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Open Access 01-12-2021 | Diarrhea | Research

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

Authors: Saber Yezli, Yara Yassin, Abdulaziz Mushi, Alhanouf Aburas, Lamis Alabdullatif, Mariyyah Alburayh, Anas Khan

Published in: BMC Public Health | Issue 1/2021

Abstract

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 (r_s = 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.

World Health Organization. Water, sanitation, hygiene and health: a primer for health professionals. Geneva: World Health Organization; 2019.

World Health Organization. WHO estimates of the global burden of foodborne diseases. Geneva: World Health Organization; 2015.

Sharif MK, Javed K, Nasir A. Foodborne illness: threats and control. In: Holban AM, Grumezescu AM, editors. Foodborne diseases. Cambridge: Academic Press; 2018. p. 501–23.

Zanin LM, da Cunha DT, de Rosso VV, Capriles VD, Stedefeldt E. Knowledge, attitudes and practices of food handlers in food safety: an integrative review. Food Res Int. 2017;100(Pt 1):53–62. https://doi.org/10.1016/j.foodres.2017.07.042.CrossRefPubMed

Patil SR, Cates S, Morales R. Consumer food safety knowledge, practices, and demographic differences: findings from a meta-analysis. J Food Prot. 2005;68(9):1884–94. https://doi.org/10.4315/0362-028X-68.9.1884.CrossRefPubMed

Redmond EC, Griffith CJ. Consumer food handling in the home: a review of food safety studies. J Food Prot. 2003;66(1):130–61. https://doi.org/10.4315/0362-028X-66.1.130.CrossRefPubMed

Hoang VT, Gautret P. Infectious diseases and mass gatherings. Curr Infect Dis Rep. 2018;20(11):44. https://doi.org/10.1007/s11908-018-0650-9.CrossRefPubMedPubMedCentral

World Health Organization. Communicable disease alert and response for mass gatherings: Key considerations. Geneva: World Health Organization; 2008.

Al-Joudi AS. An outbreak of foodborne diarrheal illness among soldiers in mina during hajj: the role of consumer food handling behaviors. J Fam Community Med. 2007;14(1):29–33.

10.

Gautret P, Benkouiten S, Sridhar S, Al-Tawfiq JA, Memish ZA. Diarrhea at the hajj and Umrah. Travel Med Infect Dis. 2015;13(2):159–66. https://doi.org/10.1016/j.tmaid.2015.02.005.CrossRefPubMed

11.

Saeed KM, Mofleh J, Rasooly MH, Aman MI. Occurrence of acute respiratory infection, diarrhea and jaundice among afghan pilgrims, 2010. J Epidemiol Glob Health. 2012;2(4):215–20. https://doi.org/10.1016/j.jegh.2012.11.003.CrossRefPubMedPubMedCentral

12.

Al-Tawfiq JA, Memish ZA. The hajj: updated health hazards and current recommendations for 2012. Euro Surveill. 2012;17(41):20295.CrossRef

13.

Saudi Ministry of Health. Health requirements and recommendations for travellers to Saudi Arabia for Hajj and Umrah 2019.

14.

World Health Organization. Five keys to safer food manual. Geneva: World Health Organization; 2006.

15.

Alotaibi B, Yassin Y, Mushi A, Maashi F, Thomas A, Mohamed G, et al. Tuberculosis knowledge, attitude and practice among healthcare workers during the 2016 hajj. PLoS One. 2019;14(1):e0210913. https://doi.org/10.1371/journal.pone.0210913.CrossRefPubMedPubMedCentral

16.

Gautret P, Steffen R. Communicable diseases as health risks at mass gatherings other than hajj: what is the evidence? Int J Infect Dis. 2016;47:46–52. https://doi.org/10.1016/j.ijid.2016.03.007.CrossRefPubMed

17.

Al-Mazrou YY. Food poisoning in Saudi Arabia. Potential for prevention? Saudi Med J. 2004;25(1):11–4.PubMed

18.

Hoang VT, Dao TL, Ly TDA, Sow D, Belhouchat K, Larbi Chaht K, et al. Gastrointestinal symptoms and the acquisition of enteric pathogens in hajj pilgrims: a 3-year prospective cohort study. Eur J Clin Microbiol Infect Dis. 2021;40(2):315–23.

19.

Abd El Ghany M, Alsomali M, Almasri M, Padron Regalado E, Naeem R, Tukestani A, et al. Enteric Infections Circulating during Hajj Seasons, 2011–2013. Emerg Infect Dis. 2017;23(10)::1640–9.

20.

Sow D, Dogue F, Edouard S, Drali T, Prades S, Battery E, et al. Acquisition of enteric pathogens by pilgrims during the 2016 hajj pilgrimage: a prospective cohort study. Travel Med Infect Dis. 2018;25:26–30. https://doi.org/10.1016/j.tmaid.2018.05.017.CrossRefPubMed

21.

AI-Faify SK, El Bushra HE, AI-Wahaibi SS, Al-Salman SA, Baomer AAS, Khawajah AA, et al. Behavioral risk factors for pilgrims to Makkah, 1997. Saudi Epidemiol Bull. 1998;5(1):1–7.

22.

AI-Rabeah AM, EI-Bushra HE, AI-Sayed MO, Al-Saigul AM, AIRasheedi AA, Abdulaziz AA. Behavioral risk factors fo disease during Hajj: the second survey. Saudi Epidemiol Bull. 1998;5(3–4):19–20.

23.

Al-Shihry AM, Al-Khan AA, Mohammed AG. Pre-hajj health related advice, Makkah, 1999. Saudi Epidemiol Bull. 1999;6(4):29–31.

24.

Al-Naheelah JM, Al-Mazroa IA, Alzahrani AG. Behavioral risk related to food practices among non-domestic Arab hajjis 1432 H (2011 G). Saudi Epidemiol Bull. 2012;19(3):26–8.

25.

Al-Faraj N, Choudhry AJ, Al-Hayani O. Behavioural risk factors for diseases during hajj 1428 H. Saudi Epidemiol Bull. 2008;15(4):28–31.

26.

Al-Mudarra S, Chaudhry AJ. The role of Hamla management in the prevention and control of food poisoning episodes in Mina during hajj 1430 H. Saudi Epidemiol Bull. 2010;17(3):20–3.

27.

AI-Honaizil I, Choudhry AJ, AI-Hayani O. Assessment of hygienic quality of food, food handlers and restaurant environments in Makkah, hajj 1428 H. Saudi Epidemiol Bull. 2008;15(4):27.

28.

Al-Maghderi Y, Al-Joudi AS, Choudhry AJ, Al-Rabeah AM, Ibrahim M, Turkistani AM. Behavioral risk factors for diseases during hajj, 1422H. Saudi Epidemiol Bull. 2002;9(3):19–20.

29.

Odeyemi OA, Sani NA, Obadina AO, Saba CKS, Bamidele FA, Abughoush M, et al. Food safety knowledge, attitudes and practices among consumers in developing countries: an international survey. Food Res Int. 2019;116:1386–90. https://doi.org/10.1016/j.foodres.2018.10.030.CrossRefPubMed

30.

Cheraghi Z, Okhovat B, Doosti Irani A, Talaei M, Ahmadnezhad E, Gooya MM, et al. Knowledge, attitude, and practice regarding food, and waterborne outbreak after massive diarrhea outbreak in Yazd Province, Iran, summer 2013. Int Sch Res Notices. 2014;2014:403058.PubMedPubMedCentral

31.

Grifth CJ, Price P, Peters AC, Clayton DA. An evaluation of food handlers knowledge, belief and attitudes about food safety and its interpretation using social cognition models. London: Food Standards Agency; 2001.

32.

Gautret P, Benkouiten S, Gaillard C, Parola P, Brouqui P. Camel milk-associated infection risk perception and knowledge in French hajj pilgrims. Vector Borne Zoonotic Dis. 2013;13(6):425–7. https://doi.org/10.1089/vbz.2012.1010.CrossRefPubMed

33.

Stanton BF, Clemens JD, Aziz KM, Rahman M. Twenty-four-hour recall, knowledge-attitude-practice questionnaires, and direct observations of sanitary practices: a comparative study. Bull World Health Organ. 1987;65(2):217–22.PubMedPubMedCentral

34.

Manun'Ebo M, Cousens S, Haggerty P, Kalengaie M, Ashworth A, Kirkwood B. Measuring hygiene practices: a comparison of questionnaires with direct observations in rural Zaire. Tropical Med Int Health. 1997;2(11):1015–21. https://doi.org/10.1046/j.1365-3156.1997.d01-180.x.CrossRef

35.

Insfran-Rivarola A, Tlapa D, Limon-Romero J, Baez-Lopez Y, Miranda-Ackerman M, Arredondo-Soto K, et al. A systematic review and meta-analysis of the effects of food safety and hygiene training on food handlers. Foods. 2020;9(9):1169.

36.

Kendall P, Scharff R, Baker S, LeJeune J, Sofos J, Medeiros L. Food safety instruction improves knowledge and behavior risk and protection factors for foodborne illnesses in pregnant populations. Matern Child Health J. 2017;21(8):1686–98. https://doi.org/10.1007/s10995-017-2291-2.CrossRefPubMed

Title: Gastrointestinal symptoms and knowledge and practice of pilgrims regarding food and water safety during the 2019 Hajj mass gathering
Authors: Saber Yezli
Yara Yassin
Abdulaziz Mushi
Alhanouf Aburas
Lamis Alabdullatif
Mariyyah Alburayh
Anas Khan
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Diarrhea
Diarrhea
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11381-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Method

Results

Conclusion

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