Exploring the experiences, motivations, and skillsets of nurse volunteers during Hajj: implications for enhancing volunteer programs.

BACKGROUND: The annual Islamic pilgrimage of Hajj attracts millions of pilgrims from around the world, necessitating the involvement of healthcare professionals, including nurse volunteers, to ensure the safety and well-being of attendees. This study aims to explore the experiences, motivations, and skillsets of nurse volunteers during the Hajj pilgrimage, focusing on the personal, professional, and spiritual dimensions of volunteering, and providing insights to enhance volunteer programs. METHODS: The demographic data shows that the majority of nurse volunteers during Hajj 2022 fell in the 30-39 age group and were predominantly women. The study provides insights into the interest, experience, and motives for volunteering, with spiritual motives cited as a primary driver. An overview of volunteer hours, perceived benefits, and pre-existing skills reveals diverse commitments and skillsets among the volunteers. RESULTS: Nurse volunteers during Hajj 2022 show diverse age and gender composition, strong commitment, spiritual motives, varied engagement, and professional skills. Team dynamics, skills development, and positive experiences are crucial. A potential gap exists in preparatory education. Significant associations are found between age, volunteer hours, training, skill practice, and gender. CONCLUSION: This study highlights the multifaceted benefits of volunteering during Hajj and underscores the need for decision-makers to devise strategies that cater to diverse needs, foster collaboration, and enhance the preparedness of nurse volunteers. Further research is suggested to examine the long-term impact of volunteering during Hajj on nurses' professional development and personal well-being and to evaluate the effectiveness of various recruitment strategies, training programs, and support initiatives.

Muslim pilgrims' knowledge, attitudes, and practices regarding complementary and alternative medicine (CAM); a study conducted during Hajj season.

Complementary and alternative medicine (CAM) has attracted much interest, and its prevalence in both developed and developing countries has increased. During the Hajj season, millions of Muslims from many different countries travel to Makkah for the pilgrimage. In dealing with health issues during the holy season, many pilgrims prefer to self-medicate with traditional remedies instead of visiting medical practitioners, which could affect the efforts of state healthcare organizations to maintain overall public health during this mass gathering. This study aims to gauge the prevalence of CAM use during Hajj, and to assess pilgrims' beliefs and knowledge of CAM therapies, with particular reference to products available in Makkah. A cross-sectional survey was conducted in several camps and hotels occupied by Hajj pilgrims in Makkah, during Hajj 2023. CAM modalities were used by 68.8 % of the study participants during the Hajj season. There were almost equal numbers of men (53.7 %) and women (46.3 %) participants, with 88 % of the CAM users being non-Saudi and only 12 % Saudi. The majority of the CAM users belonged to two age groups, the 31-40 year group (29.9 %) and the 41-50 year group (34.5 %). The most frequent self-practice therapies were religious prayer/rituals (30.2 %), and the most popular practitioner therapies was herbal treatments (12.3 %). The most common source of CAM-related information was family/friends (29.2 %), for improving well-being reason (25.8 %). More than half of the participants (56.8 %) strongly believed that CAM therapies have the potential to cure disease, although they were unaware of possible interactions between CAM and conventional drugs (76.7 %). More than half of the participants (57.8 %) did not disclose their CAM usage to healthcare practitioners. Half of the sample said they used CAMs during Hajj because of the common belief that therapeutic products from the holy city of Makkah, such as Zamzam water, are more effective. In conclusion, CAM therapies are commonly used by Hajj pilgrims as they are presumed to be natural and therefore safe, raising concerns about the potential risks of relying on CAM without adequate consultation with healthcare providers or awareness of potential interactions between prescription drugs and CAM treatments.

Undiagnosed and missed active pulmonary tuberculosis during mass gatherings: a prospective cross-sectional study from the Hajj pilgrimage.

Mass gatherings increase the risk of infectious diseases transmission including tuberculosis (TB). The Hajj pilgrimage to Mecca, Saudi Arabia, is attended by over 2 million pilgrims many of whom are from high TB-burden countries, and has been linked to increased risk of TB acquisition among travellers. We investigated the burden of undiagnosed and missed active pulmonary TB (PTB) among Hajj pilgrims symptomatic for cough. The study was conducted among hospitalised and non-hospitalised travellers attending the Hajj pilgrimage in 2016 and 2017. Questionnaires were used to collect relevant data and sputum samples were collected from participants and processed using the Xpert MTB-RIF assay. Non-hospitalised pilgrims (n = 1510) originating from 16 high and medium TB-burden countries were enrolled. Undiagnosed, rifampicin-sensitive, active PTB was identified in 0.7%. Comorbidities (adjOR = 5.9 [95% CI = 1.2-27.8]), close contact with a TB case (adjOR = 5.9 [95% CI = 1.2-27.8]), cough in household (adjOR = 4.46 [95% CI = 1.1-19.5]), and previous TB treatment (adjOR = 10.1 [95% CI = 4.1-98.1]) were independent risk factors for TB. Of the hospitalised pilgrims (n = 304), 2.9% were positive for PTB, and 2.3% were missed, including a rifampicin-resistant case. History of TB treatment was associated with increased risk of TB (adjOR = 8.1 [95% CI = 1.3-48.7]). International mass gatherings may play an important role in the global epidemiology of TB. Preventive measures should be directed to reducing the risk of TB importation and transmission during Hajj and other similar events.

Community pharmacists' knowledge, prospective and practice towards health related illness at Hajj and Umrah: A cross sectional study.

Objectives: To assess the community pharmacists' (CPs) knowledge, attitude, and perception of health-related illness among pilgrims, and to investigate the common diseases and the pattern of medications dispensed by CPs during Hajj and Umrah seasons. Method: A cross-sectional study was carried out in Riyadh, Saudi Arabia over two months in 2022, through electronic platform using prevalidated questionnaires adopted from the literature. The questionnaires were divided into 4 sections assessing the CP's knowledge, attitude, and perception about health-related illness, common dispensed agents, and required vaccination during Hajj and Umrah. Results: A total of 544 CPs, mostly between the age of 31-40 (69.9%), participated in this research. About 87.9% of the CPs received a pilgrim after performing their rituals coming to the pharmacy complaining of infection or health problem. In this study, 99.8%(n = 544), 99.6%(n = 543), and 92.7% (n = 505) of the CPs identified influenza, food poisoning, and diarrhea/gastroenteritis as the most common issues during the Hajj & Umrah season respectively. As results, anti-diarrheal agents (96.3%), painkillers (87.3%), inhalers (89.4%), and sunscreens (88.3%) were the most requested pharmaceutical agents. Additionally, 96.7%(n = 527) of the CPs agreed that vaccination is safe to be given to Hajj and Umrah pilgrims particularly for those aged ≥ 65 years, and 89.4%(n = 487) of them reported awareness of vaccines that are required by Saudi Ministry of Health. Both Influenza and meningococcal meningitis vaccines were identified by 99.8% of the CPs, but polio vaccine was identified by 33.9%. Conclusion: Community pharmacists provided pharmaceutical care services for Hajj and Umrah pilgrims. The majority of CPs had adequate knowledge about viral diseases during Hajj and Umrah and their requirement for vaccination.

[The nontrivial approach or how physicians-bolsheviks treated kings. The Soviet medicine in the Arabian peninsula in 1920-1930s].

In the late 1920s, the USSR intensified its international activities in the Arabian Peninsula. The rapprochement with Arab monarchies provided opportunity to study political, economic and ethno-cultural characteristics of region by organizing transit of pilgrims to Mecca through the Soviet territory and providing medical care in first-aid posts at diplomatic missions. The Soviet physicians, in atypical situation of Arab monarchies, played important role as intermediaries between royal courts and the Soviet government, serving as agents of "soft power". The article considers causes of Moscow geopolitical interest to this region in 1920s-1930s. The distinctions of interaction between Soviet physicians and ruling circles of Hijaz and Yemen were explored. The humanitarian, cultural and geopolitical significance of these activities were examined. The article considers and explains, through optics of geopolitical approach, situational rationality that was applied by medical men when approaching treatment of royal personages despite ideological mismatch of this work with Bolshevism dogmas. The article consistently demonstrates, noting non-triviality of both locus itself and approaches to organization of medical care, how professionalism of Soviet physicians gained confidence of monarchs of Hijaz and Yemen in complicated conditions of competition with highly qualified physicians from Western Europe. It is emphasized that in conditions of Arabia, ideological attitudes had secondary importance, while such qualities as personal charisma and medical professionalism, which created solid reputation foundation for Soviet physicians, came to foreground.

Syndromic surveillance of respiratory-tract infections and hand hygiene practice among pilgrims attended Hajj in 2021: a cohort study.

BACKGROUND: The risk of transmission of viral respiratory tract infections (RTIs) is high in mass gatherings including Hajj. This cohort study estimated the incidence of symptomatic RTIs and hand hygiene compliance with its impact among Hajj pilgrims during the COVID-19 pandemic. METHODS: During the week of Hajj rituals in 2021, domestic pilgrims were recruited by phone and asked to complete a baseline questionnaire. Pilgrims were followed up after seven days using a questionnaire about the development of symptoms, and practices of hand hygiene. Syndromic definitions were used to clinically diagnose 'possible' influenza-like illnesses (ILI) and COVID-19 infection. RESULTS: A total of 510 pilgrims aged between 18 and 69 (median of 50) years completed the questionnaire, 280 (54.9%) of whom were female, and all of them (except for one) were vaccinated against COVID-19 with at least one dose. The mean (± SD) of pilgrims' hand hygiene knowledge score (on a scale of 0 to 6) was 4.15 (± 1.22), and a higher level of knowledge was correlated with a higher frequency of handwashing using soap and water. Among those 445 pilgrims who completed the follow-up form, 21 (4.7%) developed one or more respiratory symptoms, of which sore throat and cough were the commonest (respectively 76.2% and 42.8%); 'possible ILI' and 'possible COVID-19' were present in 1.1% and 0.9% of pilgrims. Obesity was found to be a significant factor associated with the risk of developing RTIs (odds ratio = 4.45, 95% confidence interval 1.15-17.13). CONCLUSIONS: Hajj pilgrims are still at risk of respiratory infections. Further larger and controlled investigations are needed to assess the efficacy of hand hygiene during Hajj.

Respiratory pathogens among ill pilgrims and the potential benefit of using point-of-care rapid molecular diagnostic tools during the Hajj.

We investigated respiratory pathogens among ill Hajj pilgrims from Marseille. We also discuss the potential role of point-of-care (POC) rapid molecular diagnostic tools for this purpose. Clinical data were collected using a standardised questionnaire. Influenza A and B viruses, human rhinovirus and human coronaviruses, Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella pneumoniae were investigated using real-time PCR in respiratory samples obtained during travel, at the onset of symptoms. 207 participants were included. A cough, expectoration, rhinitis and a sore throat were the most frequent respiratory symptoms, followed by loss of voice and dyspnoea. 38.7% and 25.1% of pilgrims reported a fever and influenza-like symptoms, respectively. 59.4% pilgrims received antibiotics. Rhinovirus (40.6%) was the most frequent pathogen, followed by S. aureus (35.8%) and H. influenzae (30.4%). Virus and bacteria co-infections were identified in 28.5% of participants. 25.1% pilgrims who were positive for respiratory bacteria did not receive antibiotic treatment. In the context of the Hajj pilgrimage, it is important to detect infections that can be easily managed with appropriate treatment, and those that can affect prognosis, requiring hospitalisation. POC rapid molecular diagnostic tools could be used for patient management at small Hajj medical missions and to rationalise antibiotic consumption among Hajj pilgrims.

Deep Dilated Convolutional Neural Network for Crowd Density Image Classification with Dataset Augmentation for Hajj Pilgrimage.

Almost two million Muslim pilgrims from all around the globe visit Mecca each year to conduct Hajj. Each year, the number of pilgrims grows, creating worries about how to handle such large crowds and avoid unpleasant accidents or crowd congestion catastrophes. In this paper, we introduced deep Hajj crowd dilated convolutional neural network (DHCDCNNet) for crowd density analysis. This research also presents augmentation technique to create additional dataset based on the hajj pilgrimage scenario. We utilized a single framework to extract both high-level and low-level features. For creating additional dataset we divide the process of images augmentation into two routes. In the first route, we utilized magnitude extraction followed by the polar magnitude. In the second route, we performed morphological operation followed by transforming the image into skeleton. This paper presented a solution to the challenge of measuring crowd density using a surveillance camera pointed at a distance. An FCNN-based technique for crowd analysis is included in the proposed methodology, particularly for classifying crowd density. There are several obstacles in video analysis when there are a large number of pilgrims moving around the tawaf area, with densities of between 7 and 8 per square meter. The proposed DHCDCNNet method has achieved accuracy of 97%, 89% and 100% for the JHU-CROWD dataset, the UCSD dataset and the proposed Hajj-Crowd dataset, respectively. The proposed Hajj-Crowd dataset, the UCSD dataset, and the JHU-CROW dataset all had accuracy of 98%, 97% and 97%, respectively, using the VGGNet approach. Using the ResNet50 approach, the proposed Hajj-Crowd dataset, the UCSD dataset, and the JHU-CROW dataset all had an accuracy of 99%, 91% and 97%, respectively.

Cross-sectional study of Middle East respiratory syndrome coronavirus in humans and dromedary camels in Diyala, Iraq.

BACKGROUND: Middle East respiratory syndrome (MERS) is a zoonotic viral disease transmitted from dromedaries to humans. To date, more than 1500 cases of MERS have been reported and 80% of all cases have occurred in the Kingdom of Saudi Arabia (KSA). This cross-sectional study was carried out to figure out the rate of infection among humans and dromedary camels and to explore the risk factors. METHODS: This study was conducted in Diyala Province, Iraq for the period from August 2017 to October 2018. Human subjects included 90 participants; 34 (37.8%) were females and 56 (62.2%) were males. Additionally, 90 dromedary camels were also included, 50 (55.6%) males and 40 (44.4%) females. Serum samples from subjects were collected and tested for the presence of anti-MERS-coronavirus (CoV) immunoglobulin g (IgG). RESULTS: The results revealed that 46 (51.1%) of human subjects were positive for anti-MERS-CoV IgG, (95% confidence interval (CI) for the prevalence rate 40.9-61.3) with a mean titer of anti-MERS-CoV IgG antibodies (Ab) of 81.2 U/mL. The anti-MERS-CoV IgG positivity rate was insignificantly higher, but the mean of anti-MERS-CoV IgG titer was significantly higher among females (p = 0.12 and p < 0.004, respectively). Furthermore, the anti-MERS-CoV IgG positivity rate and Ab titer were significantly higher among those people who visited KSA for Hajj or Umrah (p < 0.001 and p < 0.001, respectively). In camels, 81 (90.0%) were positive for anti-MERS-CoV IgG, (95% CI for the prevalence rate 82.5-94.9), with a mean titer of 99.8 U/mL. DISCUSSION: The MERS-CoV infection rate was high among both Iraqi humans and dromedary camels. Further confirmatory studies are needed, and setting up of national precaution program is essential.

Meningococcal carriage among Hajj pilgrims, risk factors for carriage and records of vaccination: a study of pilgrims to Mecca.

OBJECTIVE: The Saudi government requires that all pilgrims receive a quadrivalent meningococcal vaccine at least 10 days before the Hajj. We conducted a study to determine the uptake of meningococcal vaccine and antibiotic use. We also investigated risk factors of meningococcal carriage and carriage of Neisseria meningitidis pathogenic serogroups A, C, W and Y. METHODS: A cross-sectional oropharyngeal carriage survey was conducted in 2973 Hajj pilgrims in September 2017. A real-time polymerase chain reaction (rt-PCR) assay was used to identify N. meningitidis from the oropharyngeal swabs. A questionnaire investigated potential risk factors for carriage of N. meningitidis. RESULTS: Two thousand two hundred forty nine oropharyngeal swabs were obtained. The overall prevalence of carriage of N. meningitidis was 4.6% (95% CI: 3.4%-6%). Carriage of pathogenic serogroups was not associated significantly with any of the meningococcal risk factors evaluated. 77% of pilgrims were vaccinated but 22.58 % said they were carrying unofficial vaccination cards. CONCLUSION: Carriage of serogroups A, C, W and Y was not significantly associated with any of the risk factors investigated. Almost a quarter of pilgrims were unlikely to have been vaccinated, highlighting a need to strengthen compliance with the current policy of vaccination to prevent meningococcal disease outbreaks during and after the Hajj.

Gastrointestinal symptoms and the acquisition of enteric pathogens in Hajj pilgrims: a 3-year prospective cohort study.

The acquisition of enteric pathogens and risk factors for Hajj-associated diarrhea in Hajj pilgrims is poorly documented. Pilgrims from Marseille participating in the Hajj in 2016-2018 underwent successive systematic rectal swabbing before and after their travel. Carriage of the main enteric pathogens was assessed by real-time PCR. Baseline demographics, adherence to individual preventive measures, gastrointestinal symptoms, and treatments were recorded. A total of 376 pilgrims were included. The median age was 62.0 years. During the Hajj, 18.6% presented at least one gastrointestinal symptom, 13.8% had diarrhea, and 36.4% had acquired at least one enteric pathogen. Enteropathogenic Escherichia coli (EPEC) and Enteroaggregative E. coli (EAEC) were the pathogens most frequently acquired by pilgrims (17.6% and 14.4%, respectively). Being female was associated with increased frequency of gastrointestinal symptoms during the pilgrimage (aOR = 2.38, p = 0.004). Enterohemorrhagic Escherichia coli (EHEC) acquisition was associated with a four-fold higher risk of reporting at least one gastrointestinal symptom and diarrhea (aOR = 3.68 and p = 0.01 and aOR = 3.96 and p = 0.01, respectively). Pilgrims who suffered from diarrhea were more likely to wash their hands more often (aOR = 2.07, p = 0.03) and to be either overweight (aOR = 2.71, p = 0.03) or obese (aOR = 2.51, p = 0.05). Enteric bacteria such as E. coli that are frequently associated with traveler's diarrhea due to the consumption of contaminated food and drink were frequently found in pilgrims. Respecting strict measures regarding food and water quality during the Hajj and adherence to preventive measures such as good personal hygiene and environmental management will help reduce the burden of gastrointestinal infections at the event.

Acquisition of multidrug-resistant bacteria and encoding genes among French pilgrims during the 2017 and 2018 Hajj.

The objective of this study is to determine the acquisition of multidrug-resistant (MDR) bacteria and antibiotic resistance-encoding genes by French Hajj pilgrims and associated risk factors. Pilgrims traveling during the 2017 and 2018 Hajj were recruited. All pilgrims underwent two successive systematic nasopharyngeal and rectal swabs, pre- and post-Hajj. Specific culture media were used to screen for MDR bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant bacteria, and extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E). qPCR was used to identify antibiotic resistance-encoding genes from cultured isolates. Direct screening of genes encoding for colistin resistance (mcr-1, 2, 3, 4, 5, and 8) from nasopharyngeal and rectal swabs was performed using qPCR, and positive qPCR results were simultaneously tested by sequencing. There were 268 pilgrims included. The percentage of pilgrims acquiring MDR bacteria during the Hajj was 19.4%. A total of 81 strains were isolated (1 carbapenem-resistant Acinetobacter baumannii, 12 MRSA, and 68 ESBL-E). ESBL-E strains were found in rectal samples of 6.0% pilgrims pre-Hajj and of 16.4% pilgrims post-Hajj. Only 0.4% pilgrims were positive for CARB post-Hajj and 1.9% carried nasal MRSA pre- and post-Hajj. In addition, 23 (8.6%) post-Hajj rectal swabs were positive for mcr genes (19 mcr-1 gene and 4 mcr-4 gene). No significant association was found between co-factors and acquisition of MDR bacteria or mcr genes. MDR bacteria and genes are acquired by pilgrims during the Hajj mass gathering. Rationalization of antibiotic consumption and implementation of measures to prevent transmission of bacteria among pilgrims during the event are of paramount importance.

Gastrointestinal symptoms and knowledge and practice of pilgrims regarding food and water safety during the 2019 Hajj mass gathering.

BACKGROUND: Food and water-borne diseases (FWBDs) are a health risk at the Hajj mass gathering. The current study documented the prevalence and management of gastrointestinal (GI) symptoms among pilgrims during the 2019 Hajj and assessed their knowledge and practice concerning food and water safety. METHOD: An analytical cross-sectional study was conducted in Macca, Saudi Arabia, among adult Hajj pilgrims from 28 countries. Data was collected from 15th-20th August 2019 by facer-to-face interviews using an anonymous structured questionnaire. Basic demographic data as well as information regarding pilgrims' knowledge and practice relating to food and water safety and any GI symptoms experienced during the Hajj was collected and analyzed. RESULTS: The study enrolled 1363 pilgrims with a mean age of 50.1 years (SD = 12.3) and 63.4% (n = 845) were male. At least 9.7% (n = 133) of pilgrims experience GI symptoms and 5.1% (69/1363) suffered diarrhea. Most respondents drunk bottled water (99.4%, n = 1324) and obtained their food from their hotel /Hajj mission (> 86%). In general, pilgrims had good knowledge and practice in relation to food and water safety, although risky practices were noted concerning keeping food at unsafe temperatures and hazardous sharing of food and water. Gender, nationality and suffering GI symptoms during Hajj were significantly associated with good knowledge and good practice. There was a moderate but statistically significant positive correlation between knowledge and practice scores (rs = 0.41, p < 0.0001). CONCLUSION: Despite overall good knowledge and self-reported practice, risky behaviors relating to food and water safety were identified among pilgrims, many of whom suffered from GI symptoms during Hajj. Our results can form the basis for developing tailored, targeted and effective interventions to improve pilgrims' knowledge and behavior and reduce the burden of FWBDs at the Hajj and beyond.

Abnormal Activity Recognition from Surveillance Videos Using Convolutional Neural Network.

Background and motivation: Every year, millions of Muslims worldwide come to Mecca to perform the Hajj. In order to maintain the security of the pilgrims, the Saudi government has installed about 5000 closed circuit television (CCTV) cameras to monitor crowd activity efficiently. PROBLEM: As a result, these cameras generate an enormous amount of visual data through manual or offline monitoring, requiring numerous human resources for efficient tracking. Therefore, there is an urgent need to develop an intelligent and automatic system in order to efficiently monitor crowds and identify abnormal activity. METHOD: The existing method is incapable of extracting discriminative features from surveillance videos as pre-trained weights of different architectures were used. This paper develops a lightweight approach for accurately identifying violent activity in surveillance environments. As the first step of the proposed framework, a lightweight CNN model is trained on our own pilgrim's dataset to detect pilgrims from the surveillance cameras. These preprocessed salient frames are passed to a lightweight CNN model for spatial features extraction in the second step. In the third step, a Long Short Term Memory network (LSTM) is developed to extract temporal features. Finally, in the last step, in the case of violent activity or accidents, the proposed system will generate an alarm in real time to inform law enforcement agencies to take appropriate action, thus helping to avoid accidents and stampedes. RESULTS: We have conducted multiple experiments on two publicly available violent activity datasets, such as Surveillance Fight and Hockey Fight datasets; our proposed model achieved accuracies of 81.05 and 98.00, respectively.

Transcultural Nurses' Caring for Pilgrims for the First Time During Hajj Season in Saudi Arabia.

The Kingdom of Saudi Arabia invests tremendous governmental resources to support the annual Hajj season, including providing free world-class healthcare for all visiting pilgrims. Nurses from around the Kingdom are encouraged to work at Makkah during this period. These nurses come from different cultural backgrounds and provide care for pilgrims from around the world. The study utlized descriptive phenomenology design. A total of 11 transcultural nurses were interviewed. A thematic analysis was performed to understand the lived experience of the transcultural nurses participating in the Hajj for the first time. Five themes emerged. These included serving with satisfaction; a supportive and fair system; professional and personal values; difference, and difficulties and problems. This is the first study of transcultural nurses' experiences of providing nursing care to pilgrims during the Hajj. The results highlight transcultural nurses' perceptions of the benefits and challenges of providing care during the Hajj and potential strategies to improve preparation and care quality.

Measuring the impact of suspending Umrah, a global mass gathering in Saudi Arabia on the COVID-19 pandemic.

Since the early days of the coronavirus (COVID-19) outbreak in Wuhan, China, Saudi Arabia started to implement several preventative measures starting with the imposition of travel restrictions to and from China. Due to the rapid spread of COVID-19, and with the first confirmed case in Saudi Arabia in March 2019, more strict measures, such as international travel restriction, and suspension or cancellation of major events, social gatherings, prayers at mosques, and sports competitions, were employed. These non-pharmaceutical interventions aim to reduce the extent of the epidemic due to the implications of international travel and mass gatherings on the increase in the number of new cases locally and globally. Since this ongoing outbreak is the first of its kind in the modern world, the impact of suspending mass gatherings on the outbreak is unknown and difficult to measure. We use a stratified SEIR epidemic model to evaluate the impact of Umrah, a global Muslim pilgrimage to Mecca, on the spread of the COVID-19 pandemic during the month of Ramadan, the peak of the Umrah season. The analyses shown in the paper provide insights into the effects of global mass gatherings such as Hajj and Umrah on the progression of the COVID-19 pandemic locally and globally.

Development and validation of knowledge, attitude and practice questionnaire for prevention of respiratory tract infections among Malaysian Hajj pilgrims.

BACKGROUND: Hajj pilgrimage faces numerous challenges including a high prevalence of respiratory tract infection as well as its prevention strategies. The aim of this study was to develop and validate a questionnaire to evaluate knowledge, attitude and practice (KAP) towards respiratory tract infections (RTIs) prevention among Malaysian Hajj pilgrims. METHODS: This study was conducted among Malaysian Umrah pilgrims in Malaysia from Kuala Lumpur and Kelantan. The questionnaire then underwent a series of validation process that included content, face validity and exploratory part. Item response theory (IRT) analysis was utilized for the validation of the knowledge domain. The attitude and practice were validated using the exploratory factor analysis (EFA). RESULTS: The validation process resulted in a questionnaire that comprised of four main sections: demography, knowledge, attitude, and practice. Following IRT analysis of the knowledge domain, all items analyzed were within the acceptable range of difficulty and discrimination. The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) was 0.72 and 0.84 for attitude and practice domain respectively and Bartlett's test of Sphericity for both domains were highly significant (P < 0.001). The factor analysis resulted in two factors with total of 12 items in attitude domain, and 2 factors with total of 13 items in the practice domain with satisfactory factor loading (> 0.3). The Cronbach's alpha for reliability of the knowledge, attitude and practice domains all showed acceptable values of > 0.6 (0.92, 0.77 and 0.85). CONCLUSION: The findings of this validation and reliability study showed that the developed questionnaire had a satisfactory psychometric property for measuring KAP of Malaysian Hajj pilgrims.

Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review.

BackgroundEvidence for face-mask wearing in the community to protect against respiratory disease is unclear.AimTo assess effectiveness of wearing face masks in the community to prevent respiratory disease, and recommend improvements to this evidence base.MethodsWe systematically searched Scopus, Embase and MEDLINE for studies evaluating respiratory disease incidence after face-mask wearing (or not). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention were performed, subgrouped by design, setting, face barrier type, and who wore the mask. Preferred outcome was influenza-like illness. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality assessment was undertaken and evidence base deficits described.Results33 studies (12 randomised control trials (RCTs)) were included. Mask wearing reduced primary infection by 6% (odds ratio (OR): 0.94; 95% CI: 0.75-1.19 for RCTs) to 61% (OR: 0.85; 95% CI: 0.32-2.27; OR: 0.39; 95% CI: 0.18-0.84 and OR: 0.61; 95% CI: 0.45-0.85 for cohort, case-control and cross-sectional studies respectively). RCTs suggested lowest secondary attack rates when both well and ill household members wore masks (OR: 0.81; 95% CI: 0.48-1.37). While RCTs might underestimate effects due to poor compliance and controls wearing masks, observational studies likely overestimate effects, as mask wearing might be associated with other risk-averse behaviours. GRADE was low or very low quality.ConclusionWearing face masks may reduce primary respiratory infection risk, probably by 6-15%. It is important to balance evidence from RCTs and observational studies when their conclusions widely differ and both are at risk of significant bias. COVID-19-specific studies are required.

Job satisfaction amongst surgical healthcare professionals during Hajj and Non-Hajj periods: An analytical multi-center cross-sectional study in the holy city of Makkah, Saudi Arabia.

OBJECTIVE: To assess the job satisfaction of surgical healthcare professionals working during Hajj, and to determine the potential predictors of overall job satisfaction in Hajj and non-Hajj periods. METHODS: A multicenter cross-sectional study was conducted at King Abdullah Medical City, King Faisal Hospital and Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from August 27 to September 5, 2018, which represented the period of 10 days following the Hajj season in that year. All surgeons who were employed during Hajj were interviewed regarding their job satisfaction in-Hajj versus non-Hajj periods using the Warr-Cook-Wall job satisfaction scale. A stepwise multiple linear regression was carried out to analyse predictors of overall job satisfaction in both Hajj and non Hajj periods separately. SPSS 16 was used for data analysis. RESULTS: Of the 146 participants, 28(19.18%) were consultants, 61(41.78%) specialists and 57(39.04%) were residents. Overall job satisfaction scores in Hajj period was 5.53 ±1.19 compared to 5.40±1.33 in non-Hajj period (p>0.05). During Hajj period, the participants were significantly more satisfied in terms of "amount of variety in work" (p<0.05), while they were significantly dissatisfied with regard to "physical work in g cond ition", "hours of work" an d "attention paid to suggestions" (p<0.05). CONCLUSIONS: The variety of cases encountered by surgeons during Hajj contributed significantly to job satisfaction. However, lack of attention to physicians' suggestions, extended hours of work and physical working condition during Hajj were potential factors causing less Job satisfaction during Hajj duty.

Nurses' job satisfaction during the mass gathering of the Hajj 2018 in Saudi Arabia.

AIM: To explore job satisfaction of nurses during the Hajj season 2018 in Saudi Arabia, determine predictors of nurses' job satisfaction and inform future healthcare provision and policy. BACKGROUND: Mass gatherings of large numbers of people inevitably pose unique public health concerns and challenges for organizers. A mass gathering happens annually in Saudi Arabia during the Hajj pilgrimage. There was a paucity of evidence regarding nurses' experiences during Hajj. This gap in knowledge needed to be addressed. METHODS: A cross-sectional survey was conducted in 198 nurses across 12 healthcare settings along the Hajj pilgrimage route. A 24-item Nurses' Job Satisfaction Questionnaire was developed exploring six domains: supervision, nature of work, retention, communication, workload and co-workers. RESULTS: Nurses reported a high level of job satisfaction. All six domains were strong predictors of job satisfaction. Nurses reported the lowest level of job satisfaction when assessed against the items 'multiple policies and procedures that were perceived as complicating nursing work', 'incompetence of other people they work with' and 'too much burden at work'. CONCLUSION: Job satisfaction levels for nurses during Hajj 2018 appeared higher than during previous Hajj pilgrimages, probably influenced by the additional healthcare measures put in place during Hajj 2018, such as improved technology. IMPLICATIONS FOR NURSING POLICY AND PRACTICE: Hajj-specific skills training must be designed to enhance the knowledge, competencies and capabilities of nurses. Policies and procedures must prevent heavy workloads and avoid complicating nurses' work during Hajj. Improvements to the nurse work environment should focus on evidence-based interventions promoting effective resource planning, interprofessional relationships and communication, for instance via innovative, technological approaches. These findings can be shared with organizers of other mass gatherings worldwide.