and problems related to lack of coordination (has 2 sub-categories of internal disharmony and external disharmony). Conclusion To increase evacuation, it is necessary to identify the relevant challenges. Establishing an early warning system and evacuation plan, supply of resources, and increase risk perception and coordination can increase the speed of evacuation and reduce the financial and human losses caused by floods.
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Affiliation(s)
| | - Arezou Karampourian
- Urology and Nephrology Research Center, Chronic Diseases (Home Care) Research Center, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Samarghandi
- Department of Environmental Health, School of Health, Health Sciences Research Center, Health Sciences & Technology Research Institute, Hamadan University of Medical Sciences, Hamadan, Iran
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Lami F, Amiri M, Majeed Y, Barr KM, Nsour MA, Khader YS. Real-Time Surveillance of Infectious Diseases, Injuries, and Chronic Conditions During the 2018 Iraq Arba'een Mass Gathering. Health Secur 2021; 19:280-287. [PMID: 33945332 DOI: 10.1089/hs.2020.0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Arba'een pilgrimage in Iraq is now the largest annual gathering in a single place worldwide. To monitor and address the health needs of pilgrims in field clinics near the pilgrimage route, a syndromic surveillance system was designed and implemented by Global Health Development/Eastern Mediterranean Public Health Network in collaboration with Iraq Ministry of Health. This study aimed to analyze the effectiveness of the surveillance system and the data it gathered in evaluating the burden of common acute and infectious conditions, chronic conditions, and trauma and injuries during the Arba'een pilgrimage in 2018. Data were collected at 152 field clinics located across 11 governorates in Iraq at strategic points along the Arba'een pilgrimage route from all governorates to Karbala between October 8 and November 3, 2018. A team of 24 surveillance supervisors trained, oversaw, and provided technical support for 304 data collectors. The data collectors recorded data from 338,399 patients (42.5% female and 57.5% male) in the span of 26 days. The vast majority of patients were from Iraq (n = 294,260, 87.6%) and Iran (n = 34,691, 10.3%). Of the 338,399 patients whose data were recorded by the surveillance system, 246,469 (72.8%) reported acute and infectious conditions, 202,032 (59.70%) reported chronic conditions, and 6,737 (2.0%) reported traumas and injuries. Many patients reported several conditions in multiple categories. The most prevalent acute condition treated was influenza-like illness, identified through patients exhibiting a combination of fever and cough symptoms. Findings from this study will help inform future planning efforts so healthcare workers can be better prepared for treating such cases at mass gatherings. With the latest challenges posed by the COVID-19 pandemic, preparations for a possible future outbreak of the novel coronavirus are also discussed. The information from this study serves as a foundation to inform and optimize future planning of wide-scale surveillance efforts and address challenges in health service delivery and health security.
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Affiliation(s)
- Faris Lami
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mirwais Amiri
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yasir Majeed
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Kira M Barr
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohannad Al Nsour
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yousef S Khader
- Faris Lami, PhD, is an Associate Professor, Department of Community Medicine, College of Medicine, Baghdad University, Bab Al Muadham, Baghdad, Iraq. Mirwais Amiri, MD, MPH, is Research and Policy Team Leader and Mohannad Al Nsour, MD, MSc, PhD, is Executive Director; both at Center of Excellence for Applied Epidemiology Global Health Development, Amman, Jordan. Yasir Majeed, MD, is Director, Field Epidemiology Training Program, Public Health Directorate, Ministry of Health, Baghdad, Iraq. Kira M. Barr is a Graduate Student, Epidemiology, Ohio State University, Columbus, OH. Yousef S. Khader, ScD, is a Professor, Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Prevalence of Influenza Among Hajj Pilgrims: A Systematic Review and Meta-Analysis. Disaster Med Public Health Prep 2021; 16:1221-1228. [PMID: 33757612 DOI: 10.1017/dmp.2020.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Respiratory transmission, especially in mass gatherings, is considered one of the main ways of influenza transmission. The Hajj ceremony, as one of the largest gatherings worldwide, can increase the distribution of influenza infection. Thus, the present study aimed to evaluate the incidence of influenza among Hajj pilgrims. METHODS In this present systematic review and meta-analysis, all English studies published by 2019 were extracted from several databases such as the Web of Science, PubMed, Scopus, Cochrane Library, Science Direct, and Google Scholar. Finally, the data were extracted using a pre-prepared checklist and then analyzed by fixed and random effects model tests in the meta-analysis, Cochran, meta-regression, and Begg's test. RESULTS Eighteen studies with a sample size of 62 431 were entered into the meta-analysis process. The overall prevalence of influenza, in addition to the prevalence of types A, B, and C influenza, was estimated at 5.9 (95% CI: 4.3-8.0), 3.6 (95% CI: 2.6-4.9), 2.9 (95% CI: 2.8-3.1), and 0.9% (95% CI: 0.5-1.5), respectively. CONCLUSIONS In general, influenza remains widespread regardless of vaccinating pilgrims and following health protocols. Therefore, it is recommended that comprehensive management and educational approaches be used to reduce the prevalence of influenza and its adverse consequences among the pilgrims.
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Al-Ansari F, Mirzaei M, Al-Ansari B, Al-Ansari MB, Abdulzahra MS, Rashid H, Hill-Cawthorne GA, Al Ansari M, Negin J, Conigrave K. Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063287. [PMID: 33810092 PMCID: PMC8005097 DOI: 10.3390/ijerph18063287] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 01/03/2023]
Abstract
COVID-19 poses grave challenges for mass gatherings. One of the world’s largest annual gatherings, Arbaeen, occurs in Iraq. We studied respiratory symptoms and risk and protective factors using representative sampling of Arbaeen pilgrims in 2019 to inform prevention of COVID-19 transmission. Structured sampling was used to recruit walking pilgrims. A questionnaire asked about respiratory symptoms, risk, and preventive factors, including hygiene-related resources of toilet facilities. The commonest symptom reported by the 1842 participants (63.3% male, 36.7% female) was cough (25.6%). Eating in mawkibs (rest areas) with indoor kitchens and drinking only packaged water were associated with lower risk of cough (AOR = 0.72, CI = 0.56–0.94; AOR = 0.60; CI = 0.45–0.78, p < 0.05). Facemask use was associated with increased risk of cough (AOR = 2.71, CI = 2.08–3.53, p < 0.05). Handwashing was not protective against cough, or against (one or more of) cough, fever, or breathlessness in multivariate analysis. Toilet facilities often lacked running water (32.1%) and soap (26.1%), and had shared hand towels (17%). To reduce risk of respiratory infections including COVID-19 during Arbaeen or other mass gatherings, needs include running water, soap, and hygienic hand drying options or hand sanitiser. Education on proper handwashing and facemask approaches and monitoring around food preparation and eating spaces are needed.
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Affiliation(s)
- Farah Al-Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Correspondence:
| | - Masoud Mirzaei
- Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd 89151-73160, Iran;
| | - Basma Al-Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
| | | | | | - Harunor Rashid
- The Children’s Hospital at Westmead, National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, NSW 2145, Australia;
- The Discipline of Child and Adolescent Health, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia
| | - Grant A. Hill-Cawthorne
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Mustafa Al Ansari
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Joel Negin
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW 2006, Australia; (G.A.H.-C.); (J.N.)
| | - Katherine Conigrave
- Faculty of Medicine and Health, Sydney School of Medicine (Central Clinical School), University of Sydney, Camperdown, NSW 2006, Australia; (B.A.-A.); (M.A.A.); (K.C.)
- Drug Health Services, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
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Al-Ansari F, Al Ansari M, Hill-Cawthorne GA, Abdulzahra MS, Al-Ansari MB, Al-Ansari B, Rashid H, Negin J, Conigrave KM. Arbaeen public health concerns: A pilot cross-sectional survey. Travel Med Infect Dis 2019; 35:101546. [PMID: 31838209 DOI: 10.1016/j.tmaid.2019.101546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Farah Al-Ansari
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia.
| | - Mustafa Al Ansari
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, 2006, NSW, Australia
| | - Grant A Hill-Cawthorne
- University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, 2006, NSW, Australia
| | | | | | - Basma Al-Ansari
- University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia
| | - Harunor Rashid
- The Children's Hospital at Westmead, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS), Westmead, 2145, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Children's Hospital Westmead Clinical School, The Discipline of Child and Adolescent Health, Westmead, 2145, NSW, Australia
| | - Joel Negin
- University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, 2006, NSW, Australia
| | - Katherine M Conigrave
- Royal Prince Alfred Hospital, Drug Health Services, Missenden Rd, Camperdown, 2050, NSW, Australia; University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, 2006, NSW, Australia
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Memish ZA, Steffen R, White P, Dar O, Azhar EI, Sharma A, Zumla A. Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events. Lancet 2019; 393:2073-2084. [PMID: 31106753 PMCID: PMC7159069 DOI: 10.1016/s0140-6736(19)30501-x] [Citation(s) in RCA: 137] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Ziad A Memish
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Infectious Diseases Division, Department of Medicine and Research, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Robert Steffen
- Epidemiology, Biostatistics and Prevention Institute, WHO Collaborating Centre for Travellers' Health, University of Zurich, Zurich, Switzerland; Division of Epidemiology, Human Genetics & Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA
| | - Paul White
- Commonwealth of the Northern Mariana Islands, Epidemiology and Laboratory Capacity Program, Public Health & Hospital Emergency Preparedness Program, Commonwealth Health Care Corporation, Saipan, Northern Mariana Islands, USA
| | - Osman Dar
- Public Health England and Chatham House Centre on Global Health Security, Royal Institute of International Affairs, London, UK
| | - Esam I Azhar
- Special Infectious Agents Unit, King Fahd Medical Research Center, Jeddah, Saudi Arabia; Medical Laboratory Technology Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Avinash Sharma
- National Centre for Microbial Resource, Pune, Maharashtra, India; National Centre for Cell Science, Pune, Maharashtra, India
| | - Alimuddin Zumla
- Division of Infection, University College London, London, UK; NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
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