International Journal of Current Medical And Applied Sciences, 2017, August, 15(3),149-152. ORIGINAL RESEARCH ARTICLE Mass Gatherings - A Public Health Perspective 1 2 Cynthia Subhaprada S. & Kalyani P. 1Associate Professor, 2 Postgraduate students, Department of Community Medicine, Kurnool Medical College, Kurnool-518002. Andhra Pradesh. India. --------------------------------------------------------------------------------------------------------------------------------------- Abstract: Background: India, a land of spirituality and philosophy, is home to a large number of religious gatherings and pilgrimages such as Pushkaras, Kumbh melas, Rath Yatra, Ramzan and Durga Puja. So, understanding the Pushkaram can highlight the health challenges faced and provide crucial lessons for the management of mass gatherings. Objectives: To describe the health problems among the pilgrims and the public health measures during an event of mass gathering Methods: This descriptive study conducted from July to August, 2016, used the Krishna Pushkaralu in Srisailam, Kurnool district, as a case study to provide an overview of the medical planning for an event of mass gathering. This festival, held from 12, August to 23, August, 2016 is observed once in twelve years, along the banks of River Krishna. The data from the pilgrims who voluntarily presented themselves to the outpatient booths allocated to the interns from the Department of Community Medicine, Kurnool Medical College, Kurnool, posted at the site, as part of the medical team, was collected to analyze the common symptoms encountered and medical services made available. Results: Among the study subjects, majority (40%) had respiratory ailments of which 45.8% were reported among under 5 children and there were a few (10%) with non-communicable diseases. Conclusions: It is necessary to better understand health risks among pilgrims for a unified approach to create awareness among pilgrims, public health personnel and community during mass gatherings. Keywords: Mass gathering, public health. Introduction: According to the World Health Organization (WHO), a large attendance, duration of the event & security mass gathering (MG) is ‘‘any occasion, either organized concern [4]. or spontaneous, that attracts sufficient numbers of Most of MGs are planned in advance and recurrent, people to strain the planning and response resources of taking place at the same location like religious the community, city or nation hosting the event’’ [1]. ceremonies (e.g. Hajj) or in a different location These have the potential to overwhelm health services comprising a wide range of activities such as sport as a result, mass gatherings require careful planning. events (e.g. the FIFA World Cup, the Olympic Games), The magnitude is widely contextual, from a couple of social events (e.g concerts), although some events such thousand to a few million [2]. The term special event as Pope’s funeral occur spontaneously. These may also medical care has also been used and has been defined as include some other public events like cultural, “the provision of preventive measures or definitive educational activities and even political rallies. primary care, or hospital referral to persons attending the mass gathering events [3]. Characteristics of mass gatherings that impact public health services include Address for correspondence: Dr. Cynthia Subhaprada S Associate Professor, Access this Article Online Department of Community Medicine, Kurnool Medical College, Website: Kurnool-518002. Andhra Pradesh. India www.ijcmaas.com EmailHow: to cite this article: [email protected] Cynthia Subhaprada S. & Kalyani P. : Mass Gatherings - A Public Health Perspective International Journal of current Medical and Applied Subject: sciences; 2017, 15(3),149-152. Medical Sciences Quick Response Code IJCMAAS,E-ISSN:2321-9335,P-ISSN:2321-9327. Page | 149 Cynthia Subhaprada S. & Kalyani P. In Hindu festivals, worshiping rivers once in twelve little attention to public health [9-11]. This makes it years along each river is called Pushkaram and in imperative to take a critical look at the public health Telugu, it is called as Pushkaralu, an Indian festival. It risks, such as infectious diseases, that could severely constitutes a large number of people gathered at a disrupt the management of MGs [12]. specific place and time. Attracting such a significant Hence the present study was conducted during the number of pilgrims, as well as support staff, the Krishna Pushkaralu, Srisailam, Kurnool district, to event has the potential to place additional pressures describe the health problems among the pilgrims on local health services, making it important to have and the public health measures during such an event appropriate medical care provided on-site. of mass gathering. Health promotion through public health messages should be the core work stream in any mass Materials and Methods: gathering planning to minimize the Public Health This descriptive study conducted from July to risk. This potential of using such events for health August, 2016, used the Pushkaram in Srisailam, promotion is largely untapped. Health problems Kurnool district, as a case study to provide an associated with changes in population dynamics and overview of the common health problems behaviors during MGs have drawn the attention of encountered and the Public Health measures in such Public Health authorities. Mass gathering events a mass gathering event. pose critical health challenges, especially for the Krishna River is one of the largest rivers in India control of diseases. The rising population, better after Ganges, Brahmaputra and Godavari. It has a connectivity, and scope of travel have increased the length of about 1300 kilometers, originating from frequency and magnitude of mass gatherings and Western Ghats of Mahabaleshwar and it flows underscore the need to shift the discourse from through the states of Maharashtra, Karnataka and reacting to the public health issues they throw up to Andhra Pradesh before merging in the Bay of Bengal taking active steps in preventing them based on at Hamasaladeevi in Andhra Pradesh. According to evidence, through research. Hindu mythology it is believed that all deities and MGs are of great importance from an rishis/holy men take a holy dip in the rivers, hence epidemiological point of view, because of the pilgrims from all over India descend on the banks of potential risk of transmission of infectious diseases. Krishna River to have a holy dip with the belief that Firstly, the participants may themselves play a role they would be relieved of all sins, and perform as a source of infection among the people (e.g. cases rituals to departed souls. Pushkaram has been an age of undiagnosed tuberculosis) or they may be old practice in southern states of Andhra Pradesh, susceptible to infectious agents which are in Karnataka and Telangana. In 2016, the celebrations circulation at the location (for example people not started on 12 August and ended on 23 August, along vaccinated against measles traveling to a country the banks of River Krishna in Patala Ganga Ghat, with an ongoing disease outbreak). Secondly, mass Srisailam [13]. gathering puts a severe strain on the health care Patients who self-presented to the outpatient booths system of the host countries and communities. In were considered as the study subjects for this study. such a complicated situation, a combination of Thus, the study subjects were the pilgrims who factors such as overcrowding, restricted accessibility, voluntarily presented themselves to the outpatient insufficient crowd control, and lack of on-site booths allocated to the interns from the Department medical and health care predictions can lead to of Community Medicine, Kurnool Medical College, catastrophic consequences [5]. Another Kurnool, posted at the site, along with the medical characteristic of MGs is the dispersion of participants team of specialists from Government General and pilgrims almost immediately following the Hospital, Kurnool, during the above period, in gathering, which increases the risk of spreading of Srisailam. No personal identifying information on communicable diseases within their country/place of individual patients was collected. Data was collected origin. With regard to the nature of population regarding the common presenting symptoms among movement that takes place in MGs, traditional com- the study subjects and medical services made municable diseases surveillance systems are not able available. to efficiently capture all the information needed for disease control and management activities [6]. Observations & Results: MGs may also have considerable implications in relation to other acute public health incidents such The Krishna Pushkaralu, like other religious events, as pandemics and disasters, which also require was largely an organized, low-adrenaline event, with planning, preparedness, and management, and an fixed rituals and practices. The role of the medical increase in the capacities of the health systems [7]. team was to attend to the emergency cases, provide However, resource materials and studies on how to primary care to the pilgrims and support staff. prepare for and manage health risks during MGs Among the study subjects, majority (73.6%) were have not been developed fully [7, 8]. Most of the males and a maximum number of subjects were from existing guidelines on MG events focus mainly on the age group of 0-10 years (Table 1). crowd control and the prevention of stampedes;