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Pattern of diseases among visitors of Mina Health Centers during Hajj season, 1429 H (2008G).

Article Info

Authors
Volume: 16
Year: 2009
Month: July
Issue: 3
Pages: 19,23
Reference: Alzahrani AG., Choudhry A., Hyani O., Abdalla M., .Saudi Epidemiology Bulletin. 2009;16(3):19,23.
This study was conducted to determine the pattern of diseases among hajjis seeking medical care at the Primary Health Care Centers (PHCCs) in Mina, in order to provide evidence-based information for future optimal allocation of health resources in these facilities. This descriptive study was conducted based on review of medical records at PHCCs in Mina area that work non-stop during a five day period starting from the 8th of Dhulhijjah, 1429 H.
Two stage stratified systematic random sampling was used. At first 13 centers were randomly selected from the 25 centers. A sample size of 3,732 was calculated to estimate diseases with proportion of 2.5% or more with a precision of 0.5% at 95% confidence level; then increased to 5,000 to cater for the anticipated incompleteness of records. Then the sample size was stratified according to work load of centers and records were systematically randomly selected and reviewed. Data was collected daily and analyzed using SPSS based on adjusted weighted values of variables.
There was variable workload between primary health care centers in Mina. Some PHCCs had a heavy daily workload (PHCC Muzdalifa-1) while others did not (PHCC 8). The daily number of patients reached its peak on day 11. Predominantly patients attended the morning shifts (58.2% compared to 41.8% during evening shift) with two peaks at the beginning of each shift (8:00 am and 8:00 pm).
The total number of patients records studied was 4,136. The majority of patients were males (70.7%), in the age group of 45-64 years (42.8%) with a male: female (M:F) ratio of 2.4:1. Hajjis constituted 94.9% of all patients; those from Arab countries 44.4%, from South Asian countries 27.0%, and the lowest to visit the centers were the Southeast Asians (0.8%). Among different nationalities, Egyptian (18.9%) and Pakistani patients (17.5%) were the most frequent attendees to the surveyed centers, followed by Saudis (8.3%).
The majority of the patients (79.8%) were suffering from only one disease, while only 20.2% had multiple diseases. The average number of diseases per patient was 1.21 (± 0.44).
The most frequently occurring diseases (Table 1) were those pertaining to respiratory system (60.8%), followed by musculoskeletal diseases (17.6%), skin diseases (15.0%) and gastrointestinal diseases. Pharyngitis (23.7%) and common cold (20.6%) were the most common among respiratory diseases. Among chronic diseases, diabetes (2.6%) and asthma (2.5%) were the major diseases reported, and were more frequent among those over 65.
Two thirds of the musculoskeletal disorders (63.4%) occurred on days 9 and 10, almost half of the injuries (45%) occurred on day 10, and two thirds of skin diseases (69.4%) occurred on day 10 and 11. Only respiratory and skin diseases showed significant difference (p value < 0.001 each).
Males were more affected by skin diseases than females (17.6% vs 8.4%, p <0.0001) while females were more affected by musculoskeletal diseases (22.8% vs 15.4%, p value of less than 0.0001). Respiratory diseases and gastro-intestinal and liver diseases were relatively higher among the age group of <15 years.
Respiratory diseases were the most common among all nationalities (59.3%), gastrointestinal diseases among Saudis (19.3%), skin diseases among other Arabs (21.5%) and those from Turkey and developed countries (13.9%), musculoskeletal diseases among Non-Arab Africans (28.9%), South Asians (21.6), Iranians (19.6%) and Southeast Asians (6.0%). Respiratory diseases, musculoskeletal diseases, skin diseases and gastro-intestinal diseases, all showed statistically significant differences with a p value of less than 0.05 for each

Editorial note:

The annual Islamic pilgrimage (hajj), of more than two million pilgrims (hajjis), is the largest mass gathering in the world. This mass gathering in a limited space and time expose hajjis to different risk factors.1 Overcrowding, climates, extra physical effort during ritual performance are the major risk factors to contract communicable diseases.2
Recent hospital based studies on the pattern of diseases during hajj have mostly been conducted among those requiring hospital care.3,4 However, PHCCs are the first level of care, are more accessible and distributed over Mina area. The total visits to Mina PHCCs during Hajj 1428H were reported as 287,756. In spite of this high number, the pattern of diseases has not been described.5
Although the study aimed at identifying the disease spectrum in Mina PHCCs, it also highlighted the utilization pattern of these first line health facilities. It described the variation of workload and the reasons behind it, in terms of frequent movement and settlement of the hajjis during their rituals performance; as evident at Muzdalifa center (M1). The detailed distribution of cases according to demographic characteristics, nationalities and geographical locations linked to diseases spectrum would be of great assistance in planning health service providers.
Reallocation of resources between PHCCs according to variable workload, recruitment of further female physicians to cope with the extra workload of female patients in some centers and provision of medications according to need in each center were recommended. Supervision is needed to ensure the completeness of prescription forms by the PHCCs reception staff and physicians, for accurate assessment of pattern of illness. Additional health facilities are needed in the Northwestern area of Mina and between Muzdalifah and PHCC 4 along the pedestrian pathway, which the study revealed were not covered with PHCCs.
References

1. Gatrad AR, Sheikh A. Hajj: journey of a lifetime. BMJ 2005 15;330(7483):133-7.

2. Ahmed QA, Arabi YM, Memish ZA. Health risks at the Hajj. Lancet 2006 25;367(9515):1008-15.

3. Madani TA, Ghabrah TM, Albarrak AM, Alhazmi MA, Alazraqi TA, Althaqafi AO, et al. Causes of admission to intensive care units in the Hajj period of the Islamic year 1424 (2004). Ann Saudi Med 2007;27(2):101-5.

4. 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):619-21.

5.Saudi Ministry Of Health. Health statistical year book 2007: Health Services in Hajj Season. 2007 ed. Riyadh: 2008.

 

Table 1: Distribution of disease groups by gender among patients attending PHCCs in Mina, hajj, 1429 H.
Diseases Groupsǂ
Total
Male
(n=2925)
Female
(n=1211)
P-value†
N
(n=4136)
%*
N
%**
N
%**
  
Cardiovascular Diseases
87
2.1
44
1.5
42
3.5
< 0.0001
Respiratory Diseases
2516
60.8
1718
58.7
750
61.9
0.0565
GIT Diseases ǂ
540
13.1
337
11.5
193
15.9
0.0001
Skin Diseases
620
15.0
516
17.6
102
8.4
< 0.0001
Eye and Ear Diseases
142
3.4
78
2.7
64
5.3
< 0.0001
Diabetes Mellitus
106
2.6
77
2.6
29
2.4
0.6597
Urinary Tract Infections
61
1.5
39
1.3
22
1.8
0.2406
Musculoskeletal Diseases
727
17.6
451
15.4
276
22.8
< 0.0001
OBsGyn Diseases ǂ
7
0.2
0
0.0
7
0.6
< 0.0002
Injuries
67
1.6
52
1.8
14
1.2
0.1465
Dental Diseases
40
1.0
32
1.1
8
0.7
0.1950
Other Diseases
112
2.7
86
2.9
26
2.1
0.1527
* percentage according to number of patients (n=4136), total of diseases = 5,025, as more than one disease may be recorded per patient.
** percentage according to gender, total of diseases = 5,025, as more than one disease may be recorded per patient.
†P value based on chi square.
ǂ GIT (gastrointestinal, liver and gallbladder) disease, ObsGyn (Obstetric and gynecological) diseases.

نمط الأمراض المنتشرة بين مراجعي المراكز الصحية بمنى خلال موسم الحج 1429 (2008).

يتعرض الحاج للعديد من المخاطر الصحية عند قيامه بمختلف مناسك الحج والمتعلقة بالظروف البيئية المحيطة، سلوكياته وأوضاعه الصحية، مما يؤدي إلى مجموعة متنوعة من الأمراض. تهدف هذه الدراسة إلى تحديد نمط الأمراض المنتشرة بين مراجعي المراكز الصحية بمشعر منى خلال موسم الحج 1428 (2008) مما قد يساهم في تحسين توزيع الخدمات الصحية بالمراكز الصحية بمشعر منى خلال موسم الحج.

اعتمدت هذه الدراسة الوصفية على السجلات الطبية لعينة عشوائية منتظمة لـ 4136 مريض من 13 مركز صحي بمشعر منى خلال الفترة من 8—12 من شهر ذو الحجة لعام 1429 هـ (2008م) وقد تم تحديد عدد الاستمارات من كل مركز في كل يوم حسب إحصائيات المراكز لموسم حج 1428 هـ .

اختلف ضغط العمل حسب المركز وحسب أيام العمل وقد سجل اليوم الحادي عشر أعلى عدد من الزيارات بينما سجل اليوم التاسع أدنى عدد. كان معظم المرضى يتوافدون على المركز خلال الفترة الصباحية (58.2٪). وكان غالبيتهم من الذكور (70.7٪)، في الفئة العمرية 45-64 سنة (42.8٪)، ومن الدول العربية (44.4٪) من غير السعوديين ومن دول جنوب آسيا (27.0٪).

الغالبية العظمى من المرضى (79.8٪) كانوا يعانون من مرض واحد، في حين كان 20.2٪ يعانون من أمراض متعددة مع متوسط عدد الأمراض لكل مريض من 1.2:1 (± 0.44). أكثر الأمراض تسجيلا في المراكز كانت تلك التي تتعلق بالجهاز التنفسي (60.8٪)، ثم الجهاز العضلي والعظمي (17.6٪)، والجلد (15.0٪)، والجهاز الهضمي (13.1٪) بينما شكلت الأمراض المزمنة مثل داء السكري والربو وارتفاع ضغط الدم أقل من 3٪ لكل منهم. 

بالإضافة إلى أمراض الجهاز التنفسي التي مثلت العبء الرئيسي طوال فترة الدراسة، فقد كانت معظم الزيارات في اليوم الثامن والحادي عشر والثاني عشر بسبب أمراض الجهاز العضلي والعظمي وفي اليوم التاسع بسبب أمراض الجهاز الهضمي وفي اليوم العاشر بسبب الأمراض الجلدية.

كانت أمراض الجهاز التنفسي الأكثر شيوعا (59.3٪) بين جميع الجنسيات بينما تمثلت الأمراض الأخرى في جنسيات محددة فقد انتشرت أمراض الجهاز الهضمي بين السعوديين (19.3٪) والأمراض الجلدية بين الجنسيات العربية الأخرى (21.5٪) والقادمين من تركيا والبلدان المتقدمة (13.9٪)، وأمراض الجهاز العضلي والعظمي بين الأفارقة غير العرب (28.9٪)، والقادمين من جنوب آسيا (21.6)، والإيرانيين (19.6٪) والقادمين من جنوب شرق آسيا (6.0٪).

من بين جميع المرضى، تلقى 19.0٪ علاجا واحدا بينما تلقى 80.2٪ منهم علاجات متعددة حيث بلغ متوسط عدد العقاقير لكل مريض 2.35 (± 0.97)، وتمثلت أكثر الأدوية المصروفة في المسكنات وخافضات الحرارة (79.4٪)، تلتها المضادات الحيوية (53.9٪)، ثم الأدوية المضادة للسعال (37.1٪).

أوصت الدراسة بضرورة توزيع الموارد حسب ضغط العمل بالمراكز الصحية والاهتمام بإرسال إحصائيات عن الأمراض والأدوية المصروفة والتركيز على التثقيف الصحي بشأن الأمراض الأكثر شيوعا سواء على المستوى المحلي أو الدولي