Introduction
The pilgrimage to Makkah (Hajj) is an annual congregation of more than 2 million Muslim pilgrims, the contact among pilgrims and high population density aggravates exposure of hajjes to the risk of injuries. In the past, injuries have been reported as component of the routine health care facility reporting system in Hajj, recently it has been identified as a separate entity in reporting system Since Hajj 1418 H. This study was conducted by a team from Field Epidemiology Training Program (FETP) to estimate the quality and efficiency of on going injury surveillance system during Hajj season this study.
Methodology
A cross sectional study was conducted in a sample of all the hospitals in Makkah and dispensaries in Haram and all the hospitals, and 6 randomly selected primary health care centres in Mina. A questionnaire was designed as combined observation/interview based, to record the existing organizational structure, system of injury registration and reporting, and an interview schedule for directors and health workers dealing with injured patients at first contact level in the facility to assess their knowledge and practices about injury reporting system and to assess the completeness of the injury management/ data collection forms. A cumulative score for assessment of Knowledge of directors was developed based on the 12 questions asked and used for further analysis of association between exposure and outcome, the median score of 7 was used as a cut off point to split the workers into low knowledge group (score of 1-6) and high knowledge group (score of 7-12). Another cumulative score for assessment of Knowledge of health workers was developed based on 7 questions, the median score of 5 was used as a cut off point to split the workers into low knowledge group (score of 0-4) and high knowledge group (score of 5-7).
Results
Reviewing of existing injury surveillance system: The injured patient is received at reception disk to register before getting medical service in all Mina hospitals and PHCs, all Makkah hospital except in Mina general hospital, PHC (No. 1), King Abdulaziz hospital (KAH) and Haram dispensary where patient immediately getting medical services without registration, and then Handling by physician in E/R. There was no preparation of special injury report at all Mina hospitals and PHCsNo.1, 6, 7, 8, 20, all Makkah hospital and Haram dispensary except in PHC No 14, King Faisl hospital and KAH which Send to main administration. Knowledge and Practices of Directors of health facilities: Fifteen medical directors of health facilities were interviewed, 5 were from Makkah and 10 from Mina health facilities, 40% directors were included in the high knowledge group and 60% in the low knowledge group. Knowledge of health workers regarding injury surveillance system (ISS): 38 health workers (HWs) were interviewed, 18 health workers in Makkah and 20 health workers in Mina. 84.2 % were male. 52.6 % were Saudi. Most of them were in the age group 25-30 years. On the basis of the cumulative score, 52.6% health workers were included in the high knowledge group and 47.4% in the low knowledge group, the proportion of high knowledge score was higher among those who had not received training to fill forms which were used to manage patient 77.8% as compared to those who had received training 40%, and the difference was statistically significant.
Conclusion
The study showed that new injury surveillance system in hajj at present is working only in Mina, excluding Makkah health facilities. Except for the timeliness issue, it needs a lot of modification to improve its deficient areas especially incomplete coverage, non-availability of standard operating procures, poor training of staff, weak supervisory and feedback mechanism, and lack of communication with non-MOH facilities.