title: Tuberculosis during the Hajj religious mass gathering: occurrence, prevention, and management
Creators: name: Al Otaibi, B
Publisher: name: University of Liverpool Repository
Year: 2019

description: Tuberculosis (TB) is a global health issue with significant morbidity and mortality. The Hajj religious mass gathering represents many of the risk factors for TB transmission and the disease has been reported among hospitalised pilgrims during the event. However, little data is available on the true burden of TB in Hajj or the management of TB cases in hospitals at the event including healthcare worker’s (HCWs) knowledge, attitude and practice (KAP) regarding TB. Accordingly, the thesis consists of three separate, but integrated studies, each with own objectives, literature review, methodology, result and discussion sections. Thesis studies are as follows: 1. Active PTB among hospitalised and non-hospitalised pilgrims during the Hajj mass gathering 2. Management of hospitalised Pulmonary Tuberculosis (PTB) patients during the Hajj mass gathering 3. TB knowledge, attitude and practice among HCWs during the Hajj mass gathering Aim The overall aim of this research project is to provide evidence-base for improvement of TB prevention, management and control during the Hajj mass gathering. The outcomes could be beneficial to other mass gatherings worldwide and will enrich knowledge in the new scientific discipline of “mass gatherings medicine”. Method The study was conducted in Makkah, Kingdom of Saudi Arabia (KSA), the location of the Hajj over 2 Hajj seasons (2016-2017). Structured questionnaires and forms were used to collect information related to the study population (non-hospitalised and hospitalized pilgrims with productive cough, TB cases admitted to hospitals during Hajj and Hajj healthcare workers). Information was also collected in relation to the management of TB cases in Hajj and the knowledge attitude and practice of healthcare workers delivering services during the event regarding TB and its management. Sputum samples were also collected from the hospitalised and non-hospitalised pilgrims and tested for TB using the Xpert MTB/RIF assay. Results 1. Active PTB among hospitalised and non-hospitalised pilgrims during the Hajj mass gathering For non-hospitalised pilgrims, out of the 1,510 pilgrims tested, 10 (0.66%) had undiagnosed active PTB. Underlying health conditions and cough in the household were independent risk factors for TB among this population. For hospitalised pilgrims, among the 304 patients investigated, 9 (2.9%) had active PTB and most (77.7%) of these were missed by the hospitals including multidrug-resistant TB cases. Previous TB treatment was an independent risk factor for TB among this population after adjusting for other variables 2. Management of hospitalized PTB patients during the Hajj mass gathering The study also documented the management of 32 confirmed TB patients during Hajj and explored the compliance of healthcare providers with the KSA TB management guidelines in hospitals during the mass gathering. Out of a maximum score of 10 for the selected TB management themes, the guideline compliance score was highest for infection prevention and control and surveillance (9.6) and identifying TB suspects (7.2). The least scores were obtained for treating TB (5.0) and diagnosing TB (3.0). 3. TB knowledge, attitude and practice among HCWs during the Hajj mass gathering Finally, the study conducted a KAP survey among 540 HCWs from 13 hospitals serving pilgrims in Hajj. In general, HCWs had average knowledge (mean knowledge score of 52%), above average attitude (mean attitude score of 73%) and good practice (mean practice score of 81%) regarding TB, based on the scoring system and cut-off points developed in the current study. Conclusions The results of the current study suggest that there are a number of key challenges in relation to TB at the Hajj. These include undiagnosed and missed TB cases at the event, inadequacy of current national and international TB management guidelines in the context of Hajj and important knowledge gaps, negative attitudes and wrong practices among HCWs in relation to TB. As such, TB during the Hajj mass gathering needs more attention from the scientific community and Hajj stakeholders. A raft of recommendations are proposed to optimize awareness, screening, management and treatment, prevention, and control measures for TB during Hajj as well as other mass gatherings both within Saudi Arabia and worldwide.