Epidemiological profile of health consultations during the Mozambique 9th National Cultural Festival, August 2016

Introduction The use of mass gatherings as spaces to practice health surveillance has been growing in recent years. In Mozambique, the 9th National Festival of Culture in 2016 was selected for this practice. A specific public health surveillance system to facilitate rapid detection of outbreaks and other health-related events was implemented for this event with real time data collection and analysis Methods A descriptive epidemiological evaluation of all the health consultations that occurred in fixed posts prepared for the event was conducted. The data were collected through electronic mobile system (tablets) in real time, with the aid of a form designed for this purpose and sent directly to the incident command system (ICS) Results During the event, a total of 355 patients were assisted, 52.3% were female, 87.0% were from Beira city and the artists were the group that most frequently sought health care at 59.4%. The largest number of visits took place on the third day (36.4%). People over 45 years of age were the age group that most frequently sought health care (30.8%). The main provisional diagnoses of those who were attended to during the festival was arterial hypertension (20.3%), followed by febrile syndrome (19.0%), with falls being the most frequent causes of trauma during the festival (60.0%). Conclusion The system of monitoring in real time using mobile technologies proved to be efficient for the monitoring of the main health events during the mass gatherings. This profile of health consultations encourages the health sector to plan strategies and actions geared to the reality of care for this type of event.


Introduction
Mass gatherings, defined as "an organized or unplanned event where the number of people attending is sufficient to strain the planning and response resources of the community, state or nation hosting the even during a specific period of time" [1,2]. Constitute a public health challenge, since it may incur risks to health with rapid spread of infectious diseases "imported" from participants' places of origin or by the illness of persons not immune or "adapted" to local

Methods
A real time surveillance system was established for the event to capture information on all the health consultations that occurred in designated fixed points in Beira City and Dondo District, from August 24 to 28, 2016. Beira is the capital of Sofala, the second largest city in the county, is situated in the center of the country with a population of 463.442 inhabitants [9]. In turn, the district of Dondo is located 30km from the city of Beira, with a population of 180,905 inhabitants [9]. The data collection was performed using the electronic forms in EpiInfo ™ version 7 (CDC, Atlanta), installed on tablets which sent data via mobile internet to an electronic database, individual that before seeking care was attending or working at the cultural festival, or that he suffered any damage or accident during or related to the festival, in the period from August 24 to 28." The common type of trauma with 12 cases (60.0%), followed by traffic accidents with 3 cases (15.0%), and an animal bite with 2 cases (10%) (Figure 3). The main diagnoses issued by health professionals at the health posts during the festival were arterial hypertension with 31 (20.3%) cases, followed by febrile syndrome with 24 (19%) cases, and gastrointestinal pain syndrome with 23 (15%) cases ( Figure 4). As to the outcome, the vast majority were discharged (98.3%), 4 (1.2%) were transferred, and 2 (0.6%) abandoned treatment. There was no record of death during the event.

Discussion
This was the first experience of implementing real time monitoring surveillance system for a mass gathering in the country. The experience was successful and can be used for surveillance during upcoming events. The results indicated that the largest number of visits was recorded on the third day of the event. However, it was expected that the increased demand for health care services were the first and last days, due to the higher concentration of people to participate/attend the ceremonies of the opening and closing of the festival. These findings are similar to those already reported in other studies which found that the greater number of visits between the second and fourth days, a period in which occurs the greatest number of physical activities [11]. The main symptom for seeking health care was a headache, which also has been observed in other similar events [11,12].  [12,15]. The febrile syndrome and musculoskeletal pain are often related to exhaustion, agitation and the noise produced at the event [15][16][17].

What is known about this topic
• Mass gathering events can impact public health due to an increased number of infectious diseases and trauma; • Public health surveillance during mass gatherings events creates an opportunity to identify health conditions and threats in a timely manner; • There is an increase use of real time internet-based methods for infectious diseases surveillance during mass gatherings.

What this study adds
• This is the first article describing the experience using realtime technology to monitor health events during mass gatherings in Mozambique; • During the Mozambique 9 th National Festival the main provisional diagnoses of those who were attended to during the festival was arterial hypertension, followed by febrile syndrome. Falls were the most frequent causes of trauma during the festival; • Initial screening upon arrival for mass gathering events is a critical component and should be considered also for detecting outbreaks.

Competing interests
The authors declare no competing interests.