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Diabetes care for the Hajj
... In a case report from Japan, Kishimoto et al highlighted the issue of language and lifestyle barriers as well as inadequate healthcare insurance as hurdles to diabetes care in foreign visitors [28]. 5 articles focused on travel in Hajj pilgrims with diabetes, 3 of these were narrative reviews [29][30][31] while 2 observational studies reported on foot ailments [32,33]. ...
... Pilgrimage is often associated with travel and lodging in crowded spaces, exposure to extreme temperatures and insanitary conditions, thereby increasing the risk of respiratory and gastrointestinal infections. [19]Pre-travel counseling should include assessment of risk and advice regarding diet, strict adherence to treatment, frequent SMBG, hypoglycemia care, foot care and sick-day rules [30][31]. ...
Long-distance travel by air has become immensely popular in modern times, but for the person with diabetes, it creates unique challenges including transportation of insulin and other supplies, performance of glucose-monitoring and insulin delivery devices within the aircraft, adaptation to new time zones and altered lifestyle, and titration of medications. There are no published guidelines for the management of diabetes in travelers. Safe flying with diabetes is all about planning ahead, packing adequate supplies, maintenance of cold chain for insulin, frequent monitoring of blood glucose and titration of medications as well as insulin, and minimizing the risk of hypoglycemia or hyperglycemia.
A study of ailments of the feet in pilgrims of Hajj revealed that 31% of them suffered from blisters, and the prevalence was five times higher in females. The presence of comorbidity (diabetes, obesity and advanced age) warrants immediate attention to them to avoid serious complications.
Copyright © 2015. Published by Elsevier Ltd.
The changing pattern of hospital admissions during Hajj, the Muslims yearly pilgrimage attracting millions of pilgrims from all around the globe, has gradually seen infectious causes of hospital admission replaced by cardiovascular diseases as a leading cause of both intensive care unit admission and death. While this trend is partly associated with the high quality of medical services and awareness programs targeted at reducing the spread of infections, at the same time it underscores an urgent need to establish a pragmatic system to manage the challenge of cardiovascular morbidities and mortality during Hajj.
A PubMed Central (PMC) literature search without date restrictions was performed for articles reporting on the medical experience during Hajj. There were 109 articles were returned using "Hajj" and "mortality" as search terms. After determining relevance to the current theme based on both direct and indirect reference to the pattern hospital admission during Hajj, 20 articles reporting on conducted studies were obtained. Data from these studies reporting on the pattern and outcome of hospitalization during Hajj were examined and helped in arriving at the conclusions presented in this review.
Saudi Arabia (SA) experienced two large invasive meningococcal disease (IMD) outbreaks during the 2000 and 2001 Hajj pilgrimages. In 2002, polysaccharide quadrivalent ACWY vaccines became mandatory for Mecca and Medina pilgrims/residents older than two years. This study aimed to analyse IMD surveillance data among citizens, residents and pilgrims in SA from 1995 to 2011, focusing on changes before and after the new vaccination policy. For all laboratory-confirmed IMD cases in the national surveillance database from 1995 to 2011, serogroup and age were retrieved. The cases' seasonal distribution as well as the case fatality ratios (CFR) were obtained. For Saudi citizens/residents and Hajj pilgrims, annual rates were calculated using mid-year population estimates. The Student's t-test was used to compare means between the pre-epidemic (1995-1999) and post-epidemic (2002-2011) periods, excluding outbreak years. From 1995 to 2011, laboratories notified 1,103 cases. Between the pre- and post-epidemic periods, mean annual IMD rates decreased from 0.20 (standard deviation (SD): 0.1) to 0.06 cases/100,000 (SD: 0.06; p=0.02), mean numbers of Hajj-related cases from 13 (SD: 9.3) to 2 cases/year (SD: 2.3; p=0.02) and the mean age from 31 (SD: 1.3) to 18 years (SD: 1.4; p<0.01). The CFR in Saudi citizens (10.4) was lower than among foreign pilgrims (28.9) and decreased from 19.3% (SD: 1.8) in the pre-epidemic to 11.4% (SD: 7.0; p=0.04) in the post-epidemic phase. The decrease of annual IMD rates, CFR and Hajj-related cases between the pre- and post- vaccine era suggests a possible positive effect of the mandatory ACWY vaccination for pilgrims/residents in Mecca and Medina. Regular surveillance with an annual data analysis is necessary to monitor trends and circulating serotypes and to implement appropriate public health measures to avoid new IMD epidemics during upcoming Hajj seasons.
A 68 year old Muslim man with diabetes, which is reasonably well controlled on twice daily insulin and who has a history of myocardial infarction 12 months previously, wants advice on his fitness to go on pilgrimage (the Hajj) to Mecca.What you should coverExplore his understanding of the HajjHajj is one of the five pillars of Islam that is compulsory for every Muslim, once in a lifetime. Is he aware that those who are physically unable to perform the Hajj because of illness or infirmity are exempt from going?Does he experience angina?Ask if he has chest pain at rest or on exertion. More than 40% of deaths during Hajj are related to cardiovascular disease.1Does he appreciate the possible effects of heat, physical exertion, crowds, and altered routine on his health?Annually, more than two million people travel to Mecca during Hajj and this results in overcrowding.2 The Hajj rituals might, depending on the time when Hajj falls, need to be undertaken in extreme temperatures that can reach more than 45°C.2 Dehydration and heat stroke are particular risks,3 and they are exacerbated by the strenuous physical exertion associated with performing the various Hajj rites.2 For example, the seven circuit circumambulation around the Ka’ba (the centre point of the Grand Mosque) can—because …
The following link provides information on the Hajj for health practitioners and pilgrims in six languages (www.moh.gov.sa/en/Hajj/Pages/default.aspx).1 Toll-free information is available by calling +8002494444.
It is essential to coordinate local messaging with official Saudi Arabia ministry sources. Details do matter. What might seem a trivial digression from official Saudi Arabia …
Diabetes is an increasingly important condition globally and robust estimates of its prevalence are required for allocating resources.
Data sources from 1980 to April 2011 were sought and characterised. The Analytic Hierarchy Process (AHP) was used to select the most appropriate study or studies for each country, and estimates for countries without data were modelled. A logistic regression model was used to generate smoothed age-specific estimates which were applied to UN population estimates for 2011.
A total of 565 data sources were reviewed, of which 170 sources from 110 countries were selected. In 2011 there are 366 million people with diabetes, and this is expected to rise to 552 million by 2030. Most people with diabetes live in low- and middle-income countries, and these countries will also see the greatest increase over the next 19 years.
This paper builds on previous IDF estimates and shows that the global diabetes epidemic continues to grow. Recent studies show that previous estimates have been very conservative. The new IDF estimates use a simple and transparent approach and are consistent with recent estimates from the Global Burden of Disease study. IDF estimates will be updated annually.
To provide robust estimates of the total prevalence of diabetes (including undiagnosed) in England to support effective planning and delivery of services.
Age- and sex-specific prevalence of diagnosed and undiagnosed diabetes in people aged 16 years and older [based on HbA(1c) of 6.5% (48 mmol/mol) or greater] were taken from the Health Survey for England 2006. Data from the Health Survey for England 2004 were used to adjust for ethnic difference in prevalence. A deprivation adjustment refined the geographical distribution of diabetes prevalence. Projected diabetes prevalence was calculated using trends in overweight and obesity prevalence from the Health Surveys for England 2003 to 2008.
In 2010 there were an estimated 3.1 million (7.4%) people aged 16 years and older with diabetes in England. Comparisons between the 2008/2009 Quality and Outcomes Framework data and estimates for 2009 suggest that that 27.1% of the total number of people with diabetes are not included on general practice diabetes registers. The total number of adults with diabetes is projected to rise to 4.6 million or 9.5% by 2030. Approximately half of this increase is attributable to the changing age and ethnic group structure of the population and half is because of the rising prevalence of obesity.
This model estimates that the prevalence of total diabetes (diagnosed and undiagnosed) in England is higher than previously suggested. An ageing population and increasing prevalence of obesity imply that the prevalence of diabetes will continue to rise and health services should be planned accordingly.
To document the pattern of medical diseases necessitating admission in a tertiary care hospital during Muslim pilgrimage (Hajj). To assess the risk factors associated with mortality during hospitalization.
The study was conducted at Al Noor Specialist Hospital, a 550-bed tertiary care teaching hospital, in Makkah, KSA. The participants included all Hajj patients admitted in the Department of Medicine in a 5-week period (January 3 to February 6, 2005) during the 2005 (1425 AH) Hajj. Information about demographics; past medical history; pre-Hajj functional status; presence of language barrier and translator availability; diagnosis for admission and complications during hospitalization including mortality was obtained prospectively using a standardized form.
Six hundred and eighty-nine patients, belonging to 49 countries, with mean age of 62 years and male:female ratio of 1.8:1 were admitted. Two hundred-twenty (31.9%) had diabetes mellitus, 256 (37.2%) had hypertension, 219 (31.8%) had cardiac disease, and 103 (14.9%) patients had chronic lung disease. Of the 449 (65.2%) patients assessed, 284 (63.2%) patients had language barrier, and translator was not available for 152 (53.5%) of them. Pre-Hajj functional status assessment of 240 patients showed that 20 (8.3%) required assistance in performing activities of daily living (ADL), and 40 (16.7%) could not walk for half kilometer without difficulty. Common causes of morbidity were: 235 (34.1%) cardiovascular, 137 (19.9%) infectious and 85 (12.3%) neurological diseases. One hundered and fourteen (16.5%) patients died, with the common causes being pneumonia (28 patients), acute coronary syndrome (21), and stroke (20). The risk factors associated with higher mortality were older age (65 +/- 1 versus 61 +/- 0.6 years, p=0.008), prior history of chronic lung disease (crude odds ratio, 1.81, p=0.034), dependence in any ADLs (4.90, p=0.025), inability to ambulate for half kilometer without difficulty (4.17, p=0.017) and non-availability of translator for patients with language barrier (5.51, p<0.0001).
Most patients were elderly with high prevalence of chronic medical disorders. Non-infectious diseases accounted for most morbidity and mortality. Pre-Hajj functional assessment should be carried out to identify patients at high risk of mortality. Provision of translator services for patients with language barrier is essential to improve future outcomes.
A cohort of 461 Hajj pilgrims to Mecca departing from Marseille was surveyed. Most of travelers originated from North Africa and one third were geriatric patients. An overall low rate of vaccination was observed. The proportions of travelers without correct vaccination were 67% for influenza, 70% for tetanus, 75% for diphteria and poliomyelitis, and 87% for pertussis and hepatitis A.
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