1
Papers published and presented by
Professor Hassan I. Ghaznawi
SOME OBSERVATIONS ON INTESTINAL PARASITES IN
HAJJIS VISITING SAUDI ARABIA, DURING 1983 (1403)H
PILGRIMAGE
By
M.A.SIDDIQUE and H.I. GHAZNAWI
Department of Parasitology and Community Medicine,
Faculty of Medicine, King Abdulaziz University,
and Ministry of Health, Western Region, Saudi Arabia
ABSTRACT (1985)
Some 28.76% (109/379) of faecal samples contained parasites. Both
direct smear and simple sedimentation technique were used. Prevalence
rate in both sexes was not about the same (20%). Although majority of
Hajjis belonged to 50-74 years age group but a relatively larger
percentage (32.4%) was found infected in 25-49 years than in 50-74
years age group (26.9%). About 16 species of intestinal parasites were
found (11 pathogenic), seven species of protozoa and 9 of helminths.
Entamoeba coli, Trichuris trichiura, Asoaris lumbricoides and
hookworms were of frequent occurrence. Although patients of 17
nationalities were included, the majority were Egyptians and
Indonesians. 28.2% (62/220) of Egyptians and 43.2% (19/44) of
Indonesians were infected.
2
A SEROPARASITOLOGICAL STUDY OF SOME LATENT PARASITIC
INFECTIONS AMONG PILGRIMS 1405h (1985G)
BY
HASSAN I. GHAZNAWI, M. AYMAN SAFI, EBTISSAM A. OMAR,
MOHAMED S. ARAFA AND MOHAMED MOSELHI
Departments of Community Medicine, Parasitology and Immunology,
Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
ABSTRACT (1986)
A seroparasitological study was carried out for the first time on some
pilgrims in Saudi Arabia coming from various ecological regions, viz Middle
East and Mediterranean, Arabian Peninsula, Indian subcontinent, Tropical
and Subtropical Africa and South East Asia. They were investigated for
subclinical infections of malaria, toxoplasmosis and visceral leishmaniasis.
Results showed a high infection rate for each of the three parasites
particularly toxoplasmosis. Recommendations were set up to alleviate their
potential danger as hidden sources of infection in the Holy places.
3
Primary Health Care
Dr. Hassan Ghaznawi (1986)
FILLING THE GAPS IN SAUDI ARABIA’S HEALTH SERVICES
This article outlines the strides taken by Saudi Arabia since 1980 towards
providing primary health care for the entire population. Basic facilities have
been introduced in accessible locations, more personnel have been trained and
retrained, and considerable attention has been given to the education of the
public in health matters.
Before 1951 there was no adequate tradition of health care in Saudi Arabia,
and not even a Ministry of Health. During the next 30 years or so the major
objective of the Ministry of Health was to establish hospitals, dispensaries and
other curative facilities. Due to an acute shortage of qualified personnel there
was a great dependence on expatriates to formulate plans and objectives.
Much emphasis was put on founding sophisticated medical institutions for the
provision of secondary and tertiary care. By 1980 there were enough
institutions of this kind to cover most of the population.
4
HEAT STROKE AND HEAT EXHAUSTION IN PILGRIMS
PERFORMING THE HAJJ (ANNUAL PILGRIMAGE) IN SAUDI ARABAI
HASSAN I. GHAZNAWI, BSc, MB, BS, MPH, DrPH;
MOHAMMAD A. IBRAHIM, BSc, MD, MPH & TM, DrPH
ABSTRACT (1987)
‫ خالفا ألهميتها لدى‬.‫ال تعتبر ضربة الشمس واال نهاك الحراري من المشكالت الشائعة بين المواطنين السعوديين‬
‫ وقد تزامن‬.‫الحجاج القادمين من بقاع أخرى من العالم خالل موسم الحج الذي يتغير وفقا لسنة التقويم القمري‬
‫موسم الحج في السنوات األخيرة مع شهري يوليو وأغسطس (تموز وآب) من أشهر الصيف إذ وصل متوسط ارتاع‬
‫ إن نقص االحتراس وطرق الوقاية هو السبب‬.)‫ درجة فرنهية‬031( ‫ درجة مئوية‬54‫الحرارة في فترة الحج إلى‬
‫ ويعزي جزء من ازدياد عدد حاالت‬.‫الرئيسي وراء كثرة حاالت ضربة الشمس واالنهاك الحراري في صفوف الحجاج‬
‫م إلى نظام التبليغ االلزامي الذي ادخلته‬0828 ‫ حالة في سنة‬0008 ‫ إلى‬0820 ‫ حالة في سنة‬842 ‫المسجلة من‬
‫ تقدم حكومة المملكة العربية السعودية أفضل الخدمات الصحية الممكنة مجانا‬.‫م‬0828 ‫وزارة الصحة في سنة‬
‫ وحدة من وحدات‬35 ‫ سري اًر باإلضافة إلى‬5334 ‫م ما مجموعه‬0824 ‫ حيث توفر بحلول عام‬،‫لجميع الحجاج‬
‫ كما يجري أيضا تخطيط‬.‫((مكة المكرمة)) لتبريد الجسم الجاهزة لخدمة الحجاج في عرفات ومنى ومكة المكرمة‬
.‫تدابير وقائية واجراءات نوعية كافية لتأمين مواسم حج افضل واسلم في المستقبل‬
Heat stroke and heat exhaustion are not common problems among Saudi Arabians.
They are, however, of significance in pilgrims from other parts of the world during
Hajj season, which varies according to the lunar calendar year. In recent years, Hajj
has coincided with the summer months of July and August. The temperatures
during Hajj reach an average high of 54°C (130°F). Lack of protection and
precautionary measures is the primary reason for the high number heat-stroke and
heat-exhaustion cases among the pilgrims, reported cases of which increased from
258 in 1981 to 1,119 in 1982, due partly to the mandatory reporting system
introduced by the Ministry of Health in 1982. The government of Saudi Arabia
provides the best possible health services free of charge to all pilgrims. By 1985,
there was a total of 4,635 hospital beds and 64 Makkah Al-Mukarramah Body
Cooling Units commissioned in the cities of Arafat, Mina and Makkah. In addition,
adequate preventive and educational measures are being promulgated to provide
better and safer Hajj seasons in the future.
5
HEALTH HAZARDS AND RISK FACTORS IN 1406H HAJJ SEASON
Dr. Hassan I. Ghaznawi, Mohamed H. Khalil
(1988)
The Hajj Season is characterized by the presence of a large number of people from
different countries in Makkah creating a high degree of overcrowding which is
favorable for the spread of communicable diseases.
The study aims at investigating health hazards and the possible risk factors during
the 1406H. (1986 ) Hajj season. All cases of communicable diseases admitted to the
hospitals in Makkah, Arafat and Mena during the period 15/11 to 15/12 H. as well
as all deaths reported during that period were included in the study. Special forms
were designed to collect information on the cases and deaths.
The study revealed that gastroenteritis was the leading cause of morbidity with
highest incidence among Egyptians and Syrian pilgrims. Older age groups seemed
to be more affected by this condition. Pneumonia was the second leading cause
among pilgrims with highest incidence among Jordanians and a very high casefertility rate (43.8%) in the age group 50+ years. The leading cause of death was sun
stroke contributing 28.3% of the total deaths among pilgrims. Also old persons and
females were at higher risk of death due to asphyxia or crushing due to
overcrowding during Al-Rajm ritual.
‫يتميز موسم الحج بوجود عدد كبير من الناس من دول مختلفة في وقت واحد في مكة المكرمة مما قد يساعد على انتشار‬
‫ ويهدف هذا البحث إلى دراسة المخاطر الصحية والعوامل المساعدة لحدوثها خالل موسم حج‬.‫بعض األمراض السارية‬
‫م) وقد شملت الدراسة جميع حاالت األمراض السارية المنومة في مستشفيات مكة وعرفات ومنى وكذلك‬0823( ‫هـ‬0513
‫هـ وقد تم تصميم استمارات خاصة لجمع البيانات عن المرضى‬08/04 ‫ إلى‬00/04 ‫جميع الوفيات المبلغة خالل الفترة‬
‫ وقد بينت الدراسة أن النزالت المعوية هي اكثر األمراض انتشا ار خاصة بين الحجاج المصريين والسوريين وان‬.‫والوفيات‬
‫ كما ان االلتهاب الرئوي المرض الثاني من حيث معدل االصابة بين الحجاج‬.‫فئات العمر المتقدمة اكثر تعرضا لإلصابة بها‬
‫ وكان السبب الرئيسي للوفاة‬. %5332 ‫ سنة فأكثر والذي بلغ‬41 ‫والذي تميز بارتفاع معدل وفيات االصابة في فئة العمر‬
‫ وقد بينت الدراسة ان كبار السن واالناث اكثر‬.‫ من جملة الوفيات‬%8233 ‫بين الحجاج هو ضربة الشمس والتي سببت‬
.‫عرضة للوفاة بسبب االسفكسيا والسحق الناتجين عن االزدحام اثناء رجم الجمرات‬
6
ANEMIA IN PREGNANCY IN JEDDAH, SAUDI ARABIA
AN EPIDEMIOLOGICAL STUDY
By
HASSAN I. GHAZNAWI, EMAD E. EID AND MOHAMED M. HUSSEIN
From
Department of Community Medicine, King Abdel-Aziz University and Maternal
and Child Health and Statistics Sections, Department of Preventive Medicine
Western Region
(1988)
INTRODUCTION
Anemia is the commonest medical disorder to occur in pregnant women (Dewhurst,
1981). Iron deficiency is by far the commonest cause of anemia and the commonest
nutritional disorder. The second common cause of nutritional anemia is folate deficiency
(W.H.O., 1975; Letsky, 1984). High illiteracy and high fertility deplete body stores of
nutrients while poverty will lead to the intake of some kind of foods which reduce iron
absorption as stated by Philpot 1982. A reduction in concentration of circulating Hb is a
relatively late development in iron deficiency. This is preceded by a depletion of iron
stores and then a reduction in serum iron before there is any detectable change in Hb
level. However, measurement of Hb is the simplest non invasive practical test at our
disposal (Letsky, 1984). According to the standards led by WHO, (1972), anemia of
pregnancy is present when the Hb concentration is less than 11 gm/dl. A level of 10
gm/dl has been suggested by Paintin (1962) since many woman in developing countries
with Hb level around 10gm/dl are apparently healthy and symptom free. Rates of 10% or
less are now common in U.K. (Allaire and Campagna, 1961). In USA it was 15% in
1961. In Egypt a prevalence rates of 75% ( Mohi El Din, 1954) and 90% (Abdou et al.,
1965) were reported. Adverse effects of anemia on both maternal and perinatal health
have been widely reported for decades (Adams and Gurung, 1977). Its effects in reducing
economic production have recently come to light as stated by Edgerton et al., (1979).
The aim of this study is to assess the prevalence of anemia in pregnancy in Jeddah and
the effect of some biological and socioeconomic factors on its prevalence.
7
AN IMMUNOSEROLOGICAL STUDY AMONG
BLOOD DONORS OF MAKKAH REGION, SAUDI ARABIA
BY
M. AYMAN SAFI, HASSAN I. GHAZNAWI, MOHAMED S. ARAFA and
MOHAMED MOSELHI
Departments of Microbiology, Community Medicine and Parasitology,
Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
Abstract (1989)
Blood services are inevitable and life saving. Therefore all measures should be
taken to guarantee that the donated blood is pathogen free. The present study
intends to throw some light on the prevalence of infectious and parasitic
disease among blood donors, whether Saudi or expatriates residing in the
Makkah region (Makkah and Jeddah cities). Results of this work indicate that
hepatitis B is one of the most important problems involved in blood services in
this region. On the contrary sexually transmitted diseases like syphilis and
AIDS do not comprise a real health problem so far. However, periodic checkup and intensive health education are of utmost importance. Hydatidosis does
not constitute a real problem as dogs are mostly avoided in this region.
8
FEEDING PATTERNS AND GROWTH OF
INFANTS IN JEDDAH
By
HASSAN I. GHAZNAWI, EMAD E. EID AND MOHAMED HUSSEIN
From
Department of Community Medicine King Abdulaziz University
And
Maternal & Child Health & Medical Statistics Sections
Department of Preventive Medicine
Makkah Al-Mukarramah Region, Ministry of Health
INTRODUCTION (1990)
As long as a satisfactory growth rate is maintained, there is little disagreement
that exclusive breast feeding is the preferred mode of feeding for healthy
babies (Sosa et al., 1976). Because many factors affect the age when breast
milk alone becomes inadequate to meet the nutritional requirements for
satisfactory growth, this age varies between populations and between
individuals within a population (Underwood & Hofvander, 1982).
A significant decline in the incidence and duration of breast feeding was
reported in both developed and developing countries. However, the declining
trend was halted or reversed in many developed countries as stated by
Hirschman and Butler (1981) while there is no evidence of any reversal or
upward trend in the developing countries (WHO, 1981).
9
RELATIONSHIP OF PREGNANCY WASTAGE AND
INFANT LOSS TO FERTILIY BEHAVIOR
IN SAUDI ARABIA
By
HASSAN GHAZNAWI, EMAD EL DIN EID, MOHAMMED HUSEEIN,
MONA MORTADA AND SAMI KAAKI
From
Department of Community Medicine, King Abd El Aziz University
Preventive Department Western Region
Department of Family Health High Institute of Public Health,
Alexandria University – Egypt
1990
INTRODUCTION
Pregnancy wastage and child mortality are major high fertility determinants in
developing countries (Omran, 1974; Eid et al., 1988 and Abd El Moniem et al.,
1986). Omran (1974) analyzed data collection from 14 maternity centers which
revealed that perinatal mortality described a J-shaped relationship with both
maternal age and parity. Omran and Standley (1981) gave a full review of recent
studies in this respect. Carbera (1980) in China reported that neonatal and
postneonatal and total infant mortality were lowest for maternal ages 20-34, highest
for ages under 20 years & 35 years and over. Stoekel and Choudhery (1971) found
that postneonatal mortality were high for young mothers (under 20) and highest for
mothers aged 35-39 years. Ayeni and Oduntin (1978) reported that infant mortality
has a j-shaped pattern of risk with maternal age.
El Sherbini et al., (1981) reported a J-shaped relation to pregnancy wastage and
maternal age. Higher social class decreased number of pregnancy wastage.
Eid et al., (1986,a) reported that the percent of women who were ever users or
current users of birth control were significantly higher among women without child
loss that among women with child loss.
10
SOCIOECONOMIC FACTORS AFFECTING THE
PREVALENCE OF OBESITY AMONG FEMALE PATIENTS
ATTENDING PRIMARY HEALTH CENTRES IN JEDDAH,
SAUDI ARABIA
RUFAIDA H. KHASHOGGI, KHALID A. MADANI, HASSAN I.
GHAZNAWI, and MAJDI A. ALI
Department of Nutrition, Home Economics, king Abdulaziz University,
Jeddah and Directorate of Health Affairs, Ministry of Health, Jeddah Region,
Saudi Arabia
(1994)
A sample of 852 Saudi women who attended the primary health care centers
in Jeddah seeking medical care were examined. Obesity was defined as a value
for the body mass index (kg/m2) ≥ 25.0. The prevalence of obesity in the
exampled sample was high (64.3%). Obesity was significantly related to age,
marital status, parity, level of education, level of work, women’s income levels,
who is the householder and the number of servants. There was no significant
association between obesity and the following factors: being the only or
youngest daughter, inhabitant’s number, number of cars, time spent watching
television, eating while watching television, number of times per week inviting
or being invited to meals, householder’s income, and his education or work.
Multiple regression analysis indicated that five variables were significant
predictors: age, marital status, number of servants, giving birth, and parity.
Knowledge of the social factors associated with obesity will help to identify
high risk groups. Those most vulnerable to the development of obesity, should
then be the focus of a vigorous preventive program.
11
SURVEILLANCE FOR DENGUE FEVER IN JEDDAH
Hassan I. Ghaznawi, Taha O. Al-Khateeb, Naeema Akbar, Huda Afifi and
Nasser Alhamdan
INTRODUCTION
1997
Dengue fever is an acute self-limited illness characterized by diphasic fever,
headache, arthralgia, myalgia, rash, lymphadenopathy and leucopenia.
Dengue haemorrhagic fever is a severe form of classic dengue, manifested by
thrombocytopenia and haemococentration. In severe cases, circulatory failure
and shock (dengue shock syndrome) result from immune enhancement due to
reinfection with a different serotype. Dengue fever is caused by the mosquitoborne dengue virus. The primary vector is Aedes aegypti; A. albopictus is a
second potential vector. Dengue virus is an enveloped RNA virus classified in
the flavivirus genus (formerly called group B arbovirus) of the Togaviridae
family.
Despite the occurrence of dengue fever in some countries bordering the Red
Sea during the last ten years, such as Sudan, Senegal, Djibouti and Yemen, its
appearance in Jeddah, Saudi Arabia was not expected as the geographical
characteristics of Jeddah City (e.g. low rainfall of < 60mm/year) are not
suitable for the natural breeding of the vector.
12
LARGE GATHERING: A MANAGEABLE THREAT
Dr. Hassan I. Ghaznawi
Abstract (1997)
The world is getting smaller and travel time is becoming shorter due to the
ever improving means of transportation. These factors and others has led to
the that certain unwanted passengers namely bacteria and viruses moves
faster from one country to the other. These passengers never did believe in
geographical nor political boundaries. The number of international travelers
is increasing dramatically every year. This mass movement unless controlled
poses a dangerous health threat to various parts of the world. Large
gatherings mainly occur during vacation seasons. However, the largest
congregation in the world takes place on Makkah during the annual
pilgrimage. The Saudi health authorities are entrusted with providing optimal
preventive and curative health services to the pilgrims. International health
regulations were developed in order to provide healthy environment. This
paper aims at elucidating the methods adopted by the Saudi health authorities
during this event. It will also outline the measures which could form the basis
upon which various health authorities can rely in coping with large gatherings
such as the Annual Pilgrimage to Makkah.
13
THE PILGRIMAGE TO MAKKAH: A UNIQUE
CHALLENGE
Professor Hassan I. Ghaznawi, King Abdul Aziz University
Jeddah, Saudi Arabia
2002
Saudi Arabia as the inheritor of the Islamic holy cities (Makkah and
Madinah) plays host annually to more than two million Moslems. They
converge to Makkah to perform at least once in a lifetime the Hajj as
prescribed in the Quran. The sheer force of this concentrated gathering
of pilgrims from all over the world makes it an awesome responsibility
to the Saudi authorities. The Hajj is a fertile area for a propagation of
infectious and communicable disease. Therefore, it is imperative that the
Saudi health authorities should enforce vigilant procedures to prevent
the entry of these diseases and also cope with such problems as they
occur. In addition, pilgrims face a number of other heath problems
ranging from mere sore throat to heat strokes. This paper intended to
give an overview of the health problems, the pilgrims may confront
during the Hajj. It will also elucidate the various measures which the
Saudi authorities in general and the health authorities in particular adopt
to safeguard the pilgrims during the Hajj. It will outline the various
programs and efforts the health authorities have to exert to prevent the
entry of communicable diseases into the country and the management of
the various health facilities in the area which provides adequate health
services to the largest congregation of people in the world. We will
prove that the pilgrimage to Makkah is a Unique Challenge.
14
THE HAJJ “A HOLY RITUAL AND A HEALTH NIGHTMARE”
DR. HASSAN I. GHAZNAWI
M.D., Dr. P. H.
2004
The Hajj is the largest congregation of people in the world. It is a very
strenuous experience especially for the old and feeble pilgrims. It is a
fertile area for the propagation of communicable diseases. Heat
exhaustion and sunstroke are but another cause of mortality and
morbidity. This paper is intended to give a detailed discussion of the
Hajj ritual and all the health problems encountered. It will also show that
there are other major incidents, which have and will occur during Hajj.
They are not related to health problems. However, the health services are
the end sufferers of any disasters occurring during the Hajj. All the
necessary steps, which are adopted by the Saudi authorities, are
discussed. Certain procedures could be adopted which might minimize
the problems occurring during the Hajj thus reducing the health
nightmare of this Holy Ritual.
15
PREVALENCE AND INTENSITY OF DENTAL CARIES
AMONG SCHOOL STUDENTS IN JEDDAH CITY
Ali H. Hassan, Hala Amer, Adel Moussa and Hassan Ghaznawi
ABSTRACT (2005)
This survey was conducted on school children of the various
educational stages in Jeddah city. The aim was to detect the caries
experience of school pupils. A stratified random sample was taken
from the various administrative districts of Jeddah. Stratification by
age, educational stage and gender was done and random samples
were drawn from the school lists of various stages. A total sample of
2400 students were surveyed, half males and half females, equally
withdrawn from private and public schools of the various
educational levels.
The results revealed a low caries experience 2.5 among 9-12 year old
group, and moderate (DMFT=3.46 and 4.31) among 13-15 and 16-18
year old groups respectively. The trend was therefore not
decreasing. Females and governmental schools had higher DMFT
levels in intermediate and high schools. Educational, preventive and
therapeutic school dental programs are recommended.
16
Religious gathering and the health threat
By Prof. Hassan I. Ghaznawi, M.d. Dr. P. H
King Abdul Aziz University Jeddah,
Saudi Arabia (2006)
The annual pilgrimage to Makkah is the largest congregation of people
in the world. It is a fertile area for the propagation of communicable
diseases. This mass gathering unless controlled poses a dangerous health
threat not only to Saudi Arabia but also to the countries from which the
pilgrims come from and the countries they transit on their return
journey.
Meningococcal meningitis outbreak during the 1987 pilgrimage has
exposed the Saudi authorities to a new form of communicable disease. It
has necessitated the adoption of new measures both locally and
internationally in order to combat such outbreaks. Although the Saudi
health authorities are entrusted with providing optimal preventive and
curative health services to the pilgrims, WHO and health authorities of
other countries are also involved. This paper aims at elucidating the
methods adopted by the Saudi health authorities during this event. It will
also outline the measures to be adopted by various countries during such
large religious gathering and the vaccine strategies for travelers and their
drawbacks.