Prevalence and risk factors of foodborne disease among Iranian pilgrims during the Arbaeen mass gathering in Karbala, Iraq

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Abstract
Foodborne diseases are a significant public health concern during mass gatherings, including the Arbaeen pilgrimage in Karbala, Iraq. This study aimed to investigate the prevalence and associated risk factors for foodborne disease among Iranian pilgrims attending the Arbaeen ceremony. A cross-sectional survey was conducted among 1,030 pilgrims via structured questionnaires. The questionnaire included sections on demographic information, potential risk factors, KAP scores (knowledge, attitudes, and practices) related to food safety, and symptoms and severity of foodborne disease. Logistic regression analysis was conducted to identify risk factors associated with moderate to severe foodborne disease. The prevalence of foodborne disease was 23.2%, with 9.4% of participants experiencing moderate disease and 6.7% experiencing severe disease. The most common symptoms included headache (42.5%), abdominal pain (27.0%), nausea (21.4%), and diarrhea (20.7%). Significant risk factors for foodborne disease included lower education levels (OR = 2.23), first-time travel (OR = 1.65), longer trip durations (OR = 4.33), and consumption of unpackaged water (OR = 5.23). Pilgrims with poor to moderate food safety practices were 2.10 times more likely to experience foodborne disease. The findings suggest that improvements in food and water safety, along with targeted education campaigns for vulnerable groups, could reduce foodborne illnesses during mass pilgrimages. Public health interventions should focus on enhancing food handling practices and ensuring safe drinking water access, particularly for first-time travelers, elderly individuals, and those with lower education levels.

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