Diseases pattern among patients attending Holy Mosque (Haram) Medical Centers during Hajj 1434 (2013)

Discussion

Saudi Arabia is unique in the Islamic world where the world’s largest mass gathering occurs every year. The Ministry of Health of Saudi Arabia endeavor to deliver the best possible health care facilities to pilgrims. The present study provides data of 16 days from the 2 health care centers located inside the Holy Mosque (Haram) area. We found that most of the patients were suffering from respiratory problems followed by the diseases of the skin, GIT, rheumatology, cardiovascular, orthopedic, endocrinology, urology, and others. These results are similar to several other studies.1,9 The present data is contrary to Khan et al,3 they reported that the 4 common reasons for admission were diabetes mellitus (31.9%), hypertension (37.2%), cardiac diseases (31.8%), and chronic lung diseases (14.9%). A discrepancy in the result is due to the different type of setups; they reported the diseases pattern among admitted patients during Hajj season in a tertiary care hospital in Makkah, while the present study reported data from the OPD of Haram Medical Centers. The present study and other previous studies4,7,10 reported that upper respiratory tract infections (URTIs) were the most common disease in pilgrims. There are many contributing factors for increasing URTIs, such as direct contact with affected individuals, climate change, and limited and overcrowded space.11,12 Al-Tawfiq & Memish13 described that the most frequent diseases during Hajj are the URTIs. Mandourah et al4 reported that in 2 successive Hajj seasons, pneumonia was the cause of admission to intensive care unit (ICU) in 27% critically ill patients. Many studies have described that during Hajj, URTIs are the principal category of infections,14-16 and the reason of serious sepsis and septic shock requiring admission to the ICU.6 Al-Jasser et al17 described that among domestic hajjis from Saudi Arabia, URTI was the common health problem followed by diarrheal symptoms. Almalki,8 described that during the Hajj season in 2011, there were 111 pilgrims admitted to Makkah region hospitals with cardiovascular diseases. In the present study, no patients arrived at the OPD with heat stroke as it was mild weather during October. Similar results were described by other studies, which were conducted in the winter season.9,14,15 Preventive measures can play an important role in controlling URTIs. It is recommended to employ individual shielding procedures such as vaccination, chemoprophylaxis, repeated hand washing/sanitizing, and wearing of a face mask.18 Using a face mask does not prevent infection completely, but it may lessen contact to droplet nuclei, believed to be one of the major means of spread of most URTIs.19

The male:female ratio in our study was 1.22:1, which is similar to Khamis9 and other studies.3,10,20 Most of the patients were treated and subsequently discharged, while <25% of the patients were referred to tertiary care centers after initial treatment. The volume of patients was referred to the Ajyad Hospital, Makkah followed by the King Abdulaziz Hospital, and others. The results indicate the need for more staff, patients’ beds, and medicines. We found that most patients attending the Haram medical center facilities belonged to the age group 41-60 years (43.7%). This figure was similar to the previous study14 that found 38.1% were admitted to the ICU at the group age of 41-60 years. The same study also reported that a large number of ICU admitted patients (92%) were older than 40 years.14 Khan et al3 also described that most of the patients admitted during Hajj were of older age, and they observed that it was the one of the risk factors linked with a high death rate. The reason may be that this age group become monetarily capable to perform Hajj, after saving money for several years for Hajj journey, and more importantly their children have grown up, and are not dependent on them. The probability of contracting diseases, developing more grave medical complications, and comparatively higher rates of death found in elderly pilgrims.14

According to geographical distribution, most of the patients were Egyptians, followed by Saudis, Pakistani, Turkish, Indians, and other nationalities. These results were similar to the figures from other studies.9,14 The reason for similar percentages could be that the number of pilgrims from these countries are of large numbers, so comparatively they attended more health care facilities as compared with other countries pilgrims. Out of these 16 days, the maximum number of patients attended the OPD on the 13th, 12th, and 3rd day of Dhul Hijjah. The reason for large number of patients on 12th and 13th day could be that after performing most of the Hajj ritual, elderly people have become exhausted and their chronic diseases are aggravated because of changes in their daily pattern of wake and sleep, dietary change, and walking long distances. Several studies have found that most of the patients hospitalized during Hajj were of old age, and with high occurrence of chronic diseases.3,8,14 A study among pilgrims,16 suggested that older aged people (46-60 years) had a higher risk of severe asthmatic attack. It was suggested that to decrease the health related issues among pilgrims, comprehensive health education programs should be planned for all those who intended to perform Hajj to enhance their awareness of protective measures against URTIs, diarrheal diseases, injuries, and exacerbations of chronic diseases for domestic pilgrims,’15 and for foreign pilgrims in their own countries. A full medical checkup prior to arrival in Saudi Arabia should also assist in correct medication reconciliation.