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Al-Ansari F, Al-Ansari B, Abdulzahra MS, Rashid H, Hill-Cawthorne GA, Al-Ansari MB, Al-Fatlaw SM, Mawash M, Al Ansari M, Conigrave KM. Managing risk of infectious disease transmission at religious mass gatherings: Insights from survey, COVID-19 PCR, and antibody tests from Arbaeen walkers in 2020. Lung India 2024; 41:185-191. [PMID: 38687229 PMCID: PMC11093134 DOI: 10.4103/lungindia.lungindia_431_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/18/2023] [Accepted: 12/12/2023] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Arbaeen in Iraq has been one of the largest mass gatherings during the COVID-19 pandemic with 14.5 million attendees in 2020. We set out to assess the prevalence of current or past COVID-19 among 2020 Arbaeen participants, and establish associations between COVID-19 test results, symptoms, and known recent exposure. METHODS This was a cross-sectional study involving participants who joined Arbaeen walk in Iraq in October 2020. COVID-19 PCR and/or rapid antibody test were conducted among consented participants. A short questionnaire was administered. Rapid antibody testing was done onsite. Nasal and throat swab samples were transferred to the laboratory for PCR testing. RESULTS A total of 835 (88.3% male; 11.7% female) participants were recruited. The most common symptom overall was cough (9.6%) followed by sore throat, fever, and loss of taste/smell (6.6%, 5.5%, and 5.0%, respectively). One in five (20.3%) participants reported close contact with a confirmed COVID-19 case in the past 14 days. Of the 237 participants with a PCR test, 18 (7.6%) were positive. Of the 765 participants with rapid antibody test, 19.3% tested positive for IgM, 39.3% for IgG, and 16.4% for both. Approximately 40% of the participants had evidence of current or past COVID-19 infection based on antibody and PCR. CONCLUSIONS The almost 1 in 10 COVID-19 cases within such a multimillion person gathering, illustrates the difficulty in limiting the participation of infectious individuals in religious mass gatherings. There is a pressing need to explore measures to reduce the risk of transmission of infectious diseases at major mass gathering events.
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Affiliation(s)
- Farah Al-Ansari
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Basma Al-Ansari
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Camperdown, NSW, Australia
| | | | - Harunor Rashid
- The Children’s Hospital at Westmead, National Centre for Immunisation Research and Surveillance (NCIRS), Westmead, NSW, Australia
| | - Grant A. Hill-Cawthorne
- Faculty of Medicine and Health, Sydney School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Mohammad Mawash
- Department of Medicine, College of Medicine, University of Kufa, Najaf, Iraq
| | - Mustafa Al Ansari
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Camperdown, NSW, Australia
| | - Katherine M. Conigrave
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Camperdown, NSW, Australia
- Royal Prince Alfred Hospital, Drug Health Services, Camperdown, NSW, Australia
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Suraifi M, Delpisheh A, Karami M, Mehrabi Y, Jahangiri K, Lami F. Enhancing Public Health Surveillance: Outbreak Detection Algorithms Deployed for Syndromic Surveillance During Arbaeenia Mass Gatherings in Iraq. Cureus 2024; 16:e60134. [PMID: 38736767 PMCID: PMC11088799 DOI: 10.7759/cureus.60134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Large gatherings often involve extended and intimate contact among individuals, creating environments conducive to the spread of infectious diseases. Despite this, there is limited research utilizing outbreak detection algorithms to analyze real syndrome data from such events. This study sought to address this gap by examining the implementation and efficacy of outbreak detection algorithms for syndromic surveillance during mass gatherings in Iraq. METHODS For the study, 10 data collectors conducted field data collection over 10 days from August 25, 2023, to September 3, 2023. Data were gathered from 10 healthcare clinics situated along Ya Hussein Road, a major route from Najaf to Karbala in Iraq. Various outbreak detection algorithms, such as moving average, cumulative sum, and exponentially weighted moving average, were applied to analyze the reported syndromes. RESULTS During the 10 days from August 25, 2023, to September 3, 2023, 12202 pilgrims visited 10 health clinics along a route in Iraq. Most pilgrims were between 20 and 59 years old (77.4%, n=9444), with more than half being foreigners (58.1%, n=7092). Among the pilgrims, 40.5% (n=4938) exhibited syndromes, with influenza-like illness (ILI) being the most common (48.8%, n=2411). Other prevalent syndromes included food poisoning (21.2%, n=1048), heatstroke (17.7%, n=875), febrile rash (9.0%, n=446), and gastroenteritis (3.2%, n=158). The cumulative sum (CUSUM) algorithm was more effective than exponentially weighted moving average (EWMA) and moving average (MA) algorithms for detecting small shifts. CONCLUSION Effective public health surveillance systems are crucial during mass gatherings to swiftly identify and address emerging health risks. Utilizing advanced algorithms and real-time data analysis can empower authorities to improve their readiness and response capacity, thereby ensuring the protection of public health during these gatherings.
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Affiliation(s)
- Mustafa Suraifi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | - Ali Delpisheh
- Department of Epidemiology, Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | - Manoochehr Karami
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | - Yadollah Mehrabi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | - Katayoun Jahangiri
- Department of Health in Disaster and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IRN
| | - Faris Lami
- Department of Community and Family Medicine, College of Medicine, Baghdad University, Baghdad, IRQ
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Alsobhi M, Aldhabi R. Understanding the pattern of musculoskeletal pain and its contributing factors among Hajj pilgrims. Work 2024:WOR230483. [PMID: 38427527 DOI: 10.3233/wor-230483] [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: 03/03/2024] Open
Abstract
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.
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Affiliation(s)
- Mashael Alsobhi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rawan Aldhabi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
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Ninsiima M, Wanyana MW, Kiggundu T, King P, Lubwama B, Migisha R, Bulage L, Kadobera D, Ario AR. Syndromic surveillance during 2022 Uganda Martyrs' commemoration. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002068. [PMID: 38271379 PMCID: PMC10810525 DOI: 10.1371/journal.pgph.0002068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/29/2023] [Indexed: 01/27/2024]
Abstract
Mass gatherings frequently include close, prolonged interactions between people, which presents opportunities for infectious disease transmission. Over 20,000 pilgrims gathered at Namugongo Catholic and Protestant shrines to commemorate 2022 Uganda Martyr's Day. We described syndromes suggestive of key priority diseases particularly COVID-19 and viral hemorrhagic fever (VHF) among visiting pilgrims during May 25-June 5, 2022. We conducted a survey among pilgrims at the catholic and protestant shrines based on signs and symptoms for key priority diseases: COVID-19 and VHF. A suspected COVID-19 case was defined as acute respiratory illness (temperature greater 37.5°C and at least one sign/symptom of respiratory infection such as cough or shortness of breath) whereas a suspected VHF case was defined as fever >37.5°C and unexplained bleeding among pilgrims who visited Namugongo Catholic and Protestant shrines from May 25 to June 5, 2022. Pilgrims were sampled systematically at entrances and demarcated zonal areas to participate in the survey. Additionally, we extracted secondary data on pilgrims who sought emergency medical services from Health Management Information System registers. Descriptive analysis was conducted to identify syndromes suggestive of key priority diseases. Among 1,350 pilgrims interviewed, 767 (57%) were female. The mean age was 37.9 (±17.9) years. Nearly all pilgrims 1,331 (98.6%) were Ugandans. A total of 236 (18%) reported ≥1 case definition symptom and 42 (3%) reported ≥2 symptoms. Thirty-nine (2.9%) were suspected COVID-19 cases and three (0.2%) were suspected VHF cases from different regions of Uganda. Among 5,582 pilgrims who sought medical care from tents, 628 (11.3%) had suspected COVID-19 and one had suspected VHF. Almost one in fifty pilgrims at the 2022 Uganda Martyrs' commemoration had at least one symptom of COVID-19 or VHF. Intensified syndromic surveillance and planned laboratory testing capacity at mass gatherings is important for early detection of public health emergencies that could stem from such events.
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Affiliation(s)
- Mackline Ninsiima
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Mercy W. Wanyana
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Thomas Kiggundu
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Patrick King
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Bernard Lubwama
- Division of Integrated Epidemiology and Surveillance, Ministry of Health, Kampala, Uganda
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
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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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Spector E, Zhang Y, Guo Y, Bost S, Yang X, Prosperi M, Wu Y, Shao H, Bian J. Syndromic Surveillance Systems for Mass Gatherings: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084673. [PMID: 35457541 PMCID: PMC9026395 DOI: 10.3390/ijerph19084673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/02/2022] [Accepted: 04/06/2022] [Indexed: 11/16/2022]
Abstract
Syndromic surveillance involves the near-real-time collection of data from a potential multitude of sources to detect outbreaks of disease or adverse health events earlier than traditional forms of public health surveillance. The purpose of the present study is to elucidate the role of syndromic surveillance during mass gathering scenarios. In the present review, the use of syndromic surveillance for mass gathering scenarios is described, including characteristics such as methodologies of data collection and analysis, degree of preparation and collaboration, and the degree to which prior surveillance infrastructure is utilized. Nineteen publications were included for data extraction. The most common data source for the included syndromic surveillance systems was emergency departments, with first aid stations and event-based clinics also present. Data were often collected using custom reporting forms. While syndromic surveillance can potentially serve as a method of informing public health policy regarding specific mass gatherings based on the profile of syndromes ascertained, the present review does not indicate that this form of surveillance is a reliable method of detecting potentially critical public health events during mass gathering scenarios.
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Affiliation(s)
- Eliot Spector
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Yahan Zhang
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL 32610, USA; (Y.Z.); (H.S.)
| | - Yi Guo
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Sarah Bost
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Xi Yang
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Mattia Prosperi
- Department of Epidemiology, University of Florida, Gainesville, FL 32610, USA;
| | - Yonghui Wu
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
| | - Hui Shao
- Department of Pharmaceutical Outcomes & Policy, University of Florida, Gainesville, FL 32610, USA; (Y.Z.); (H.S.)
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, FL 32610, USA; (E.S.); (Y.G.); (S.B.); (X.Y.); (Y.W.)
- Correspondence:
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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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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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Alshehri MA, Alzaidi J, Alasmari S, Alfaqeh A, Arif M, Alotaiby SF, Alzahrani H. The Prevalence and Factors Associated with Musculoskeletal Pain Among Pilgrims During the Hajj. J Pain Res 2021; 14:369-380. [PMID: 33603452 PMCID: PMC7881773 DOI: 10.2147/jpr.s293338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/16/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Mansour Abdullah Alshehri
- Physiotherapy Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Mecca, Saudi Arabia.,NHMRC Centre of Clinical Research Excellence in Spinal Pain, Injury and Health, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Jamal Alzaidi
- Medical Rehabilitation Department, Makkah Health Affairs General Directorate, Mecca, Saudi Arabia
| | - Sultan Alasmari
- Medical Rehabilitation Department, Makkah Health Affairs General Directorate, Mecca, Saudi Arabia
| | - Ali Alfaqeh
- Medical Rehabilitation Department, Makkah Health Affairs General Directorate, Mecca, Saudi Arabia
| | - Mohammad Arif
- Medical Rehabilitation Department, Makkah Health Affairs General Directorate, Mecca, Saudi Arabia
| | | | - Hosam Alzahrani
- Physiotherapy Department, College of Applied Medical Science, Taif University, Taif, Saudi Arabia
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