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Pattern of diseases among visitors of health care facilities in Madinah during hajj season, 1428 H (2007).

Article Info

Authors
Volume: 15
Year: 2008
Month: October
Issue: 4
Pages: 25-26,29
Reference: Al-Quwaidhi A., Choudhry A., Hyani O., .Saudi Epidemiology Bulletin. 2008;15(4):25-26,29.
Studying the disease pattern of hajjis is imperative in designing future plans and providing the best medical care during hajj. This study aims to investigate the disease pattern among visitors of Ministry of Health (MOH) facilities near the Prophet’s Mosque (Haram) in Madinah. This cross-sectional study was conducted during Hajj season, 1428 H. It covered visits by the patients (hajjis and non-hajjis) to the Emergency Room (ER) of Al-Anssar Hospital and 4 PHCCs near the Haram (namely Bab Jibreel "permanent", Bab Al-Salam "seasonal", Bab Al-Majidi "seasonal", and Bab Al-Rahma "seasonal") from 16-30 Dhul Qaeda, 1428 H. It also covered the in-patient workload of Al-Ansaar Hospital during the same period. A total of 2110 outpatients and 301 inpatients were included. Weights were calculated to take 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 into consideration. All results of outpatients were based on the weighted values of variables.
The largest weighted proportion of outpatients came from Bab Jibreel PHCC (41.3%), followed by the Emergency Room (ER) of Al-Anssar Hospital (28.1%) and Bab Al-Salam PHCC (26.8%). Among outpatients, respiratory diseases were the most common affecting 974 patients (46.2%), followed by Gastro-intestinal diseases 368 patients (17.4%), and skin diseases 251 patients (11.9%). Heat-related diseases were not reported. Diseases grouped in the patient forms as "others" were found among 613 (29.3%) (Table 1), among those rheumatic diseases were the most common among outpatients (565 patients; 26.8%), followed by Pharyngitis (343 or 16.3%), common cold (337 or 16.0%), allergic skin diseases and bronchitis (173 or 8.2% for each).
Paracetamol tablets were the most commonly used treatment item, having been prescribed for 992 (47.0%) of outpatients, followed by ibuprofen tablets (33.1%),and amoxicillin capsules (29.6%).
Among inpatients admitted to Al-Ansar Hospital, circulatory diseases were the most common (38.2%), followed by respiratory (16.6%), endocrine and metabolic diseases (10.6%), and injuries and poisoning (10.0%). (Table 2) Diabetes mellitus and ischemic heart disease formed the largest proportion of admission diagnoses (10.3% each), followed by Myocardial infarction (9.6%), fractures (9.3%), cerebrovascular disease (8.3%), and pneumonia (8.0%).
This study highlighted that respiratory diseases were the most common diagnosis among outpatients. Hospital admission was related to old age, and showed predominance of chronic diseases. There were no cases of heat-related illnesses or meningitis.

Editorial note:

The Hajj season represents an ideal time for developing acute diseases or exacerbation of pre-existing chronic diseases as a result of interplay between many factors such as weather changes, crowdedness, and extra physical efforts. Very few studies have been conducted at the holy city of Madinah, in spite of the fact that it is visited by a large number of hajjis. According to official statistics of the governmental "Madinah Hajj Committee", around 700,000 hajjis from different countries arrived to Madinah during Dhul Qaedah 1428 H, alone.1

Among outpatients, respiratory diseases were the most common, which is in concordance with previous hajj studies,2 followed by rheumatic complaints (26.8%), which is higher than previous reports. In a study at Al-Noor Hospital in Makkah, only 4.6% of outpatients presented with musculoskeletal complaints.3 Skin and gastro-intestinal disorders were higher among outpatients in this study (11.9% and 17.4%, respectively) than the Al-Noor Hospital study (7.1% and 6.8% respectively).3 Furthermore, Hajj season serves as an ideal environment for developing different skin conditions as a result of warm weather and overcrowding.4
Health problems linked to food safety such as gastroenteritis, diarrhea, or abdominal pain collectively affected 9.4% of outpatients, which is lower than previous reports,3 and may be justified by the fact that this year's hajj season fell in a cooler climate, when the risk of food borne illnesses may be lower.
Among inpatients, there was a predominance of circulatory diseases (38.2%), followed by respiratory diseases (16.6%). Yousuf et al. reported that respiratory diseases were the most common (74.3%), followed by circulatory (57%) and metabolic diseases (23.2%).5 Most of the inpatients in this study were elderly, which explains the predominance of chronic diseases.
There were no cases of meningitis or heat-related illnesses. Heat-related illnesses represent a major health problem among hajjis during hot seasons.6 However, the incidence of heat exhaustion among hajjis in Makkah and the holy places fell from 206/100,000 hajjis in 1417 H (April, 1997) to 3.4/100,000 hajjis in 1426 H (January, 2006),7 as the timing of hajj moved towards cooler winter months.
Another major health problem during hajj in previous years was Meningitis, with high incidence and fatality.8 This explains the MOH's strict regulation on the mandatory vaccination of all hajjis with the quadrivalent meningococcal vaccine.
It was recommended to re-allocate resources among health facilities during hajj season according to their workload. Coordination with health departments of other countries is required to provide hajjis with chronic diseases with a special document recording the diagnosis and treatment. Health education programs should be directed to avoid crowded areas and use protective measures against respiratory infections, such as the face mask and influenza vaccination. Health facilities should be equipped with adequate supplies of the commonly prescribed medications before hajj season.
References:
1. Madinah Hajj Committee. Number of hajjis arriving Madinah duringthe Month of Dhul Qidah, 1428 H (Arabic). Saudi Arabia: Madinah Hajj Committee; 2007 [cited 2008 January 26]. Available from: www.hajcomatmad.gov.sa
2. Shakir HAS, Gazzaz ZJ, Dhaffar KO, Shahbaz J. Outpatient Services during (1423 H) Hajj Season. Sultan Qaboos University Medical Journal. 2006; 6(1):47-50.
3. Al-Ghamdi SM, Akbar HO, Qari YA, Fathaldin OA, Al-Rashed RS. Pattern of admission to hospitals during Muslim pilgrimage (hajj). SMJ 2003; 24(10):1073-1076.

4. Fatani MI, Al-Afif KA, Hussain H. Pattern of skin diseases among pilgrims during Hajj season in Makkah, Saudi Arabia. Int J Dermatology. 2000; 39(7):493-496.

5. Yousuf M, Al-Saudi DA, Sheikh RA, Lone MS. Pattern of medical problems among haj pilgrims admitted to King Abdul Aziz Hospital, Madinah Al-Munawarah. Ann Saudi Med 1995; 15(6):619-621.

6. Al-Harthi SS, Yaqub B, Al-Nozha M, Al-Aska AK, Seraj M. Pilgrimage (Hajj 1404) comparing a conventional method with a Body Cooling Unit. SMJ 1986; 7:369-376.

7. Ministry of Health, Saudi Arabia. Health Statistical Year Book (1426 H). p. 323-325.

8. El Bushra HE, Hassan NM, Al-Hamdan NA, Al-Jeffri MH, Turkistani AM, Al-Jumaily A, et al. Determinants of case fatality rates of meningococcal disease during outbreaks in Makkah, Saudi Arabia, 1987-97. Epidemiol Infect. 2000;125:555-560.

Table 1: Distribution of disease groups among outpatients, Madinah, 1428 H (2007), (N=2110).
Disease group
No.
%
Heat-related
0
0.0
Circulatory and metabolic
71
3.3
Gastro-intestinal
368
17.4
Respiratory
974
46.2
Injury and trauma
32
1.5
Eye and ear
100
4.7
Skin
251
11.9
Others
613
29.1

Table 2: Distribution of disease groups among admitted patients, Al Anssar Hospital, Madinah - 1428 H (2007 G), (N=301)
Disease group
No.
%
Infectious and parasitic diseases
9
3.0
Neoplasm
3
1.0
Endocrine and metabolic diseases
32
10.6
Blood diseases
12
4.0
Nervous system and sensory diseases
26
8.6
Circulatory diseases
115
38.2
Respiratory diseases
50
16.6
Digestive system diseases
24
8.0
Genitourinary diseases
7
2.3
Musculoskeletal/Connective tissue diseases
1
0.3
Injury and poisoning
30
10.0
Other unclassified diseases
32
10.6

دراسة نمط الأمراض بين مُراجعي المرافق الصحية في المدينة المنورة خلال موسم الحج لعام 1428 هـ (2007 م).

لا يزال موسم الحج يشكل بيئة مثالية لاكتساب الأمراض على الرغم من الجهود الجبارة التي تبذلها المملكة، و ذلك بسبب الازدحام الشديد و الجهد البدني الشاق. لقد تمت دراسة نمط الأمراض بين الحجاج في مكة المكرمة و المشاعر المقدسة سابقاً، أما في المدينة المنورة فإن هذه الدراسات لا تزال قليلة جداً.

قام فريق من برنامج الوبائيات الحقلي بدراسة مقطعية تهدف إلى دراسة نمط الأمراض بين مراجعي مرافق وزارة الصحة القريبة من الحرم النبوي الشريف بالمدينة المنورة خلال موسم حج عام 1428 هـ، و الخروج بتوصيات لتحسين رصد الموارد في نظام الرعاية الصحية بالمدينة المنورة خلال موسم الحج.

قامت الدراسة بتغطية زيارات المراجعين (حجاج و غير حجاج) لمستشفى الأنصار ( قسم الطوارئ) و 4 مراكز رعاية صحية أولية (دائمة و موسمية) في منطقة الحرم النبوي الشريف خلال الفترة من 16 إلى 30 من شهر ذي القعدة لعام 1428هـ ، كما شملت جميع المرضى المنوّمين بالأقسام الداخلية بمستشفى الأنصار خلال نفس الفترة.

شملت الدراسة 2110 مرضى راجعوا العيادات الخارجية بالمراكز الصحية و قسم الطوارئ بمستشفى الأنصار، بالإضافة إلى 301 مريضاً تم تنويمهم بالمستشفى خلال فترة الدراسة. أوضحت الدراسة بأن الأمراض التنفسية كانت الأكثر شيوعاً بين المرضى مراجعي العيادات الخارجية (46,2%)، تليها الأمراض المعوية (17,4%)، و أمراض الجلد (11,9%)، أما الأمراض المصنّفة في نماذج المراجعين كـ "أمراض أخرى" فقد تم تسجيلها في (29,3%). و بخصوص نمط الأمراض كأمراض منفصلة فقد كانت الأمراض الروماتزمية أكثرها شيوعاً (26,8%)، تليها التهاب البلعوم (16,3%)، ثم الزكام (16,0%)، ثم أمراض حساسية الجلد و التهاب القصبات الهوائيةِ (8,2 % لكُلّ منهما).

أما بين المرضى المنوّمين فقد كانت أمراض الجهاز الدوري الأكثر شيوعاً (38,2%)، تليها الأمراض التنفسية (16,6%)، ثم أمراض الغدد الصمّاء و الأيض (10,6%)، ثم حوادث الإصابات و التسمم (10,0%). أوضحت الدراسة بأن مرض السكري و مرض ضيّق شرايين القلب التاجية كانا الأكثر شيوعاً (10,3% لكل منهما)، ثم الجلطة القلبية (9,6%)، ثم الكسور (9,3%)، ثم ضيّق شرايين الدماغ (8,3%)، ثم ذات الرئة (8,0%).

تمت التوصية بضرورة التنسيق مع الجهات الصحية بالدول الأخرى لتزويد الحجاج الذين يعانون من الأمراض المزمنة بوثيقة رسمية (بطاقة) تشمل التشخيص و العلاج تُحمل مع الحاج. و تنفيذ برامج توعية صحية يتم توجيهها للحجاج المسنّين الذين يعانون من أمراض مزمنة بخصوص أهمية الالتزام بالعلاج و تفادي الإجهاد الجسماني. كما تمت التوصية بتنفيذ دراسات أخرى في المدينة المنورة خلال موسم الحج بين المرضى المنوّمين لدراسة مصير الحالات و معدلات الوفيّات.