Pattern of referral of sick Omani pilgrims from Omani medical mission during hajj 2019 (Preprint)

BACKGROUND Annually, in the month of Dhul hijjah, over 2 million Muslims travel to Saudi Arabia to perform Hajj. Hajj is the biggest mass gathering globally, which creates a significant influence on Hajjes' health. The Omani medical mission is the official delegation from the Omani government to Saudi Arabia to serve the Omani hajjees regarding their health issues. OBJECTIVE This study investigates the referral rate and pattern of diseases among hajjees referred by the Omani medical mission during Hajj 1440 H. METHODS We conducted a cross-sectional study at the Omani Medical missions in Makkah, Madinah, Mina, and Arafat. Data was collected via a predesigned form. All Omani pilgrims presenting to the mission who were referred to local hospitals were included. RESULTS The total number of cases was 5000, of which 106 (2.1%) were referred to local hospitals (21.2 per 1000 hajjees). The most common causes of referral were cardiovascular diseases (23.6%), followed by gastrointestinal disease (17.9%) and trauma (16.9%). Males comprised 60.1%. Their mean age was 47.3 years (SD ±11.27), with the highest referrals in the 51-60 years age group (30%). Over half (55.7%) had co-morbidities. Patients' mean time to reach the clinic was 8.87 min (SD ±6.41), with 65% arriving in 5 min or less. The mean time needed to reach the hospital by ambulance was 11.39 min (SD ±6.6), with 36% arriving within 5 min. Of the referrals, 42% were admitted into hospital. Hospitalization was significantly higher among patients with chest pain (P-value < 0.0057), diabetics (P-value < 0.0001), and patients with Heart Disease (P-value = 0.013). CONCLUSIONS The most common causes for referral of Hajjees from the Omani Medical Mission were cardiovascular diseases, gastrointestinal disease, and trauma. This information should assist the Omani government in planning their medical services in hajj season in future years.

Agent-Based Simulation Framework for Epidemic Forecasting during Hajj Seasons in Saudi Arabia

The religious pilgrimage of Hajj is one of the largest annual gatherings in the world. Every year approximately three million pilgrims travel from all over the world to perform Hajj in Mecca in Saudi Arabia. The high population density of pilgrims in confined settings throughout the Hajj rituals can facilitate infectious disease transmission among the pilgrims and their contacts. Infected pilgrims may enter Mecca without being detected and potentially transmit the disease to other pilgrims. Upon returning home, infected international pilgrims may introduce the disease into their home countries, causing a further spread of the disease. Computational modeling and simulation of social mixing and disease transmission between pilgrims can enhance the prevention of potential epidemics. Computational epidemic models can help public health authorities predict the risk of disease outbreaks and implement necessary intervention measures before or during the Hajj season. In this study, we proposed a conceptual agent-based simulation framework that integrates agent-based modeling to simulate disease transmission during the Hajj season from the arrival of the international pilgrims to their departure. The epidemic forecasting system provides a simulation of the phases and rituals of Hajj following their actual sequence to capture and assess the impact of each stage in the Hajj on the disease dynamics. The proposed framework can also be used to evaluate the effectiveness of the different public health interventions that can be implemented during the Hajj, including size restriction and screening at entry points.

Hajj Pilgrimage amidst covid-19 pandemic: a review

Hajj pilgrimage is a nobligation for every Muslim that must be carried out at least once in their lifetime. Every year, more than 3 million pilgrims from over 180 countries travel to worship within a confined area of twelve kilometres in Makkah, Kingdom of Saudi Arabia (KSA). The host country and participating countries need to institute effective measures for a safer and healthier Hajj pilgrimage. In the immediate Hajj season during the COVID-19 pandemic, the number of pilgrims need to be reduced to the optimum number that can be managed individual countries’ Hajj missions. Beside proof COVID-19 clearance before travelling and completed Covid-19 vaccination, the stay in KSA should be shortened for Hajj ritual only. The participating countries responsible to thoroughly select individuals with low risk of severe infections, provide health education program, offer all compulsory and recommended vaccines and allocate adequate healthcare/isolation centres in KSA. The participating countries are also liable to prepare adequate quarantine places for hajj pilgrims when returning home. Individual pilgrims are responsible to prevent respiratory pathogens from spreading. Prior to departure for Hajj, they need to undergo a thorough medical examination, received all compulsory and recommended vaccines and follow health education program. During Hajj, they need to follow instructions by Hajj authorities, practicing proper hygiene, wearing a face mask and avoid crowded places. They also need to report to countries’ Hajj mission healthcare if having any fever or respiratory syndromes. With adequate measures prior, during and post-Hajj, we hope health security risk during the next Hajj seasons will be minimized. Bangladesh Journal of Medical Science Vol.20(4) 2021 p.732-740

Estimating Social Contacts in Mass Gatherings Through Agent-Based Simulation Modeling: Case of Hajj Pilgrimage

Most mass gathering events have been suspended due to the SARS-CoV-2 pandemic. However, with vaccination rollout, whether and how to organize some of these mass gathering events arises as part of the pandemic recovery discussions, and this calls for decision support tools. Hajj, one of the world's largest religious gatherings, was substantively scaled down in 2020 and it is still unclear if it will take place in 2021 and sub-sequent years. Considering the disease trends and vaccination conditions in the pilgrims’ country of origin, and the operational and logistical aspects of implementing public health measures, Hajj reopening conditions could be very complex. Simulating disease transmission dynamics during the Hajj season under differ-ent conditions can provide some insights for better decision-making. Since most disease risk assessment models require data on the number and nature of possible close contacts between individuals, we seek to use integrated agent-based modeling and discrete events simulation techniques to capture risky contacts among the pilgrims in one of the Hajj major sites, namely Masjid-Al-Haram. In particular, we assessed different scenarios concerning the total number of pilgrims and enforced physical distancing measures. Our simulation results show that a plethora of risky contacts may occur during the rituals. Also, as the total number of pilgrims increases at each site, the number of risky contacts increases, and physical distancing measures may be challenging to maintain beyond a certain number of pilgrims in the site.

Estimating Social Contacts in Mass Gatherings Through Agent-Based Simulation Modeling: Case of Hajj Pilgrimage

Most mass gathering events have been suspended due to the SARS-CoV-2 pandemic. However, with vaccination rollout, whether and how to organize some of these mass gathering events arises as part of the pandemic recovery discussions, and this calls for decision support tools. Hajj, one of the world's largest religious gatherings, was substantively scaled down in 2020 and it is still unclear if it will take place in 2021 and subsequent years. Considering the disease trends and vaccination conditions in the pilgrims’ country of origin, and the operational and logistical aspects of implementing public health measures, Hajj reopening conditions could be very complex. Simulating disease transmission dynamics during the Hajj season under different conditions can provide some insights for better decision-making. Since most dis-ease risk assessment models require data on the number and nature of possible close contacts between individuals, we seek to use integrated agent-based modeling and discrete events simulation techniques to capture risky contacts among the pilgrims in one of the Hajj major sites, namely Masjid-Al-Haram. In particular, we assessed different scenarios concerning the total number of pilgrims and enforced physical distancing measures. Our simulation results show that a plethora of risky contacts may occur during the rituals. Also, as the total number of pilgrims increases at each site, the number of risky contacts increases, and physical distancing measures may be challenging to maintain beyond a certain number of pilgrims in the site.

Nurses Compassion Fatigue during the Pilgrim (Al-Hajj) Season

<b><i>Background:</i></b> Compassion fatigue leads to behavioral, emotional, and physical changes, which affect the nurse, as well as the nurse-patient relationship. The consequences of compassion fatigue are not limited to the personal well-being of nurses but are also associated with poorer patient outcomes, increased thoughts of quitting among nurses, and higher job turnover rates. <b><i>Objective:</i></b> The purpose of this study was to examine the risk for compassion fatigue in nurses working a special assignment consisting of 15 consecutive 12-h days during the 1440 (2018) Al-Hajj pilgrimage season in Mecca (Makkah), Saudi Arabia. <b><i>Methods:</i></b> This study was a descriptive survey. A convenience sample of 542 nurses working a special nursing assignment during the Al-Hajj pilgrimage was recruited from 2 large metropolitan hospitals located in the center of Mecca. Three online surveys were completed (1) the Demographic Information Form, (2) the Professional Characteristics Information Form, and the (3) Professional Quality of Life Scale (ProQOL 5). <b><i>Results:</i></b> The sample yielded a moderate risk of compassion fatigue (Burnout [BO] [<i>M</i> = 22.5, SD = 5.7], secondary traumatic stress [<i>M</i> = 25.0, SD = 6.4]), and compassion satisfaction (CS) (<i>M</i> = 40.5, SD = 6.0). There was a positive relationship between the number of working days and compassion fatigue (BO [<i>r</i> = 0.16, <i>N</i> = 542, <i>p</i> &#x3c; 0.01], secondary trauma stress [<i>r</i> = 0.90, <i>N</i> = 542, <i>p</i> &#x3c; 0.05]), and a negative relationship with CS (<i>r</i> = −0.20, <i>N</i> = 542, <i>p</i> &#x3c; 0.01). Level of competence (Novice-Expert) was associated with levels of CS (X2 [4, <i>N</i> = 540] = 12.70, <i>p</i> = 0.013) and with levels of BO (X2 [4, <i>N</i> = 540] = 10.48, <i>p</i> = 0.033). <b><i>Conclusion:</i></b> Hospitals need to provide a healthy, supportive, and positive workplace. Nurse managers must provide a compassionate leadership style. Nurses must practice self-compassion and ensure work-life balance.

Pattern of Respiratory Viruses among Pilgrims during 2019 Hajj Season Who Sought Healthcare Due to Severe Respiratory Symptoms

The aim of our study was to define the spectrum of viral infections in pilgrims with acute respiratory tract illnesses presenting to healthcare facilities around the holy places in Makkah, Saudi Arabia during the 2019 Hajj pilgrimage. During the five days of Hajj, a total of 185 pilgrims were enrolled in the study. Nasopharyngeal swabs (NPSs) of 126/185 patients (68.11%) tested positive for one or more respiratory viruses by PCR. Among the 126 pilgrims whose NPS were PCR positive: (a) there were 93/126 (74%) with a single virus infection, (b) 33/126 (26%) with coinfection with more than one virus (up to four viruses): of these, 25/33 cases had coinfection with two viruses; 6/33 were infected with three viruses, while the remaining 2/33 patients had infection with four viruses. Human rhinovirus (HRV) was the most common detected viruses with 53 cases (42.06%), followed by 27 (21.43%) cases of influenza A (H1N1), and 23 (18.25%) cases of influenza A other than H1N1. Twenty-five cases of CoV-229E (19.84%) were detected more than other coronavirus members (5 CoV-OC43 (3.97%), 4 CoV-HKU1 (3.17%), and 1 CoV-NL63 (0.79%)). PIV-3 was detected in 8 cases (6.35%). A single case (0.79%) of PIV-1 and PIV-4 were found. HMPV represented 5 (3.97%), RSV and influenza B 4 (3.17%) for each, and Parechovirus 1 (0.79%). Enterovirus, Bocavirus, and M. pneumoniae were not detected. Whether identification of viral nucleic acid represents nasopharyngeal carriage or specific causal etiology of RTI remains to be defined. Large controlled cohort studies (pre-Hajj, during Hajj, and post-Hajj) are required to define the carriage rates and the specific etiology and causal roles of specific individual viruses or combination of viruses in the pathogenesis of respiratory tract infections in pilgrims participating in the annual Hajj. Studies of the specific microbial etiology of respiratory track infections (RTIs) at mass gathering religious events remain a priority, especially in light of the novel SARS-CoV-2 pandemic.

Adherence of Healthcare Workers to Saudi Management Guidelines of Heat-Related Illnesses during Hajj Pilgrimage

Heat-related illnesses (HRIs), such as heatstroke (HS) and heat exhaustion (HE), are common complications during Hajj pilgrims. The Saudi Ministry of Health (MoH) developed guidelines on the management of HRIs to ensure the safety of all pilgrims. This study aimed to assess healthcare workers’ (HCWs) adherence to the updated national guidelines regarding pre-hospital and in-hospital management of HRIs. This was a cross-sectional study using a questionnaire based on the updated HRI management interim guidelines for the Hajj season. Overall, compliance with HE guidelines scored 5.5 out of 10 for basic management and 4.7 out of 10 for advanced management. Medical staff showed an average to above average adherence to pre-hospital HS management, including pre-hospital considerations (7.2), recognition of HS (8.1), case assessment (7.7), stabilizing airway, breathing, and circulation (8.7), and cooling (5). The overall compliance to in-hospital guidelines for HS management were all above average, except for special conditions (4.3). In conclusion, this survey may facilitate the evaluation of the adherence to Saudi HRIs guidelines by comparing annual levels of compliance. These survey results may serve as a tool for the Saudi MoH to develop further recommendations and actions.

Application of a multi-objective multi traveling salesperson problem with time windows

The pilgrimage to Mecca, which is called Hajj, is the largest annual pedestrian crowd management problem in the world. During the Hajj, the pilgrims are accommodated in camps. For safety reasons, exact times and directions are given to the pilgrims who are moving between holy sites. Despite the importance of complying with those schedules, violations can often be conjectured. Directing a small workforce between the camps to monitor the pilgrims’ compliance with the schedule is an important matter, which will be dealt with in this paper. A type of multi-objective multiple traveling salesperson optimization problem with time windows is introduced to generate the tours for the employees monitoring the flow of pilgrims at the campsite. Four objectives are being pursued: As many pilgrims as possible (1), should be visited with a preferably small workforce (2), the tours of the employees should be short (3) and employees should have short waiting times between visits (4). A goal programming, an enumeration, Augmecon2 and an interactive approach are developed. The topic of supported and non-supported efficient solutions is addressed by determining all efficient solutions with the enumeration approach. The suitability of the approaches is analyzed in a computational study, while using an actual data set of the Hajj season in 2015. For this application, the interactive approach has been identified as the most suitable approach to support the generation of an offer for the project.