Factors Influencing the Health of Participants in Religious Mass Gathering Ceremonies in Iraq: A Systematic Review

Introduction: In the last decade, the number of religious mass gathering ceremonies, which take place in Iraq, has increased considerably. Millions of participants visit the country annually from across the world to reach Karbala on foot or by other vehicles for participation in a religious ritual called Arbaeen, which lasts about 20 days. Unlike the Hajj mass gathering, another important annual religious mass gathering event of Muslims, an evidence-based review of scientific literature about influential factors on the health of participants in these ceremonies in Iraq has not been done.Methods: Using PRISMA guidelines and searching PubMed, Scopus, ISI_Web of Science, Cochrane Library, ProQuest, and Google Scholar databases, original English language studies focused on participants' health in religious ceremonies of Iraq until October 2021 were selected. The methodological quality of the studies and the risk of bias were checked using the Joanna Briggs Institute (JBI) checklists. In addition, the data from the Iraqi Ministry of Health and other organizations, including WHO and CDC, about Iraq's health condition and other resources were used to describe the related findings better and make health recommendations for the participants.Results: Thirty-two studies passed our criteria and were included for analysis. There was not any clinical trial. All of them were observational (cross-sectional) or qualitative (interview) research;the majority had low to moderate quality scores. Considering the limitations, the leading health risks of participants in religious ceremonies in Iraq include road accidents, insufficiency of Iraq's health system, cardiovascular disease, respiratory tract (including Covid-19) infections, unhealthy food and drink, gastrointestinal infections (including hepatitis), and zoonotic infections(leishmaniasis).Conclusion: Regarding the grandeur of Iraqi-related mass gatherings, preparation must begin before the events. Pre-participation examination, vaccination of high-risk individuals, and training of pilgrims and authorities on the health hazards are critical.

Risk Assessment of Arbaeen Mass Gathering in the Covid-19 Pandemic.

Introduction: Arbaeen is a religious ceremony held annually with the participation of a large number of pilgrims. During the pandemic of Covid-19, a mass gathering of Arbaeen pilgrims can strengthen the transmission of this disease and put more pressure on the health care system of countries. The aim of the study is to evaluate the risk of Arbaeen ceremony in the Covid-19 pandemic in 2021. Materials and methods: A mixed method was performed to perform the study using qualitative and quantitative methods. A national risk assessment tool was used that consisted of hazard identification and assessment, scenario development, exposure assessment, vulnerability assessment and risk estimation. The national risk assessment tool was completed through a focused group discussion and the opinions of 20 representatives of the health system and the level of risks were estimated. Data were collected, analyzed, and integrated by the research team. Results: Based on the results of risk matrix analysis, factors such as the increase in the number of new cases of COVID-19, the probability of exposure to a new variant of COVID-19, the probability of arrival of a new variant of COVID-19 to the country, the probability of increasing referrals to healthcare facilities (score 16), the probability of getting respiratory diseases, and the environmental contamination (score 12) occupied the red area of the matrix and were found to have the highest risk (unbearable risk), that needs immediate action. Conclusion: Preparing for a mass gathering such as Arbaeen is very important in order to reduce the risk of communicable disease, and the first step in improving preparedness is risk assessment and its continuity in the various stages of the ceremony. Therefore, policy makers and planners of such events should conduct risk assessments with the participation of local and national public health authorities regularly.

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

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.