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. 2021 Mar 22;18(6):3287.
doi: 10.3390/ijerph18063287.

Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics

Farah Al-Ansari  1 , Masoud Mirzaei  2 , Basma Al-Ansari  1 , Mohammad Basim Al-Ansari  3 , Mohammed Saeed Abdulzahra  4 , Harunor Rashid  5   6 , Grant A Hill-Cawthorne  7 , Mustafa Al Ansari  1   7 , Joel Negin  7 , Katherine Conigrave  1   8
Affiliations

Health Risks, Preventive Behaviours and Respiratory Illnesses at the 2019 Arbaeen: Implications for COVID-19 and Other Pandemics

Farah Al-Ansari et al. Int J Environ Res Public Health. .

Abstract

COVID-19 poses grave challenges for mass gatherings. One of the world's largest annual gatherings, Arbaeen, occurs in Iraq. We studied respiratory symptoms and risk and protective factors using representative sampling of Arbaeen pilgrims in 2019 to inform prevention of COVID-19 transmission. Structured sampling was used to recruit walking pilgrims. A questionnaire asked about respiratory symptoms, risk, and preventive factors, including hygiene-related resources of toilet facilities. The commonest symptom reported by the 1842 participants (63.3% male, 36.7% female) was cough (25.6%). Eating in mawkibs (rest areas) with indoor kitchens and drinking only packaged water were associated with lower risk of cough (AOR = 0.72, CI = 0.56-0.94; AOR = 0.60; CI = 0.45-0.78, p < 0.05). Facemask use was associated with increased risk of cough (AOR = 2.71, CI = 2.08-3.53, p < 0.05). Handwashing was not protective against cough, or against (one or more of) cough, fever, or breathlessness in multivariate analysis. Toilet facilities often lacked running water (32.1%) and soap (26.1%), and had shared hand towels (17%). To reduce risk of respiratory infections including COVID-19 during Arbaeen or other mass gatherings, needs include running water, soap, and hygienic hand drying options or hand sanitiser. Education on proper handwashing and facemask approaches and monitoring around food preparation and eating spaces are needed.

Keywords: Arbaeen; COVID-19; communicable diseases; facemasks; global health; handwashing; infectious disease transmission; mass gathering medicine; public health.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Karbala and its location in the globe (A) and in Iraq (B). Recruitment stations are shown in Figure 1B. Map adapted from Google Directions (Google Maps, 2020. Karbala, Iraq. Google Maps [online] Available through: https://www.google.com.au/maps/place/Karbala [accessed on 2 June 2020]) and checked by authors familiar with the region.
Figure 2
Figure 2
Prevalence of health-related preventive measures used by 1842 Arbaeen participants in 2019.
Figure 3
Figure 3
Comparison of the prevalence of respiratory symptoms that started during the walk in participants who used handwashing (A) or facemask (B) as preventive measures to that of those not using those measures in a sample of 1842 Arbaeen participants in the year 2019.
Figure 3
Figure 3
Comparison of the prevalence of respiratory symptoms that started during the walk in participants who used handwashing (A) or facemask (B) as preventive measures to that of those not using those measures in a sample of 1842 Arbaeen participants in the year 2019.
See this image and copyright information in PMC

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