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LitCovid-PubTator

Id Subject Object Predicate Lexical cue tao:has_database_id
22 733-742 Disease denotes infection MESH:D007239
23 748-776 Disease denotes Respiratory tract infections MESH:D012141
26 1840-1848 Disease denotes COVID-19 MESH:C000657245
27 2082-2100 Disease denotes infectious disease MESH:D003141
30 2202-2221 Disease denotes infectious diseases MESH:D003141
31 2272-2281 Disease denotes infection MESH:D007239
43 2747-2752 Chemical denotes water MESH:D014867
44 2709-2715 Disease denotes coughs MESH:D003371
45 3052-3071 Disease denotes infectious diseases MESH:D003141
46 3082-3090 Disease denotes COVID-19 MESH:C000657245
47 3272-3281 Disease denotes infection MESH:D007239
48 3358-3386 Disease denotes respiratory tract infections MESH:D012141
49 3863-3884 Disease denotes respiratory infection MESH:D012141
50 3981-3989 Disease denotes COVID-19 MESH:C000657245
51 4317-4321 Disease denotes SARS MESH:D045169
52 4327-4335 Disease denotes COVID-19 MESH:C000657245
53 4336-4345 Disease denotes infection MESH:D007239
55 4620-4628 Disease denotes COVID-19 MESH:C000657245
57 5109-5117 Disease denotes COVID-19 MESH:C000657245
60 5367-5386 Disease denotes infectious diseases MESH:D003141
61 5435-5443 Disease denotes COVID-19 MESH:C000657245
65 9234-9249 Disease denotes Chronic disease MESH:D002908
66 9304-9327 Disease denotes Cardiovascular diseases MESH:D002318
67 9382-9399 Disease denotes diabetes mellitus MESH:D003920
71 9640-9650 Disease denotes meningitis MESH:D008581
72 9681-9692 Disease denotes Hepatitis B MESH:D006509
73 9729-9742 Disease denotes poliomyelitis MESH:D011051
75 9798-9811 Disease denotes poliomyelitis MESH:D011051
78 11419-11424 Chemical denotes water MESH:D014867
79 11445-11453 Disease denotes coughing MESH:D003371
81 12134-12139 Chemical denotes water MESH:D014867
85 12602-12612 Disease denotes meningitis MESH:D008581
86 12625-12638 Disease denotes poliomyelitis MESH:D011051
87 12925-12933 Disease denotes COVID-19 MESH:C000657245
95 13037-13050 Disease denotes meningococcal MESH:D008589
96 13554-13562 Disease denotes COVID-19 MESH:C000657245
97 13838-13847 Disease denotes mortality MESH:D003643
98 14087-14106 Disease denotes respiratory disease MESH:D012140
99 14142-14154 Disease denotes tuberculosis MESH:D014376
100 14160-14192 Disease denotes Middle East Respiratory Syndrome MESH:D018352
101 15006-15014 Disease denotes COVID-19 MESH:C000657245
106 15230-15243 Disease denotes poliomyelitis MESH:D011051
107 15299-15312 Disease denotes poliomyelitis MESH:D011051
108 15402-15415 Disease denotes poliomyelitis MESH:D011051
109 15583-15601 Disease denotes infectious disease MESH:D003141
111 16242-16252 Disease denotes infections MESH:D007239
115 17945-17953 Disease denotes COVID-19 MESH:C000657245
116 18092-18114 Disease denotes respiratory infections MESH:D012141
117 18252-18280 Disease denotes respiratory tract infections MESH:D012141
119 19110-19126 Disease denotes viral infections MESH:D001102
121 19368-19376 Disease denotes coughing MESH:D003371
124 19811-19831 Disease denotes blood-borne diseases MESH:D006402
125 19840-19859 Disease denotes HIV and Hepatitis B MESH:D006509
131 21877-21887 Disease denotes meningitis MESH:D008581
132 21892-21917 Disease denotes poliomyelitis vaccination MESH:D011051
133 22247-22257 Disease denotes infections MESH:D007239
134 22440-22448 Disease denotes COVID-19 MESH:C000657245
135 22561-22566 Disease denotes death MESH:D003643

LitCovid-PD-HP

Id Subject Object Predicate Lexical cue hp_id
T6 748-776 Phenotype denotes Respiratory tract infections http://purl.obolibrary.org/obo/HP_0011947
T7 3358-3386 Phenotype denotes respiratory tract infections http://purl.obolibrary.org/obo/HP_0011947
T8 3388-3391 Phenotype denotes RTI http://purl.obolibrary.org/obo/HP_0011947
T9 3863-3884 Phenotype denotes respiratory infection http://purl.obolibrary.org/obo/HP_0011947
T10 9304-9327 Phenotype denotes Cardiovascular diseases http://purl.obolibrary.org/obo/HP_0001626
T11 9382-9399 Phenotype denotes diabetes mellitus http://purl.obolibrary.org/obo/HP_0000819
T12 9640-9650 Phenotype denotes meningitis http://purl.obolibrary.org/obo/HP_0001287
T13 9681-9690 Phenotype denotes Hepatitis http://purl.obolibrary.org/obo/HP_0012115
T14 11445-11453 Phenotype denotes coughing http://purl.obolibrary.org/obo/HP_0012735
T15 12602-12612 Phenotype denotes meningitis http://purl.obolibrary.org/obo/HP_0001287
T16 18092-18114 Phenotype denotes respiratory infections http://purl.obolibrary.org/obo/HP_0011947
T17 18246-18280 Phenotype denotes acute respiratory tract infections http://purl.obolibrary.org/obo/HP_0011948
T18 18282-18285 Phenotype denotes ARI http://purl.obolibrary.org/obo/HP_0011948
T19 18412-18415 Phenotype denotes ARI http://purl.obolibrary.org/obo/HP_0011948
T20 18456-18459 Phenotype denotes ARI http://purl.obolibrary.org/obo/HP_0011948
T21 19368-19376 Phenotype denotes coughing http://purl.obolibrary.org/obo/HP_0012735
T22 19848-19857 Phenotype denotes Hepatitis http://purl.obolibrary.org/obo/HP_0012115
T23 21877-21887 Phenotype denotes meningitis http://purl.obolibrary.org/obo/HP_0001287

LitCovid-sentences

Id Subject Object Predicate Lexical cue
T24 0-2 Sentence denotes 1.
T25 3-15 Sentence denotes Introduction
T26 16-170 Sentence denotes Around 10 million pilgrims travel annually to the Kingdom of Saudi Arabia (KSA) for Umrah (a minor pilgrimage to Makkah) from more than 180 countries [1].
T27 171-406 Sentence denotes According to The Ministry of Hajj and Umrah, the government of KSA has issued 7,584,424 Umrah visas since 30 May 2019 (25 Ramadan 1440 H), with pilgrims coming via air, land, or sea to visit the holy cities of Makkah and Madinah [1,2].
T28 407-540 Sentence denotes Umrah is a spiritual practice that is not obligatory and has no fixed date or time to be performed so may be seasonally affected [3].
T29 541-747 Sentence denotes Similarly to the Hajj and other mass gatherings, the Umrah entails global movement of people, gathering of crowds, and therefore an increased health challenge, including the risk of spreading infection [4].
T30 748-979 Sentence denotes Respiratory tract infections, overcrowding accidents, pollution, and many other medical and health issues are encountered by the host country, which requires special attention and measurable responses to mitigate these risks [4,5].
T31 980-1243 Sentence denotes Without proper planning and preventative measures, this religious activity can overwhelm the health system of the host country and impact global health preparedness, because the majority of Umrah pilgrims come from, and return to, their different countries [5,6].
T32 1244-1610 Sentence denotes The Umrah performer (pilgrim), called hajji in the Arabic language, must be received and accompanied by a company authorized by the Ministry of Hajj, called “Al Hamla”, which provides Hajj and Umrah services including catering, transportation, travel arrangements, accommodation, and first aid health services for every pilgrim who has paid for their services [1,6].
T33 1611-1823 Sentence denotes Before travelling to Saudi Arabia for Umrah, pilgrims are advised to seek medical advice about potential health risks and bring vaccination certificates to be inspected at the entry port by Saudi authorities [3].
T34 1824-2115 Sentence denotes Even before the COVID-19 pandemic, the Saudi Arabian Ministry of Health (MOH) published a guide for pilgrims on health issues and standard vaccination requirements, together with important control measures for the safety of the individuals and prevention of infectious disease outbreaks [7].
T35 2116-2373 Sentence denotes There is no doubt that providing health education to pilgrims on non-communicable and infectious diseases (including the preventative measures and modes of infection transmission) is of great interest for the Hajj and health authorities in Saudi Arabia [5].
T36 2374-2563 Sentence denotes It is also critical for global public health and disease control, which is considered good practice to minimize the risks and improve compliance with preventative control measures [8,9,10].
T37 2564-2887 Sentence denotes During Umrah, pilgrims have a vital role in sustaining public health through practicing preventative measures such as personal hygiene, catching coughs and sneezes, hand washing with water and soap or sanitizers, wearing face masks (and doing so properly), and subsequent waste disposal of materials in sanitary bins [5,7].
T38 2888-3195 Sentence denotes Face mask use was considered an affordable and effective method to control the exposure to pathogens in high-risk environments, to reduce the risk of transmittable infectious diseases including COVID-19 [11], and to protect from the inhalation of aerosols containing organic and inorganic particulates [12].
T39 3196-3455 Sentence denotes More recent studies cast doubt on the effectiveness of masks for preventing infection transmission, with some studies reporting over 90% of pilgrims experiencing respiratory tract infections (RTI), suggesting preventative measures are needed [13,14,15,16,17].
T40 3456-3561 Sentence denotes Hoang et al. (2019) conducted sequential systematic testing of 121 French pilgrims during Hajj 2018 [18].
T41 3562-3687 Sentence denotes Amongst their sample, 40.5% reported wearing a face mask, 55.4% washing hands more often, and 87.6% using disposable tissues.
T42 3688-3920 Sentence denotes They found RTIs at the Hajj were as “a result of complex interactions between a number of respiratory viruses and bacteria” with 93.4% (n = 113/121) experiencing at least one respiratory infection despite preventative measures [18].
T43 3921-4092 Sentence denotes The same research team conducted a smaller study focused on COVID-19 at the 2020 Hajj, which had restricted attendance (n = 1000) with only Saudi nationals permitted [19].
T44 4093-4213 Sentence denotes The wearing of face masks was mandated with no public health emergency noted when the Hajj ended early August 2020 [19].
T45 4214-4417 Sentence denotes However, a recent systematic review of 21 studies by Liang et al. (2020) found “the risk of influenza, SARS, and COVID-19 infection were reduced by 45%, 74%, and 96% by wearing masks, respectively” [20].
T46 4418-4496 Sentence denotes The evidence is both contradictory and inconclusive [13,14,15,16,17,18,19,20].
T47 4497-4594 Sentence denotes On 27 February 2020, the KSA Foreign Ministry took a decisive and proactive preventative measure.
T48 4595-4728 Sentence denotes To prevent the spread of COVID-19, it suspended Umrah visas, denying entry of pilgrims to the holy cities and the entire Kingdom [2].
T49 4729-4878 Sentence denotes The Saudi Arabian Vision 2030 aimed to build outstanding health and economic services for visitors to the country, including Umrah and Hajj pilgrims.
T50 4879-5306 Sentence denotes In light of an initiative called “To care about Rahman Guests” introduced by the Ministry of Health Community Services in Jeddah, in collaboration with a voluntary group (Vision Team) and in view of the current global pandemic of COVID-19 that has affected millions of people worldwide, there is an imperative need for effective preventative measures to be adopted nationally to increase preparedness for future Umrah and Hajj.
T51 5307-5590 Sentence denotes Given the clear importance of controlling public health and infectious diseases at mass religious gatherings, underlined by the COVID-19 pandemic, this study aimed to assess the experiences of preventative measures practiced among Umrah pilgrims following their Hajj in Saudi Arabia.
T52 5592-5594 Sentence denotes 2.
T53 5595-5602 Sentence denotes Methods
T54 5604-5608 Sentence denotes 2.1.
T55 5609-5621 Sentence denotes Study Design
T56 5622-5802 Sentence denotes A cross-sectional survey was conducted among Umrah pilgrims before departure from February to the end of April 2019 at King Abdul Aziz Airport-Islamic port in Jeddah, Saudi Arabia.
T57 5804-5808 Sentence denotes 2.2.
T58 5809-5834 Sentence denotes Questionnaire Development
T59 5835-6404 Sentence denotes The questionnaire (Appendix A) was composed of sociodemographic items including age, gender, nationality, level of education, history of vaccinations and chronic illnesses; whether the pilgrim had received any health education and orientation prior to coming to Saudi Arabia; or upon their arrival, their experiences of the practice of preventative measures such as using umbrellas, hats, or sunscreen to protect from excessive heat and sun, use of hygiene tools and practices such as wearing of face masks and washing hands, and the availability of relevant resources.
T60 6405-6546 Sentence denotes Pilgrims were also asked to rate their level of satisfaction around the health services provided by the Saudi Arabian MOH or other providers.
T61 6547-6783 Sentence denotes Item types included closed questions, where the tick list was originated from a combination of previous research on mass gatherings and public health issues, with respondents permitted to select more than one response in some questions.
T62 6784-6917 Sentence denotes The questionnaire was reviewed for face and content validity by members of the research team and experts in public health in the MOH.
T63 6918-7075 Sentence denotes Validity testing was followed by piloting with twenty Umrah pilgrims of different nationalities and spoken languages, with no changes required post-piloting.
T64 7076-7159 Sentence denotes Therefore, the pilot responses were included in the analysis dataset for reporting.
T65 7160-7317 Sentence denotes The questionnaire was written in Arabic and was translated by the Al Hamla company’s supervisors to the pilgrim’s specific languages to be easily understood.
T66 7318-7443 Sentence denotes Finally, all responses were gathered by the multi-lingual research team and translated to English for analysis and reporting.
T67 7445-7449 Sentence denotes 2.3.
T68 7450-7461 Sentence denotes Recruitment
T69 7462-7667 Sentence denotes Potential participants were approached opportunistically by a research team member from February until the end of April 2019 at the departure lounge at King Abdul Aziz International Airport in Jeddah city.
T70 7668-7789 Sentence denotes They were asked if they had time to participate in a short survey concerning the preventative measures in Umrah practice.
T71 7790-7986 Sentence denotes Those who agreed were administered the questionnaire by one of the 22 trained personnel who recorded the responses electronically into an automated dataset that excluded incomplete questionnaires.
T72 7987-8069 Sentence denotes Participants had to be at least 18 years of age; there were no exclusion criteria.
T73 8071-8075 Sentence denotes 2.4.
T74 8076-8084 Sentence denotes Analysis
T75 8085-8197 Sentence denotes Statistical analysis was undertaken using SPSS (IBM SPSS Statistics for Windows Inc, Cart, NY, USA, version 22).
T76 8198-8276 Sentence denotes The data were summarized and analyzed using descriptive and inferential tests.
T77 8277-8493 Sentence denotes A t-test for independent samples was conducted to identify the relationship between receiving health education and the practice of preventative measures by pilgrims; p < 0.05 was considered statistically significant.
T78 8495-8497 Sentence denotes 3.
T79 8498-8505 Sentence denotes Results
T80 8506-8595 Sentence denotes 1012 questionnaires were completed by the participants with 41 nationalities represented.
T81 8597-8601 Sentence denotes 3.1.
T82 8602-8634 Sentence denotes Sociodemographic Characteristics
T83 8635-8771 Sentence denotes As shown in Table 1, the majority of participants were male (n = 656, 64.8%), with 34.6% female (n = 356), and married (n = 773, 76.3%).
T84 8772-8957 Sentence denotes Pilgrims were from Iraq (n = 177, 17.5%) followed by Egypt (n = 161, 15.9 %), Sudan (n = 113, 11.1%), Indonesia (n = 111, 11%) and Pakistan (n = 92, 9.1%), respectively, as per Table 2.
T85 8959-8963 Sentence denotes 3.2.
T86 8964-8982 Sentence denotes Level of Education
T87 8983-9209 Sentence denotes While the majority had attended high school or above (n = 622, 61.4%), there was a proportion with only a basic level of reading and writing ability (n = 94, 9.3%), with some describing themselves as illiterate (n = 58, 5.7%).
T88 9211-9215 Sentence denotes 3.3.
T89 9216-9233 Sentence denotes Medical Condition
T90 9234-9303 Sentence denotes Chronic disease including multimorbidity was reported among pilgrims.
T91 9304-9431 Sentence denotes Cardiovascular diseases were the most prevalent (n = 164, 42.4%), followed by diabetes mellitus (n = 139, 37%), as per Table 1.
T92 9433-9437 Sentence denotes 3.4.
T93 9438-9458 Sentence denotes Immunization History
T94 9459-9782 Sentence denotes Despite the Umrah visa requirements, some pilgrims (n = 223; 22%) had not received any vaccination prior to travel; however, others had received influenza vaccine (n = 514; 50.8%), meningitis vaccination (n = 418; 41.3%), Hepatitis B vaccine (HBV) (n = 310; 30.6%), and poliomyelitis vaccination (n = 285; 28.1%) (Table 3).
T95 9783-10086 Sentence denotes In the case of poliomyelitis vaccination for pilgrims attending from countries listed at the time of the 2019 Umrah as polio active, some of the pilgrims had not taken a polio vaccine before travelling from at risk countries including Pakistan (n = 34/92; 31.2%) and Afghanistan (n = 16/80; 12.8%) [21].
T96 10088-10092 Sentence denotes 3.5.
T97 10093-10131 Sentence denotes Duration of Stay in Makkah and Madinah
T98 10132-10282 Sentence denotes The majority of participants stayed in Makkah for less than two weeks (n = 660, 65.2%) and in Madinah for less than a week (n = 614, 60.6%) (Table 3).
T99 10284-10288 Sentence denotes 3.6.
T100 10289-10305 Sentence denotes Health Education
T101 10306-10527 Sentence denotes The majority of pilgrims had received some form of health education (n = 799, 78.9%) described as self-education (n = 185, 23.2%); however, a proportion (n = 123, 12.1%) indicated that they had not received any (Table 4).
T102 10528-10648 Sentence denotes The majority received health education in their homeland (n = 450, 44.4%) or on arrival in Saudi Arabia (n= 201, 19.8%).
T103 10649-10864 Sentence denotes Many believed that the health education they had received was helpful (n = 661, 65.3%) or helpful “to some extent” (n = 216; 21.3%); however, some pilgrims (n = 135; 13.3%) did not find the health education helpful.
T104 10865-11097 Sentence denotes The most cited source of health education was lectures (n = 262; 25.8%), followed by travel clinics (n = 134; 13.2%), followed by family and friends (n = 127, 12.5%), followed by health care providers (n = 122, 12%), as per Table 4.
T105 11099-11103 Sentence denotes 3.7.
T106 11104-11137 Sentence denotes Practice of Preventative Measures
T107 11138-11243 Sentence denotes Nearly a third of pilgrims (n = 305; 30.1%) never wore a face mask in crowded areas during Umrah in 2019.
T108 11244-11341 Sentence denotes In contrast, similar numbers said they always wore a face mask (n = 351, 34.6%) in crowded areas.
T109 11342-11467 Sentence denotes The majority of pilgrims (n = 840, 82.9%) did wash their hands with soap and water or sanitizers after coughing and sneezing.
T110 11468-11647 Sentence denotes Most pilgrims reported that they never used an umbrella or hat to protect them from the sun (n = 509, 50.2%), while some always used an umbrella or hat (n = 144, 14.2%) (Table 5).
T111 11648-11761 Sentence denotes Table 6 shows the responses to items on aspects of availability and the sources of Personal Protective Equipment.
T112 11762-11832 Sentence denotes Many pilgrims reported face masks were not available (n = 642, 63.4%).
T113 11833-11965 Sentence denotes Table 7 reports the association between receiving some form of health education and practicing of preventative measures by pilgrims.
T114 11966-12236 Sentence denotes Receiving health education was significantly associated with the wearing of face masks in crowded areas (p = 0.04) and healthy practice score (i.e., washing hands with water, soap, or sanitizers, use of personal tools, disposing of used tissues in waste bin) (p = 0.02).
T115 12237-12358 Sentence denotes Table 8 indicates that the majority of pilgrims were very satisfied with the Saudi Arabian MOH Services (n = 734, 72.9%).
T116 12360-12362 Sentence denotes 4.
T117 12363-12373 Sentence denotes Discussion
T118 12374-12704 Sentence denotes One thousand and twelve pilgrim of 41 nationalities who performed Umrah in the Saudi Arabia in 2019 had completed the survey, almost a quarter of whom had not received any vaccination prior to travel to the holy city, including meningitis vaccine and poliomyelitis vaccine, which are mandatory by Saudi Arabian health authorities.
T119 12705-12943 Sentence denotes Another issue is that a considerable percentage of pilgrims (30.1%) never wore a face mask in crowded areas during Umrah, which merits further investigations for the causes and improvement polices, particularly amid the COVID-19 pandemic.
T120 12944-13228 Sentence denotes Notably, all pilgrims arriving Saudi Arabia must have received a single dose of quadrivalent meningococcal vaccine and provide proof of a valid vaccination or prophylaxis in the five years before arrival to allow the issue of a Hajj or Umrah visa by the Saudi Arabian Authorities [7].
T121 13229-13513 Sentence denotes However, this study reported less than half of the pilgrims (n = 418, 41.3%) surveyed actually had this vaccination, an issue that has been raised before by Ahmed et al. (2006) [5] and Shibl et al. (2017) [13], which should be examined again to avoid the spread of contagious disease.
T122 13514-13619 Sentence denotes This is especially important during the COVID-19 pandemic, as recent studies have noted [16,17,18,19,20].
T123 13620-13903 Sentence denotes The Center for Disease Control and Prevention (CDC) goes further in strongly recommending that hajjis receive a seasonal influenza vaccine, which is recommended for high risk pilgrims to reduce their own morbidity and mortality, but also to reduce transmission of the disease [3,18].
T124 13904-14277 Sentence denotes As raised by Barasheed et al. (2014) [14], Benkouiten et al. (2013) [15], and others more recently [16,17,18,19,20], the crowded conditions during Hajj and Umrah increase the risk of respiratory disease transmission including influenzas, tuberculosis, and Middle East Respiratory Syndrome (MERS) coronavirus, which was first identified in Saudi Arabia in 2012 [3,18,21,22].
T125 14278-14549 Sentence denotes In this study, 50.8% of pilgrims had reported that they were vaccinated against seasonal influenzas, which is higher than recently reported among Malaysian pilgrims (24.9%) [23], French pilgrims (31.8%), and Saudi Arabian, Qatari, and Australian pilgrims (31.0%) [14,15].
T126 14550-14750 Sentence denotes It should be considered whether the CDC recommendation should be added to the Umrah and Hajj visa requirements, although the evidence is still inconclusive and at times contradictory [16,17,18,19,20].
T127 14751-14991 Sentence denotes Whether greater enforcement of the regulations would help promote public health remains to be seen, but dramatically reducing the size of mass religious gatherings and adopting preventative measures has been shown to work at Hajj 2020 [19].
T128 14992-15164 Sentence denotes Following the COVID-19 pandemic these restrictions, and greater adoption of preventative measures such as the wearing of face masks may also be more acceptable to pilgrims.
T129 15165-15244 Sentence denotes Yet again, few pilgrims (n = 285, 28.1%) were vaccinated against poliomyelitis.
T130 15245-15436 Sentence denotes The Saudi Arabian health authorities require proof of poliomyelitis vaccination from at least four weeks before arrival from pilgrims who are traveling from poliomyelitis reporting countries.
T131 15437-15663 Sentence denotes This is an issue returned to again and again over the years by research teams including Memish et al. (2012a,2012b,2014, 2016, 2019), considering infectious disease prevention during Umrah and Hajj pilgrimages [8,22,24,25,26].
T132 15664-15817 Sentence denotes Of note, free polio vaccination is administered to pilgrims by Saudi Arabian MOH at the entry ports to promote the aim of world eradication of polio [7].
T133 15818-15903 Sentence denotes Perhaps there are more opportunities to offer further vaccinations at ports of entry.
T134 15904-16056 Sentence denotes The majority of respondents believed that the health education they had received was helpful (n = 661, 65.3%); however, some (n = 135, 13.3%) disagreed.
T135 16057-16365 Sentence denotes Promoting health education and awareness programs prior to and during this spiritual journey is essential to improve their practices and to ensure lower risk of acquiring and spreading infections or existing medical conditions deteriorating, thus helping pilgrims to complete their rites safely and properly.
T136 16366-16567 Sentence denotes The Saudi Arabian MOH has created an easy read guide to Hajj for Umrah pilgrims that comprises important information about vaccinations required and other preventative and precautionary measures [1,7].
T137 16568-16693 Sentence denotes These measures are founded in research following year on year Umrah pilgrimages [4,5,6,8,9,10,13,14,15,22,23,24,25,26,27,28].
T138 16694-16921 Sentence denotes Despite evidence to the contrary on information provided by the MOH in KSA [1,7], almost one quarter of the participants reported not receiving any health education and orientation around preventative measures (n = 213, 21.1%).
T139 16922-17094 Sentence denotes This adds to the challenges in the management of the Hajj and Umrah and may have an impact on the services that are offered by the Saudi Hajj and Health authorities [7,10].
T140 17095-17253 Sentence denotes Clearly, despite all attempts to date to include advance provision of health education to pilgrims, there is more to be done in reaching the wider population.
T141 17254-17406 Sentence denotes With hindsight, this study was an opportunity to establish which types of content and delivery of health education are seen as most helpful to pilgrims.
T142 17407-17443 Sentence denotes This is an area for future research.
T143 17444-17719 Sentence denotes Of note, less than half of the pilgrims (n = 485, 47.9%) had reported using face masks “always or often”, and less than a third of participants (n = 305, 30.1%) had reported never using face masks in crowded areas; however, 63.2% reported lack of availability of these masks.
T144 17720-17821 Sentence denotes This study showed an almost equal divide in those who do and do not use face masks in crowded places.
T145 17822-17922 Sentence denotes This finding is in accordance with other studies in Saudi Arabia (56%) and the USA (42%) [19,24,25].
T146 17923-18041 Sentence denotes Since the outbreak of COVID-19 [27,28], the use of face masks has become universal in China and the rest of the world.
T147 18042-18178 Sentence denotes However, the evidence of their protection against respiratory infections in the community is still controversial [16,17,18,20,28,29,30].
T148 18179-18533 Sentence denotes In Saudi Arabia, a study to estimate the incidence of Hajj-related acute respiratory tract infections (ARI) among pilgrims travelling from Riyadh revealed that the use of a facemask by men was a significant protective factor against ARI in Hajj, and fewer pilgrims (15.0%) had ARI compared with hajjis who used it sometimes (31.4%) or never (61.2%) [29].
T149 18534-18727 Sentence denotes It was reported in other studies that the use of face masks for more than eight hours can lead to a substantial decrease in the incidence of influenza-like illness (ILI) among pilgrims [14,29].
T150 18728-18802 Sentence denotes However, the effectiveness depended largely on adherence to mask use [30].
T151 18803-18953 Sentence denotes Hoang et al. (2019 and 2020) noted the complexity of the bacterial and viral RTIs [18] and high transmission rates despite preventative measures [19].
T152 18954-19141 Sentence denotes Adaptations to accommodation should be considered as the current use of large, single space dormitory style tents has been noted to encourage the spread of viral infections [16,18,19,20].
T153 19142-19271 Sentence denotes In the chain of transmission, regularly washing hands and the use of hand sanitizers resulted in significantly less ILI symptoms.
T154 19272-19390 Sentence denotes A large proportion of the respondents (n = 840, 83%) always performed proper hand hygiene after coughing and sneezing.
T155 19391-19499 Sentence denotes This percentage is higher than the French pilgrims in 2012 (46.3%) and USA pilgrims in 2009 (45.5%) [14,15].
T156 19500-19641 Sentence denotes Recent studies again emphasize the need for good hygiene practices and the ready provision of personal protective equipment [16,17,18,19,20].
T157 19642-19873 Sentence denotes In the present study, 852 pilgrims (84.1%) always used razor blades for shaving their heads, a practice which, if not done hygienically, poses a risk of transmission of blood-borne diseases such as HIV and Hepatitis B and C [5,18].
T158 19874-19984 Sentence denotes Some studies have identified issues with unlicensed barbers and sharing of razor blades amongst pilgrims [20].
T159 19985-20120 Sentence denotes The majority of pilgrims rated their experience with the Saudi Arabia Ministry of Health Services as “very satisfied” (n = 734, 72.9%).
T160 20121-20285 Sentence denotes Of note is that health services including primary, secondary, and intensive care medical services are offered to millions of Umrah and Hajj pilgrims free of charge.
T161 20286-20389 Sentence denotes Whether pilgrims felt open to express their opinions during completion of the survey is open to debate.
T162 20391-20415 Sentence denotes Limitations of the Study
T163 20416-20540 Sentence denotes There are a number of biases that are present in this study, including the self-reporting and recall biases of participants.
T164 20541-20780 Sentence denotes There may also be recruitment bias from the researchers at the airport in whom they approach and participation bias in those who decided to take part in this study and the responses (the number of refusals to participate was not recorded).
T165 20781-20999 Sentence denotes Although the sample size is reasonable, when compared with the cited literature, and considering the millions of Umrah pilgrims arriving at the holy cities in Saudi Arabia yearly, the findings may not be generalizable.
T166 21000-21118 Sentence denotes Time constraints and language barriers were also limiting factors, since the recruitment was conducted at the airport.
T167 21119-21204 Sentence denotes The definition of health education was left open to the participant’s interpretation.
T168 21205-21447 Sentence denotes This is an area that would benefit from closer attention in future studies to establish the content and type of information to include targeting the perhaps varying needs of different groups of pilgrims (language, literacy, economic aspects).
T169 21448-21684 Sentence denotes Despite these limitations, this study has currency and has provided several insights that were consistent with other studies, and some further insights on the behaviors and practices of pilgrims attending Hajj and Umrah in Saudi Arabia.
T170 21686-21688 Sentence denotes 5.
T171 21689-21700 Sentence denotes Conclusions
T172 21701-21848 Sentence denotes This study has identified several issues relating to the preventative measures that were practiced by Umrah pilgrims in Saudi Arabia in 1440H-2019.
T173 21849-22032 Sentence denotes This highlighted inadequate meningitis and poliomyelitis vaccination and insufficient hygiene and safety practices, such as availability and proper wearing of face masks during Umrah.
T174 22033-22104 Sentence denotes The Saudi MOH has the option to enforce mandatory proof of vaccination.
T175 22105-22258 Sentence denotes The behavioral and practice issues amongst pilgrims have been shown in the literature to pose a high risk for acquiring respiratory and other infections.
T176 22259-22400 Sentence denotes The worsening of pre-existing medical conditions is particularly relevant for Umrah pilgrims who tend to be older and with multi-morbidities.
T177 22401-22567 Sentence denotes This is especially the case during the COVID-19 pandemic, given that these pilgrims fit the profile of those more likely to experience more severe symptoms and death.
T178 22568-22805 Sentence denotes It is the duty and responsibility of each country in which their pilgrims participate in this holy rite to promote health education and raise awareness amongst individuals on basic preventative measures in order to promote public health.
T179 22806-23042 Sentence denotes Further studies should focus on development of accessible health education content in a form that engages pilgrims from diverse backgrounds to promote comprehensive preventative measures during mass religious gatherings and pilgrimages.