Introduction
Hajj represents an ideal ground for developing acute diseases or exacerbation of pre-existing chronic diseases because of many precipitating factors such as weather changes, crowdedness, and extra physical efforts. Studying the disease pattern during Hajj is an important aspect of helping the concerned departments to design future plans and provide the best medical care during Hajj season. In contrast to Makkah, very few studies have been conducted long time ago in the holy city of Madinah during Hajj season, although a large number of hajjis go there and similar risk factors of Makkah could be present (e.g. crowdedness, weather changes). Our research aims to study the disease pattern among visitors to the Ministry of Health (MOH) facilities near the Prophet's Mosque (Haram) in Madinah during the Hajj season, 1428 H and to provide recommendations in order to improve the allocation of resources in health care system in Madinah during Hajj season.
Methodology
A cross-sectional study was conducted in Madinah. It covered visits by the patients (hajjis and non-hajjis) to the ER of Al-Anssar Hospital and the 4 PHCCs near the holy Haram during period from 16-30 Dhuul Qida, 1428 H. It also covered the whole in-patient workload of Al-Ansaar Hospital during the same period. A total of 2110 outpatients and 301 inpatients were included in the study. Weights were calculated to take into care the daily variation of outpatients within facility; and variation between sampling proportions calculated based upon last year's data and this year's actual workload within the facility and between facilities. All our results of outpatients were based on the weighted values of variables. The collected information was tabulated and statistically analyzed using Epi Info software (version 3.3.2).
Results
This study showed that the largest weighted proportion of outpatients came from Bab Jibreel PHCC (41.3%), followed by ER of Al-Anssar Hospital (28.1%) and Bab Al-Salam PHCC (26.8%). Among outpatients, respiratory diseases was the commonest disease group affecting 974 patients (46.2%). Gastro-intestinal diseases were found to affect 368 patients (17.4%), while skin diseases affected 251 patients (11.9%). Heat-related diseases were not reported in any of our participants. However, Diseases that are grouped in the patient forms as "others" were found to affect 613 patients (29.3%). As individual illnesses, rheumatic diseases (from diseases grouped as "others") were the commonest among outpatients affecting more than one quarter (565 patients; 26.8%) of them. Pharyngitis was found to affect 343 patients (16.3%), common cold affected 337 patients (16.0%), followed by allergic skin diseases and bronchitis that affected 173 patients (8.2%) for each of them. Paracetamol tablets was the most commonly used treatment item, where they were prescribed for 992 (47.0%) of the total outpatients, followed by ibuprofen tablets that were prescribed for 699 patients (33.1%), and amoxicillin capsules for 625 patients (29.6%) of them. Among inpatients admitted to Al-Anssar Hospital, circulatory diseases were the commonest affecting 115 patients (38.2%), followed by respiratory diseases that affected 50 patients (16.6%), endocrine and metabolic diseases affecting 32 patients (10.6%), and injuries and poisoning that were reported in 30 (10.0%) of inpatients. Regarding pattern of admissions as individual diseases, our data showed that diabetes mellitus and ischemic heart disease formed the largest proportion of admission diagnoses with 31 patients (10.3%) for each of them. Myocardial infarction was diagnosed in 29 patients (9.6%), fractures in 28 patients (9.3%), cerebrovascular disease in 25 patients (8.3%), and pneumonia in 24 patients (8.0%).
Conclusion
During this relatively cold Hajj season, respiratory diseases were the commonest among outpatients presented to ER of Al-Anssar Hospital and PHCCs. This may highlight the epidemiological importance of Hajj season, in which cross infections spread quickly in such dense population. Among inpatients, hospital admission was found to be related to old age, which led to predominance of chronic diseases (e.g. diabetes, ischemic heart disease, myocardial infarction, cerebrovascular disease). Heat-related illnesses and meningitis were absent among patients in contrast to many other previous studies which reported these diseases as major health problems during Hajj.