Article Info
Year: 2010
Month: July
Issue: 3
Pages: 20-21,23
Reference: AlMudarra S., Choudhry A., .Saudi Epidemiology Bulletin. 2010;17(3):20-21,23.
Every year during Hajj, over two million hajjis gather in Mina; a relatively small area with temporary cooking, storage, and serving facilities. Hamla managements’ major responsibilities include assuring the quality of food services provided for hajjis, availability of medical facilities and reporting of incidents, such as food poisoning episodes, to authorities. This study aims to identify the role of Hamla management in prevention and control of food poisoning outbreaks during Hajj.
A cross-sectional survey was conducted by interviewing Hamla managers and observing food preparation and dining services provided at the camps. Stratified random sampling was used to identify the sampling units. Data was collected on the 7th, 8th, 10th and 11th of Dhul Hijjah, 1430 H.
A total of 91 camps were surveyed; 33 (36.3%) domestic and 58 (63.7%) international. The mean number of years of Hamlas’ experience in hajj was 12.8 years (SD ±7.4). The mean number of hajjis served by the Hamlas was 2020.9 (SD ± 1655.7). International hamlas had a significantly higher number of hajjis per camp than domestic hamlas (P-value <0.001).
A total of 54 camps (59.3%) had a contract with a caterer; particularly domestic hamlas (P-value=0.016). Twenty 20 camps (22.0%) did not have any supervisory staff, almost all (19) were International (P-value=0.027). Among camps with supervisory staff, the most senior supervisor of 49 (69.0%) had previous experience of supervising food services other than hajj. The most frequently supervised food service was cleanliness of the cooking and dining areas (97.8%), followed by supervision of the served food (94.5%). Domestic camps were supervising food preparation significantly more often than international camps (P-value=0.014). This was mostly done by visual inspection (80.2%). The only significant actions taken by the supervisory team were that towards defective food preparation equipment (P-value=0.008), and defective heaters and cooling equipment (P-value= 0.048), by getting them repaired.
Open buffet was served more frequently in domestic camps (P-value <0.001). Gas stoves were the most frequent heating appliances (86.8%), and were used more often in international camps (P-value <0.001). A separate dining area was available in 25.3%, which was higher in domestic camps (P-value <0.001). The mean dining area size in all camps was 75.4 m2 (SD= 45.2 m2) and the mean cooking area size was 94.6 m2 (SD= 34.7 m2). Cooking area cleanliness was satisfactory in 25.3%, and storage area cleanliness was satisfactory in 24.2% of hamlas. Both were significantly better in domestic hamlas (P-value= 0.020 & <0.001, respectively).
A mechanism to lodge complaints was available in 61.1% of hamlas, and was higher in domestic (P-value= 0.008). Discarding food that was a source of complaint was the most frequent measure undertaken in response to complaints regarding food.
Medical facilities were available in 44 (48.4%), and were higher in domestic hamlas (P-value <0.001). A physician was available in 45 (49.5%) hamlas, and was higher in domestic (P-value <0.001). A reporting mechanism was in place in 63 hamlas (69.2%), which was also higher in domestic (P-value=0.042). Reporting was the responsibility of hamla managers in almost all camps (96.8%).
Editorial note:
Food poisoning is a preventable disease that is acquired by consumption of foods contaminated by a variety of organisms, ranging from infective organisms (bacteria, viruses, or parasites) or their toxins to chemical contaminants. A food poisoning outbreak occurs when a group of people consume the same contaminated food and two or more of them develop the same sickness.1,2
Continuous changes in human populations and the epidemiology of infectious diseases are important risk factors for food borne disease. The population of highly susceptible persons is expanding worldwide because of ageing, malnutrition, low immunity persons and other underlying medical conditions. Epidemiological studies have shown that the majority of reported food poisoning outbreaks originate from food service providers, and can be attributed to improper food preparation practices.3-5
In Saudi Arabia, the peak occurrence of food poisoning outbreaks is in the summer, and during Hajj and Umrah seasons. From 1986 to 1998, the number of reported cases of food poisoning ranged from 44 to 132 in each Hajj season.3 Fortunately, this number has gone down in recent years.
Hamla management is responsible for providing and supervising a variety of services for hajjis, such as the food served, residence, transportation, and medical services. This study may be the first direct study addressing the issue of the role of Hamla managements in preventing and controlling food poisoning episodes during Hajj.
Most of the camps participating in this study had a good experience in hajj, therefore, better services for hajjis are expected. Two roles of Hamla management were identified in this study that play a major role in prevention of food poisoning episodes; these are the presence of contract with a caterer and the location of food preparation place. Foodproviders and caterers usually follow food safety protocols which minimize the risk of food poisoning.
Serving food by open buffet was found in over one third of the camps, mostly domestic, which may carry a higher risk of food poisoning, due to easier contamination of food. Gas stoves were the most frequent heating appliances used, which were higher in international camps. A previous study in 2006 reported that 64.4% of camps used liquid gas stoves in food preparation.6 Our results support an improvement in the quality of food preparation. Presence of a mechanism to lodge complaints by hajjis, an important control and preventive measure, was in place in two thirds of camps and was more frequent in domestic. Reporting of cases is another important control and preventive measure that helps in rapid identification and treatment. In this study, most Hamla managements would report food poisoning cases to authorities when they occurred. Again, this was practiced more frequently in domestic camps.
In order to provide hajjis with better and immediate health services, and to decrease the burden on governmental health facilities, new Saudi hajj regulations have enforced the availability of medical facilities and a physician and/or nurse in each domestic camp. No such regulations are forced on international camps. Fortunately, most international camps had medical facilities.
General food services provided by Hamla management; such as the availability of supervisory staff, contract with a caterer, etc, were generally acceptable. Domestic camps provided significantly better services than international camps. It was recommended to strengthen food safety health education among Hamla management, staff, and hajjis by all possible means, before or during hajj.
References:
1.CDC, Atlanta. Food borne Illness: Frequently Asked Questions. 2005. Available at:
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm. Accessed on May 27, 2010.
2.Mead PS, et al. Food related illness in the United States. Emerg inf Dis 1999, 5: 607-625.
3.Al-Turki, et al. Bacterial food poisoning. Saudi med j 1998; 19 (5): 581-584.
4.Lammerding AM, Paolit GM. Quantitative Risk Assessment: An Emerging Tool for Emerging Food borne Pathogens, Emerging Infectious Diseases, National Center for Infectious Diseases, CDC, 1997; 3(4): 1-5.
5.Saudi Ministry of Hajj. Instructions Regulating Agreements between Hajj Missions and the Ministry. 2009. Available at: http://www.hajinformation.com/main/m40.htm. Accessed on May 30, 2010.