Article Info
Year: 2001
Month: April
Issue: 2
Reference: AlGheilani A., Alhamdan N., Mustafa T., .Saudi Epidemiology Bulletin. 2001;8(2):.
During Hajj season every year, all Gulf Cooperation Council (GCC) states send medical missions to provide health services, mainly for their citizens, in addition to other hajjees who may attend their clinics. GCC Medical Mission Clinics (GMMCs) are equipped for the provision of simple surgical procedures and emergency care. The GMMCs are divided into male and female clinics each with separate staff, and consist of doctors, staff nurses, pharmacists or assistant pharmacists, health inspectors and administrators, the number varying from one mission to the other.
The GMMCs start their activities in Makkah from the 1st to 7th of Dhul Hijjah, and in Mina from the 8th to the 12th. The objective of this study was to identify the pattern of health services provided by the GMMCs by measuring the following health indicators: characteristics of patients attending the GMMCs, pattern of workload, most common illnesses, and the most commonly prescribed drugs.
The Study was conducted for three days in Makkah from 5th-7th Dhul Hijjah. Systematic random sampling was used, the sampling proportion depending on the average daily attendance in the previous year. A total of 983 records were collected, 136 from the Bahraini clinic, 172 from the Kuwaiti clinic, 311 from the Omani clinic, 142 from the Qatari clinic, and 222 from the UAE clinic. The number of daily attendance of GMMCs increased progressively reaching its peak on 7th Dhul Hijjah. The workload showed a consistent daily bimodal pattern, the busiest periods were between 6-11 A.M and 6-10 P.M.
The number of visits/physician and visits/nurse varied between GMMCs, and from day to day, increasing progressively, and reaching the maximum on 7th of Dhul Hijjah (Table 1). The characteristics, diseases, and drugs prescribed to patients attending GMMCs are presented in Table 2. The most common illnesses were respiratory diseases (58.9%). Overuse of antibiotics was noted, having been prescribed for 46.8% of cases with common cold.
Editorial note:
Pilgrims to Makkah undergo strenuous physical and mental effort during Hajj. The large number, congestion, and mass movement can contribute to the occurrence of different types of illnesses despite all efforts. Medical services are therefore stretched by the large number of patients and the different diseases presenting. Saudi health authorities provide free medical services for all religious visitors during hajj, including medicines and hospitalization.[1]
In modern health care systems, continuing measurement and monitoring of relevant clinical data comprise the basis of documentation for the quality of care. Internationally there has been an increasing focus on monitoring and measuring the quality of care using principles from clinical and epidemiological viewpoints, including quality monitoring using clinical indicators.[2,3]
During Hajj, many factors play a role in determining the total number of clinic visits, which subsequently affects the workload, such as the total number of doctors joining hamla, distance between the GMMC and its own Hajjees, which is expected to play an important role in increasing the workload especially in the Omani clinic, since all Omani Hamlas were located in one place (Malawi), with the clinic in the middle of this location. Another factor is the distance from the nearest Saudi primary health care center or hospital. In general, the male to female ratio was 2:1, which was consistent in all GMMCs. Most of the attendees were mainly citizens of the same mission for both Bahrain and Oman, in contrast to Qatar, UAE, and Kuwait, which demonstrates the role GMMCs play in giving medical care to other hajjees.
The leading cause of morbidity were respiratory diseases, which is similar to other Hajj studies,[4] and may be attributed to overcrowding and congestion, in addition to the fact that, in current years Hajj occurs in the winter months when respiratory diseases are more frequent. In this study, heat disorders constituted only 0.4%, and urinary problems 0.6%, showing a downward trend from previous studies conducted when hajj took place in the summer months.[5]
Hypertension (4.1%) and diabetes (2.1%) comprised all circulatory and endocrine diseases respectively. Factors that might have influenced the attendance of patients with chronic diseases to GMMCs could have been the mandatory pre-Hajj medical examination and whether these patients bring their medicines with them. In a previous Hajj behavior study, 77.8% of GCC nationalities with chronic diseases (hypertension, diabetes and cardiac diseases) were reported to have brought their medicines with them.[6]
Overuse of antibiotics is an important factor in the increase of drug resistant bacteria. During Hajj, however, it could be argued that difficulty in following the patients, lack of time to spend with patients due to overcrowded clinics and lack of laboratory facilities in some clinics, may excuse the high rate of antibiotic prescription.
It is important to educate Hajjees on the importance of early seeking of medical advice. Coordination between all Gulf countries is needed in terms of preventive and curative activities during Hajj.
References
- Ministry of Health. Annual Health Report. Kingdom of Saudi Arabia. 1996 (1416 H) 269-79.
- Mainz J, Kjaergaard J, Knudsen JL. Monitoring quality of health care indicators. Ugskr Laeger, 1999; 161(40): 5563-42.
- Khoja TA, Farag MK. Synopsis of indicators, Monitoring, Evaluation and supervision of health care quality. Saudi Arabia, Ministry of health, 1997; 11:60.
- El-Bushra HE, Abodahish AA. Utilization of primary Health Care Services during Hajj. Saudi Med J 1999; 20(12): 931-938.
- Al-Aska A, Yaqub BA, Al-Harthi SS, Al-Dalian A. Rapid cooling in management of heat stroke: clinical methods and practical implications. Ann Saudi Med 1987; 7(2): 135138.
- Al-Rabeah AM, ELBushra H. Behavioral risk factors for diseases during Hajj to Makkah. Saudi Epidemiol Bull 1998; 5(3): 3-5.
|
Table 1: Daily visits/ physician and visits/nurse for Gulf countries medical missions, Makkah, Dhul Hijjah, 1420H
|
||||||||||||
|
Country
|
5th Dhul Hiiiah
|
6th DhuI Hijjah
|
7th Dhul Hiiiah
|
|||||||||
|
Visits / Physician
|
visits / Nurse
|
Visits / Physician
|
visits / Nurse
|
Visits / Physician
|
visits / Nurse
|
|||||||
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
M
|
F
|
|
|
Bahrain
|
4.0
|
5.6
|
10
|
5.6
|
6.0
|
5.3
|
15
|
5.3
|
6.0
|
7.3
|
15
|
7.3
|
|
Kuwait
|
34.1
|
22.5
|
68.3
|
11.2
|
31.6
|
45.0
|
63.3
|
22.5
|
39.1
|
47.5
|
78.3
|
23.7
|
|
Oman
|
113.3
|
48.3
|
113.3
|
41.4
|
120.0
|
48.3
|
120.0
|
41.4
|
131.6
|
56.6
|
131.6
|
48.5
|
|
Qatar
|
13.5
|
16.6
|
16.8
|
12.5
|
20.5
|
10.0
|
25.6
|
20.0
|
22.5
|
18.3
|
28.1
|
13.7
|
|
UAE
|
26.9
|
22.5
|
38.8
|
22.5
|
41.5
|
33.7
|
60.0
|
30.0
|
41.5
|
42.5
|
60.D
|
42.5
|
|
Table 2. Characteristics, diseases, and medications of patients visiting Gulf Countries medical missions, Makkah, Dhul-Hijja, 1420 H.
|
||||||
|
Characteristics
|
Bahrain
|
Kuwait
|
Oman
|
Qatar
|
UAE
|
Total
|
|
N=136
|
N=172
|
N=311
|
N=142
|
N=222
|
N=983
|
|
|
Sex
|
||||||
|
Male
|
59.3%
|
73.3%
|
70.4%
|
69.6%
|
64.3%
|
69.3%
|
|
Female
|
40.7%
|
26.7%
|
29.6%
|
20.4%
|
35.7%
|
30.7%
|
|
Age
|
||||||
|
0-14
|
0.0%
|
1.2%
|
0.6%
|
2.1%
|
0.0%
|
0.6%
|
|
15-24
|
3.7%
|
3.5%
|
3.8%
|
9.4%
|
2.7%
|
3.2%
|
|
25-44
|
50.7%
|
51.2%
|
37.8%
|
52.8%
|
44.1%
|
45.5%
|
|
45-64
|
39.0%
|
40.1%
|
51.9%
|
38.0%
|
47.3%
|
45.0%
|
|
>65
|
1.5%
|
1.2%
|
5.5%
|
3.5%
|
3.6%
|
3.3%
|
|
Unknown
|
5.1%
|
2.9%
|
0.6%
|
1.4%
|
2.3%
|
2.1%
|
|
Nationality
|
||||||
|
Native
|
88.2%
|
45.9%
|
73.4%
|
18.3%
|
36.5%
|
54.4%
|
|
Other
|
11.8%
|
54.1%
|
26.6%
|
81.7%
|
63.5%
|
45.6%
|
|
Diseases
|
||||||
|
Respiratory tract
|
50.7%
|
54.1%
|
60.6%
|
67.6
|
590%
|
58.9%
|
|
Digestive system
|
15.4%
|
11.0%
|
9.6%
|
8.5%
|
13.1%
|
11.3%
|
|
Musculoskeletal
|
10.3%
|
14.5%
|
11.9%
|
16.2%
|
11.2%
|
12.8%
|
|
Injury & trauma
|
5.9%
|
5.2%
|
2.9%
|
5.6%
|
6.3%
|
4.9%
|
|
Circulatory & bld.
|
5.1%
|
4.7%
|
3.8%
|
4.2%
|
3.2%
|
4.1%
|
|
Endocrine system
|
2.2%
|
2.9%
|
1.9%
|
2.1%
|
1.8%
|
2.1%
|
|
Heat disorders
|
0.0%
|
0.6%
|
0.6%
|
0.0%
|
0.5%
|
0.4%
|
|
Urinary system
|
0.0%
|
0.6%
|
1.3%
|
0.7%
|
0.0%
|
0.6%
|
|
Other
|
8.1%
|
7.0%
|
7.7%
|
4.2%
|
4.5%
|
6.4%
|
|
Drugs Prescribed
|
||||||
|
Analgesics
|
72.8%
|
72.5%
|
69.5%
|
83.1%
|
74.3%
|
73.4%
|
|
Antitussives
|
20.6%
|
18.7%
|
34.4%
|
38.7%
|
34.2%
|
30.3%
|
|
Antibiotics
|
37.5%
|
32.0%
|
33.8%
|
37.3%
|
50.0%
|
38.1%
|
|
Anti-histamines
|
27.9%
|
33.0%
|
38.0%
|
32.6%
|
24.3%
|
26.7%
|
|
Anti spasmodics
|
5.9%
|
5.8%
|
3.7%
|
2.8%
|
7.2%
|
4.5%
|
|
Antacid
|
8.1%
|
2.0%
|
9.2%
|
2.8%
|
6.0%
|
4.8%
|
|
Anti hypertensives
|
4.4%
|
4.1%
|
4.2%
|
4.2%
|
2.7%
|
3.8%
|
|
Oral & injectable
|
2.2%
|
2.9%
|
1.9%
|
2.8%
|
1.8 %
|
2.2%
|
|
hypoglycemics
|
||||||
|
Other
|
9.6%
|
11.1%
|
11.9%
|
7.7%
|
7.7%
|
9.2%
|